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SRNAPharmacology II > EXAM 2 PQ > Flashcards

EXAM 2 PQ Flashcards

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1
Q

Neuromuscular, nondepolarizing blockers which exhibit longer durations of action (greater than about half an hour) are most likely eliminated by:

A

Renal

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2
Q

Which one(s) of the following “intermediate-acting” steroid neuromuscular blocking drugs Exhibit elimination as a result of hepatic metabolism or biliary excretion.

A

Vecuronium and Rocuronium

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3
Q

Intermediate acting steroid NMB drugs

A

Vecuronium and Rocuronium

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4
Q

This agent is most likely to ensure maintenance of the cardiovascular reflex, a condition preferable during anesthesia

A

Vecuronium

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5
Q

Cleared most slowly by the liver:

A

Pancuronium

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6
Q

Characteristic(s) of nondepolarizing neuromuscular blocking drugs:

A

Lipid soluble

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7
Q

This intermediate-acting isoquinoline-type intermediate acting nondepolarizing drug exhibits Hofman elimination (spontaneous breakdown).

A

Atracurium

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8
Q

T/FNeuromuscular blockade associated with nondepolarizing drugs is highly correlated with the elimination half-life.

A

True

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9
Q

Quaternary, charged, neuromuscular blocking drugs) show essentially NO Central effects after typical clinical doses.

A

True

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10
Q

Pharmacokinetic properties/properties of nondepolarizing neuromuscular blocking drugs:

A

Volume of distribution comparable to the blood volume

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11
Q

This neuromuscular blocking agent exhibits a sufficient anti-vagal action such that tachycardia may ensue.

A

PANCURONIUM

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12
Q

Compared to atricurium, cisatracurium is:

A

NOT dependent on the liver for inactivation.

NOT likely to cause histamine release.

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13
Q

T/F Neuromuscular blockade due to depolarization induced by agents such as succinylcholine is initially described as a phase I block.

A

True

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14
Q

Muscle cell changes associated with prolonged depolarization include:

A

Reduced Potassium

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15
Q

Over time and with increasing succinylcholine concentrations, neuromuscular blockade may transition from a.

A

depolarizing, phase I block to a non-depolarizing phase II block

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16
Q

Neuromuscular blockade reversal agent.

A

Sugammadex

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17
Q

Phase I blockade could be potentiated by which one(s) of the following?

A

Edrophonium

Donepezil

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18
Q

The prototypical depolarizing-type neuromuscular blocking drug:

A

Succinylcholine

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19
Q

Succinylcholine, an example of a depolarizing neuromuscular blocker, exhibits longer duration compared to acetylcholine mainly due to which one(s) of the following?

A

Resistance to inactivation by acetylcholinesterase

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20
Q

_______is more clinically advantageous compared atracurium and as a result has replaced atracurium in practice.

A

Cisatracurium

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21
Q

Botulinum toxin which may be used to manage ocular blepharospasm as well as control other muscle spasms block neuromuscular transmission mainly through

A

inhibition of acetylcholine release.

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22
Q

Isoquinoline derivative:

A

atracurium

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23
Q

Vlinical condition associated with spasticity:

A

Stroke, MS

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24
Q

Spasticity Characteristics

A

muscle weakness
increased flexor muscle spasm
increase in tonic stretch reflexes

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25
Sequence of events following IV neuromuscular-blocking injection (nondepolarizing drug) to an awake patient:{first presentations to last}
difficulty in focusing, mandibular muscle weakness, ptosis, diplopia, dysphagia
26
Nondepolarizing neuromuscular agents -- elimination characteristics
renal elimination: long half lives -- longer ration of action > 35 minutes; hepatic elimination: shorter half lives, less than 30 minutes
27
Isoquinoline derivative:
-Acurium
28
Liver failure will have the most significant effect on the duration of action of which NDNMB
Rocuronium
29
Drugs that does not decrease butyrylcholinesterase activity?
Ranitidine
30
This drug class causes resistance to NMB drugs
Anticonvulsants (carbamezipine , phenytoin)
31
Elevated Laudanosine associated with
ATRACURIUM
32
NDNMB with the most potent active metabolite
VECURONIUM
33
No active metabolite with this benzylisoquinoliniu
CIsatracurium
34
What is the metabolite of vecuronium
3-OH, 80% as potent
35
During surgery , an adult patient is given a 2nd dose of succinylcholine approx 5 minutes after the first dose, the scenario increase the chance of this side effect
BRADYCARDIA
36
AVOID This NDNMB is asthmatic patients
ATRACURIUM
37
Succ ok to use in those patient
Renal failure
38
Succinylcholine contraindicated in the
routine pediatric patient
39
A patient is tested for butyrylcholinesterase activity and has number of 80. she is given succinylcholine, what is most likely to occur?
normal response to succinylcholine
40
Possible effect if anesthesiologist does not give enough glycopyrrolate
INTESTINAL SPASMS
41
Inhaled anesthetics and TIVA can potentiate effects of NDNMB , which is the most potent at doing that?
DESFLURANE
42
Which ABT has no effet of NMB
CEFAZOLIN
43
HOw does MAGNESIUM SULFATE AFFECT Pharmacokinetics and phramacodynamics of VECURONIUM?
Will decrease the ED95 meaning enhance the effects of VECURONIUM and other NDNMB
44
Which drugs augment the effects of NDNMB?
Lithium | Via both pre and postsynaptic effects
45
Class of anesthetics most commonly LINKED to anaphylactic reations
MUSCLE RELAXANTS
46
``` Which anticholinergic is classified as quaternary amine? A. Scopolamine B. Atropine C. Neogstimine D. Glycopyrrolate ```
Glycopyrrolate
47
Which anticholinergic CANNOT CROSS BBB
Glycopyrrolate
48
Renal disease best choice NDNMB
cisatracurium
49
Considered a Ach receptor agonist
Succinylcholine.
50
What do you expect to happen to receptors when administering NMB to patient with Myasthenia G.
DOWN -REGULATION
51
As compared to Other anticholinergic, what are scopalamie's sedative effects?
GREATER THAN GLYCOPYRROLATE
52
Compared to NEOSTIGMINE, onset of PYRIDOSTIGMINE
SLower
53
What condition potentiate neuromuscular BLOCKADE a. Hypomagnesemia b. Hypercalcemia c. Hyperkalemia d. Hypothermia
HYPOTHERMIA
54
Patient weight is 80kg what dose of Cisatracurium
16 (0.2mg/kg)
55
During surgery for a bowel obstruction, you note PERSISTENT TACHYCARDIA and HYPERTENSION which NMB most likely was used?
PANCURONIUM; no significant CV effect with cisatracurium, atracurim and Rocuronium
56
Antibiotic to avoid in MG why?
Gentamycin; prolong effect of NMB
57
AT what dose is the onset of action of ROCURONIUM similar to that of Succinylcholine for RSI? a. 0.9- 1.2mg/kg b. 1.5 - 2.0 mg/kg c. 2.0-2.5 mg/kg d. >2.5mg/kg
A. 0.9 - 1.2 mg/kg
58
When given NEOSTIGMINE what is the resultant MUSCARNINC effect?
BRADYCARDIA
59
What anticholinesterase crosses the BBB a. Edrophonium b. Neostigmine c. Pyridostigmine d. Physostigmine
PHYSOSTIGMINE (tertiary amine)
60
Your patient's TOF is 1/4 you decide to reverse with NMB what drug combination and dose do you use
Neo 0.04mg/kg and glycop 0.2mg per 1 mg of neogstimine
61
What is the physical structures of Succinylcholine? A. Two joined Ach molecules B. Benzylisoquinoline C. Steroid ring with 2 modified ach molecules D. Monoquaternary steroid
Two joined ACH molecules
62
``` Which of the following factors produces 4-8 hours of SUCCINYLCHOLINE INDUCED NMB? A. Homozygous atypical enzyme B. Hyperthermia C. Heterozygous atypical enzyme D. Reduce pseudocholinesterase levels. ```
A. Homozygous atypical enzyme
63
``` What is the anticholinergic with the least ANTISIOLOGUE effect? A. Atropine B. Glycopyrrolate C. Scopolamine D. Neostigmine ```
A. Atropine
64
What is the anticholinergic with the least Tachycardia effect?
Scopolamine
65
What is the anticholinergic with the 0 Sedtion?
Glycopyrrolagte
66
What is the anticholinergic with the least bronchodilation ?
SCOPOLAMINE
67
What is the anticholinergic with the MOST ANTISIOLOGUE effect?
Scopolamine and GLYCOPYRROLATE
68
What is the anticholinergic with the MOST Sedation?
SCOPOLAMINE
69
The patient presents for OP surgery with a hx of asthma , when using GLYCOPYRROLATE expect
RELEAXATION OF bronchial smooth muscle
70
Avoid in Parkinson's this med
METOCLOPROMIDE
71
Which inhalation Agent affect BP the least ?
SEVOFLURANE
72
Minimal cardiac depression with those 2 VA
ISoflurane and desflurant
73
AVOID this NMB agent for renal failure
VECURONIUM
74
This medication BLOCKS MUSCARINIC RECEPTOR
ATROPINE
75
Which part of the structure of GLYCOPYRROLATE is responsible for the binding of acetylcholine receptors?
ESTER linkage
76
``` What manifestation occurs as a results of anticholinergic overdose? A. Tachycardia B. Oral secretions C. Bradycardia D. Cutaneous Vasoconstriction ```
A. TACHYCARDIA (central cholnergic syndrome)
77
What are the 3 signs of Central cholinergic syndrom
Tachycardia, Excessive dry mouth, CUTANEOUS VASODILATION or flush.
78
How does lithium affect NDNMB?
Increase DOA of VECURONIUM (or NMBs )
79
How does chronic Alcoholism affect VA
Increase requirements
80
What are the risk factors for HALOTHANE HEPATITIS (AFO)
Age > 40 years Female Obesity
81
Patient taking TCAs and MAC requirements
MAC requirements may be increased
82
Which neuromuscular disease associated with increased resistance to succinylcholine?
MYASTHENIA GRAVIS
83
Compound A is one of the by products of degradation of VA
Sevoflurane
84
Anticholinergic increase the heart rate the most
ATROPINE
85
Blood gas partition coefficient of Halothane
2.4
86
Blood gas partition coefficient of Nitrous oxide
0.47
87
Blood gas partition coefficient of Sevoflurane
0.65
88
Blood gas partition coefficient of ISOFLURANE
1.4
89
Blood gas partition coefficient of DESFLURANE
0.42
90
which inhalational agent is a HALOGENATED ALKANE
HALOTHANE
91
NMB CONTRAINDIATED in GBS
Succinylcholine
92
Conscious memory is suppressed by
``` volatile anesthetics (0.45 MAC isoflurane) and nitrous (0.6 MAC). These concentrations are similar to MAC awake. ```

SRNAPharmacology II (32 decks)

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