Quiz 6 Flashcards
Which Beta blocker has additional alpha blocking properties?
A. Metoprolol
B. Atenolol
C. Labetelol
D. Esmolol
Answer: C, Labetolol. Labetolol not only has the ability to block beta receptors but the alpha receptors as well. This allows Labetolol to vasodilate in addition to reducing cardiac rate and contractility.
Which of the following patients would direct myocardial depressant effects be more apparent with higher dose Ketamine administration? Select two.
A. 27-year-old male trauma patient
B. 57-year-old female in severe end-stage septic shock
C. 46-year-old woman with a small bowel obstruction
D. 24-year-old male with a spinal cord transection
Correct Answer: B & D
Rationale
Ketamine is known to increase sympathetic nervous system stimulation and inhibit the reuptake of norepinephrine at nerve terminals, leading to rises in blood pressure and cardiac output (Butterworth et al., 2022). However, myocardial depressant characteristics can become unmasked in patients receiving higher doses of Ketamine when sympathetic blockade occurs (Butterworth et al., 2022). These occurrences can be evident in patients with depleted catecholamine stores and autonomic nervous system dysfunction.
Which of the following inhalation anesthetics is known for causing airway irritation?
A. Isoflurane
B. Nitrous Oxide
C. Sevoflurane
D. Desflurane
Answer: D. Desflurane
Rationale: Nitrous Oxide and Sevoflurane are known for their low incidence of causing airway irritation and complications such as breath holding, coughing, excessive secretions, or laryngospasm. Desflurane is known to be a respiratory irritant when used for mask inductions in concentrations greater than 6%, making it an unsuitable choice for induction in pediatric and adult patients.
Which of the following antiemetics are effective for postdischarge nausea and vomiting (PDNV)? (select 2)
a) Ondansetron (Zofran)
b) Metoclopramide (Reglan)
c) Scopolamine transdermal
d) Palonosetron (Aloxi)
Answer: C & D
Rational: Scopolamine patch has an onset of 4 hours and minimum duration of 24 hours. It works by blocking transmission of cholinergic impulses from vestibular nuclei to higher centers in the CNS and from the reticular formation to the vomiting center. It is chosen for PDNV due to its long duration. While Ondansetron and Palonosetron belong to the same class, Palonosetron is a second-generation serotonin antagonist and has a long half-life of 44 hours, which makes it effective for PDNV. Ondansetron and Metoclopramide are not used for PDNV due to their short durations of action.
Which patient requires additional education regarding sugammadex administration for surgery?
A) A 32-year-old male with a history of hypertension controlled with lisinopril.
B) A 45-year-old female with a history of asthma using albuterol as needed.
C) A 28-year-old female taking hormonal contraceptives for birth control.
D) A 60-year-old male with type 2 diabetes managed with metformin.
Correct Answer:
C) A 28-year-old female taking hormonal contraceptives for birth control.
Rationale:
Sugammadex can bind to and increase the excretion of steroidal hormones, including those found in hormonal contraceptives, which can reduce their effectiveness. Patients taking hormonal contraceptives should be advised to use an alternative, nonhormonal contraceptive for at least 7 days following sugammadex administration to prevent unintended pregnancy.
Which of the following treats mild pain?
a. Ketorolac
b. Hydromorphone
c. Tylenol
d. Fentanyl
Answer: C
Rationale: While all of the medications treat pain, all medications mentioned are used to treat pain that is greater than mild except for tylenol.
What is the primary concern regarding the respiratory effects of benzodiazepines?
A. Depressed ventilatory response to CO2
B. Increased airway resistance
C. Increased hypoxic drive
D. Benzodiazepines have no respiratory effects
Answer: A - Depressed ventilatory response to CO2
Rationale: Benzodiazepams lower the hypercapnic drive by blunting the central chemoreceptors’ response to increased CO2 levels. It does not directly cause increased airway resistance. Bezodiazepams, especially in combination with other medications, can lower the hypoxic drive, not increase it.
Which of the following opioids has the highest potency compared to morphine?
A) Hydromorphone
B) Meperidine
C) Fentanyl
D) Sufentanil
Correct answer: D) Sufentanil
Rationale: Sufentanil is the most potent of the phenylpiperidines and is used for situations in which profound analgesia is required.
Which of the following best describes the role of the liver in the metabolism of succinylcholine?
A) The liver directly metabolizes succinylcholine via cytochrome P450 enzymes.
B) The liver produces plasma cholinesterase, responsible for hydrolyzing succinylcholine.
C) Succinylcholine undergoes first-pass metabolism in the liver, reducing its bioavailability.
D) Succinylcholine skips the liver and is entirely excreted unchanged by the kidneys.
Correct Answer:
B) The liver produces plasma cholinesterase, responsible for hydrolyzing succinylcholine
Elimination. Succinylcholine is degraded via hydrolysis by plasma cholinesterase. These enzymes, although found in the plasma, are produced by the liver.
Which of the following patients would most benefit from ketamine induction?
A) A patient with severe asthma
B) A patient with uncontrolled hypertension
C) A patient with schizophrenia
D) A patient with a full stomach at risk for aspiration
Correct Answer: A) A patient with severe asthma
Rationale: Ketamine is a potent bronchodilator, making it an excellent choice for patients with reactive airway disease such as asthma
Which of the following drugs are NMDA receptor antagonists? (Select 2)
A. Nitrous Oxide
B. Propofol
C. Ketamine
D. Etomidate
Answer: A and C
Rationale: Nitrous Oxide and Ketamine function as NMDA receptor antagonists, distinguishing them from Propofol and Etomidate, which act primarily through GABA-A receptor modulation.
Which of the following statements about propofol is correct?
A) Propofol is a respiratory stimulant and enhances the response to hypercarbia.
B) Propofol-induced depression of upper airway reflexes is less than that of thiopental.
C) Propofol can be administered for sedation by any healthcare personnel without specific training.
D) Propofol is a profound respiratory depressant and can cause apnea following an induction dose.
Answer: D) Propofol is a profound respiratory depressant and can cause apnea following an induction dose.
Rationale: Propofol is a profound respiratory depressant that usually causes apnea following an induction dose. Even when used for conscious sedation in subanesthetic doses, propofol inhibits hypoxic ventilatory drive and depresses the normal response to hypercarbia.
Which of the following drugs are alpha 2 agonists? (Select 2)
A. Carvedilol (Coreg)
B. Dexmedetomidine (Precedex)
C. Prazosin (Minipress)
D. Clonidine (Catapres)
E. Labetalol (Normodyne)
Answer: B. Dexmedetomidine (Precedex) & D. Clonidine (Catapres)
Rationale: Clonidine is a presynaptic alpha 2 agonist. Clonidine decreases blood pressure by agonizing peripheral presynaptic alpha 2 receptors and central alpha 2 receptors. Dexmedetomidine is an alpha 2 agonist that is used for short term sedation in critical care. It can also be used as an adjunct to anesthesia in a variety of situations. Dexmedetomidine provides dose-dependent sedation, analgesia, sympatholysis, and anxiolysis without significant respiratory depression. Carvedilol and labetalol are both beta blockers. Prazosin is an alpha 1 antagonist.
Which of the following best explains why neostigmine requires an anticholinergic agent for co-administration, while sugammadex does not?
A. Neostigmine directly stimulates the vagus nerve; therefore, it requires counteraction.
B. Sugammadex binds to muscarinic receptors and prevents parasympathetic effects.
C. Sugammadex increases acetylcholine breakdown, which counteracts muscarinic effects.
D. Neostigmine increases endogenous acetylcholine around the cholinoreceptors.
Answer: D. Neostigmine increases endogenous acetylcholine around the cholinoreceptors.
Rationale: Neostigmine inhibits acetylcholinesterase, which increases acetylcholine levels at the neuromuscular junction. This can cause bradycardia, arrhythmias, bronchoconstriction, and hypersalivation, so anticholinergics (glycopyrrolate or atropine) are given to counteract these effects. Sugammadex is a modified y-cyclodextrin that works by encapsulating and forming very tight water-soluble complexes at a 1:1 ratio with steroidal neuromuscular blocking drugs, therefore, it does not affect ACh levels and does not require an anticholinergic.
How can an anesthesia provider accelerate the onset of Rocuronium during rapid sequence intubation?
A. By priming rocuronium, which involves giving 10% of the calculated dose before inducing anesthesia and then giving the remaining dose 1 to 3 minutes after the patient is anesthetized
B. By giving a larger single bolus of rocuronium at once
C. By infusing rocuronium over 30 minutes before induction
D. By priming rocuronium by giving half the dose before inducing anesthesia and then giving the remaining dose 1 to 3 minutes after the patient is anesthetized
Answer: A. By priming rocuronium, which involves giving 10% of the calculated dose before inducing anesthesia and then giving the remaining dose 1 to 3 minutes after the patient is anesthetized.
Rationale: Priming involves giving about 10% of the calculated intubating dose of rocuronium a few minutes before induction, which will speed the onset of blockade when the remainder is administered. Priming does produce respiratory distress in 10% of the patients in which it is used.
Which of the following opioids is most likely to cause histamine release leading to hypotension and pruritus?
a) Fentanyl
b) Morphine
c) Remifentanil
d) Sufentanil
Answer: b) Morphine.
Rationale: Morphine can cause significant histamine release, leading to vasodilation, hypotension, and pruritus. This effect is less pronounced with synthetic opioids like fentanyl, remifentanil, and sufentanil. Other drugs that can cause histamine release include codeine and meperidine.
Which of the following are true about ketamine?
A. Ketamine provides dissociative sedation AND analgesia
B. Ketamine increases blood pressure and heart rate
C. Ketamine is an NMDA receptor antagonist
D. Ketamine can be administered IV, IM, and orally.
E. All of the above are true of ketamine
Answer: E. All of the above are true of ketamine.
Rationale: Ketamine works by antagonizing NMDA receptors, leading to dissociative sedation and analgesia. Ketamine is well known to increase blood pressure and heart rate, and it can be administered IV, IM, and orally.
After administering a neuromuscular blocking agent, you perform a train of four (TOF) assessment on the ulnar nerve and observe the absence of twitches T3 and T4. What percentage of neuromuscular blockade does this correspond with?
A. <70%
B. 75-80%
C. 85-90%
D. 80-85%
Answer: D - 80-85% block
Rationale: Train of four monitoring is most sensitive between 70-100% paralysis. Absence of specific twitches corresponds to percentages of neuromuscular blockade. When T4 and T3 are absent, this indicates that you have between 80-85% blockade.
