Pharm II- Quiz 1

48 Questions

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Pharm II- Quiz 1

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. 
    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

  • 28. 
    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

  • 29. 
    Antipsychotic drugs should not be administered to patients with which medical condition?
    • A. 

      Asthma

    • B. 

      Renal Insufficiency

    • C. 

      Parkinsons

    • D. 

      Schizophrenia

  • 30. 
    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.

  • 31. 
    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

  • 32. 
    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.

  • 33. 
    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.

  • 34. 
    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

  • 35. 
    A patient taking levodopa should not be administered which medication?
    • A. 

      Metaclopromide

    • B. 

      Furosemide

    • C. 

      Odansetron

    • D. 

      Ephedrine

  • 36. 
    What is the primary glucocorticoid released by the body?
    • A. 

      Aldosterone

    • B. 

      Cortisol

    • C. 

      Prednisolone

    • D. 

      ACTH

  • 37. 
    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

  • 38. 
    What is the normal rate of secretion of cortisol daily?
    • A. 

      5 mg

    • B. 

      30 mg

    • C. 

      150 mg

    • D. 

      10 mg

  • 39. 
    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.

  • 40. 
    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.

  • 41. 
    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

  • 42. 
    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

  • 43. 
    Peniciilin G may cause what electrolyte imbalance when given to patients with renal failure?
    • A. 

      Hyperkalemia

    • B. 

      Hypernatremia

    • C. 

      Hypercalcemia

    • D. 

      Hypermagnesemia

  • 44. 
    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

  • 45. 
    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

  • 46. 
    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

  • 47. 
    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

  • 48. 
    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.