2012 Pharm II- Quiz 3

1. What could you give to treat a patient with post dural puncture headache?

Ritalin

Doxipram

Dantrolene

Caffeine

2. Which of the following is used to treat tuberculosis?

Isoniazide & Rifampin

Amoxicillin & Clavulanic Acid

Ampicillin & Sulbactam

Metronidazole & Vancomycin

3. Seizure disorders are most likely caused by:

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

Too little dopaminergic input from the substantia nigra into the striam

5 HT serotonin in excess in the synaptic cleft.

Spending too much time standing under strobe lights

4. 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.

True

False

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

Hyperkalemia

Hypernatremia

Hypercalcemia

Hypermagnesemia

6. What is the mechanism of action of Dantrolene?

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

Causes cortical arousal and delay of fatigue.

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

None of above

7. What is the primary glucocorticoid released by the body?

Aldosterone

Cortisol

Prednisolone

ACTH

8. 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?

Ampicillin

Cefoxitin

Clindamycin

Cefazolin

9. Lithium is most consistently used to treat…

Bipolar Disorder

Schizophrenia

Epilepsy

Parkinsons

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

1 gm PO

10 mg/kg IV over 20 minutes

10 mg/kg IV over 60 minutes

15 mg/kg over 24 hours

11. Which of the following contains a Beta-Lactam ring?

Tetracycline

Macrolides

Fluoroquinolones

Penicillins

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

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

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

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

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

13. Which of the following is not a known side effect of Aminoglycosides?

Peptic Ulcer Disease

Ototoxicity

Nephrotoxicity

Skeletal Muscle Weakness

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

Dexamethasone

Famotidine

Metaclopromide

Odansetron

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

Those with Renal Failure

Those with a PCN allergy

Those with history of PONV

Those with a Fish allergy

16. Why is Cefoxitin, a second generation cephalosporin, commonly used for GI cases?

Increased acitivity against gram negative bacteria

Broad spectrum activity against gram positive bacteria

Due to high resistance against beta lactamases

Due to inhibition of bacterial protein synthesis

17. COMIC RELIEF:

If you don't like to click here, then here is the link.
https://www.youtube.com/watch?v=E9UXVgmbBrI

Ooooh, Holy niiiight..... Sweet!

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

Funny stuff.

All The Above

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

Gamma-amino butyric acid

Acetycholine

Glutamate

Dopamine

19. Which of the following should not be administered concurrently with and MAO inhibitor?

Fluoxetine

Sertraline

Nefazodone

All the above

20. What is a severe adverse effect associated with antipsychotics, particularly Haldol?

Neuroleptic malignant syndrome

Malignant Hyperthermia

Status Epilepticus

All the Above

21. 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?

Discontinue medication 5 weeks prior to surgery

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

Discontinue drug 4-6 days prior to surgery.

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

22. 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?

Naloxone 1-4 mcg/kg IV

Diazepam 0.1 mg/kg

IV infusion of Lidocaine at 1mg/min

Physostigmine 0.5-2 mg IV

23. Antipsychotic drugs should not be administered to patients with which medical condition?

Asthma

Renal Insufficiency

Parkinsons

Schizophrenia

24. WHY does someone on steroid therapy need steroid replacement prior to surgery?

Because of Increase susceptibility to bacterial and fungal infections

Because of susceptibility to electrolyte imbalances

Because of the CRNA that tells me to

Because of Suppression of the hypothalamic-pituitary axis

25. 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?

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

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

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

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

26. If protamine is given too fast IV it may cause…

Anaphylaxis

Anticoagulation

Vomitting

Hypotension

27. 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?

Tetracycline

Cefoxitin

Vancomycin

Ciprofloxacin

28. What is the mechanism of action of Heparin?

Activates antithrombin III to inhibit coagulation cascade

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

Inhibition of cycloxygenase to inhibit production of thromboxane

Highly selective for degredation of fibrin in clots

29. What is mechanism of action of Aspirin?

Activates antithrombin III to inhibit coagulation cascade

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

Inhibition of cycloxygenase to inhibit production of thromboxane

Highly selective for degredation of fibrin in clots

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

10 mg

5 mg

20 mg

30 mg

31. What is the Mechanism of Action of SSRI’s?

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

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

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

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

32. What is the Mechanism of Action of tricyclic antidepressants?

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

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

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

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

33. 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?

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

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

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

Just keep giving fluid boluses to control the hypotension.

34. 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?

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

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

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

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

Methylprednisolone

Aldosterone

Dexamethasone

Prednisolone

36. 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?

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

Gentamicin will increase the duration of nondepolarizing neuromuscular blockers.

Pre-op Cefazolin will cause hyperglycemia.

None of the above, these meds are fine.

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

14 mg

140 mg

35 mg

280 mg

38. What is mechanism is action of Coumadin?

Activates antithrombin III to inhibit coagulation cascade

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

Inhibition of cycloxygenase to inhibit production of thromboxane

Highly selective for degredation of fibrin in clots

39. Which of the following carries the risk of causing pseudomembranous colitis?

Cefazolin

Clindamycin

Ketonazole

Acyclovir

40. When should prophylocatic antibiotic be administered in relation to surgery?

Ideally, 3-4 hours prior to incision

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

Immediately after surgery antibiotics are given

Shortly before incision is made and completed before induction

41. What is mechanism of action of tPA?

Activates antithrombin III to inhibit coagulation cascade

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

Inhibition of cycloxygenase to inhibit production of thromboxane

Highly selective for degredation of fibrin in clots

42. The majority of the bodies serotonin is stored where?

Pineal Body in the brain

In the intermediate lobe of pituitary gland

Enterochromaffin cells of small intestine

Serovessicle cells of large intestine

43. What is the mechanism of action of Levodopa?

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

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

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

44. 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?

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

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

All the above.

45. 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?

Cefoxitin

Cefazolin

Clindamycin

Vancomycin

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

Metronidazole

Doxorubicin

5 – FU

Bleomycin

47. Anticoagulants like Heparin and Coumadin have absolutely no effect on clots already formed.

True

False

48. Which of the following would not be a clinical use of steroids?

Pneumothorax

Ulcerative colitis

Myasthenia gravis

Cerebral edema

49. What is the Mechanism of action of MAO inhibitors?

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

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

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

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

50. Which of the following would be a concern for a patient taking Doxorubicin?

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

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

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

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

51. What is the primary effect of mineralcorticoids?

Production of an anti-inflammatory response

Immunosuppression following organ transplants

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

All the above

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

Aminoglycosides

Fluoroquinolones

Vancomycin

Cephalosporins

53. With many of our chemotherapeutic agents, myelosuppression will manifest within ________ of start of treatment.

7-14 days

3-5 weeks

1-2 months

1-5 days

54. Heparin enhances the activity of antithrombin by how much?

1,000

100

10,000

10

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

Metaclopromide

Furosemide

Odansetron

Ephedrine

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

These drugs are potent P450 inhibitors

The tendency of these drugs to cause sexual dysfunction

These drugs interact with anesthetic agents to cause severe hypotension

These drugs may cause neuroleptic malignant syndrome

57. Which of the following 2^nd generation antidepressants has a greater incidence of seizures?

Trazodone

Paroxetine

Bupropion

Venlafaxine

58. 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?

Lidocaine mixed with 25 mcg fentanyl

Tetracaine mixed with epi

Bupivicaine plain.

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

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

Dexamethasone

Penicillin G

Carbenicillin

Vancomycin

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

INR

PT

TT

APTT

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

4-6 days

1-3 days

6-16 days

12-24 hours

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

Warfarin

Bivalirudin

Danaparoid

Lovenox

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

Red Thrombus

Yellow Thrombus

White Thrombus

Platothrombus

64. 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?

Give additional 5-10k units

Recheck ACT, consider technical error

Give 2 units FFP

Give another 350 units/kg

65. 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….

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

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

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

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

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

Doxorubicin

Flutamide

Plicamycin

Doxipram

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

Hemophiliac

Unable to break down clots

Unable to initiate intrinsic clotting cascade

Hypercoagulable

68. 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.

5,000 u

2,800 u

21,000 u

700 u

69. Which of the following 2^nd generation antidepressants has the greatest sedative potency?

Venlafaxine

Paroxetine

Bupropion

Trazodone

70. How will lithium affect your management of a patient during anesthesia?

Patient may not receive epinephrine or opioids during regional anesthesia

Action of Neuromuscular blockers may be prolonged

Interferes with exogenously admistered dopamine

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

71. 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?

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

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

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

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

72. Which of the following is true regarding the nigrostriatal pathway?

Controlls vomiting

Affected by parkinsons disease

Regulates prolactin release

Responsible for neurotransmission of norepinephrine and serotonin.

73. 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?

May prolong effects of muscle relaxants such as vecuronium

May make this patient more prone to bleeding.

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

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

74. How many units of heparin are in 1 mg?

1000 u

10 u

100 u

500 u

75. Which drug is the most potent producer of skeletal muscle weakness?

Penicillin G

Gentamicin

Clindamycin

Polymixin B

76. Which of the following is not a side effect of antivirals?

Leukopenia

Ototoxicity

Nephrotoxic

Bluish nail pigmentation

77. 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?

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

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

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

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

78. What does Prothrombin time measure?

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

None of above

79. What is the normal rate of secretion of cortisol daily?

5 mg

30 mg

150 mg

10 mg

80. 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…

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

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

You should not give ephedrine due to exaggerated response.

All the above.

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

Osteoporosis

Cataracts

Increased bleeding

Trouble healing from surgery

82. What is the elimination half time of tricyclic antidepressants?

1-3 days

17-30 hours

4-6 days

1-2 weeks

83. When does breakdown of a clot begin?

24-48 hours after clot is formed

As soon as clot is formed

Upon activation of antithrombin

~ 4-5 days after formation of clot

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

Factor X pathway

Arachidonic pathway

Extrinsic pathway

Intrinsic pathway

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

Factor X pathway

Arachidonic pathway

Extrinsic pathway

Intrinsic pathway

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

Renal Toxicity

Seizures

Hyperkalemia

Hypotension

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

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

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

Dexamethasone 4-8 mg just prior to surgery.

Diabetic patients should not receive replacement.

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

Regional anesthesia when possible

LMA airway

ETT airway

Every airway would be equally as good

89. What is the mechanism of action of the chemotherapeutic Alklating drugs?

Interferes with RNA synthesis and prevents microtubule formation

Selectively target cancer cells by using monoclonal antibody technology

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

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

90. 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?

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

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

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

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

91. Which of the following drugs is not ambiphillic?

Fluoxetine

Lithium

Imipramine

Phenelzine

92. Which of the following is not true regarding systemic effects of antipsychotic drugs?

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

Produce amnesia and work as anticonvulsants.

May make patient more prone to laryngospasm

Benadryl may be given to treat extrapyramidal effects.

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

Generalized flaccidity

Alterations in BP & Tachycardia

Fluctuating LOC

Liver Failure

Fever

Submit

94. Methotrexate may cause all of the following except…..

Neuro toxicity

Pulmonary toxicity

Renal toxicity

Hepatic toxicity

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

320 units

10,000 units

2,400 units

30,000 units

96. 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…

Seizures

Post-op delirium

Ataxia

Post op nausea and vomiting

97. Which of the following drugs would be useful in the treatment of chronic neuropathic pain?

Fluvoxamine

Imipramine

Phenelzine

Alprazolam

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

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

It should not be given at all! Get some PF4

1mg/50 ml test dose over 10 minutes

1 mg per 100 units of heparing given IV slowly

99. Which two drugs are more commonly associated with neuroleptic malignant syndrome?

Thioridazine & Compazine

Droperidol & Phenobarbitol

Haldol & Reglan

Dantrolene & Fluoxetine

100. Which patient would not be at an increased risk of anaphylaxis to protamine?

Vasectomized male

Patient with Fish allergy

Diabetic patient taking NPH insulin

All are at an increased risk

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

May have prolonged effects due to inhibition of cytochrome P 450

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

May have shortened effect due to P 450 enzyme induction

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

102. What is the mechanism of action of Vinchristine, a plant alkaloid?

Interferes with RNA synthesis and prevents microtubule formation

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

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

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

103. The majority of the acetylcholine receptors in the brain are…

MAO-A

5 HT-1 and 5 HT-2 receptors

Nicotinic

Muscarinic

104. Which of the following toxicitys would not be caused by asparaginase?

Pancreas

Pulmonary

CNS

Liver

105. 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?

Increased risk of seizures, compazine will severely lower seizure threshold

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

Extreme anxiety, hyperactivity, and restlessness.

A decrease in systemin BP and hypothermia.

106. What is the half life of Heparin?

1 hour

2.5 hours

4 hours

Half life is dose dependent

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

12-24 hours

1-3 days

3-5 days

2 weeks

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

Tachycardia and prolonged PR interval

Dry mouth and slowed gastric emptying

Insomnia and agitation

Impotence and orthostatic hypotension

Submit

109. 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?

Fentanyl

Succinylcholine

Nicardipene drip

Odansetron

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

Drug induced inhibition of norepinephrine uptake

Accumulation of serotonin in synaptic cleft

Accumulation of octopamine, a false neurotransmitter

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

2012 Pharm II- Quiz 3

1. What could you give to treat a patient with post dural puncture headache?

2.

What first name or nickname would you like us to use?

2. Which of the following is used to treat tuberculosis?

3. Seizure disorders are most likely caused by:

4. 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.

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

6. What is the mechanism of action of Dantrolene?

7. What is the primary glucocorticoid released by the body?

8. 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?

9. Lithium is most consistently used to treat…

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

11. Which of the following contains a Beta-Lactam ring?

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

13. Which of the following is not a known side effect of Aminoglycosides?

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

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

16. Why is Cefoxitin, a second generation cephalosporin, commonly used for GI cases?

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

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

19. Which of the following should not be administered concurrently with and MAO inhibitor?

20. What is a severe adverse effect associated with antipsychotics, particularly Haldol?

21. 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?

22. 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?

23. Antipsychotic drugs should not be administered to patients with which medical condition?

24. WHY does someone on steroid therapy need steroid replacement prior to surgery?

25. 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?

26. If protamine is given too fast IV it may cause…

27. 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?

28. What is the mechanism of action of Heparin?

29. What is mechanism of action of Aspirin?

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

31. What is the Mechanism of Action of SSRI’s?

32. What is the Mechanism of Action of tricyclic antidepressants?

33. 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?

34. 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?

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

36. 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?

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

38. What is mechanism is action of Coumadin?

39. Which of the following carries the risk of causing pseudomembranous colitis?

40. When should prophylocatic antibiotic be administered in relation to surgery?

41. What is mechanism of action of tPA?

42. The majority of the bodies serotonin is stored where?

43. What is the mechanism of action of Levodopa?

45. 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?

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

47. Anticoagulants like Heparin and Coumadin have absolutely no effect on clots already formed.

48. Which of the following would not be a clinical use of steroids?

49. What is the Mechanism of action of MAO inhibitors?

50. Which of the following would be a concern for a patient taking Doxorubicin?

51. What is the primary effect of mineralcorticoids?

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

53. With many of our chemotherapeutic agents, myelosuppression will manifest within ________ of start of treatment.

54. Heparin enhances the activity of antithrombin by how much?

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

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

57. Which of the following 2nd generation antidepressants has a greater incidence of seizures?

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

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

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

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

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

64. 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?

65. 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….

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

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

68. 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.

69. Which of the following 2nd generation antidepressants has the greatest sedative potency?

70. How will lithium affect your management of a patient during anesthesia?

72. Which of the following is true regarding the nigrostriatal pathway?

73. 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?

74. How many units of heparin are in 1 mg?

75. Which drug is the most potent producer of skeletal muscle weakness?

76. Which of the following is not a side effect of antivirals?

77. 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?

78. What does Prothrombin time measure?

79. What is the normal rate of secretion of cortisol daily?

80. 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…

17. COMIC RELIEF:

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57. Which of the following 2^nd generation antidepressants has a greater incidence of seizures?

65. 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….

69. Which of the following 2^nd generation antidepressants has the greatest sedative potency?