Fall 2016 Flashcards by Riley Shugg

Propofol induces CNS depression by enhancing the effects of which of the following neurotransmitters?

Serotonin
GABA
NMDA
Glutamate

GABA

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Which of the following statements is most accurate with regard the use of etomidate in dogs?

Etomidate inhibits adrenal steroidogenesis
Etomidate causes modest respiratory and cardiovascular depression
Etomidate causes an increase in heart and blood pressure when used alone
Etomidate does not undergo hepatic metabolism

Etomidate inhibits adrenal steroidogenesis

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Which of the following best describes the term dissociative anesthesia?

Dissociative anesthesia is used to describe an anesthetic state induced by drugs that interrupt ascending signal transmission from the part of the brain responsible for consciousness
Dissociative anesthesia is used to describe an anesthetic state induced by drugs that stimulate inhibitory neurotransmitters.
Dissociative anesthesia is used to describe an anesthetic state induced by inhibition of neuromuscular junctions
Dissociative anesthesia is used to describe an anesthetic state induced by drugs that inhibit stimulatory neurotransmitters

Dissociative anesthesia is used to describe an anesthetic state induced by drugs that interrupt ascending signal transmission from the part of the brain responsible for consciousness

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The minimum alveolar concentration(MAC) measured at a total intra-alveolar pressure of 1 atmosphere of an inhaled anesthetic agent is defined as the MAC that produces immobility in…

1% of subjects exposed to a supramaximal noxious stimulus
10% of subjects exposed to a supramaximal noxious stimulus
25% of subjects exposed to a supramaximal noxious stimulus
50% of subjects exposed to a supramaximal noxious stimulus

50% of subjects exposed to a supramaximal noxious stimulus

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A recent paper titled ‘Clinical effects of midazolam or lidocaine co-induction with a propofol target controlled (TCI) infusion in dogs’ demonstrated that midazolam had which of the following effects?

Midazolam provided a significant reduction in a propofol TCI requirement and improved cardiovascular hemodynamics as compared to lidocaine
Midazolam had no effect on the propofol TCI requirement and no effect of cardiovascular hemodynamics as compared to lidocaine
Midazolam provided a significant reduction in the propofol TCI requirement but no effect of cardiovascular hemodynamics as compared to lidocaine
Midazolam provided a significant reduction in the propofol TCI requirement but worsened cardiovascular hemodynamics as compared to lidocaine

Midazolam provided a significant reduction in the propofol TCI requirement but no effect of cardiovascular hemodynamics as compared to lidocaine

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Which of the following is classified as a ‘depolarizing neuromuscular blocking agent’?

Rocuronium
Succinylcholine
Atracurium
Neostigmine

Succinylcholine

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Which of the following changes in the pulse oximetry waveform can indicate hypovolemia in a patient under anesthesia being mechanically ventilated.

Cyclical changes in the pulse waveform amplitude during inspiration versus expiration
Cyclical changes in the pulse waveform width during inspiration versus expiration
Persistent increase in the pulse waveform amplitude
Persistent increased in the pulse waveform width

Cyclical changes in the pulse waveform amplitude during inspiration versus expiration

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Portal hypertension caused by right-sided congestive heart failure can be classified, based on anatomical location, as…

a) prehepatic
b) intrahepatic pre-sinusoidal
c) intrahepatic post-sinusoidal
d) posthepatic

posthepatic

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Normal portal pressure is _______ mmHg, and multiple acquired portosystemic shunts are noted to develop at portal pressures greater than ________ mmHg.

a) 3 and 15
b) 8 and 12
c) 12 and 20
d) 25 and 40

c) 12 and 20

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The milk thistle extract silybinin provides effective hepatoprotection via the following mechanism:

Suppresses the proinflammatory cytokines TNF-α and IL-1β and promotes the upregulation of the anti-inflammatory cytokine IL-6.
Scavenges high molecular weight free radicals such as H2O2.
Inhibits of hepatic stellate cells from forming into myofibroblasts by decreasing DNA synthesis, proliferation and migration.
Enhances adhesion molecule expression.

Inhibits of hepatic stellate cells from forming into myofibroblasts by decreasing DNA synthesis, proliferation and migration.

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Hepatic encephalopathy (HE) in cats with hepatic lipidosis can develop secondary to a deficiency of the following amino acid:

a) Arginine
b) Taurine
c) Glutamine
d) Asparagine

Arginine

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Which of the following scenarios does NOT represent a potential contributing factor in the pathogenesis of hepatic encephalopathy?

Increased protein catabolism resulting in a larger supply of substrates for ammonia production and potentially leading to generalized muscle atrophy.
Neutrophil-mediated increased permeability of the blood-brain barrier resulting in increased diffusion of ammonia into astrocytes.
A reduction in the ratio of the circulating concentrations of branched-chain amino (BCAA) to aromatic amino acids (AAA).
Activation of peripheral-type benzodiazepam receptors secondary to elevated circulating ammonia and manganese concentrations and a subsequent increase in neurosteroid production.

Increased protein catabolism resulting in a larger supply of substrates for ammonia production and potentially leading to generalized muscle atrophy.

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In a 2006 study investigating 207 dogs with various hepatobiliary diseases, the following diagnostic test was significantly different between the microvascular dysplasia group and the portosystemic shunt group:

a) Measurement of pre- and post-prandial concentrations of serum bile
acids.
b) Measurement of plasma Protein C concentration.
c) Measurement of blood ammonia concentration.
d) Measurement of the PT and aPTT.

b) Measurement of plasma Protein C concentration.

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In a 2016 retrospective study evaluating acute liver failure in dogs, which of the following clinicopathologic variables obtained at admission was significantly different between survivors and non-survivors…

a) An elevated serum total bilirubin concentration.
b) A reduced serum albumin concentration.
c) A prolongation of the PT and PTT.
d) An elevated serum ALT concentration.

d) An elevated serum ALT concentration.

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A study investigating thromboelastography (TEG) evaluation of dogs diagnosed with acute liver disease that was published in the Journal of Veterinary Internal Medicine in 2015 concluded that…

a) Dogs with low antithrombin and Protein C concentrations also had TEG tracing abnormalities that were consistent with hypercoagulability
b) PT and PTT values correlated well with TEG findings to predict bleeding tendencies
c) A significant number of study dogs had TEG LY30 measurements that were consistent with hyperfibrinolysis
d) Dogs had R and K TEG values and serum von Willebrand’s factor activities that were significantly decreased as compared to respective reference ranges

c) A significant number of study dogs had TEG LY30 measurements that were consistent with hyperfibrinolysis

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A client presents her 2-year old Spayed Female Labrador Retriever following ingestion of multiple items from her purse. Medications in the purse included fish oil capsules, alprazolam, fluoxetine, and caffeine pills. A package of Trident gum was also found to have been chewed with an unknown number of pieces suspected to have been ingested. Exposure was within the last 30 minutes and no behavioral/ neurologic, vital signs, or systemic blood pressure abnormalities identified at the time of presentation. In the scenario above, what is the most appropriate action to take first?

Call a poison control center to identify the items that are of most concern, the standard toxic dose of potentially ingested drugs or toxins and therefore guide further treatment
Attempt to induce diuresis via intravenous fluid administration
Administer activated charcoal
Induce emesis with apomorphine

Induce emesis with apomorphine

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In the scenario above, 20 minutes after presentation, the patient begins to tremble, seems agitated and is found to be tachycardic. Which of the potentially ingested drug is least likely to cause this constellation of clinical signs?

Fluoxetine
Alprazolam
Xylitol
Caffeine

Caffeine

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In the scenario above, a poison control center was contacted and there were specific concerns about the possibility of an adverse interaction between two of the agents that may have been ingested. Which two drugs may have interactions and why could that be concerning?

Caffeine and xylitol – liver dysfunction caused by xylitol could decrease phosphorylation of caffeine, thereby increase the agent’s half life
Alprazolam and fluoxetine – fluoxetine could inhibit the metabolism of alprazolam and other benzodiazepines, thereby increasing the concentration of these agents
Caffeine and fluoxetine – severe neurologic side effects can occur
Fish oil and caffeine – fish oil can increase the risk of bleeding in a patient that might develop systemic hypertension secondary to a caffeine overdose

Alprazolam and fluoxetine – fluoxetine could inhibit the metabolism of alprazolam and other benzodiazepines, thereby increasing the concentration of these agents

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Intravenous lipid emulsion (ILE) therapy has been proposed as a treatment option for a number of toxicities. Which of the following statements best explains why ILE specifically recommended as a treatment option for some toxicants but not for others?

ILE therapy is not effective in the treatment of toxins with extensive enterohepatic circulation.
Due to the alkaline nature of ILE, drugs with an acidic carbon moiety will not bind to the fatty acids contained within ILE.
A drug’s phospholipid-carbon ratio must match that of ILE in order for the “lipid sink” effect to occur.
The ability of ILE to act as an antidote is dependent on a toxin’s lipophilicity.

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The ability of ILE to act as an antidote is dependent on a toxin’s lipophilicity.

A recent study by Koenigshof AM[-] et al, published in the Journal of Veterinary Emergency and Critical Care in 2015, challenged previous recommendations for the use of multiple-dose activated charcoal (MDAC) in the treatment of carprofen intoxication. What is the most appropriate summary statement regarding the rationale for the use of MDAC in a toxicity case?

Some drugs will remain in a nidus or present as a “bolus” within the stomach, requiring the administration of MDAC to allow maximal adsorption of the toxin.
Maximal adsorption of lipophilic drugs requires MDAC
Some drugs undergo enterohepatic circulation and are re-secreted into the gastro-intestinal tract over time, requiring the administration of MDAC to allow maximal adsorption to the toxin.
MDAC coats the intestinal tract more completely, providing protection in cases of NSAID toxicity

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Some drugs undergo enterohepatic circulation and are re-secreted into the gastro-intestinal tract over time, requiring the administration of MDAC to allow maximal adsorption to the toxin.

Many toxins can cause anemia, some specifically by inducing hemolysis. Which of the following toxins induces hemolysis?

Copper
Lead
Meloxicam
Methylxanthines

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Copper

A client tells you that her Australian Shepherd cannot be given acepromazine, as she is “sensitive” to sedatives and anesthesia. What is the likely explanation of this statement?

Lack of anxiolytic efficacy due to individual response variability.
D2 receptor gene deletion
Previous doctors’ inexperience and likely overdose
P- glycoprotein deficiency due to MDR1 gene mutation

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P- glycoprotein deficiency due to MDR1 gene mutation

Which of the following is not indicated in the treatment for acetaminophen toxicity?

Ursodiol
N-acetylcysteine
Extracorporeal blood purification technique
S-adenosyl-methionine

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Ursodiol

Which of the following is a list of physical examination parameters associated with the serotonin syndrome (as utilized in the Sternbach criteria, the Hunter Serotonin Toxicity criteria, and the Radomski criteria to diagnosis the condition in humans)?
Hyperthermia, myoclonus, agitation, tremors, hypertonia
Hypothermia, myoclonus, agitation, tremors, hypotonia
Hypothermia, myoclonus, agitation, tremors, hypertonia
Hyperthermia, myoclonus, agitation, tremors, hypotonia

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Hyperthermia, myoclonus, agitation, tremors, hypertonia

By which mechanism may cyproheptadine be effective in reversing the symptoms associated with the serotonin syndrome? Cyproheptadine is a first-generation histamine-1 receptor antagonist with nonspecific antagonist properties at 5-HT1A and 5-HT2A receptors Cyproheptadine is a first-generation histamine-1 receptor agonist with nonspecific agonist properties at 5-HT1A and 5-HT2A receptors Cyproheptadine is a first-generation histamine-2 receptor antagonist with nonspecific antagonist properties at 5-HT1A and 5-HT2A receptors Cyproheptadine is a first-generation histamine-2 receptor agonist with nonspecific agonist properties at 5-HT1A and 5-HT2A receptors

Cyproheptadine is a first-generation histamine-1 receptor antagonist with nonspecific antagonist properties at 5-HT1A and 5-HT2A receptors

According to a study by Koenigshof, et al, published in the Journal of Veterinary Emergency and Critical Care in 2015, which of the following is true about the efficacy of activated charcoal (AC) in reducing the absorption of carprofen (based on serum carprofen levels) from the gastrointestinal tract? A single dose of AC without sorbitol was more effective than administration of a single dose of AC with sorbitol. A single dose of AC without sorbitol was less effective than administration of a single dose of AC with sorbitol. A single dose of AC without sorbitol had similar efficacy than multiple doses of AC. The gastrointestinal side effects rates were similar between a single dose of AC and multiple doses of AC.

A single dose of AC without sorbitol had similar efficacy than multiple doses of AC.

According to an in vitro study published in 2013, mixing activated charcoal with food to ease administration is likely to… interfere with the absorptive ability of charcoal when mixed at large amount of food. This interference is likely to be clinically significant. interfere with the absorptive ability of charcoal when mixed with even a smallest amount of food tested. The interference is likely to be clinically significant. interfere with the absorptive ability of charcoal when mixed with even the smallest amount of food tested. This interference is NOT likely to be clinically significant. cause no detectable change in the absorptive ability of charcoal when food is added.

interfere with the absorptive ability of charcoal when mixed with even the smallest amount of food tested. This interference is NOT likely to be clinically significant.

How is whole bowel irrigation performed? Induction of emesis, followed by administration of multiple doses of activated charcoal and administration of multiple enemas. Performance of gastric lavage, followed by administration of multiple doses of activated charcoal and administration of multiple enemas. Administration of alternating doses of an osmotically balanced polyethylene glycol electrolyte solution (PEG-ES) and activated charcoal over a 24-hour period or until the patient produces charcoal-stained stool. Administration of a PEG-ES as a constant rate infusion, typically via nasogastric tube, until a clear liquid stool is identified.

Administration of a PEG-ES as a constant rate infusion, typically via nasogastric tube, until a clear liquid stool is identified.

Which of the following characteristics of acetaminophen make it a strong candidate for removal with hemodialysis/hemoperfusion? It is a large molecule. It is highly protein-bound. It has a small volume of distribution. It is highly lipophilic.

It has a small volume of distribution.

Which of the following statements regarding acetaminophen ingestion is true? The predominant adverse effects are seen in the liver in both cats and dogs. The predominant adverse effects are seen in the red blood cells in both cats and dogs The predominant adverse effects are seen in the liver in dogs and the red blood cells in cats. The predominant adverse effects are seen in the red blood cells in dogs and the liver in cats.

The predominant adverse effects are seen in the liver in dogs and the red blood cells in cats.

33) According to a study published in the American Journal of Veterinary Research in 2016, administration of which of the following commonly-prescribed antimicrobials resulted in decreased olfactory capabilities in explosives detection dogs? Amoxicillin-clavulanic acid Doxycycline Enrofloxacin Metronidazole

Metronidazole

Acetaminophen intoxication occurs following conversion of the drug to the reactive intermediate N-acetyl-P-benzoquinone-imine (NAPQI). Toxicity occurs via all of the following mechanisms EXCEPT… NAPQI binds to the hepatocellular membrane and damages the lipid layer, causing hepatocyte injury and death. NAPQI causes severe oxidative stress to red blood cells, resulting in methemoglobin production. Within red blood cells, NAPQI causes ferrous iron to be oxidized to ferric iron, thereby resulting in the conversion of hemoglobin to methemoglobin. Intoxication is associated with increased thromboxane production, which results in local vasoconstrictive effects at the level of the kidney

Intoxication is associated with increased thromboxane production, which results in local vasoconstrictive effects at the level of the kidney

34) According to a study published in the Journal of Veterinary Internal Medicine in 2015, co-administration of which of the following antimicrobial drugs with sucralfate decreased its relative bioavailability in healthy drugs? Enrofloxacin Marbofloxacin Ciprofloxacin Pradofloxacin

Ciprofloxacin

35) Which of the following antimicrobials is lipid soluble and has a large volume of distribution? Chloramphenicol Ticarcillin /clavulanate Cefoxitin Metronidazole

Chloramphenicol

36) Which of the following antimicrobials is ionized at physiologic pH and has a small volume of distribution? Enrofloxacin Amikacin Metronidazole Doxycycline

Amikacin

37) Which if the following statements most accurately describes fluoroquinolones as a class of antimicrobials? Bacteriostatic, with high oral bioavailability, and a large volume of distribution. Bactericidal, with low oral bioavailability, and a large volume of distribution. Bactericidal, with high oral bioavailability, and a small volume of distribution Bactericidal, with high oral bioavailability, and a large volume of distribution.

Bactericidal, with high oral bioavailability, and a large volume of distribution.

38) Which of the following bacteria-antimicrobial drug combinations are typically associated with intrinsic resistance of the specific microbe to the respective antibiotic agent? Enterococcus faecalis, ceftiofur Salmonella spp., gentamicin Proteus mirabilis, ticarcillin-clavulanate Pseudomonas aeruginosa, ceftazidime

Enterococcus faecalis, ceftiofur

39) Which of the following antimicrobials is eliminated primarily via biliary excretion? Gentamicin Doxycycline Azithromycin Ciprofloxacin

Azithromycin

Drug penetration into a specific tissue depends in part on the nature of the capillary bed in that particular tissue (sinudoidal, fenestrated, or continuous). Which of the following organs/tissues is associated with a fenestrated capillary bed? Liver Kidney Adrenal cortex Adipose

Kidney

Which of the following defines a ‘hospital-acquired infection?’ An infection arising at any time after hospital admission An infection arising more than 24 hours after hospital admission An infection arising more than 48 hours after hospital admission An infection arising subsequent to any medical/surgical intervention

An infection arising more than 48 hours after hospital admission

According to the Surviving Sepsis Guideline of 2012, antibiotics should be administered to a patient Within one hour of sepsis being suspected Within one hour of receiving bacterial culture and sensitivity results Within one hour of the recognition of septic shock (only) Within one hour of the recognition of septic shock or severe sepsis

Within one hour of the recognition of septic shock or severe sepsis

Which of the following antibiotics are classified as bacteriostatic? Chloramphenicol Amikacin Meropenem Cefpodoxime

Chloramphenicol

Resistance to fluoroquinolones is mediated by which of the following mechanisms? Bacterial production of β-lactamases that subsequently inactivate the drug Generation of plasmid-mediated resistance genes that alter the bacterial DNA-gyrase Alteration of the targeted bacterial metabolic pathway Bacterial-induced inhibition of bacterial topoisomerase II

Generation of plasmid-mediated resistance genes that alter the bacterial DNA-gyrase

Which of the following statements is true with regards to presence of hypoalbuminemia and the use of antibiotics? Hypoalbuminemia will increase antibiotic exposure due to a reduction of the drug’s volume of distribution Hypoalbuminemia will decrease antibiotic exposure due to a reduction of the drug’s volume of distribution Hypoalbuminemia will decrease antibiotic exposure due to an increase of the drug’s volume of distribution Hypoalbuminemia will increase antibiotic exposure due to an increase of the drug’s volume of distribution

Hypoalbuminemia will decrease antibiotic exposure due to an increase of the drug’s volume of distribution

Which of the following antibiotics is classified as concentration-dependent? Marbofloxacin Clindamycin Vancomycin Imipenem-cilastatin

Marbofloxacin

Which of the following describes the antimicrobial mechanism of action associated with imipenem? It binds to the bacterial 50S ribosomal subunit and thereby interferes with protein synthesis. It binds to the bacterial 30S ribosomal subunit and thereby interferes with protein synthesis. It inhibits bacterial folic acid synthesis, thereby inhibiting protein and nucleic acid synthesis. It binds to bacterial penicillin-binding proteins, inhibiting peptidoglycan synthesis and ultimately interfering with cell wall synthesis.

It binds to bacterial penicillin-binding proteins, inhibiting peptidoglycan synthesis and ultimately interfering with cell wall synthesis.

Fall 2016 Flashcards

(46 cards)