Pharm II Quiz 2
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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
- 2.Which of the following local anesthetic agents are Esters? (more than one answer)
- A.
Lidocaine
- B.
Chloroprocaine
- C.
Cocaine
- D.
Mepivicaine
- E.
Prilocaine
- 3.Which of the following local anesthetic agents are Amides? (More than one answer)
- A.
Lidocaine
- B.
Chloroprocaine
- C.
Cocaine
- 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.
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 15.Which of the following has the longest duration of action?
- A.
Chloroprocaine
- B.
Tetracaine
- C.
Bupivacaine
- D.
Lidocaine
- 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
- 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
- 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.
- 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
- 20.Risk for toxicity is directly proportionate to potency.
- A.
True
- B.
False
- 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?"
- 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
- 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
- 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
- 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
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