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Flashcards in Group presentation questions Deck (60):
1

Antiemetic
What is the profile of a high-risk patient?

 Female
 Under 50 years old
 Non smoker
 Hx of PONV/ motion sickness
 Not Gandalf

2

Antiemetic
For a patient with prior hx of PONV, what alterations can be made in the anesthetic care plan?

 Avoid inhalation anesthetics
 Consider regional+MAC or TIVA
 Avoid N2O
 Minimize intra/post op narcotics
 Provide adequate hydration
 Use multi-modal approach with drug therapy

3

Antiemetic
What are some deleterious effects of PONV?

 Increased length of stay/ recovery
 Increase healthcare cost
 Patient dissatisfaction
 Serious consequences include:
 Suture dehiscence
 Aspiration
 Esophageal rupture

4

Antiemetic
When should a Scopolamine patch be applied in relation to a surgical procedure?

 Preferable night before but at least 4 hours before procedure

5

Antiemetic
Using the multimodal approach, what steps can be taken to reduce PONV?

 See answer to question 2
 Drug therapy (1 agent for adult at moderate risk, 2-3 agents for adult high risk, 2+ agents for children at moderate and high risk)
 i.e. Dexamethasone and Ondansetron (and Scop patch)

6

Antiemetic
Which antiemetic should be used cautiously in patients with hepatic impairment and why?

 Ondansetron: 95% metabolism by liver (cautious with Scop and Decadron)

7

Antiemetic
Which antiemetic can cause respiratory depression and sedation?

 Phenergan has high sedative properties (Scop can but lesser extent)

8

Antiemetic
What adjustments to your medications would you make for the pregnant patients?

 All drugs class B and C, same considerations as other at risk patients

9

Antiemetic
Which drug can cause EPS side effects?

 Metoclopramide (reglan)- anti-dopaminergic effect

10

Antiemetic
How much higher is the incidence of PONV in children?

2x

11

What are some of the physiologic processes corticosteroids are involved in?

a. Electrolyte regulation
b. Immune responses
c. Stress response
d. None of the above
e. All of the above - right answer

12

What is/are clinical uses of corticosteroids?




a. Organ transplant
b. Asthma
c. Rheumatoid Arthritis
d. Two of the above
e. All of the above - right answer

13

3. How are corticosteroids classified?

a. Endogenous versus synthetic
b. Based on their duration of action - right answer
c. According to their solubility
d. None of the above

14

4. Which of the following are considered synthetic corticosteroids?


a. Prednisone
b. Hydrocortisone
c. Cortisol
d. Two of the above - right answer
e. All of the above

15

5. Why is it important to administer corticosteroids during induction of surgery to a patient that is on long-term corticosteroid therapy?


a. They have suppression of the HPA axis
b. They have a relative adrenal insufficiency
c. They are unable to produce adequate amounts of cortisol
d. Circulatory collapse can occur
e. All of the above - right answer

16

6. When should you administer dexamethasone to prevent PONV?
a) Immediately post op
b) Preoperatively or immediately after induction
c) At the first sign of nausea
d) Dexamethasone is not used to prevent POVN

a) Immediately post op
b) Preoperatively or immediately after induction -- right
c) At the first sign of nausea
d) Dexamethasone is not used to prevent POVN

17

7. What is the current recommended dose of Dexamethasone for treatment of PONV as published in the SAMBA guidelines?



a) 1mg to 2mg IV
b) 4mg to 5mg IV - right answer
c) 8mg to 10mg IV
d) 10mg to 12mg IV

18

8. What is the proposed MOA for prevention of PONV?


a) GABA mimetic
b) NMDA mimetic
c) COX 2 inhibitor
d) Unknown --right answer

19

9. Which of the following are effective adjuvants to prolong the effects of local anesthetics in brachial plexus blocks?


a) Clozapine
b) Dexmedetomidine
c) Dexamethasone
d) Two of the above -- right answer
e) All of the above

20

10. Dexamethasone prolongs the effects of local anesthetics in brachial plexus blocks by which of the following mechanisms?

a) Attenuating the release of inflammatory mediators
b) Reducing ectopic neuronal discharge
c) Inhibiting potassium channel mediated discharge of nociceptive C-fibers
d) A & C
e) All of the above -- right answer

21

To produce its cellular effects, insulin diffuses through the cell membrane to bind to its target receptors (T/F)

False – insulin binds to a cell membrane receptor and does not diffuse into the cell.

22

Regular insulin has the fastest onset and duration of action among the available formulations of insulin (T/F)

False – rapid acting insulin has the shortest onset and duration

23

List the following insulin formulations from shortes to longest duration

a. Glargine
b. Regular
c. Lispro
d. NPH
Shortest to longest: C, B, D, A

24

As CRNAs, we will primarily deliver IV Insulin so we do not need to worry too much about the SQ formulations (T/F)

False - we still need to be aware of these medications as some patients may forget to modify their dosing and arrive NPO preoperatively having taken a full insulin dose

25

What triggers insulin release?

Answer: Elevated plasma glucose levels

26

What is the difference between Type I and Type II diabetes?

Answer: Type I is insulin deficient. Type II is insulin resistant.

27

In the pre-operative setting, what must the anesthesia provider be aware of?


a) Cardiovascular Function/Volume Status
b) Renal Function/Electrolyte Status
c) Patient's glycemic control
d) Aspiration Prophalaxis
e) All of the Above

Answer: E

28

A significant risk of surgery is hypoglycemia due to the release of neuroendocrine hormones (T/F)

False – hyperglycemia

29

Intraoperative hyperglycemia serves as a protective mechanism for post-op infections and promotes wound healing


False – impairs wound healing and increases infections

30

Duration of action for intravenous regular insulin administration is

a. 5-8 hours
b. 7 minutes
c. 1 hour
d. 2-5 hours

Answer: C 1 hour

31

1. Epinephrine would be indicated in all of the following situations except:

a) Symptomatic bradycardia
b) Ventricular fibrillation
c) PEA
d) Metabolic acidosis ***

32

2. Indications for sodium bicarbonate include:

a) pH < 7.10, HCO3- < 15, hyperkalemia ***
b) pH < 7.40, HCO3- < 15, hyperkalemia
c) pH > 7.40, HCO3- < 10, hypokalemia
d) pH > 7.40, HCO3- < 24, hypokalemia

33

3. The use of sodium bicarbonate is reserved for severe metabolic acidosis because:

a) It is caustic to veins
b) It can potentiate an acidosis by causing an increase in CO2 production****
c) It is difficult to mix and administer.
d) It can potentiate an acidosis by causing an increase in HCO3-.

34

4. Dobutamine primarily acts as a(n):

a) Alpha 1 adrenergic receptor agonist-antagonist
b) Alpha 2 adrenergic receptor antagonist
c) Beta 1 adrenergic receptor agonist****
d) Beta 1 adrenergic receptor antagonist

35

5. A potential complication of epinephrine is:

a) It can increase myocardial O2 demand****
b) It can cause severe hypotension
c) It can cause puritis
d) It can cause altered mental status

36

6. Which of the following situations would you NOT administer atropine?

a) Rapid Sequence Intubation
b) Symptomatic bradycardia
c) OD with insecticides
d) Asystole***

37

7. What is a concern when administering atropine to head injury patients?

a. Mydriasis***
b. Increased ICP
c. Inhibition of the SNS to maintain cerebrovascular tone
d. Miosis

38

8. Which of the following is NOT an effect of adenosine?

a. Brief asystole
b. Bradycardia
c. Chest tightness/pain
d. Excess secretions***

39

9. Which is an adverse effect of amiodarone?

a. Ventricular tachycardia
b. Torsade de pointes***
c. Hypertension
d. tachycardia

40

10. What drug is used to decrease local toxic effects of dopamine if infiltrated?
a. Papaverine
b. Lidocaine
c. Phentolamine
d. Nitroglycerin

a. Papaverine
b. Lidocaine
c. Phentolamine****
d. Nitroglycerin

41

1. What general type of IV fluid would be more appropriate for a pediatric patient?

a. Colloid
b. Crystalloid***
c. No difference in pediatric patients
d. Depends on type of surgery

42

2. What type of fluid loss is most common during surgery and anesthesia?

a. Isotonic***
b. Hypotonic
c. Hypertonic d. Hypoosmotic

43

3. Development of which of the following is a concern during high-volume Normal Saline administration?

a. Hypochloremic metabolic alkalosis
b. Hyperchloremic metabolic alkalosis
c. Hypocholoremic metabolic acidosis
d. Hyperchloremic metabolic acidosis****

44

4. Which comorbidity would be a concern for the administration of Lactated Ringer’s?

a. Hepatic cirrhosis
b. Renal failure****
c. COPD
d. Hypoalbuminemia

45

5. Which is NOT a drawback of colloid solution administration?

a. Expensive
b. Transient effects***
c. Possible decrease in Ca2+
d. Associated with coagulopathies

46

6. Which category of patients would be appropriate for consideration of administration of 5%
Dextrose?

a. Neonates
b. Diabetics receiving insulin
c. TPN-dependent patients
d. All of the above

47

7. Which IV fluid can be administered along with blood products?

a. LR
b. NS***
c. Dextran
d. 5% Dextrose

48

8. Which of these is not a risk associated with administration of hypertonic salt solutions?

a. Significant peripheral edema***
b. Cellular dehydration
c. Hemolysis at side of injection
d. Hypernatremia

49

9. Which of these IV fluids is derived from human blood products?

A. Lactated Ringer’s
B. Dextran
C. Plasmanate ***
D. Hetastarch

50

10. What type of surgery is most often associated with the use of Dextran?

a .Cardiac surgery
b. Gastrointestinal surgery
c. Orthopedic surgery
d. Vascular surgery***

51

1.What medication lowers blood pressure, but is not an effective tocolytic?

Magnesium Sulfate

52

2.Which drugs should be considered first when seeking tocolysis, and why?

Atosiban (oxytocin antagonist) and Calcium channel blockers as they have significantly less side effects.

53

3.What is a common contraindications for tocolytic therapy?

Mother has severe pre-eclampsia

54

4.What other intervention might an anesthetist consider besides medication that has been suggested by some to decrease uterine activity?

Hydration.

55

5. Which uterotonic is an ergot alkaloid?

Methergine2.

56

6. What receptor does hemabate bind to?

PGE2

57

7. Which uterotonic should not be administered IV?

Methergine

58

8. Why is Indomethacin contraindicated in the last two months of pregnancy?

Possible effects on fetal heart development.

59

9. Which of the following are side affects seen in long term use of non-selective COX inhibitors?

Decreased renal blood flow & GI ulcers

60

10. What receptor does Nifedipine act on?

Blocks calcium slow channels