2012 Pharm II- Quiz 3

110 Questions

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2012 Pharm II- Quiz 3

A review of the material for second semester pharmacology, test #1.


Questions and Answers
  • 1. 
    Seizure disorders are most likely caused by:
    • A. 

      A focus of hyperexcitable neurons that fire in the absence of appropriate stimuli

    • B. 

      Too little dopaminergic input from the substantia nigra into the striam

    • C. 

      5 HT serotonin in excess in the synaptic cleft.

    • D. 

      Spending too much time standing under strobe lights

  • 2. 
    Which of the following is true regarding the nigrostriatal pathway?
    • A. 

      Controlls vomiting

    • B. 

      Affected by parkinsons disease

    • C. 

      Regulates prolactin release

    • D. 

      Responsible for neurotransmission of norepinephrine and serotonin.

  • 3. 
    The majority of the bodies serotonin is stored where?
    • A. 

      Pineal Body in the brain

    • B. 

      In the intermediate lobe of pituitary gland

    • C. 

      Enterochromaffin cells of small intestine

    • D. 

      Serovessicle cells of large intestine

  • 4. 
    The majority of the acetylcholine receptors in the brain are…
    • A. 

      MAO-A

    • B. 

      5 HT-1 and 5 HT-2 receptors

    • C. 

      Nicotinic

    • D. 

      Muscarinic

  • 5. 
    Which of the following is an inhibitory neurotransmitter which is stimulated by many sedative drugs?
    • A. 

      Gamma-amino butyric acid

    • B. 

      Acetycholine

    • C. 

      Glutamate

    • D. 

      Dopamine

  • 6. 
    Which of the following drugs is not ambiphillic?
    • A. 

      Fluoxetine

    • B. 

      Lithium

    • C. 

      Imipramine

    • D. 

      Phenelzine

  • 7. 
    What is the Mechanism of Action of SSRI’s?
    • A. 

      Potentiate effects biogenic amines by inhibiting reuptake of norepi and serotonin thus making more available in the synaptic space

    • B. 

      Forms a stabe, irreversible complex with MAO to prevent demaination of monoamines.

    • C. 

      Selectively block the reuptake of serotonin and thus enhance serotogenic activity.

    • D. 

      Converts to dopamine by dopa decarboxylase enzyme to replenish stores in the basal ganglia

  • 8. 
    You are the SRNA for Mrs. Viano who was recently started on Fluoxetine. She is having a minor procedure today but you make note that this patient may be more susceptible to…
    • A. 

      Seizures

    • B. 

      Post-op delirium

    • C. 

      Ataxia

    • D. 

      Post op nausea and vomiting

  • 9. 
    What is the ½ life of fluoxetine for a patient who is taking the drug chronically?
    • A. 

      4-6 days

    • B. 

      1-3 days

    • C. 

      6-16 days

    • D. 

      12-24 hours

  • 10. 
    You are doing an outpatient pre-op assessment for a patient who is taking a tricyclic antidepressant. What pre-op instructions would you give to this patient regarding their antidepressant medication?
    • A. 

      Discontinue medication 5 weeks prior to surgery

    • B. 

      Continue to take medication as normal, but you will make sure to be aware of possible interactions.

    • C. 

      Discontinue drug 4-6 days prior to surgery.

    • D. 

      They should increase the dosage to relieve anxiety related to surgery.

  • 11. 
    Which of the following 2nd generation antidepressants has a greater incidence of seizures?
    • A. 

      Trazodone

    • B. 

      Paroxetine

    • C. 

      Bupropion

    • D. 

      Venlafaxine

  • 12. 
    Which of the following 2nd generation antidepressants has the greatest sedative potency?
    • A. 

      Venlafaxine

    • B. 

      Paroxetine

    • C. 

      Bupropion

    • D. 

      Trazodone

  • 13. 
    Which of the following should not be administered concurrently with and MAO inhibitor?
    • A. 

      Fluoxetine

    • B. 

      Sertraline

    • C. 

      Nefazodone

    • D. 

      All the above

  • 14. 
    You are the SRNA for Mr. Cumpeo  today. You see a past history of hypothyroidism, HTN and anxiety. Her medication list includes Fluoxetine administered once daily. How might you anticipate this medication to effect your anesthesia for this case?
    • A. 

      May prolong effects of muscle relaxants such as vecuronium

    • B. 

      May make this patient more prone to bleeding.

    • C. 

      Patient will be more prone to severe hypertension in response to ephedrine

    • D. 

      This patient should NOT be given any opioids during the procedure.

  • 15. 
    Which of the following drugs would be useful in the treatment of chronic neuropathic pain?
    • A. 

      Fluvoxamine

    • B. 

      Imipramine

    • C. 

      Phenelzine

    • D. 

      Alprazolam

  • 16. 
    What is the Mechanism of Action of tricyclic antidepressants?
    • A. 

      Potentiate effects biogenic amines by inhibiting reuptake of norepi and serotonin thus making more available in the synaptic space

    • B. 

      Forms a stabe, irreversible complex with MAO to prevent demaination of monoamines.

    • C. 

      Selectively block the reuptake of serotonin and thus enhance serotogenic activity.

    • D. 

      Converts to dopamine by dopa decarboxylase enzyme to replenish stores in the basal ganglia

  • 17. 
    What is the elimination half time of tricyclic antidepressants?
    • A. 

      1-3 days

    • B. 

      17-30 hours

    • C. 

      4-6 days

    • D. 

      1-2 weeks

  • 18. 
    What side effects would you expect to see on a patient who is taking tricyclic antidepressants? (Check all that apply)
    • A. 

      Tachycardia and prolonged PR interval

    • B. 

      Dry mouth and slowed gastric emptying

    • C. 

      Insomnia and agitation

    • D. 

      Impotence and orthostatic hypotension

  • 19. 
    You are caring for Mrs. Noopy who is having a Left BKA today. Her medication list includes Amitriptyline, Insulin, Avandia & Nexium. During surgery Mrs. Noopy becomes hypotensive and requires pharmacologic intervention. Which drug would be the best choice for this patient?
    • A. 

      Ephedrine, full dose since only indirect acting sympathomimetics are safe.

    • B. 

      Levophed drip, you can not use either of your standard drugs on this patient.

    • C. 

      Neosynephrine, but cut dose to 1/3 due to possibility of pronounced response.

    • D. 

      Just keep giving fluid boluses to control the hypotension.

  • 20. 
    Tricyclic antidepressants have a  wide therapeutic index and are relatively safe when taken in overdose when compared to SSRI’s which produce life threatening overdose symptoms. 
    • A. 

      True

    • B. 

      False

  • 21. 
    You are caring for Mr. Press who is admitted to ER after having overdosed Amitriptyline. The patient appears to be suffering from psychosis due to the overdose. What medication should you administer to help treat this?
    • A. 

      Naloxone 1-4 mcg/kg IV

    • B. 

      Diazepam 0.1 mg/kg

    • C. 

      IV infusion of Lidocaine at 1mg/min

    • D. 

      Physostigmine 0.5-2 mg IV

  • 22. 
    What is the Mechanism of action of MAO inhibitors?
    • A. 

      Potentiate effects biogenic amines by inhibiting reuptake of norepi and serotonin thus making more available in the synaptic space

    • B. 

      Forms a stabe, irreversible complex with MAO to prevent demaination of monoamines.

    • C. 

      Selectively block the reuptake of serotonin and thus enhance serotogenic activity.

    • D. 

      Converts to dopamine by dopa decarboxylase enzyme to replenish stores in the basal ganglia

  • 23. 
    What is the most likely cause of orthostatic hypotension in patients taking MAO inhibitors?
    • A. 

      Drug induced inhibition of norepinephrine uptake

    • B. 

      Accumulation of serotonin in synaptic cleft

    • C. 

      Accumulation of octopamine, a false neurotransmitter

    • D. 

      Action on sodium channels which causes smooth muscle relaxation and dilation of vessels.

  • 24. 
    You are the SRNA for Hannibal Lector.  He has recently been placed on an MAO inhibitor. You ask about his diet and he tells you this about his favorite foods: Liver, fava beans, & chianti. He has a really creepy grin on his face.... What do you tell Mr. Lector?
    • A. 

      Ummm, pardon me but I have to leave. (Then, RUN LIKE HELL!!)

    • B. 

      That sounds very nutritionally balanced! It sounds like you are properly adhering to all dietary restrictions.

    • C. 

      You need to try to cut out the wine, but your other food choices are just fine.

    • D. 

      Mr. Lector I am afraid you may not eat any of those foods anymore, they are all listed as very unsafe for you.

  • 25. 
    You are the SRNA for Mrs. Loc who is having a removal of foreign mass from the bottom of her right foot. She is having a peripheral block for the procedure. In her medication list you see she takes: Phenelzine, Ultram, Celebrex & a daily aspirin. What medication would you choose for the local blockade of this patient?
    • A. 

      Lidocaine mixed with 25 mcg fentanyl

    • B. 

      Tetracaine mixed with epi

    • C. 

      Bupivicaine plain.

    • D. 

      All the above would be fine, none of the listed meds are known to cause problems here

  • 26. 
    How would a patient taking an MAO inhibitor effect your administration of nondepolarizing muscle relaxants?
    • A. 

      May have prolonged effects due to inhibition of cytochrome P 450

    • B. 

      It is OK to give these, no interactions are listed.

    • C. 

      May have shortened effect due to P 450 enzyme induction

    • D. 

      STOP ASKING ME QUESTIONS!!! MY BRAIN IS GOING TO EXPLODE!

  • 27. 
    Lithium is most consistently used to treat…
    • A. 

      Bipolar Disorder

    • B. 

      Schizophrenia

    • C. 

      Epilepsy

    • D. 

      Parkinsons

  • 28. 
    How will lithium affect your management of a patient during anesthesia?
    • A. 

      Patient may not receive epinephrine or opioids during regional anesthesia

    • B. 

      Action of Neuromuscular blockers may be prolonged

    • C. 

      Interferes with exogenously admistered dopamine

    • D. 

      Patient will be more prone to seizure due to lowered seizure threshold

  • 29. 
    What is the Mechanism of Action of antipsychotic drugs (like phenothiazides and butyrophenones)?
    • A. 

      Potentiate effects biogenic amines by inhibiting reuptake of norepi and serotonin thus making more available in the synaptic space

    • B. 

      Blockade of dopamine D2 receptors in the basal ganglia and the limbic portions of the forebrain.

    • C. 

      Selectively block the reuptake of serotonin and thus enhance serotogenic activity.

    • D. 

      Converts to dopamine by dopa decarboxylase enzyme to replenish stores in the basal ganglia

  • 30. 
    Antipsychotic drugs should not be administered to patients with which medical condition?
    • A. 

      Asthma

    • B. 

      Renal Insufficiency

    • C. 

      Parkinsons

    • D. 

      Schizophrenia

  • 31. 
    You are the SRNA for a patient who is currently taking antipsychotic medications to control schizophrenia. This patient has just had a cholectomy and is complaining of Post-op nausea. Some idiot just gave your patient compazine for nausea. What should you now check this patient for?
    • A. 

      Increased risk of seizures, compazine will severely lower seizure threshold

    • B. 

      Severe nausea and vomiting due to a paradoxical effect caused by this combination of drugs.

    • C. 

      Extreme anxiety, hyperactivity, and restlessness.

    • D. 

      A decrease in systemin BP and hypothermia.

  • 32. 
    What is a severe adverse effect associated with antipsychotics, particularly Haldol?
    • A. 

      Neuroleptic malignant syndrome

    • B. 

      Malignant Hyperthermia

    • C. 

      Status Epilepticus

    • D. 

      All the Above

  • 33. 
    Which of the following is not true regarding systemic effects of antipsychotic drugs?
    • A. 

      They are cerebral vasoconstrictors and may be undesirable for patients with cerbrovascular disease.

    • B. 

      Produce amnesia and work as anticonvulsants.

    • C. 

      May make patient more prone to laryngospasm

    • D. 

      Benadryl may be given to treat extrapyramidal effects.

  • 34. 
    You are the SRNA for Mr. Raj who has been taking Phenytoin for several years. When your CRNA pimps you and asks how this will affect your management of the case you blow him away by answering…
    • A. 

      Depolarizing muscle relaxants will have a shorter duration due to enzyme induction

    • B. 

      Non-depolarizing muscle relaxants may have shorter duration due to enzyme induction

    • C. 

      You should not give ephedrine due to exaggerated response.

    • D. 

      All the above.

  • 35. 
    What is the mechanism of action of Levodopa?
    • A. 

      It saunters up to the hot chic at the bar, really smoothly, then softly murmurs “Hey baby, are you a parking ticket? Because you have FINE written all over you!”

    • B. 

      Blockade of dopamine D2 receptors in the basal ganglia and the limbic portions of the forebrain.

    • C. 

      Selectively block the reuptake of serotonin and thus enhance serotogenic activity.

    • D. 

      Converts to dopamine by dopa decarboxylase enzyme to replenish stores in the basal ganglia

  • 36. 
    A patient taking levodopa should not be administered which medication?
    • A. 

      Metaclopromide

    • B. 

      Furosemide

    • C. 

      Odansetron

    • D. 

      Ephedrine

  • 37. 
    What is the primary glucocorticoid released by the body?
    • A. 

      Aldosterone

    • B. 

      Cortisol

    • C. 

      Prednisolone

    • D. 

      ACTH

  • 38. 
    What is the primary effect of mineralcorticoids?
    • A. 

      Production of an anti-inflammatory response

    • B. 

      Immunosuppression following organ transplants

    • C. 

      Evoke distal renal tubular reabsorption of sodium in exchange for potassium ions

    • D. 

      All the above

  • 39. 
    What is the normal rate of secretion of cortisol daily?
    • A. 

      5 mg

    • B. 

      30 mg

    • C. 

      150 mg

    • D. 

      10 mg

  • 40. 
    You are the SRNA for Mrs. Leez  and are going up to the floor to do your pre-op.  You find she has a past medical history of COPD, cholecystectomy, obesity, arthritis, and a Left knee replacement. She has been taking daily prednisolone for the 3 weeks. You look through her chart and find her current dosing is prednisolone 10 mg PO daily. Is this sufficient for surgery?
    • A. 

      No, ask the surgeon is he wants 100mg hydrocortisone IV every 8 hours starting this evening.

    • B. 

      No, plan to administer 25 mg hydrocortisone at induction and 100 mg as an infusion after the surgery.

    • C. 

      No, give Dexamethasone 4-8 mg just prior to surgery.

    • D. 

      Yes, since she is already taking prednisolone she has sufficient cortisol.

  • 41. 
    You are the SRNA for Mrs.Pukefest today. She has a past medical history of cataracts, DM, peripheral neuropathy, GERD,arthritis, DVT,and PONV. She is also allergic to PCN’s and Zofran. The states she afraid of having sever nausea after surgery and you give her dexamethasone at the beginning of the case to help with this. Given her past medical history, what might you be concerned about with this patient?
    • A. 

      Dexamethasone may worsen her joint pain and make her more susceptible to post op pain and muscle weakness

    • B. 

      Her blood glucose levels may be elevated and she will need to be checked more frequently

    • C. 

      She may be more prone to post-op bleeding since the dexamethsone will potentiate the effects of the anticoagulant she takes for DVT prevention.

    • D. 

      All the above.

  • 42. 
    Which of the following would you not expect to see on a patient who is on chronic steroid therapy?
    • A. 

      Osteoporosis

    • B. 

      Cataracts

    • C. 

      Increased bleeding

    • D. 

      Trouble healing from surgery

  • 43. 
    Which anti-emetic would be best to give near the end of the case to prevent PONV?
    • A. 

      Dexamethasone

    • B. 

      Famotidine

    • C. 

      Metaclopromide

    • D. 

      Odansetron

  • 44. 
    Peniciilin G may cause what electrolyte imbalance when given to patients with renal failure?
    • A. 

      Hyperkalemia

    • B. 

      Hypernatremia

    • C. 

      Hypercalcemia

    • D. 

      Hypermagnesemia

  • 45. 
    For which patient would it be appropriate to give a test dose of Ancef?
    • A. 

      Those with Renal Failure

    • B. 

      Those with a PCN allergy

    • C. 

      Those with history of PONV

    • D. 

      Those with a Fish allergy

  • 46. 
    Which of the following should not be given to a patient with a past history of CHF & hypokalemia?
    • A. 

      Dexamethasone

    • B. 

      Penicillin G

    • C. 

      Carbenicillin

    • D. 

      Vancomycin

  • 47. 
    You are the SRNA for Mr. Guther who is having a right lobectomy today. He has no history of drug allergies, which of the following would be the most appropriate pre-op antibiotic?
    • A. 

      Ampicillin

    • B. 

      Cefoxitin

    • C. 

      Clindamycin

    • D. 

      Cefazolin

  • 48. 
    You are the SRNA for Mr. Kust who is having surgery to correct a Bowel Obstruction. He has no history of drug allergies, which of the following would be the most appropriate pre-op antibiotic?
    • A. 

      Cefoxitin

    • B. 

      Cefazolin

    • C. 

      Clindamycin

    • D. 

      Vancomycin

  • 49. 
    You are going up to the floor to do a pre-op assessment on a patient who is having wound debridement in the AM. You review the MAR and find the patient has been taking: Insulin, Gentamicin, Lansoprazole, and Lovenox (On hold this evening). Do you have any concerns regarding these medications?
    • A. 

      Lovenox will still increase the risk of bleeding significantly. You should have FFP ready.

    • B. 

      Gentamicin will increase the duration of nondepolarizing neuromuscular blockers.

    • C. 

      Pre-op Cefazolin will cause hyperglycemia.

    • D. 

      None of the above, these meds are fine.

  • 50. 
    You are the SRNA for Mrs. Alder who is having a prosthetic heart valve placed today. She is allergic to PCN, Cephalosporins, and Sulfa drugs. Which of the following would be an appropriate pre-op antibiotic to give this patient?
    • A. 

      Tetracycline

    • B. 

      Cefoxitin

    • C. 

      Vancomycin

    • D. 

      Ciprofloxacin

  • 51. 
    Which drug is the most potent producer of skeletal muscle weakness?
    • A. 

      Penicillin G

    • B. 

      Gentamicin

    • C. 

      Clindamycin

    • D. 

      Polymixin B

  • 52. 
    Which of the following is used to treat tuberculosis?
    • A. 

      Isoniazide & Rifampin

    • B. 

      Amoxicillin & Clavulanic Acid

    • C. 

      Ampicillin & Sulbactam

    • D. 

      Metronidazole & Vancomycin

  • 53. 
    You have a patient who is taking Ritonavir to treat HIV infection. Due to drug interaction you should be cautious when administering all of the following except?
    • A. 

      Fentanyl

    • B. 

      Succinylcholine

    • C. 

      Nicardipene drip

    • D. 

      Odansetron

  • 54. 
    Which of the following corticosteroids lacks mineralcorticoid properties and would be appropriate to give during neurosurgery?
    • A. 

      Methylprednisolone

    • B. 

      Aldosterone

    • C. 

      Dexamethasone

    • D. 

      Prednisolone

  • 55. 
    WHY does someone on steroid therapy need steroid replacement prior to surgery?
    • A. 

      Because of Increase susceptibility to bacterial and fungal infections

    • B. 

      Because of susceptibility to electrolyte imbalances

    • C. 

      Because of the CRNA that tells me to

    • D. 

      Because of Suppression of the hypothalamic-pituitary axis

  • 56. 
    Which of the following is not a known side effect of Aminoglycosides?
    • A. 

      Peptic Ulcer Disease

    • B. 

      Ototoxicity

    • C. 

      Nephrotoxicity

    • D. 

      Skeletal Muscle Weakness

  • 57. 
    Which of the following carries the risk of causing pseudomembranous colitis?
    • A. 

      Cefazolin

    • B. 

      Clindamycin

    • C. 

      Ketonazole

    • D. 

      Acyclovir

  • 58. 
    In order to prevent histamine release and hypotension, what dose of vancomycin should be given?
    • A. 

      1 gm PO

    • B. 

      10 mg/kg IV over 20 minutes

    • C. 

      10 mg/kg IV over 60 minutes

    • D. 

      15 mg/kg over 24 hours

  • 59. 
    Which of the following may not require significant changes in dosage for elderly patients?
    • A. 

      Aminoglycosides

    • B. 

      Fluoroquinolones

    • C. 

      Vancomycin

    • D. 

      Cephalosporins

  • 60. 
    When caring for a patient who is taking an SSRI such as sertraline or paroxetine, one of the primary concerns for anesthesia is…..
    • A. 

      These drugs are potent P450 inhibitors

    • B. 

      The tendency of these drugs to cause sexual dysfunction

    • C. 

      These drugs interact with anesthetic agents to cause severe hypotension

    • D. 

      These drugs may cause neuroleptic malignant syndrome

  • 61. 
    What symptoms would you expect to see on a patient with neuroleptic malignant syndrome? (multiple answers)
    • A. 

      Generalized flaccidity

    • B. 

      Alterations in BP & Tachycardia

    • C. 

      Fluctuating LOC

    • D. 

      Liver Failure

    • E. 

      Fever

  • 62. 
    Which two drugs are more commonly associated with neuroleptic malignant syndrome?
    • A. 

      Thioridazine & Compazine

    • B. 

      Droperidol & Phenobarbitol

    • C. 

      Haldol & Reglan

    • D. 

      Dantrolene & Fluoxetine

  • 63. 
    Which of the following contains a Beta-Lactam ring?
    • A. 

      Tetracycline

    • B. 

      Macrolides

    • C. 

      Fluoroquinolones

    • D. 

      Penicillins

  • 64. 
    Why is Cefoxitin, a second generation cephalosporin, commonly used for GI cases?
    • A. 

      Increased acitivity against gram negative bacteria

    • B. 

      Broad spectrum activity against gram positive bacteria

    • C. 

      Due to high resistance against beta lactamases

    • D. 

      Due to inhibition of bacterial protein synthesis

  • 65. 
    Which of the following is not a side effect of antivirals?
    • A. 

      Leukopenia

    • B. 

      Ototoxicity

    • C. 

      Nephrotoxic

    • D. 

      Bluish nail pigmentation

  • 66. 
    Which of the following would you not expect to see on a patient who is currently taking Amphotericin B to treat meningitis?
    • A. 

      Renal Toxicity

    • B. 

      Seizures

    • C. 

      Hyperkalemia

    • D. 

      Hypotension

  • 67. 
    When should prophylocatic antibiotic be administered in relation to surgery?
    • A. 

      Ideally, 3-4 hours prior to incision

    • B. 

      At the same time incision is made antibiotics should be given IV

    • C. 

      Immediately after surgery antibiotics are given

    • D. 

      Shortly before incision is made and completed before induction

  • 68. 
    Which of the following would not be a clinical use of steroids?
    • A. 

      Pneumothorax

    • B. 

      Ulcerative colitis

    • C. 

      Myasthenia gravis

    • D. 

      Cerebral edema

  • 69. 
    What would be an appropriate replacement dose of hydrocortisone for a diabetic who is on chronic steroid therapy for asthma?
    • A. 

      100mg hydrocortisone IV every 8 hours starting the evening prior to surgery.

    • B. 

      Administer 25 mg hydrocortisone at induction and 100 mg as an infusion after the surgery.

    • C. 

      Dexamethasone 4-8 mg just prior to surgery.

    • D. 

      Diabetic patients should not receive replacement.

  • 70. 
    What is the mechanism of action of the chemotherapeutic Alklating drugs?
    • A. 

      Interferes with RNA synthesis and prevents microtubule formation

    • B. 

      Selectively target cancer cells by using monoclonal antibody technology

    • C. 

      Miscode DNA information or open purine ring with damage to the DNA molecule

    • D. 

      Inhibition of folic acid which will lead to inhibition of cell division

  • 71. 
    You are doing a pre-op today when you notice your patient is on the alklating agent Cyclophosphamide. How will this effect your plan of care for this patient?
    • A. 

      This drug may cause myocardial ischemia in patients, especially if they have CAD

    • B. 

      This drug may cause cardiomyopathy that is unresponsive to intotropic drugs or mechanical ventricular devices

    • C. 

      This drug may cause pulmonary toxicity, you should keep your FiO2 at 30% or less.

    • D. 

      This drug will prolong action of succinylcholine due to depletion of pseudocholinesterase.

  • 72. 
    Methotrexate may cause all of the following except…..
    • A. 

      Neuro toxicity

    • B. 

      Pulmonary toxicity

    • C. 

      Renal toxicity

    • D. 

      Hepatic toxicity

  • 73. 
    You are going through a patients medical record when you see this patient is currently taking Florouracil (5-FU). What should you be aware of with this particular patient?
    • A. 

      This drug may cause myocardial ischemia in patients, especially if they have CAD

    • B. 

      This drug may cause cardiomyopathy that is unresponsive to intotropic drugs or mechanical ventricular devices

    • C. 

      This drug may cause pulmonary toxicity, you should keep your FiO2 at 30% or less.

    • D. 

      This drug will prolong action of succinylcholine due to depletion of pseudocholinesterase.

  • 74. 
    What is the mechanism of action of Vinchristine, a plant alkaloid?
    • A. 

      Interferes with RNA synthesis and prevents microtubule formation

    • B. 

      Most of the ability comes from it’s ability to bind to microtubules and arrest cell division during the metaphase

    • C. 

      Miscode DNA information or open purine ring with damage to the DNA molecule

    • D. 

      Inhibition of folic acid which will lead to inhibition of cell division

  • 75. 
    Which of the following would be a concern for a patient taking Doxorubicin?
    • A. 

      This drug will prolong action of succinylcholine due to depletion of pseudocholinesterase

    • B. 

      This drug may cause myocardial ischemia in patients, especially if they have CAD

    • C. 

      This drug may cause cardiomyopathy that is unresponsive to intotropic drugs or mechanical ventricular devices

    • D. 

      This drug may cause pulmonary toxicity, you should keep your FiO2 at 30% or less.

  • 76. 
    For which of the following drugs would you want to replace fluid with colloids instead of crystalloids?
    • A. 

      Metronidazole

    • B. 

      Doxorubicin

    • C. 

      5 – FU

    • D. 

      Bleomycin

  • 77. 
    You are the SRNA for 26 yr old Mr. Kearn who has testicular CA. He has been treated with bleomycin and today is having removal of the mass done. Will the Bleomycin affect your plan of care?
    • A. 

      This drug will prolong action of succinylcholine due to depletion of pseudocholinesterase

    • B. 

      This drug may cause myocardial ischemia in patients, especially if they have CAD

    • C. 

      This drug may cause cardiomyopathy that is unresponsive to intotropic drugs or mechanical ventricular devices

    • D. 

      This drug may cause pulmonary toxicity, you should keep your FiO2 at 30% or less.

  • 78. 
    You are caring for a patient who has osteosarcoma and has been taking Plicamycin.  During the surgery the patient becomes hypotensive, and your preceptor asks you for a possible cause of the hypotension. Knowing the side effect of Plicamycin you *totally own* that preceptor when you say….
    • A. 

      May be due to lowered calcium which will reduce contractility of heart

    • B. 

      May be due to cardiac ischemia which is common with treatment with this drug

    • C. 

      May be due to cardiac myopathy and Left ventricular failure, this may not respond to inotropes.

    • D. 

      This may be due to lowered cortisol levels and patient can not respond to stimuli as effectively.

  • 79. 
    Which of the following toxicitys would not be caused by asparaginase?
    • A. 

      Pancreas

    • B. 

      Pulmonary

    • C. 

      CNS

    • D. 

      Liver

  • 80. 
    What sort of airway management would you generally use for patients currently on chemotherapeutic agents?
    • A. 

      Regional anesthesia when possible

    • B. 

      LMA airway

    • C. 

      ETT airway

    • D. 

      Every airway would be equally as good

  • 81. 
    Which drug may be given to a COPD patient on O2 therapy to temporarily maintain ventilation?
    • A. 

      Doxorubicin

    • B. 

      Flutamide

    • C. 

      Plicamycin

    • D. 

      Doxipram

  • 82. 
    What would be an appropriate starting dose of dantrolene to give to a patient weighing 56 kg to treat malignant hyperthermia?
    • A. 

      14 mg

    • B. 

      140 mg

    • C. 

      35 mg

    • D. 

      280 mg

  • 83. 
    What is the mechanism of action of Dantrolene?
    • A. 

      Centrally acting analeptic that selectively increases minute ventilation by activating the carotid bodies

    • B. 

      Causes cortical arousal and delay of fatigue.

    • C. 

      Direct action on excitation-contraction coupling, presumably by decreasing the amount of calcium released from the sarcoplasmic reticulum

    • D. 

      None of above

  • 84. 
    What could you give to treat a patient with post dural puncture headache?
    • A. 

      Ritalin

    • B. 

      Doxipram

    • C. 

      Dantrolene

    • D. 

      Caffeine

  • 85. 
    With many of our chemotherapeutic agents, myelosuppression will manifest within ________ of start of treatment.
    • A. 

      7-14 days

    • B. 

      3-5 weeks

    • C. 

      1-2 months

    • D. 

      1-5 days

  • 86. 
    When does breakdown of a clot begin?
    • A. 

      24-48 hours after clot is formed

    • B. 

      As soon as clot is formed

    • C. 

      Upon activation of antithrombin

    • D. 

      ~ 4-5 days after formation of clot

  • 87. 
    A clot which contains only platelets is known as what?
    • A. 

      Red Thrombus

    • B. 

      Yellow Thrombus

    • C. 

      White Thrombus

    • D. 

      Platothrombus

  • 88. 
    Which coagulation pathway is initiated when contact is made between blood and exposed endothelial surface?
    • A. 

      Factor X pathway

    • B. 

      Arachidonic pathway

    • C. 

      Extrinsic pathway

    • D. 

      Intrinsic pathway

  • 89. 
    Which coagulation pathway is initiated upon vascular injury which leads to exposure of tissue factor?
    • A. 

      Factor X pathway

    • B. 

      Arachidonic pathway

    • C. 

      Extrinsic pathway

    • D. 

      Intrinsic pathway

  • 90. 
    A person with a protein C or protein S deficiency will be…
    • A. 

      Hemophiliac

    • B. 

      Unable to break down clots

    • C. 

      Unable to initiate intrinsic clotting cascade

    • D. 

      Hypercoagulable

  • 91. 
    What is the mechanism of action of Heparin?
    • A. 

      Activates antithrombin III to inhibit coagulation cascade

    • B. 

      Inhibits Vit K dependent reactions in Factors II, VII, X

    • C. 

      Inhibition of cycloxygenase to inhibit production of thromboxane

    • D. 

      Highly selective for degredation of fibrin in clots

  • 92. 
    What is mechanism is action of Coumadin?
    • A. 

      Activates antithrombin III to inhibit coagulation cascade

    • B. 

      Inhibits Vit K dependent reactions in Factors II, VII, X

    • C. 

      Inhibition of cycloxygenase to inhibit production of thromboxane

    • D. 

      Highly selective for degredation of fibrin in clots

  • 93. 
    What is mechanism of action of Aspirin?
    • A. 

      Activates antithrombin III to inhibit coagulation cascade

    • B. 

      Inhibits Vit K dependent reactions in Factors II, VII, X

    • C. 

      Inhibition of cycloxygenase to inhibit production of thromboxane

    • D. 

      Highly selective for degredation of fibrin in clots

  • 94. 
    What is mechanism of action of tPA?
    • A. 

      Activates antithrombin III to inhibit coagulation cascade

    • B. 

      Inhibits Vit K dependent reactions in Factors II, VII, X

    • C. 

      Inhibition of cycloxygenase to inhibit production of thromboxane

    • D. 

      Highly selective for degredation of fibrin in clots

  • 95. 
    Anticoagulants like Heparin and Coumadin have absolutely no effect on clots already formed.
    • A. 

      True

    • B. 

      False

  • 96. 
    Heparin enhances the activity of antithrombin by how much?
    • A. 

      1,000

    • B. 

      100

    • C. 

      10,000

    • D. 

      10

  • 97. 
    What is the half life of Heparin?
    • A. 

      1 hour

    • B. 

      2.5 hours

    • C. 

      4 hours

    • D. 

      Half life is dose dependent

  • 98. 
    What would be the best choice for a patient who has developed HIT but must be anticoagulated immediately?
    • A. 

      Warfarin

    • B. 

      Bivalirudin

    • C. 

      Danaparoid

    • D. 

      Lovenox

  • 99. 
    How many units of heparin are in 1 mg?
    • A. 

      1000 u

    • B. 

      10 u

    • C. 

      100 u

    • D. 

      500 u

  • 100. 
    What would be an appropriate loading dose of heparin for a patient undergoing cardiopulmonary bypass? This patient weighs 80 kg.
    • A. 

      320 units

    • B. 

      10,000 units

    • C. 

      2,400 units

    • D. 

      30,000 units

  • 101. 
    What is a proper dose of heparin to give to a patient just prior to vascular occlusion? This patient is undergoing insertion of AV fistula and weighs 70 kg.
    • A. 

      5,000 u

    • B. 

      2,800 u

    • C. 

      21,000 u

    • D. 

      700 u

  • 102. 
    You have just given a patient 350 units/kg of heparin and have drawn an ACT to assess response to dose. The ACT comes back within normal range, what should you do first?
    • A. 

      Give additional 5-10k units

    • B. 

      Recheck ACT, consider technical error

    • C. 

      Give 2 units FFP

    • D. 

      Give another 350 units/kg

  • 103. 
    What is an appropriate dose of protamine for a patient who has received 2,000 units of heparin?
    • A. 

      10 mg

    • B. 

      5 mg

    • C. 

      20 mg

    • D. 

      30 mg

  • 104. 
    If protamine is given too fast IV it may cause…
    • A. 

      Anaphylaxis

    • B. 

      Anticoagulation

    • C. 

      Vomitting

    • D. 

      Hypotension

  • 105. 
    Which patient would not be at an increased risk of anaphylaxis to protamine?
    • A. 

      Vasectomized male

    • B. 

      Patient with Fish allergy

    • C. 

      Diabetic patient taking NPH insulin

    • D. 

      All are at an increased risk

  • 106. 
    How should protamine be given to a patient who is at risk for sensitivity?
    • A. 

      IV Push, either they react or don’t. Speed of injection doesn’t matter

    • B. 

      It should not be given at all! Get some PF4

    • C. 

      1mg/50 ml test dose over 10 minutes

    • D. 

      1 mg per 100 units of heparing given IV slowly

  • 107. 
    Warfarin should be discontinued how many days prior to surgery?
    • A. 

      12-24 hours

    • B. 

      1-3 days

    • C. 

      3-5 days

    • D. 

      2 weeks

  • 108. 
    What does Prothrombin time measure?
    • A. 

      Time needed to convert fibrinogen to fibrin after thrombin is added to plasma

    • B. 

      Measures activity of intrinsic (VIII, IX, XI) and common (I, II, V, X) pathways. Reflects time required for fibrin clot to appear after addition of partial thromboplastin, calcium, and an activating agent to sample of pt’s plasma

    • C. 

      Assesses function of extrinsic (VII) and common (I, II, V, X) pathways. Measures activity of the vitamin K-dependent factors (II,VII, X). Reflects time required for fibrin strands to appear after addition of tissue thromboplastin to sample of pt’s plasma.

    • D. 

      None of above

  • 109. 
    Which laboratory test could be performed to measure  activity of intrinsic (VIII, IX, XI) and common (I, II, V, X) pathways?
    • A. 

      INR

    • B. 

      PT

    • C. 

      TT

    • D. 

      APTT

  • 110. 
    COMIC RELIEF: If you don't like to click here, then here is the link.http://www.youtube.com/watch?v=E9UXVgmbBrI
    • A. 

      Ooooh, Holy niiiight..... Sweet!

    • B. 

      Ya think our preceptors will start doing that to US soon?

    • C. 

      Funny stuff.

    • D. 

      All The Above