Pharm II Quiz 2
A review of the material for pharm test 2. Includes: local anesthetics, alpha and beta antagonists, antihypertensives, diuretics.
Most questions come directly from notes.
- 1.
What are the two classifications of local anesthetics?
- A.
Esters
- B.
Ethers
- C.
Amides
- D.
Carboxylic Acids
- E.
Thiols
Correct Answer(s)
A. Esters
C. Amides -
- 2.
Which of the following local anesthetic agents are Esters? (more than one answer)
- A.
Lidocaine
- B.
Chloroprocaine
- C.
Cocaine
- D.
Mepivicaine
- E.
Prilocaine
Correct Answer(s)
B. Chloroprocaine
C. Cocaine -
- 3.
Which of the following local anesthetic agents are Amides? (More than one answer)
- A.
Lidocaine
- B.
Chloroprocaine
- C.
Cocaine
- D.
Mepivicaine
- E.
Prilocaine
Correct Answer(s)
A. Lidocaine
D. Mepivicaine
E. Prilocaine -
- 4.
What is the mechanism of action of local anesthetics?
- A.
Mimics acetylcholinesterase to Cause sustained depolarization rendering the NMJ unable to conduct further impulses=Muscle relaxation
- B.
Produces skeletal muscle relaxation by a direct action on excitation-contraction coupling, presumably by decreasing the amount of calcium released from the sarcoplasmic reticulum
- C.
Dependent upon type of anesthetic as ester and amides have different MOA’s
- D.
Prevents passage of sodium ions through ion selective channels in nerve membranes to block nerve conduction.
Correct Answer
D. Prevents passage of sodium ions through ion selective channels in nerve membranes to block nerve conduction. -
- 5.
How is Procaine metabolized?
- A.
By hydrolysis via pseudocholinesterase
- B.
Via hepatic enzymes P450
- C.
Via proteins present within CSF
- D.
Via renal metabolism and excretion
Correct Answer
A. By hydrolysis via pseudocholinesterase -
- 6.
How is Bupivicaine metabolized?
- A.
By hydrolysis via pseudocholinesterase
- B.
Via hepatic enzymes P450
- C.
Via proteins present within CSF
- D.
Via renal metabolism and excretion
Correct Answer
B. Via hepatic enzymes P450 -
- 7.
Depolarization is due to inflow of ____ ions from the extracellular to the intracellular space while repolarization is due to outflow of ____ ions from intracellular to extracellular space.
- A.
Cl , K
- B.
Na, Cl
- C.
Na, K
- D.
K, Na
Correct Answer
C. Na, K -
- 8.
You are doing a pre-op on a pt who will be receiving spinal anesthesia today for surgery. When interviewing the patient they state they previously had a serious allergic reaction to Procaine. You question the patient further and verify it is indeed a true allergy. What do you do now? The surgeon and patient both want spinal anesthesia but what about the allergy?
- A.
Use Tetracaine instead, since this is a different class of anesthetic
- B.
This pt may not receive any spinal anesthetics and will need to have GA
- C.
Cancel procedure for today and reschedule for a later time.
- D.
Use Ropivacaine instead, since this is a different class of anesthetic
Correct Answer
D. Use Ropivacaine instead, since this is a different class of anesthetic -
- 9.
You are about to perform regional anesthesia when the patient informs you they are allergic to local anesthetics. You question the patient and discover that while having some dental work done a few years back the patient experienced palpitations, anxiety, sweating and tremors after receiving Procaine. (Which coincidentally is what you were going to use today!) What is your response to this?
- A.
Use the procaine anyway! The patient is being a spazz since palpitations are a normal side effect and not an allergic reaction.
- B.
Realize this patient has a true allergy and switch to bupivacaine which is less likely to cause an allergy.
- C.
Put the pt under general anesthesia since she can not receive any local anesthetics and because she is talking WAY too much.
- D.
None of the above
Correct Answer
A. Use the procaine anyway! The patient is being a spazz since palpitations are a normal side effect and not an allergic reaction. -
- 10.
Which of the following is responsible for the potency of local anesthetics?
- A.
Degree of protein binding
- B.
Lipid Solubility
- C.
Degree of Ionization
- D.
Size of Molecule
Correct Answer
B. Lipid Solubility -
- 11.
Which of the following is mainly responsible for the duration of action of local anesthetics?
- A.
Degree of protein binding
- B.
Lipid Solubility
- C.
Degree of Ionization
- D.
Size of Molecule
Correct Answer
A. Degree of protein binding -
- 12.
Which of the following is responsible for time until onset of action for local anesthetics?
- A.
Degree of protein binding
- B.
Lipid Solubility
- C.
Degree of Ionization
- D.
Size of Molecule
Correct Answer
C. Degree of Ionization -
- 13.
Which nerve fibers are likely to be the first blocked after administration of local anesthetic?
- A.
A delta fibers
- B.
B Fibers
- C.
A Alpha fibers
- D.
C Fibers
Correct Answer
D. C Fibers -
- 14.
What would be the max dose of mepivacaine plain to give to a pt who weighs 45 kg?
- A.
225 mg
- B.
112 mg
- C.
450 mg
- D.
315 mg
Correct Answer
A. 225 mg -
- 15.
Which of the following has the longest duration of action?
- A.
Chloroprocaine
- B.
Tetracaine
- C.
Bupivacaine
- D.
Lidocaine
Correct Answer
B. Tetracaine -
- 16.
What would be the max dose of chloroprocaine with epi to give to a pt weighing 32 kg?
- A.
256 mg
- B.
160 mg
- C.
320 mg
- D.
480 mg
Correct Answer
D. 480 mg -
- 17.
What is the max dose of tetracaine plain to give to a pt weighing 70 kg?
- A.
175 mg
- B.
350 mg
- C.
105 mg
- D.
560 mg
Correct Answer
C. 105 mg -
- 18.
You perform an ankle block for amputation of a toe secondary to nonhealing diabetic ulceration and sepsis. The block technique looked good but the patient almost jumped off the OR table when the surgeon made the incision. What went wrong?
- A.
The technique must have been wrong, try again.
- B.
The acidic environment of the foot cause a greater concentration of ionized anesthetic, which can not cross cell membrane.
- C.
The basic environment of the foot cause a greater concentration of ionized anesthetic, which can not cross cell membrane.
- D.
Pt must have a tolerance to local anesthetics, try again using a larger dose.
Correct Answer
B. The acidic environment of the foot cause a greater concentration of ionized anesthetic, which can not cross cell membrane. -
- 19.
How does epinephrine prolong spinal anesthesia?
- A.
By blocking passage of sodium ions into nerve cells
- B.
Through beta1 agonistic effects
- C.
Through vasoconstriction and decreasing vascular absorption
- D.
All the above
Correct Answer
C. Through vasoconstriction and decreasing vascular absorption -
- 20.
Risk for toxicity is directly proportionate to potency.
- A.
True
- B.
False
Correct Answer
A. True -
- 21.
What would you expect a pt to say to you as an early sign of toxicity due to accidental vascular injection during administration of spinal anesthesia? (more than one answer)
- A.
“My legs are starting to feel really numb….”
- B.
“I can’t feel my tongue anymore… weird.”
- C.
“It feels a little hard to breathe... is this normal with an epidural?”
- D.
“My ears just started ringing really bad.”
- E.
"Ow! ow! Ouch!!! What the heck are you hitting back there?"
Correct Answer(s)
B. “I can’t feel my tongue anymore… weird.”
D. “My ears just started ringing really bad.” -
- 22.
Which of the following patients would be at greatest risk for toxicity?
- A.
Pt receiving intercostal nerve block
- B.
Pt receiving caudal block
- C.
Pt receiving brachial plexus nerve block
- D.
Pt receiving sub-q local anesthetic
Correct Answer
A. Pt receiving intercostal nerve block -
- 23.
Which of the following will have the greatest amount of unionized molecules when injected into physiologic pH?
- A.
Procaine – pKa 8.9
- B.
Lidocaine – pKa 7.7
- C.
Chloroprocaine – pKa 9.1
- D.
Bupivacaine – pKa 8.1
Correct Answer
B. Lidocaine – pKa 7.7 -
- 24.
Which of the following will have the most rapid onset?
- A.
Procaine – pKa 8.9
- B.
Bupivacaine – pKa 8.1
- C.
Mepivacaine- pKa7.6
- D.
Ropivacaine- pKa 8.1
Correct Answer
C. Mepivacaine- pKa7.6 -
- 25.
How will mixing your local anesthetic with bicarbonate effect the anesthetic?
- A.
Greater degree of protein binding and thus longer duration
- B.
No effect at all
- C.
Decreased lipid solubility resulting in decreased potency
- D.
Increased unionized drug causing more rapid onset
Correct Answer
D. Increased unionized drug causing more rapid onset -
- 26.
How would you perform local anesthesia on a patient with a known pseudocholinesterase deficiency?
- A.
Administer local anesthesia with Bupivacaine
- B.
This has no effect on local anesthetics, only on succinylcholine.
- C.
Administer local anesthesia with Procaine
- D.
Patient may not receive any local anesthetics
Correct Answer
A. Administer local anesthesia with Bupivacaine -
- 27.
You are the SRNA caring for a pt about to undergo local anesthesia, and were planning to use Rpivacaine. On their medication list you see Fluoxetine, Insulin, Cardizem and nexium. Will any of these effect your plan of care?
- A.
I will use a higher dose of Ropivacaine due to induction of P450
- B.
I will plan to use Tetracaine due to inhibition of cytochrome P450
- C.
Use ropivacaine due to inhibition of pseudocholinesterase
- D.
Use higher dose of tetracaine due to induction of pseudocholinesterase
Correct Answer
B. I will plan to use Tetracaine due to inhibition of cytochrome P450 -
- 28.
Which of the following tissues has the highest blood flow?
- A.
Intercostal
- B.
Paracervical
- C.
Subarachnoid
- D.
Tracheal
Correct Answer
D. Tracheal -
- 29.
Which of the following has the lowest blood flow?
- A.
Subcutaneous
- B.
Sciatic
- C.
Caudal
- D.
Epidural
Correct Answer
A. Subcutaneous -
- 30.
Which of the following may cause methemoglobinemia?
- A.
Lidocaine
- B.
Prilocaine
- C.
Bupivacaine
- D.
Cocaine
Correct Answer
B. Prilocaine -
- 31.
What could you add to increase the duration of local anesthetic on a pt with mild aortic stenosis whose HR you do not wish to elevate?
- A.
Epinephrine
- B.
Metoprolol
- C.
Phenylephrine
- D.
Ephedrine
Correct Answer
C. Phenylephrine -
- 32.
In response to hypovolemia, or hypotension the juxtaglomerular cells of the kidney release what enzyme?
- A.
Angiotensin I
- B.
Angiotensin II
- C.
Angiotensin converting enzyme
- D.
Renin
Correct Answer
D. Renin -
- 33.
Where does angiotensin converting enzyme act upon angiotenin I?
- A.
Lungs
- B.
Kidneys
- C.
Liver
- D.
Coronary Vessels
Correct Answer
A. Lungs -
- 34.
What is the MOA of ACE inhibitor drugs such as captopril?
- A.
Blocks the vasoconstrictor and aldosterone-secretion effects of Angiotensin II to the AT1 receptors in the smooth muscles
- B.
Blocks the conversion of angiotensin I to angiotensin II to prevent vasoconstriction
- C.
Inhibits reabsorption of sodium and chloride ions in the loop of Henle
- D.
Increases the osmolarity of the renal tubular fluid and prevents reabsorption of water
Correct Answer
B. Blocks the conversion of angiotensin I to angiotensin II to prevent vasoconstriction -
- 35.
What is the most common side effect associated with ACE inhibitors?
- A.
Bradycardia
- B.
Bronchospasm
- C.
Chronic Cough
- D.
Hypokalemia
Correct Answer
C. Chronic Cough -
- 36.
For a patient who is taking Captopril, you would expect see a decrease in serum ______ while seeing a compensatory increase in _____.
- A.
Angiotensin I, angiotensin II
- B.
Angiotensin II, Aldosterone
- C.
Renin, Angiotensin I
- D.
Aldosterone, Renin
Correct Answer
D. Aldosterone, Renin -
- 37.
Which of the following may antagonize the effects of Captopril?
- A.
Aspirin
- B.
Tylenol
- C.
Furosemide
- D.
Mannitol
Correct Answer
A. Aspirin -
- 38.
Which of the following is a pro-drug which must be metabolized by the liver before reaching its active form?
- A.
Captopril
- B.
Enalapril
- C.
Losartan
- D.
Hydrochlorothiazide
Correct Answer
B. Enalapril -
- 39.
What is the MOA of Losartan?
- A.
Blocks the vasoconstrictor and aldosterone-secretion effects of Angiotensin II to the AT1 receptors in the smooth muscles
- B.
Blocks the conversion of angiotensin I to angiotensin II to prevent vasoconstriction
- C.
Inhibits reabsorption of sodium and chloride ions in the loop of Henle
- D.
Increases the osmolarity of the renal tubular fluid and prevents reabsorption of water
Correct Answer
A. Blocks the vasoconstrictor and aldosterone-secretion effects of Angiotensin II to the AT1 receptors in the smooth muscles -
- 40.
Which of the following side effects is not usually associated with thiazide diurectics?
- A.
Hypokalemia
- B.
Metabolic Alkalosis
- C.
Skeletal muscle weakness
- D.
Hemodilution
Correct Answer
D. Hemodilution -
- 41.
Which of the following is not a clinical use of furosemide?
- A.
Prophylaxis against acute renal failure
- B.
Mobilization of Edema
- C.
Treatment of increased ICP
- D.
Differential diagnosis of acute oliguria
Correct Answer
A. Prophylaxis against acute renal failure -
- 42.
Which of the following would be the best choice for a 60 kg patient with acute pulmonary edema?
- A.
Mannitol 30g IV
- B.
Furosemide 40 mg IV
- C.
Aldactone 250mg PO
- D.
Enalapril 2.5 mg IV
Correct Answer
B. Furosemide 40 mg IV -
- 43.
You are SRNA today for a patient who has been taking Furosemide. When your preceptors asks you if this drug effects any of the common anesthesia drugs what do you say?
- A.
Has potential to cause angioedemia if given with propofol
- B.
It does not effect any of our drugs! I’ll just watch their volume status closely though.
- C.
May potentiate Non depolarizing NMB’s
- D.
Interacts with neosynephrine to cause arrhythmias
Correct Answer
C. May potentiate Non depolarizing NMB’s -
- 44.
What is the MOA of Mannitol?
- A.
Blocks the vasoconstrictor and aldosterone-secretion effects of Angiotensin II to the AT1 receptors in the smooth muscles
- B.
Blocks the conversion of angiotensin I to angiotensin II to prevent vasoconstriction
- C.
Inhibits reabsorption of sodium and chloride ions in the loop of Henle
- D.
Increases the osmolarity of the renal tubular fluid and prevents reabsorption of water
Correct Answer
D. Increases the osmolarity of the renal tubular fluid and prevents reabsorption of water -
- 45.
Mannitol should be given with extreme caution to patients with which of the following?
- A.
CHF
- B.
Renal Failure
- C.
Increased ICP
- D.
COPD
Correct Answer
A. CHF -
- 46.
What would be an appropriate dose of mannitol to give to a 58 yr old pt weighing 80 kg to reduce ICP?
- A.
8 g IV
- B.
40 g IV
- C.
160 g IV
- D.
1.6 g IV
Correct Answer
B. 40 g IV -
- 47.
Which of the following drugs can inhibit seizure activity?
- A.
Urea
- B.
Captopril
- C.
Acetazolamide
- D.
Furosemide
Correct Answer
C. Acetazolamide -
- 48.
What is the post synaptic neurotransmitter for the sympathetic nervous system?
- A.
Acetycholine
- B.
Serotonin
- C.
Glutamate
- D.
Norepinephrine
Correct Answer
D. Norepinephrine -
- 49.
What is the post synaptic neurotransmitter of the parasympathetic nervous system?
- A.
Acetycholine
- B.
Serotonin
- C.
Glutamate
- D.
Norepinephrine
Correct Answer
A. Acetycholine -
- 50.
The nerves of the sympathetic nervous system arise from where?
- A.
Craniosacral nerves
- B.
T1-L2
- C.
Cauda Equina
- D.
All the above, these nerves are throughout the body
Correct Answer
B. T1-L2 -
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