1.
Which of the following induction agents is contraindicated with an intracranial hemorrhage?
Correct Answer
A. Ketamine
Explanation
Increases CPP, CMRO2, ICP, and IOP
2.
Which of the following induction agents is associated with adrenal corticoid suppression and should be used cautiously or avoided with patients on chronic steroids/Addison's disease?
Correct Answer
A. Etomidate
Explanation
Etomidate is associated with adrenal corticoid suppression and should be used cautiously or avoided with patients on chronic steroids/Addison's disease. This is because etomidate inhibits the production of cortisol, a hormone produced by the adrenal glands. Patients with chronic steroid use or Addison's disease already have compromised adrenal function, and the use of etomidate can further suppress cortisol production, leading to adrenal insufficiency. Therefore, it is important to exercise caution and consider alternative induction agents in these patients to prevent adrenal crisis.
3.
Which of the following induction agents has minimal effects on the cardiovascular system, usually not changing contractility or cardiac output, and also does not usually result in apnea unless opioids have also been administered?
Correct Answer
A. Etomidate
Explanation
Etomidate is the correct answer because it is known to have minimal effects on the cardiovascular system. It typically does not change contractility or cardiac output, making it a suitable choice for patients with cardiovascular concerns. Additionally, it usually does not result in apnea unless opioids have also been administered, further highlighting its safety profile.
4.
Which of the following agents should be avoiding in patients with coronary artery disease, uncontrolled HTN, or CHF due to its ability to increase myocardial workload?
Correct Answer
A. Ketamine
Explanation
Ketamine should be avoided in patients with coronary artery disease, uncontrolled hypertension, or congestive heart failure due to its ability to increase myocardial workload. Ketamine is a dissociative anesthetic that can cause an increase in heart rate and blood pressure, leading to increased myocardial oxygen demand. This can be dangerous in patients with pre-existing cardiovascular conditions as it may exacerbate their symptoms and potentially lead to cardiovascular complications. Therefore, it is recommended to avoid using ketamine in these patients to minimize the risk of cardiovascular events.
5.
Patients with end stage renal disease do not need reduced dosing for benzodiazepines or morphine.
Correct Answer
B. False
Explanation
Patients with end stage renal disease do need reduced dosing for benzodiazepines or morphine. This is because their kidneys are not functioning properly, leading to a decreased ability to eliminate these medications from the body. Therefore, lower doses are required to prevent potential toxicity or adverse effects.
6.
The addition of epinephrine to a local anesthetic leads to vessel vasoconstriction and _______ absorption/metabolism of the local anesthetic.
Correct Answer
A. Less
Explanation
The addition of epinephrine to a local anesthetic leads to vessel vasoconstriction, which means that the blood vessels in the area constrict or narrow. This constriction reduces blood flow to the area, resulting in less absorption and metabolism of the local anesthetic. As a result, the anesthetic stays in the area for a longer duration, providing prolonged pain relief.
7.
Cocaine is special because it has vasoconstrictive properties related to its ability to block the reuptake of norepinephrine.
Correct Answer
A. True
Explanation
Cocaine is indeed special because it has vasoconstrictive properties. This means that it can narrow or constrict blood vessels, leading to a decrease in blood flow. This property is related to its ability to block the reuptake of norepinephrine, a neurotransmitter involved in regulating blood vessel size. By blocking the reuptake of norepinephrine, cocaine increases its levels in the body, causing vasoconstriction and various physiological effects. Therefore, the statement "Cocaine is special because it has vasoconstrictive properties related to its ability to block the reuptake of norepinephrine" is true.
8.
The addition of sodium bicarbonate to the local will________ the pH of the LA and therefore increase the amount of drug in the nonionized form.
Correct Answer
A. Increase
Explanation
When sodium bicarbonate is added to the local anesthetic (LA), it acts as a buffer and increases the pH of the solution. This increase in pH shifts the equilibrium of the LA towards the nonionized form. The nonionized form of the drug is more lipophilic and can easily cross cell membranes, leading to an increased amount of drug available for action. Therefore, the addition of sodium bicarbonate increases the amount of drug in the nonionized form, ultimately enhancing its effectiveness.
9.
Systemic absorption of injected local anesthetics depends on the blood flow to the site. IV>tracheal>intrapleural, intercostal>Caudal>paracervical>epidural>brachial plexus>subarachnoid,sciatic,femoral>subcutaneous
Correct Answer
A. True
Explanation
Mnemonic=In Time I Can Please Everyone But Susie & Sally
10.
Local anesthetics that are more lipid soluble also tend to have a higher degree of protein binding. Local anesthetics bind mostly to:
Correct Answer
A. AlpHa 1-acid glycoproteins
Explanation
Local anesthetics that are more lipid soluble tend to have a higher degree of protein binding. In this case, the correct answer is Alpha 1-acid glycoproteins. This means that local anesthetics with higher lipid solubility have a greater affinity for binding to Alpha 1-acid glycoproteins rather than albumin.
11.
The duration of action is ________ for local anesthetics that exhibit the greatest protein binding and the highest lipid solubility.
Correct Answer
A. Longest
Explanation
Local anesthetics that exhibit the greatest protein binding and highest lipid solubility have a longer duration of action. This is because these properties allow the anesthetic to stay bound to proteins and remain within the lipid-rich environment for a longer period of time, resulting in a slower release and metabolism of the drug. As a result, the effects of the anesthetic are prolonged, leading to a longer duration of action.
12.
Levobupivacaine is the isomer of bupivacaine that is less cardiotoxic.
Correct Answer
A. True
Explanation
Ropivacaine is mentioned in the ppt to have less cardiotoxicity than bupivacaine - it is "the propyl analogue of, bupivacaine having a butyl group in the same position."
13.
The lower the pKa of a local anesthetic, the faster the onset of action will be, with the only exception being chloroprocaine which has a high pKa but a rapid onset.
Correct Answer
A. True
Explanation
The explanation for the given correct answer is that the pKa of a local anesthetic determines its ability to penetrate the nerve membrane and become ionized, which affects its onset of action. A lower pKa means that the anesthetic is more likely to be in its non-ionized form, allowing it to easily cross the nerve membrane and reach its target site. This results in a faster onset of action. However, chloroprocaine is an exception to this rule. Despite having a high pKa, it still has a rapid onset of action due to its unique chemical properties.
14.
Injecting a LA into an infected site will generally _______ the onset of action.
Correct Answer
A. Lengthen
Explanation
Injecting a local anesthetic (LA) into an infected site can cause the onset of action to be prolonged or delayed. This is because the infection can alter the pH and blood flow in the area, affecting the absorption and distribution of the LA. As a result, the LA may take longer to reach its target and exert its numbing effect, thus lengthening the onset of action.
15.
With epinephrine added, the max dose of lidocaine and mepivacaine are both _ mg/kg.
Correct Answer
7
Explanation
With epinephrine added, the maximum dose of lidocaine and mepivacaine is both 7 mg/kg.
16.
Cocaine and amphetamines are examples _______ adrenergic agonists.
Correct Answer
A. Indirect
Explanation
Amphetamines are resistant to MAO while cocaine decreases the reuptake of NE
17.
Patients taking MAOI's should not be treated with ________ acting adrenergic agonists due to the potential for a hypertensive crisis.
Correct Answer
A. Indirect
Explanation
Patients taking MAOI's should not be treated with indirect-acting adrenergic agonists due to the potential for a hypertensive crisis. MAOI's inhibit the breakdown of norepinephrine, dopamine, and serotonin, leading to an accumulation of these neurotransmitters. Indirect-acting adrenergic agonists, such as tyramine, can displace norepinephrine from storage sites and cause a sudden release of norepinephrine, leading to a dangerous increase in blood pressure. Direct-acting adrenergic agonists, on the other hand, directly stimulate adrenergic receptors and do not rely on the release of norepinephrine, making them safer to use in patients taking MAOI's.
18.
Methyldopa, clonidine, and dexmedetomidine are all _______ agonists, they are considered to be sympatholytic, abrupt discontinuation can cause acute withdrawal syndrome leading to hypertensive crisis.
Correct Answer
A. AlpHa 2
Explanation
Methyldopa, clonidine, and dexmedetomidine are all alpha 2 agonists. Alpha 2 agonists work by stimulating alpha 2 adrenergic receptors in the body, leading to a decrease in sympathetic outflow from the central nervous system. This results in a decrease in sympathetic activity and a reduction in blood pressure. These drugs are considered sympatholytic because they inhibit the release of norepinephrine, which is responsible for activating the sympathetic nervous system. Abrupt discontinuation of alpha 2 agonists can cause acute withdrawal syndrome, which can lead to a sudden increase in sympathetic activity and hypertensive crisis.
19.
Which of the following are the naturally occuring adrenergic agonists?
Correct Answer(s)
A. EpinepHrine
B. NorepinepHrine
C. Dopamine
Explanation
Epinephrine, norepinephrine, and dopamine are naturally occurring adrenergic agonists. Adrenergic agonists are substances that activate adrenergic receptors in the sympathetic nervous system, leading to various physiological responses. Epinephrine, also known as adrenaline, is released by the adrenal glands and plays a role in the "fight or flight" response. Norepinephrine, also known as noradrenaline, is a neurotransmitter that is released by sympathetic nerve endings. Dopamine is a neurotransmitter that has various functions in the brain and body. These three substances have adrenergic effects and can bind to adrenergic receptors to stimulate the sympathetic nervous system.
20.
It is okay for patients on monoamine oxidase inhibitors to receive ephedrine.
Correct Answer
B. False
Explanation
NE is in abundance - will cause htn crisis
21.
Phenylephrine is a non-catecholamine predominantly ______ agonist.
Correct Answer
A. AlpHa1
Explanation
Phenylephrine is a non-catecholamine that primarily acts as an agonist on alpha1 adrenergic receptors. This means that it stimulates these receptors, leading to vasoconstriction and increased blood pressure. Alpha1 agonists are commonly used to treat conditions such as nasal congestion, hypotension, and shock.
22.
Epinephrine utilizes dosing for effect and can stimulate all of the following receptors except:
Correct Answer
A. AlpHa2
Explanation
Epinephrine is a medication that acts as a sympathomimetic by stimulating adrenergic receptors. It primarily targets alpha1, beta1, and beta2 receptors, leading to vasoconstriction, increased heart rate, and bronchodilation respectively. However, it does not directly stimulate alpha2 receptors. Alpha2 receptors are inhibitory autoreceptors that regulate the release of norepinephrine, and epinephrine does not have a significant affinity for these receptors. Therefore, epinephrine does not utilize dosing for effect on alpha2 receptors.
23.
Epinephrine _________ myocardial oxygen demand.
Correct Answer
A. Increases
Explanation
Epinephrine increases myocardial oxygen demand. Epinephrine is a hormone that is released during times of stress or excitement. It acts on the heart by increasing heart rate and contractility, which in turn increases the amount of oxygen that the heart muscle needs to function properly. This increased demand for oxygen can be beneficial in certain situations, such as during exercise when the body needs more oxygen to meet the increased energy demands. However, in individuals with heart disease or other cardiac conditions, this increased demand for oxygen can be detrimental and may lead to chest pain or heart attack.
24.
__________ is an alpha and beta receptor antagonist that reduces BP w/o reflex tachycardia due to its combined receptor effects, it has a ratio of 1:7 alpha to beta blockade.
Correct Answer
labetolol
Explanation
Labetolol is a medication that acts as an antagonist for both alpha and beta receptors. This means that it blocks the effects of these receptors, leading to a reduction in blood pressure. Unlike other medications in its class, labetolol does not cause reflex tachycardia, which is an increase in heart rate that can occur as a compensatory response to a drop in blood pressure. This is due to its combined effects on both alpha and beta receptors. Labetolol has a ratio of 1:7 alpha to beta blockade, meaning it has a stronger effect on alpha receptors compared to beta receptors.
25.
A _______ selective blocker are preferred for COPD and PVD.
Correct Answer
A. Beta1
Explanation
Beta1 selective blockers are preferred for COPD (Chronic Obstructive Pulmonary Disease) and PVD (Peripheral Vascular Disease). This is because beta1 selective blockers primarily target the beta1 adrenergic receptors found in the heart, while having minimal effect on the beta2 adrenergic receptors found in the lungs and blood vessels. By selectively blocking beta1 receptors, these medications can help manage conditions like COPD and PVD without exacerbating respiratory symptoms or causing vasoconstriction in the peripheral blood vessels.
26.
Beta blockers are generally avoided in asthmatics due to the potential to trigger severe asthma attacks.
Correct Answer
A. True
Explanation
Beta blockers are medications that can block the effects of adrenaline, which can cause bronchial constriction and narrowing of the airways. This can be particularly dangerous for individuals with asthma, as it can potentially trigger severe asthma attacks. Therefore, it is generally recommended to avoid using beta blockers in asthmatics to minimize the risk of exacerbating their condition.
27.
Which of the following is a selective beta1 antagonist?
Correct Answer
A. Esmolol
Explanation
Esmolol is a selective beta1 antagonist because it specifically targets and blocks beta1 adrenergic receptors in the heart. This selective action allows it to primarily affect the heart, reducing heart rate and contractility, without significantly affecting beta2 receptors in other tissues. Labetolol and propanolol, on the other hand, are non-selective beta blockers that block both beta1 and beta2 receptors, leading to broader effects on the body.
28.
Which of the following non-selectively blocks beta1 and beta2 receptors?
Correct Answer
A. Propranolol
Explanation
Propranolol is the correct answer because it is a non-selective beta blocker that blocks both beta1 and beta2 receptors. This means that it can affect the heart (beta1) as well as other organs such as the lungs (beta2). Esmolol is a selective beta1 blocker, meaning it primarily targets beta1 receptors in the heart. Labetolol, on the other hand, is a non-selective beta blocker but it also has alpha-blocking properties, making it a better choice for conditions that involve both beta and alpha receptor blockade.
29.
Which of the following antimuscarinics do NOT cross the placenta?
Correct Answer
B. Glycopyrrolate
Explanation
Glycopyrrolate is the correct answer because it is a quaternary ammonium compound that does not easily cross the placenta due to its large molecular size and positive charge. This makes it a safer choice during pregnancy compared to atropine, which is a tertiary amine and can cross the placenta more readily.
30.
Which of the following antimuscarinics crosses the BBB?
Correct Answer
A. Atropine
Explanation
Atropine is able to cross the blood-brain barrier (BBB), allowing it to exert its effects on the central nervous system. This is due to its lipophilic nature, which enables it to pass through the lipid-rich barrier. On the other hand, glycopyrrolate is a quaternary ammonium compound, which means it carries a positive charge and is therefore unable to cross the BBB. Hence, atropine is the correct answer as it is the antimuscarinic that can penetrate the BBB.
31.
Verapamil is a calcium channel blocker used to prevent cerebral vasospasms because it is the only Ca++ channel blocker that crosses the BBB.
Correct Answer
B. False
Explanation
Nimodipine
32.
Which of the following would you NOT consider using for treating a hypertensive crisis intraoperatively?
Correct Answer
A. Dobutamine
Explanation
Dobutamine is a medication that is primarily used to increase cardiac output in patients with heart failure. It works by stimulating the heart to beat more forcefully. However, in the context of a hypertensive crisis, where blood pressure is dangerously high, the goal is to lower blood pressure. Therefore, using dobutamine, which can increase blood pressure, would not be appropriate in this situation.
33.
The dose of sodium nitroprusside is 0.5-10 mcg/kg/min. It can cause what type of toxicity if ran at high doses?
Correct Answer
A. Cyanide
Explanation
Sodium nitroprusside, when administered at high doses, can cause cyanide toxicity. Cyanide is a highly toxic substance that inhibits cellular respiration by binding to cytochrome oxidase, preventing the utilization of oxygen by cells. Symptoms of cyanide toxicity include headache, confusion, dizziness, seizures, respiratory distress, and cardiac arrest. Prompt recognition and treatment are essential in managing cyanide toxicity.
34.
Antacids lower gastric pH by neutralizing acid.
Correct Answer
A. True
Explanation
Antacids are medications that work by neutralizing stomach acid, therefore lowering gastric pH. This helps to relieve symptoms of acid reflux, heartburn, and indigestion. By neutralizing the acid, antacids can provide temporary relief and reduce the acidity in the stomach. This is why the statement "Antacids lower gastric pH by neutralizing acid" is true.
35.
Which drug is a centrally acting dopamine antagonist that causes selective GI cholinergic stimulation, increases LES/fundal smooth muscle tension, increases gastric & small intestine motility, relaxes pylorus/duodenum during contraction?
Correct Answer
A. Metoclopramide
Explanation
Metoclopramide is a centrally acting dopamine antagonist that stimulates cholinergic receptors in the gastrointestinal (GI) tract. It increases the tension of the lower esophageal sphincter (LES) and fundal smooth muscles, which helps prevent reflux. It also increases the motility of the gastric and small intestine, aiding in digestion. Additionally, metoclopramide relaxes the pylorus and duodenum during contraction, allowing for the smooth passage of food through the GI tract.
36.
Hypotension, bradycardia, dysrhythmias and akathisia (restlessness/uneasiness) are common side effects of Reglan.
Correct Answer
A. True
Explanation
The statement is true because hypotension, bradycardia, dysrhythmias, and akathisia are indeed common side effects of Reglan. Hypotension refers to low blood pressure, bradycardia is a slow heart rate, dysrhythmias are abnormal heart rhythms, and akathisia is a condition characterized by restlessness or uneasiness. These side effects can occur when taking Reglan, a medication commonly used to treat gastrointestinal issues such as acid reflux and gastroparesis. It is important for patients to be aware of these potential side effects and discuss them with their healthcare provider.
37.
An allergy to penicillins implies an 8% likelihood of an allergy to:
Correct Answer
A. CepHalosporins (ancef)
Explanation
An allergy to penicillins implies an 8% likelihood of an allergy to cephalosporins (ancef). This means that there is a relatively high chance of cross-reactivity between penicillins and cephalosporins, as both are beta-lactam antibiotics and have a similar chemical structure. However, there is no significant evidence to suggest a similar cross-reactivity with aminoglycosides, antivirals, or vancomycin. Therefore, the correct answer is cephalosporins (ancef).
38.
Ancef is an example of a cephalosporin that is commonly used because it offers broad spectrum coverage and is inexpensive.
Correct Answer
A. True
Explanation
Ancef is indeed an example of a cephalosporin that is commonly used. It is known for its broad spectrum coverage, meaning that it can effectively treat a wide range of bacterial infections. Additionally, it is also relatively inexpensive, making it a cost-effective choice for many healthcare providers. Therefore, the statement that Ancef offers broad spectrum coverage and is inexpensive is true.
39.
The most common complication of antimicrobial use is:
Correct Answer
A. Pseudomembraneous colitis (poops)
Explanation
Pseudomembranous colitis is the most common complication of antimicrobial use. This condition is caused by the overgrowth of a bacteria called Clostridium difficile in the colon, which produces toxins that damage the lining of the colon. Symptoms of pseudomembranous colitis include severe diarrhea, abdominal pain, and fever. It is important to note that "poops" is not a medical term, but it is likely used here to describe the symptom of diarrhea associated with this condition.
40.
H2 receptors relax bronchial smooth muscles, therefore patients on H2 antagonists are at an increased risk for bronchial constriction.
Correct Answer
A. True
Explanation
H2 receptors are found in the bronchial smooth muscles, and when these receptors are activated by H2 antagonists, they cause relaxation of the muscles. This relaxation can lead to bronchial constriction, which is a narrowing of the airways. Therefore, patients on H2 antagonists are indeed at an increased risk for bronchial constriction.
41.
This class of medications halts secretion of HCl by gastric parietal cells by blocking the function of hydrogen ion pumps, increasing gastric fluid pH and decreased gastric fluid volume. They do cross the BBB, and may cause abdominal pain and N/V
Correct Answer
A. Proton pump inhibitors
Explanation
Proton pump inhibitors are a class of medications that work by blocking the function of hydrogen ion pumps in gastric parietal cells. This action stops the secretion of hydrochloric acid (HCl) in the stomach, leading to an increase in gastric fluid pH and a decrease in gastric fluid volume. Proton pump inhibitors are able to cross the blood-brain barrier (BBB), which means they can affect the central nervous system. They are associated with side effects such as abdominal pain and nausea/vomiting.
42.
Which receptor antagonists are used for signs and symptoms of allergic rhinitis?
Correct Answer
A. H1 receptor
Explanation
H1 receptor antagonists are used for signs and symptoms of allergic rhinitis because they block the action of histamine at the H1 receptor, which is responsible for causing allergic symptoms such as sneezing, itching, and nasal congestion. By blocking the H1 receptor, these antagonists help to alleviate the symptoms of allergic rhinitis. H2 and H3 receptor antagonists are not typically used for allergic rhinitis as they are involved in different physiological processes and are not directly related to allergic symptoms.
43.
Histamine receptor antagonists inhibit the release of histamine.
Correct Answer
B. False
Explanation
Block the receptors on effector cell membranes
44.
H2 receptor antagonists _______ the clearance of lidocaine, procainamide, meperidine, propanolol, theophylline, nifedipine, and warfarin.
Correct Answer
A. Decrease
Explanation
Inhibits P-450 enzyme function
45.
Serotonin is an endogenous vasoactive autocoid.
Correct Answer
A. True
Explanation
Serotonin is a neurotransmitter that is involved in various physiological processes, including the regulation of blood vessels. As an endogenous vasoactive autocoid, it means that serotonin is produced within the body and acts as a signaling molecule to regulate blood vessel constriction and dilation. This helps in maintaining blood pressure and blood flow to different tissues and organs. Therefore, the statement that serotonin is an endogenous vasoactive autocoid is true.
46.
Kallidin and bradykinin are plasma kinins which are the most potent endogenous vasoconstrictors known.
Correct Answer
B. False
Explanation
Most potent endogenous vasodilators**
47.
What stimulates renin secretion?
Correct Answer
A. Decreased renal perfusion
Explanation
Decreased renal perfusion refers to a reduction in blood flow to the kidneys. When the kidneys sense a decrease in blood flow, they release renin, an enzyme that plays a crucial role in regulating blood pressure. Renin acts on angiotensinogen to convert it into angiotensin I, which is further converted to angiotensin II. Angiotensin II causes vasoconstriction and stimulates the release of aldosterone, leading to increased blood volume and blood pressure. Therefore, decreased renal perfusion stimulates renin secretion as a compensatory mechanism to restore blood pressure.
48.
Aldosterone secretion causes the reabsorption of Na+, the loss of hydrogen ions and which electrolyte?
Correct Answer
A. K+
Explanation
Aldosterone secretion causes the reabsorption of Na+ and the loss of hydrogen ions. This hormone also stimulates the reabsorption of potassium ions (K+) in the kidneys. Therefore, the correct answer is K+.
49.
Prostaglandins cause bronchial muscle relaxation, uterus contraction, inhibit gastric acid secretion, and prevent platelet aggregation.
Correct Answer
A. True
Explanation
Prostaglandins are lipid compounds that play a role in various physiological processes. They are known to cause bronchial muscle relaxation, which helps in widening the airways and facilitating breathing. Prostaglandins also stimulate uterine contractions during labor and delivery. Additionally, they inhibit gastric acid secretion, which can help in reducing stomach acid levels and preventing gastric ulcers. Lastly, prostaglandins prevent platelet aggregation, which is important for maintaining normal blood flow and preventing the formation of blood clots. Therefore, the statement is true as prostaglandins do indeed cause all of these effects.
50.
Toradol is safe to use on patients with a history of asthma.
Correct Answer
B. False
Explanation
NSAID-induced bronchospasms appear to be caused by the inhibition of cyclooxygenase-1 (Cox-1); this in turn activates the lipoxygenase pathway, which eventually increases the release of cysteinyl leukotrienes (Cys-LTs) that induces bronchospasm and nasal obstruction.