Pharm II Quiz 2

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  • 1/105 Questions

    In response to hypovolemia, or hypotension the juxtaglomerular cells of the kidney release what enzyme?

    • Angiotensin I
    • Angiotensin II
    • Angiotensin converting enzyme
    • Renin
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About This Quiz

A review of the material for pharm test 2. Includes: local anesthetics, alpha and beta antagonists, antihypertensives, diuretics.
Most questions come directly from notes.

Pharm II Quiz 2 - Quiz

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  • 2. 

    Which of the following would be the best choice to treat a pt diagnosed with essential hypertension?

    • Hydrochlorothiazide

    • Urea

    • Spironolactone

    • Acetazolamide

    Correct Answer
    A. Hydrochlorothiazide
  • 3. 

    How will mixing your local anesthetic with bicarbonate effect the anesthetic?

    • Greater degree of protein binding and thus longer duration

    • No effect at all

    • Decreased lipid solubility resulting in decreased potency

    • Increased unionized drug causing more rapid onset

    Correct Answer
    A. Increased unionized drug causing more rapid onset
  • 4. 

    What is the post synaptic neurotransmitter of the parasympathetic nervous system?

    • Acetycholine

    • Serotonin

    • Glutamate

    • Norepinephrine

    Correct Answer
    A. Acetycholine
  • 5. 

    LA toxicity is more likely to occur in area of the body that have…

    • Access to CSF

    • Increased fat stores

    • Increased blood flow

    • None of above

    Correct Answer
    A. Increased blood flow
  • 6. 

    What are the two classifications of local anesthetics?

    • Esters

    • Ethers

    • Amides

    • Carboxylic Acids

    • Thiols

    Correct Answer(s)
    A. Esters
    A. Amides
  • 7. 

    What is the most common side effect associated with ACE inhibitors?

    • Bradycardia

    • Bronchospasm

    • Chronic Cough

    • Hypokalemia

    Correct Answer
    A. Chronic Cough
  • 8. 

    What is the MOA of Losartan?

    • Blocks the vasoconstrictor and aldosterone-secretion effects of Angiotensin II to the AT1 receptors in the smooth muscles

    • Blocks the conversion of angiotensin I to angiotensin II to prevent vasoconstriction

    • Inhibits reabsorption of sodium and chloride ions in the loop of Henle

    • 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
  • 9. 

    What is the MOA of Mannitol?

    • Blocks the vasoconstrictor and aldosterone-secretion effects of Angiotensin II to the AT1 receptors in the smooth muscles

    • Blocks the conversion of angiotensin I to angiotensin II to prevent vasoconstriction

    • Inhibits reabsorption of sodium and chloride ions in the loop of Henle

    • Increases the osmolarity of the renal tubular fluid and prevents reabsorption of water

    Correct Answer
    A. Increases the osmolarity of the renal tubular fluid and prevents reabsorption of water
  • 10. 

    How does epinephrine prolong spinal anesthesia?

    • By blocking passage of sodium ions into nerve cells

    • Through beta1 agonistic effects

    • Through vasoconstriction and decreasing vascular absorption

    • All the above

    Correct Answer
    A. Through vasoconstriction and decreasing vascular absorption
  • 11. 

    Accidental IV injection of bupivacaine would result in which of the following?

    • Precipitous Hypotension

    • Cardiac Dysrhythmias

    • AV Heart block

    • All the above

    Correct Answer
    A. All the above
  • 12. 

    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.

    • Cl , K

    • Na, Cl

    • Na, K

    • K, Na

    Correct Answer
    A. Na, K
  • 13. 

    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?

    • The technique must have been wrong, try again.

    • The acidic environment of the foot cause a greater concentration of ionized anesthetic, which can not cross cell membrane.

    • The basic environment of the foot cause a greater concentration of ionized anesthetic, which can not cross cell membrane.

    • Pt must have a tolerance to local anesthetics, try again using a larger dose.

    Correct Answer
    A. The acidic environment of the foot cause a greater concentration of ionized anesthetic, which can not cross cell membrane.
  • 14. 

    Which of the following would be the best choice for a 60 kg patient with acute pulmonary edema?

    • Mannitol 30g IV

    • Furosemide 40 mg IV

    • Aldactone 250mg PO

    • Enalapril 2.5 mg IV

    Correct Answer
    A. Furosemide 40 mg IV
  • 15. 

    How is Bupivicaine metabolized?

    • By hydrolysis via pseudocholinesterase

    • Via hepatic enzymes P450

    • Via proteins present within CSF

    • Via renal metabolism and excretion

    Correct Answer
    A. Via hepatic enzymes P450
  • 16. 

    Which of the following is  mainly responsible for the duration of action of local anesthetics?

    • Degree of protein binding

    • Lipid Solubility

    • Degree of Ionization

    • Size of Molecule

    Correct Answer
    A. Degree of protein binding
  • 17. 

    What is the MOA of ACE inhibitor drugs such as captopril?

    • Blocks the vasoconstrictor and aldosterone-secretion effects of Angiotensin II to the AT1 receptors in the smooth muscles

    • Blocks the conversion of angiotensin I to angiotensin II to prevent vasoconstriction

    • Inhibits reabsorption of sodium and chloride ions in the loop of Henle

    • Increases the osmolarity of the renal tubular fluid and prevents reabsorption of water

    Correct Answer
    A. Blocks the conversion of angiotensin I to angiotensin II to prevent vasoconstriction
  • 18. 

    Sympathetic stimulation results in all of the following except?

    • Increased HR

    • Decreased urine secretion

    • Secretion of norepi

    • Increased Saliva and mucus production

    Correct Answer
    A. Increased Saliva and mucus production
  • 19. 

    Which diuretic would be the best choice for a patient who suffers from chronic hypokalemia?

    • Hydrochlorothiazide

    • Furosemide

    • Triamterene

    • Ethacrynic Acid

    Correct Answer
    A. Triamterene
  • 20. 

    Which of the following will have the greatest amount of unionized molecules when injected into physiologic pH?

    • Procaine – pKa 8.9

    • Lidocaine – pKa 7.7

    • Chloroprocaine – pKa 9.1

    • Bupivacaine – pKa 8.1

    Correct Answer
    A. Lidocaine – pKa 7.7
  • 21. 

    Which of the following has the lowest blood flow?

    • Subcutaneous

    • Sciatic

    • Caudal

    • Epidural

    Correct Answer
    A. Subcutaneous
  • 22. 

    Which of the following is likely to cause bronchoconstriction and should be used cautiously in asthmatics?

    • Alpha 1 receptor blockers

    • Beta 2 receptor Blockers

    • Beta 1 receptor blockers

    • All the above will cause bronchoconstriction

    Correct Answer
    A. Beta 2 receptor Blockers
  • 23. 

    Which of the following is given only in IV form?

    • Labetolol

    • Phenoxybenzamine

    • Atenolol

    • Esmolol

    Correct Answer
    A. Esmolol
  • 24. 

    Which portion of the Local anesthetic molecules makes the cationic form which is most active at the intracellular site?

    • Lipophilic aromatic group

    • Esther linkage

    • Amide Linkage

    • Hydrophilic amine group

    Correct Answer
    A. Hydrophilic amine group
  • 25. 

    You are delivering spinal anesthetic to a patient when they begin to complain of feeling light headed and ringing in their ears. What should you do?

    • Slow down your rate of injection, and then administer rest of anesthetic.

    • Immediately notify MD and prepare pt for cardiac bypass, your plasma concentration is most likely too high now.

    • Immediately stop injection, start lipid infusion, monitor patient, your plasma concentration should still be low enough to reverse this.

    • Comfort the patient that this is normal to experience and deliver rest of anesthetic quickly.

    Correct Answer
    A. Immediately stop injection, start lipid infusion, monitor patient, your plasma concentration should still be low enough to reverse this.
  • 26. 

    COMIC RELIEF:  Jizz in my pants

    • Ha ha!!

    • Kind of a catchy tune...

    • I love the looks on their faces!

    • All the above

    Correct Answer
    A. All the above
  • 27. 

    What is the mechanism of action of local anesthetics?

    • Mimics acetylcholinesterase to Cause sustained depolarization rendering the NMJ unable to conduct further impulses=Muscle relaxation

    • Produces skeletal muscle relaxation by a direct action on excitation-contraction coupling, presumably by decreasing the amount of calcium released from the sarcoplasmic reticulum

    • Dependent upon type of anesthetic as ester and amides have different MOA’s

    • Prevents passage of sodium ions through ion selective channels in nerve membranes to block nerve conduction.

    Correct Answer
    A. Prevents passage of sodium ions through ion selective channels in nerve membranes to block nerve conduction.
  • 28. 

    What is the post synaptic neurotransmitter for the sympathetic nervous system?

    • Acetycholine

    • Serotonin

    • Glutamate

    • Norepinephrine

    Correct Answer
    A. Norepinephrine
  • 29. 

    How is Procaine metabolized?

    • By hydrolysis via pseudocholinesterase

    • Via hepatic enzymes P450

    • Via proteins present within CSF

    • Via renal metabolism and excretion

    Correct Answer
    A. By hydrolysis via pseudocholinesterase
  • 30. 

    Risk for toxicity is directly proportionate to potency.

    • True

    • False

    Correct Answer
    A. True
  • 31. 

    Which of the following patients would be at greatest risk for toxicity?

    • Pt receiving intercostal nerve block

    • Pt receiving caudal block

    • Pt receiving brachial plexus nerve block

    • Pt receiving sub-q local anesthetic

    Correct Answer
    A. Pt receiving intercostal nerve block
  • 32. 

    Patients taking beta adrenergic blockers, such as propanolol, are at an increased risk for bupivacaine toxicity.

    • True

    • False

    Correct Answer
    A. True
  • 33. 

    Local anesthetic toxicity is most often due to which of the following?

    • Absorption from tissues during nerve blocks

    • Inadvertent intravascular injection

    • Inadvertent administration of epidural dose into subdural space

    • Drug interactions between pt meds and LA’s

    Correct Answer
    A. Inadvertent intravascular injection
  • 34. 

    You have just performed spinal anesthesia and find your patient has experienced total spinal anesthesia. What do you do?

    • Prepare for the patient to be placed on cardiac bypass due to arrhythmias.

    • Intubate the patient and wait it out.

    • Deliver neo and glyco to reverse the paralysis.

    • Begin delivering pain medication to counteract the headache.

    Correct Answer
    A. Intubate the patient and wait it out.
  • 35. 

    Where does angiotensin converting enzyme act upon angiotenin I?

    • Lungs

    • Kidneys

    • Liver

    • Coronary Vessels

    Correct Answer
    A. Lungs
  • 36. 

    In regard to local anesthetics their _______ nature allows them pass through cell membranes, but once inside the cell membrane their ______ portion binds inside the cell.

    • Lipophilic, hydrophilic

    • Hydrophilic, lipophilic

    • Ionized, unionized

    • None of above

    Correct Answer
    A. Lipophilic, hydrophilic
  • 37. 

    Which of the following diuretics is associated with hypochloremic, hypokalemic, metabolic alkalosis?

    • Potassium sparing diuretics

    • Aldosterone Antagonists

    • Osmotic Diuretics

    • Thiazide Diuretics

    Correct Answer
    A. Thiazide Diuretics
  • 38. 

    Which of the following is not a side effect associated with use of labetolol?

    • Chronic Cough

    • Orthostatic hypotension

    • Bronchospasm

    • Heart block

    Correct Answer
    A. Chronic Cough
  • 39. 

    Stimulation of beta 2 receptors causes these effects except

    • Bronchodilation

    • Glycogenolysis/gluconeogenesis

    • Activation of Na/K pump

    • Vasoconstriction

    Correct Answer
    A. Vasoconstriction
  • 40. 

    Which of the following local anesthetic agents are Amides? (More than one answer)

    • Lidocaine

    • Chloroprocaine

    • Cocaine

    • Mepivicaine

    • Prilocaine

    Correct Answer(s)
    A. Lidocaine
    A. Mepivicaine
    A. Prilocaine
  • 41. 

    Which of the following will have the most rapid onset?

    • Procaine – pKa 8.9

    • Bupivacaine – pKa 8.1

    • Mepivacaine- pKa7.6

    • Ropivacaine- pKa 8.1

    Correct Answer
    A. Mepivacaine- pKa7.6
  • 42. 

    Which of the following is a selective alpha 1 receptor blocker?

    • Phenoxybenzamine

    • Prazosin

    • Esmolol

    • Labetolol

    Correct Answer
    A. Prazosin
  • 43. 

    Stimulation of Beta 1 receptors would result in all of the following except…

    • Brochodilation

    • Increase heart rate

    • Increase contractility

    • All the above result from Beta 1 stimulation

    Correct Answer
    A. Brochodilation
  • 44. 

    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?

    • Use Tetracaine instead, since this is a different class of anesthetic

    • This pt may not receive any spinal anesthetics and will need to have GA

    • Cancel procedure for today and reschedule for a later time.

    • Use Ropivacaine instead, since this is a different class of anesthetic

    Correct Answer
    A. Use Ropivacaine instead, since this is a different class of anesthetic
  • 45. 

    Which of the following is responsible for the potency of local anesthetics?

    • Degree of protein binding

    • Lipid Solubility

    • Degree of Ionization

    • Size of Molecule

    Correct Answer
    A. Lipid Solubility
  • 46. 

    Mannitol should be given with extreme caution to patients with which of the following?

    • CHF

    • Renal Failure

    • Increased ICP

    • COPD

    Correct Answer
    A. CHF
  • 47. 

    Dopamine B-hydroxylase acts upon Dopamine to convert it into what substance?

    • Dihydroxyphenylalanine

    • Norepinephrine

    • Epinephrine

    • N-methyltransferase

    Correct Answer
    A. Norepinephrine
  • 48. 

    Which of the following may cause methemoglobinemia?

    • Lidocaine

    • Prilocaine

    • Bupivacaine

    • Cocaine

    Correct Answer
    A. Prilocaine
  • 49. 

    The first chemical involved in production of norepinephrine is what?

    • Tyrosine

    • DOPA

    • Epinephrine

    • Hydroxylase

    Correct Answer
    A. Tyrosine

Quiz Review Timeline (Updated): Mar 21, 2022 +

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  • Mar 21, 2022
    Quiz Edited by
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  • Mar 07, 2009
    Quiz Created by
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