Pharmacology For Nurse Anesthesiology! Quiz

The correct answer is "move on incision." This means that during the procedure, patients will not move or breathe on the incision site. This is important because movement or breathing on the incision can disrupt the surgical process and potentially lead to complications.

Morphine is known to be a potent histamine releaser. Histamine is a chemical compound released by the body in response to an allergic reaction. It causes symptoms such as itching, redness, and swelling. In this case, out of the given options, morphine is the strongest histamine releaser, meaning it has the highest ability to trigger the release of histamine in the body.

Tension is usually measured in millimeters of mercury (mmHg) or millimeters of mercury column (mmhg). This unit is commonly used to measure the pressure exerted by a liquid or gas. The abbreviation "mmHg" represents the pressure exerted by a column of mercury of one millimeter in height, while "mmhg" is a variation in capitalization but still refers to the same unit of measurement.

Meperidine is the only option among the given drugs that will not cause miosis. Miosis refers to the constriction of the pupil, which is a common side effect of opioids like morphine, fentanyl, and sufentanil. These drugs act on the opioid receptors in the central nervous system, causing miosis as part of their pharmacological effects. However, meperidine, also known as Demerol, is an opioid analgesic that does not typically cause miosis as a side effect.

The correct answer suggests that the patient may require more opioids to relieve pain. The increased heart rate and absence of muscle response (0/4 train of four) indicate inadequate pain control. Increasing the dose of opioids can help alleviate the patient's pain and potentially reduce the heart rate.

The correct answer is "Inside of circuit". This is not a characteristic of vaporizers because vaporizers are external devices that are used to convert liquid medication into a vapor or mist form for inhalation. They do not operate inside of a circuit or have any internal circuitry.

Relative potency compared to morphine

Meperidine 0.1:1
Morphine 1:1
Remifentanil 100:1
Sufentanil 1000:1

Epinorphin is not an endogenous opioid peptide. Enkephalin, endorphin, and dynorphin are all examples of endogenous opioid peptides that are naturally produced in the body. Epinorphin, on the other hand, is not a naturally occurring opioid peptide but rather a synthetic opioid that is not found in the body.

Fentanyl does not release histamine and is safe for asthmatics. Morphine = Histamine releaser. Ethanol = Bad for pancreas Ketorolac = Contraindicated for asthmatics.

Remifentanil does not require pseudocholinesterase for metabolism. It is actually metabolized by non-specific tissue and plasma esterases. Pseudocholinesterase is responsible for the metabolism of drugs like succinylcholine, not remifentanil. Therefore, the statement is false.

Opioids would not be given to a patient undergoing a cholangiogram because opioids can cause relaxation of the sphincter of Oddi, which is the muscle that controls the flow of bile into the small intestine. This relaxation can lead to an increase in pressure in the biliary system, potentially causing complications during the cholangiogram procedure.

Remifentanil is unique among opioids because its context-sensitive half-time is independent of infusion time. This means that the duration of its effect does not change based on the length of the infusion. This characteristic is important because it allows for precise control over the depth and duration of anesthesia during surgical procedures. Other opioids may have a longer duration of action that can be difficult to predict or control, making remifentanil a preferred choice in certain situations.

Solubility refers to the ability of a substance to dissolve in a solvent. When an agent is less soluble, it means that it does not dissolve easily in a solvent. In the context of reaching equilibration, a less soluble agent will have fewer molecules in the solvent, leading to a lower concentration and a slower rate of reaching equilibrium. Therefore, the statement "The less soluble an agent is, the slower it will reach equilibration" is incorrect. The correct statement is "The less soluble an agent is, the faster it will reach equilibration."

Babies upregulate CYP450 enzymes, which are responsible for metabolizing drugs and toxins, between the ages of 6-12 months. This means that their bodies start producing more of these enzymes during this time period. This upregulation is important because it affects how quickly and efficiently drugs are processed and eliminated from the body. Understanding the timing of CYP450 upregulation is crucial for determining appropriate drug dosages and avoiding potential adverse effects in infants.

The wooden chest is a result of a central mu effect. This suggests that the wooden chest is caused by the activation of mu receptors in the central nervous system. Mu receptors are a type of opioid receptor that are involved in pain modulation, reward, and addiction. It is likely that the central mu effect is causing a sensation of pain or discomfort in the chest area, resulting in the wooden chest sensation.

The kappa opioid receptor causes diuresis. Diuresis refers to increased urine production, and activation of the kappa receptor can lead to this effect. The mu1 and mu2 receptors are primarily involved in analgesia and respiratory depression, while the delta receptor is involved in modulation of mood and pain perception. Therefore, kappa is the most likely opioid receptor to cause diuresis.

Dynorphin is responsible for stimulating the kappa opioid receptor. Dynorphin is an endogenous opioid peptide that acts as a natural ligand for the kappa receptor. When dynorphin binds to the kappa receptor, it activates a signaling cascade that produces analgesic effects and can also modulate mood and behavior. The kappa receptor is one of the three main types of opioid receptors, along with the mu and delta receptors, and each receptor type has different functions and effects when activated.

Partial pressure is a measure of the pressure exerted by a single gas component in a mixture of gases. It is expressed as a fraction or percentage of the total pressure. Therefore, the correct answer is % or percentage, as it represents the measurement unit used to quantify partial pressure.

Nalbuphine would be the appropriate medication to reverse post-op ventilatory depression from Fentanyl while maintaining analgesia. Nalbuphine is a mixed opioid agonist-antagonist that can reverse the respiratory depression caused by Fentanyl without completely reversing its analgesic effects. Unlike Naloxone, which is a pure opioid antagonist and can completely reverse the effects of opioids, Nalbuphine has a ceiling effect on respiratory depression reversal, making it a safer option to maintain pain control while improving ventilation. Flumazenil is a benzodiazepine antagonist and would not be effective in reversing the effects of Fentanyl. Switching to meperidine is not recommended as it is also an opioid and may further contribute to respiratory depression.

Nalbuphine is the best agent to relieve post-op itching caused by Morphine. Nalbuphine is an opioid analgesic that acts as a partial agonist at the mu-opioid receptor and an antagonist at the kappa-opioid receptor. It has been shown to effectively relieve itching without reversing the analgesic effects of Morphine. Naloxone, Flumazenil, Meperidine, and Butorphanol are not specifically indicated for relieving itching caused by Morphine.

Highly protein-bound drugs have a PB >90%.
Sufentanil PB 92%.
Morphine PB 30%.
Fentanyl PB 84%
Remifentanil PB 80%.

Enkephalin is a type of endorphin that acts as a natural painkiller in the body. It stimulates both the mu and delta opioid receptors. The mu opioid receptor is primarily responsible for producing analgesic effects and is also involved in the reward system of the brain. The delta opioid receptor is also involved in pain modulation and can contribute to the analgesic effects of enkephalin. Therefore, enkephalin stimulates both the mu and delta opioid receptors to produce its pain-relieving effects.

The adrenal medulla is not a site of synthesis for Pro-opiomelanocortin. Pro-opiomelanocortin (POMC) is a precursor molecule that is synthesized and processed into various hormones, including adrenocorticotropic hormone (ACTH), in the pituitary gland. The placenta is also capable of synthesizing POMC. However, the adrenal medulla primarily synthesizes and releases catecholamines, such as adrenaline and noradrenaline, in response to stress or stimulation from the sympathetic nervous system.

Alfentanil, when combined with benzodiazepines, causes the greatest drop in Mean Arterial Pressure (MAP). This is because Alfentanil is a potent opioid analgesic that acts on the central nervous system, leading to vasodilation and decreased vascular resistance. When combined with benzodiazepines, which also have sedative and muscle relaxant effects, the synergistic effect results in a more pronounced drop in MAP compared to other opioids like Sufentanil and Fentanyl.

Alfentanil and erythromycin battle for CYP450-3A

Morphine does not cause itching by releasing large amounts of histamine. Itching caused by morphine is primarily due to the activation of opioid receptors in the central nervous system, which leads to the release of certain substances that can cause itching. Histamine release is not the primary mechanism behind morphine-induced itching.

MAOIs (Monoamine oxidase inhibitors) are a class of medications used to treat depression. They work by increasing the levels of certain chemicals in the brain. When combined with certain drugs, MAOIs can cause a dangerous increase in blood pressure, leading to a condition called hypertensive crisis. Tramadol, meperidine, and methadone are opioids that can potentially interact with MAOIs and increase the risk of this hypertensive crisis. Therefore, these drugs should be avoided in patients taking MAOIs.

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Meperidine is obviously the best choice