Pharmacology Of Anesthesia Quiz: Exam!

Glycopyrrolate is the anticholinergic agent of choice for neostigmine because its onset of action is very similar to neostigmine. This means that both drugs start working at around the same time, allowing for a more balanced and coordinated effect. This is important in situations where neostigmine is used to reverse the effects of neuromuscular blockade, as the simultaneous action of glycopyrrolate helps to prevent excessive cholinergic stimulation and maintain a more stable heart rate.

The correct answer is true because the statement states that the majority of incidences of MH occur in patients under 15. This implies that more cases of MH are observed in individuals below the age of 15 compared to those above that age.

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The maximum dose of Dantrolene that can be given to a 10-year-old child weighing 30 kg is 300 mg. This dosage is determined based on the child's weight and age, as well as the recommended dosage guidelines for Dantrolene. It is important to adhere to the maximum dosage to ensure the safety and effectiveness of the medication.

The common side effects of Dantrolene include muscle weakness, difficulty swallowing or choking, pulmonary edema, anaphylaxis, and rhabdomyolysis. Therefore, the correct answer is "All of the above." These side effects can occur when taking Dantrolene, and it is important to be aware of them and seek medical attention if any of these symptoms occur.

An appropriate intubating dose of Rocuronium is 0.6-1.2 mg/kg. This range of dosage is commonly used for intubation, as it provides effective muscle relaxation for the procedure. Using a higher dose may lead to prolonged paralysis, while using a lower dose may result in inadequate muscle relaxation. Therefore, the recommended range of 0.6-1.2 mg/kg ensures optimal conditions for intubation.

An appropriate intubating dose of Atracurium is 0.4-0.5 mg/kg.

1.5-2.5mg/kg

Dantrolene is a muscle relaxant that works by inhibiting calcium release from the sarcoplasmic reticulum in skeletal muscle, leading to muscle relaxation. It is specifically used to treat malignant hyperthermia and muscle spasticity. Dantrolene has been found to potentiate the effects of neuromuscular blockers like vecuronium. This means that when dantrolene is administered along with vecuronium, the muscle relaxant effect of vecuronium is enhanced, leading to a greater degree of muscle relaxation. This can be beneficial in certain medical situations where a stronger muscle relaxant effect is desired.

The maximum dose of Dantrolene that can be given to a 10-year-old child weighing 30 kg is 300 mg. This dosage is determined based on the weight of the child and the recommended dosage guidelines for Dantrolene. It is important to adhere to the recommended dosage to ensure the safety and effectiveness of the medication.

An appropriate intubating dose of Atracurium for a patient is typically calculated based on their weight. In this case, the patient weighs 60 kg. The recommended dose of Atracurium is usually around 0.5-0.6 mg/kg. Therefore, for a 60 kg patient, the appropriate dose would be around 30-36 mg. The closest option to this range is 30 mg, which makes it the correct answer.

The patient has a known pseudocholinesterase deficiency, which means they have a decreased ability to metabolize succinylcholine. Succinylcholine is typically used for rapid sequence induction, but in this case, it would lead to prolonged muscle relaxation due to the patient's deficiency. Therefore, an alternative medication should be chosen. Rocuronium is a non-depolarizing muscle relaxant that does not rely on pseudocholinesterase for metabolism. It is a suitable choice for rapid sequence induction in this patient.

Versed, also known as midazolam, is a drug that could be given to decrease the incidence of emergence delirium in patients receiving ketamine. Emergence delirium is a common side effect of ketamine anesthesia, characterized by confusion, agitation, and hallucinations upon awakening from anesthesia. Versed is a benzodiazepine sedative that can help reduce these symptoms and provide a smoother transition from anesthesia to wakefulness. It has sedative, amnestic, and anxiolytic properties, making it an effective choice for managing emergence delirium in patients undergoing ketamine anesthesia.

The correct answer is to immediately notify the MD and send an ABG and labs to assess for MH and cancel the case. This is because the inability to open the patient's mouth after administering succinylcholine may be indicative of a rare but potentially life-threatening condition called malignant hyperthermia (MH). MH is a hypermetabolic reaction to certain triggering agents, such as succinylcholine, and can lead to muscle rigidity, hyperthermia, acidosis, and other systemic complications. Prompt recognition and management of MH is crucial to prevent further complications and ensure patient safety.

An appropriate intubating dose of Atracurium is 0.4-0.5 mg/kg.

Ketamine is the correct answer because it is commonly used as a racemic mixture. A racemic mixture is a combination of equal amounts of two enantiomers, or mirror-image forms, of a compound. Ketamine is a dissociative anesthetic that is known for its analgesic and sedative effects. It is often used in surgical procedures and emergency medicine.

The recommended dose of neostigmine is 0.08 mg/kg. This means that for every kilogram of body weight, a patient should receive 0.08 mg of neostigmine. This dosage is based on the specific characteristics of neostigmine and its desired effects in the body. It is important to follow the recommended dose to ensure the safe and effective use of the medication.

Surgical relaxation is achieved when the muscles are completely relaxed, allowing for easy manipulation during surgery. Non-depolarizing muscle relaxants work by blocking the action of acetylcholine at the neuromuscular junction, leading to muscle relaxation. The percentage of blockade refers to the degree of inhibition of muscle contraction. Therefore, to achieve surgical relaxation, a high percentage of blockade is required. Among the given options, 90% blockade by non-depolarizing muscle relaxants would provide the necessary level of muscle relaxation for surgery.

Etomidate is metabolized by hepatic microsomal enzymes. Hepatic microsomal enzymes are responsible for the metabolism of various drugs in the liver. They break down the drug into smaller molecules that can be easily eliminated from the body. In the case of etomidate, these enzymes play a crucial role in its metabolism, ensuring its elimination from the body. This information is important for understanding the pharmacokinetics and clearance of etomidate in patients.

1-2mg/kg

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Ketamine is classified as an NMDA antagonist. NMDA receptors are involved in the transmission of pain signals in the brain, and by blocking these receptors, ketamine can effectively reduce pain perception. As an antagonist, ketamine binds to the NMDA receptor and prevents its activation by other substances, thereby inhibiting its function. This mechanism of action contributes to ketamine's analgesic and anesthetic properties.

Succinylcholine is a neuromuscular blocking agent that is commonly used during anesthesia. However, it should not be used in patients with a history of Muscular Dystrophy, as they may have an increased risk of developing adverse reactions such as hyperkalemia and malignant hyperthermia. Additionally, succinylcholine should be used with caution in patients with burns, spinal cord injuries, and hyperkalemia, as these conditions can also increase the risk of complications. Therefore, the correct answer is "None of the above" because succinylcholine should not be used in any of the mentioned patient scenarios.

The appropriate intubating dose of Vecuronium is .08-0.1 mg/kg.

In MH, the temperature can increase by 1-2 degrees Celsius every 5 minutes. This means that the temperature can rise by a significant amount in a short period of time.

An appropriate dose of propofol sedation during a MAC case is 25-100 mcg/kg/min. This range ensures that the patient receives a sufficient level of sedation without causing excessive sedation or respiratory depression. It allows for individualized dosing based on the patient's weight and response to the medication. This dosage range is commonly used in MAC cases to provide effective sedation while maintaining patient safety.

Pancuronium would be the muscle relaxant of choice to counteract the bradycardia caused by narcotics during cardiac surgery. This is because pancuronium has a sympathomimetic effect, meaning it stimulates the sympathetic nervous system, which can help increase heart rate. Succinylcholine, rocuronium, and mivacurium do not have this sympathomimetic effect and would not be as effective in counteracting bradycardia.

The half-life of a drug refers to the time it takes for half of the drug to be eliminated from the body. In the case of Dantrolene, the correct answer is 6 hours, which means that it takes approximately 6 hours for half of the drug to be eliminated from the body. This information is important for determining the dosing frequency and duration of action of the drug.

S&H 155

The appropriate intubating dose of Pancuronium is .08-0.1 mg/kg.

The Caffeine Halothane Test is used to diagnose Malignant Hyperthermia (MH), a potentially life-threatening reaction to certain medications used during general anesthesia. This test involves exposing a muscle sample from the patient to caffeine and halothane in a laboratory setting and observing for abnormal muscle contractions. If the muscle sample contracts abnormally, it indicates a positive result for MH. This test is considered the gold standard for diagnosing MH and is crucial in identifying patients at risk before undergoing anesthesia.

The MH gene is passed via an autosomal dominant gene, meaning that only one copy of the gene is needed for the trait to be expressed. This means that if a person inherits the MH gene from one parent, they will have the condition. Autosomal dominant inheritance patterns are characterized by the presence of affected individuals in each generation of a family, as each affected individual has a 50% chance of passing on the gene to their offspring.

Mivacurium is metabolized by pseudocholinesterase. Pseudocholinesterase is an enzyme that breaks down certain drugs, including mivacurium, in the body. This enzyme is responsible for the rapid metabolism of mivacurium, leading to its short duration of action. Other drugs listed, such as atracurium, rocuronium, and vecuronium, are not metabolized by pseudocholinesterase.

Malignant Hyperthermia is a severe reaction that occurs due to the activation of ryanodine receptors. This activation leads to an increase in intracellular calcium levels, causing intracellular hypercalcemia.

The correct answer is CO2 61, BE -11, Ph 7.20. In a patient with MH (malignant hyperthermia), there is an increased production of carbon dioxide (CO2) due to increased muscle metabolism. This leads to respiratory acidosis, which is reflected by an elevated CO2 level. The base excess (BE) is negative, indicating metabolic acidosis. The pH is decreased, indicating acidemia. Therefore, the ABG values in the given answer are consistent with the expected findings in a patient with MH.

Ketamine is contraindicated in patients with a history of Malignant Hyperthermia and in patients with head trauma. Malignant Hyperthermia is a potentially life-threatening reaction to certain medications, including Ketamine. Head trauma patients may have increased intracranial pressure, and Ketamine can further elevate this pressure. Therefore, these two patients should not receive Ketamine.

The correct answer is to increase the patient's respiratory rate because hypoventilation is causing the increase in ETCO2. By increasing the respiratory rate, the patient will be able to eliminate more carbon dioxide and prevent further elevation of ETCO2. This will help maintain adequate ventilation and prevent complications associated with hypoventilation.

The correct answer is to call for help and tell the surgeon to stop the procedure. This is the first thing that should be done because the patient's sudden tachycardia, elevated ETCO2, and muscle rigidity may indicate malignant hyperthermia (MH), a potentially life-threatening reaction to certain medications used during anesthesia. MH requires immediate intervention and treatment, including stopping the triggering agents and providing specific medications and interventions. Calling for help and informing the surgeon is crucial in ensuring prompt and appropriate management of the situation.

Malignant Hyperthermia (MH) is a potentially life-threatening reaction to certain medications used during general anesthesia. It is an inherited condition, usually passed down from a parent. Patients with Muscular Dystrophy and patients whose mother has MH are at an increased risk for MH because of the genetic component. A patient who had a heat stroke last year while playing outdoors may be at an increased risk for heat-related complications but not specifically for MH. Being immunosuppressed does not directly increase the risk for MH.

An appropriate intubating dose of Rocuronium for a patient undergoing a bowel resection would be 30 mg. This dose is determined based on the patient's weight, which is 50 kg in this case. The dosage of Rocuronium is typically calculated at 0.6-1.2 mg/kg, depending on various factors such as the patient's age, medical condition, and the desired level of muscle relaxation. In this scenario, a dose of 30 mg falls within the recommended range for a patient of this weight, making it an appropriate choice.

Calcium Channel blockers are contraindicated in Malignant Hyperthermia (MH). MH is a potentially life-threatening condition triggered by certain medications used during anesthesia. Calcium Channel blockers can exacerbate the symptoms of MH by further increasing muscle contractions and elevating body temperature. Therefore, they should be avoided in individuals with MH susceptibility to prevent severe complications.

Propofol is a sedative-hypnotic medication that can be used to relieve itching caused by pain medications such as morphine. It has antihistamine properties and can help alleviate itching in the patient. Ketamine and etomidate are not typically used for itching relief, and the higher dose of propofol (50 mg) may be excessive for this purpose. Therefore, the most appropriate option is to administer a lower dose of propofol (10 mg) to help relieve the itching.

An increased end-tidal carbon dioxide (ETCO2) level is the most important clinical sign/symptom that would lead to a suspicion of malignant hyperthermia (MH). MH is a rare but potentially life-threatening condition that can occur as a reaction to certain medications used during anesthesia. It is characterized by a rapid increase in body temperature, muscle rigidity, and increased heart rate. However, an increased ETCO2 level is specific to MH and is considered a hallmark sign, as it indicates an abnormal increase in carbon dioxide production due to increased muscle activity. This can help alert healthcare providers to the possibility of MH and prompt immediate intervention.

CV stimulant, will increase BP and CO, great for shock and high risk pts, bad for angina, CAD though

An appropriate intubating dose of Nimbex is 0.15-0.2 mg/kg.

propofol 95-99% protein bound

Non-barbituate notes- dose of propofol must be reduced 25-50% in people over the age of 60.

The recommended dose of propofol for maintenance of anesthesia is 100-300 mcg/kg/min. This dosage range ensures a continuous and steady level of anesthesia throughout the procedure. Using a lower dose may result in inadequate anesthesia, while a higher dose may increase the risk of side effects and complications. Therefore, it is important to administer propofol within the recommended dosage range to ensure optimal patient safety and comfort during anesthesia.

The incidence of Malignant hyperthermia in adults is 1 in 50,000. This means that for every 50,000 adults, one person will experience Malignant hyperthermia.

An appropriate starting dose of dantrolene for a 2-year-old child weighing 14 kg would be 35 mg. The dosage of dantrolene is typically based on the weight of the patient, and a common starting dose for children is 2-4 mg/kg. In this case, 2 mg/kg would be 28 mg (2 x 14 kg), and 4 mg/kg would be 56 mg (4 x 14 kg). The closest option to these calculations is 35 mg, which falls within the appropriate dosage range for a child of this weight.

Propofol is unique among the non-barbiturate agents because it has no stereoisomers. Stereoisomers are molecules that have the same chemical formula and connectivity but differ in the spatial arrangement of atoms. Propofol does not have any mirror-image forms or chiral centers, making it the only option in the given list without stereoisomers. This characteristic of propofol can have implications for its pharmacokinetics and pharmacodynamics.

The R isomer of ketamine is known to cause delirium and combativeness on emergence.

Physostigmine can be given to counteract delirium caused by benzodiazepines and the central nervous system (CNS) effects of anticholinergic drugs. Physostigmine is a reversible acetylcholinesterase inhibitor, which means it increases the levels of acetylcholine in the brain. This can help to improve cognitive function and reduce delirium symptoms. Neostigmine, edrophonium, and pyridostigmine are also acetylcholinesterase inhibitors, but they are not typically used to counteract delirium.

Succinylcholine is a medication that is quickly broken down in the body to form succinylmonocholine. Succinylmonocholine has been found to cause bradycardia, which is a slower than normal heart rate. This means that the correct answer to the question is bradycardia.

S&H 161

Etomidate is a GABAa agonist, meaning it acts by binding to and activating GABAa receptors. GABAa receptors are inhibitory receptors in the brain, and their activation leads to an increase in chloride ion influx into neurons, resulting in neuronal inhibition and sedation. Therefore, etomidate's mechanism of action involves enhancing the effects of GABA, the main inhibitory neurotransmitter in the central nervous system.

The incidence of Malignant Hyperthermia in children is 1 in 15,000. This means that out of every 15,000 children, one will develop Malignant Hyperthermia.

Mivacurium is metabolized by plasma cholinesterase, independent of direct organ metabolism. Sux is too, but you don't want to give Sux to renal fl.

The correct answer is "Will shorten the effect of the medication. So will need more." This is because Dilantin, which is used to control seizures, can increase the metabolism of muscle relaxants, leading to a shorter duration of action. As a result, higher doses of muscle relaxants may be required to achieve the desired effect.

An elevated serum potassium level (Serum K 6.5), low pH (Ph 7.10), and negative base excess (Base excess -10) are all consistent with the diagnosis of malignant hyperthermia. Malignant hyperthermia is a potentially life-threatening reaction to certain medications used during general anesthesia. It is characterized by rapid onset of high fever, muscle rigidity, and metabolic acidosis. An elevated PCO2 level (PCO2 50) would not help to confirm the diagnosis of malignant hyperthermia as it is not a specific finding associated with this condition.

Ketamine is known to inhibit PLT aggregation.

Pyridostigmine is commonly used in the treatment of myasthenia gravis. Myasthenia gravis is an autoimmune disorder that affects the neuromuscular junction, causing muscle weakness and fatigue. Pyridostigmine is a cholinesterase inhibitor that helps improve muscle strength by increasing the levels of acetylcholine, a neurotransmitter involved in muscle contractions. It works by blocking the enzyme that breaks down acetylcholine, allowing more of it to be available for muscle stimulation. This medication helps to alleviate the symptoms of myasthenia gravis and improve muscle function.

Anticholinergics inhibit secretions by blocking the action of acetylcholine, a neurotransmitter responsible for stimulating secretions in various parts of the body. They also decrease bladder tone by relaxing the smooth muscles in the bladder, leading to urinary retention. However, anticholinergics do not cause bradycardia or bronchospasm.

The recommended dose of Edrophonium is 0.5-1.0 mg/kg. This means that for every kilogram of body weight, a patient should receive a dose of Edrophonium within this range. It is important to adhere to this recommended dose to ensure safe and effective administration of the medication.

Sux should be avoided due to hyperkalemia, diabetics should be rapid sequence, Roc is the only other NMB for rapid seq

0.2-0.8 mg/kg N&P 130

Edrophonium will have the most rapid onset compared to Neostigmine and Pyrdiostigmine. This is because Edrophonium has a shorter duration of action and a faster onset of action compared to the other two drugs. Neostigmine and Pyrdiostigmine have a longer duration of action and a slower onset of action. Therefore, Edrophonium is the correct answer as it will take effect more quickly than the other options.

increases evoked potentials, may precipitate sz's, can cause adrenocortical suppression w/ longterm use. decreases IOP, no histamine production

Cholinesterase inhibitors are medications that block the activity of the enzyme cholinesterase, which breaks down the neurotransmitter acetylcholine. Decreasing heart rate is a systemic effect of cholinesterase inhibitors because acetylcholine normally stimulates the vagus nerve, which slows down the heart rate. Increasing peristalsis is also a systemic effect of cholinesterase inhibitors because acetylcholine stimulates smooth muscle contractions in the gastrointestinal tract, promoting bowel movements. However, causing bronchodilation and pupillary dilation are not systemic effects of cholinesterase inhibitors.

Edrophonium is a short-acting cholinesterase inhibitor that can be used as a reversal agent for neuromuscular blockade. It works by inhibiting the enzyme acetylcholinesterase, which breaks down acetylcholine, allowing acetylcholine to accumulate and compete with the neuromuscular blocking agent. Atropine is a muscarinic antagonist that can be used in combination with edrophonium to prevent excessive muscarinic effects. In this case, edrophonium 20 mg and atropine 0.28 mg would be the most appropriate reversal agents for a child weighing 20 kg.

An appropriate intubating dose of Nimbex for a 50 yr old 5’11” male weighing 110 kg is 22 mg. This is determined based on the patient's weight and the recommended dosage guidelines for Nimbex. The dosage may vary depending on the individual's specific needs and medical condition, but in this case, 22 mg is the appropriate dose.

In a patient with Malignant Hyperthermia (MH), their serum myoglobin levels would be expected to be greater than 170 mcg. This is because MH is a condition characterized by a rapid and severe increase in body temperature, which can lead to muscle breakdown and release of myoglobin into the bloodstream. Elevated levels of serum myoglobin indicate muscle damage, which is a common feature of MH. Therefore, a myoglobin level higher than 170 mcg would be expected in patients with MH.

0.2-0.5mg/kg

The recommended dose of Pyridostigmine is 0.1-0.4 mg/kg. This means that for every kilogram of body weight, the patient should be given a dosage within this range.

allergy to egg yolks is contraindicated, not contraindicated in asthma patients M&M 201,

The half-life of etomidate is the time it takes for half of the drug to be eliminated from the body. In this case, the correct answer is 2-5 hours, which means that after 2-5 hours, half of the etomidate will be eliminated from the body. This information is important for determining the dosing frequency and duration of action of etomidate in medical settings.

MH affects smooth muscles and skeletal muscles. Smooth muscles are found in the walls of organs and blood vessels, and they are responsible for involuntary movements. Skeletal muscles, on the other hand, are attached to bones and are responsible for voluntary movements. Cardiac muscles, which are found in the heart, are not affected by MH.

The recommended dose of physostigmine is 0.01-0.03 mg/Kg. This means that for every kilogram of body weight, the patient should be given a dose of physostigmine between 0.01 mg and 0.03 mg. This dose is considered safe and effective for the intended purpose of using physostigmine.

The correct answer is 0.56 mg. Atropine is commonly used as an antidote for Edrophonium, which is a medication used to diagnose and treat myasthenia gravis. The typical recommended dose of atropine is 0.5 to 2.0 mg, depending on the patient's response. In this case, since the patient is receiving 40 mg of Edrophonium, it would be appropriate to administer 0.56 mg of atropine as a starting dose.

Rocuronium is known for its high degree of individual variability. This means that the effects of Rocuronium can vary greatly from person to person. Factors such as age, weight, and overall health can influence how an individual responds to Rocuronium. This variability makes it important for healthcare providers to carefully monitor patients who are receiving Rocuronium to ensure that the appropriate dosage is administered and to minimize any potential adverse effects.

The correct answers for treating high serum K+ levels (hyperkalemia) include hyperventilation, IV insulin/D50, and calcium chloride or gluconate. Hyperventilation helps to lower K+ levels by shifting it from the extracellular fluid into cells. IV insulin/D50 promotes the uptake of K+ into cells, while calcium chloride or gluconate stabilizes the cell membrane and prevents the release of K+ into the bloodstream. IV Kayexalate is not an appropriate treatment for hyperkalemia and is not mentioned in the correct answers.