2012 Pharm II Quiz 1

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

    • Bradycardia
    • Bronchospasm
    • Chronic Cough
    • Hypokalemia
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2012 Pharm II Quiz 1 - Quiz
About This Quiz

A review of the material for pharm test 2. Includes: local anesthetics, antihypertensives, diuretics, vasodilators.

Most questions come directly from notes.

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  • 2. 

    What are the two classifications of local anesthetics?

    • Esters

    • Ethers

    • Amides

    • Carboxylic Acids

    • Thiols

    Correct Answer(s)
    A. Esters
    A. Amides
  • 3. 

    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
  • 4. 

    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
  • 5. 

    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
  • 6. 

    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.
  • 7. 

    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.
  • 8. 

    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
  • 9. 

    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
  • 10. 

    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
  • 11. 

    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
  • 12. 

    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
  • 13. 

    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
  • 14. 

    Can be used for pregnancy induced hypertension?

    • Hydralazine

    • Adenosine

    • Nipride

    • Nitric oxide

    Correct Answer
    A. Hydralazine
  • 15. 

    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
  • 16. 

    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
  • 17. 

    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
  • 18. 

    Which of the following local anesthetic agents are Esters? (more than one answer)

    • Lidocaine

    • Chloroprocaine

    • Cocaine

    • Mepivicaine

    • Prilocaine

    Correct Answer(s)
    A. Chloroprocaine
    A. Cocaine
  • 19. 

    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
  • 20. 

    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.
  • 21. 

    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
  • 22. 

    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
  • 23. 

    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.
  • 24. 

    Which of the following has the lowest blood flow?

    • Subcutaneous

    • Sciatic

    • Caudal

    • Epidural

    Correct Answer
    A. Subcutaneous
  • 25. 

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

    • Angiotensin I

    • Angiotensin II

    • Angiotensin converting enzyme

    • Renin

    Correct Answer
    A. Renin
  • 26. 

    Where does angiotensin converting enzyme act upon angiotenin I?

    • Lungs

    • Kidneys

    • Liver

    • Coronary Vessels

    Correct Answer
    A. Lungs
  • 27. 

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

    • True

    • False

    Correct Answer
    A. True
  • 28. 

    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
  • 29. 

    Nitroglycerin is metabolized to what substance?

    • CGMP

    • Prusside

    • Nitric Oxide

    • Cyandie

    Correct Answer
    A. Nitric Oxide
  • 30. 

    Which of the following is NOT true regarding NTG?

    • Causes Spincter of Oddi spasms

    • Uses special tubing when administered

    • May cause headaches

    • Decreases left end diastolic pressure

    Correct Answer
    A. Causes Spincter of Oddi spasms
    Explanation
    Causes spincter of oddi relaxation

    Rate this question:

  • 31. 

    Which drug works through blockade of receptors in autonomic ganglia?

    • Hydralizine

    • Trimethapan

    • Ephedrine

    • Nimotop

    Correct Answer
    A. Trimethapan
  • 32. 

    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
  • 33. 

    You are the SRNA for Mr. Avier who has been having some problems with hypertension during surgery. He has been well controlled on a Nipride drip from the ICU that has been going 9 mcg/kg/min for an unknown amount of time. During the procedure he becomes severely hypertensive, and also develops tachycardia. You send an ABG just in case and find him to have metabolic acidosis. What should you do first?

    • Push Methlene blue 1-2mg/kg of 1% solution over 5 min

    • Stop the Nipride infusion and administer 100% O2

    • Give Thiosulfate 150 mg/kg over 15 min

    • Titrate Nipride until effective dose is reached

    Correct Answer
    A. Stop the Nipride infusion and administer 100% O2
  • 34. 

    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
  • 35. 

    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
  • 36. 

    What is the MOA of Loop diuretics?

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

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

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

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

    Correct Answer
    A. Inhibits reabsorption of sodium and chloride ions in the medullary portion of the ascending loop of Henle
  • 37. 

    Risk for toxicity is directly proportionate to potency.

    • True

    • False

    Correct Answer
    A. True
  • 38. 

    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
  • 39. 

    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
  • 40. 

    Which of the following is a pro-drug which must be metabolized by the liver before reaching its active form?

    • Captopril

    • Enalapril

    • Losartan

    • Hydrochlorothiazide

    Correct Answer
    A. Enalapril
  • 41. 

    How would you perform local anesthesia on a patient with a known pseudocholinesterase deficiency?

    • Administer local anesthesia with Bupivacaine

    • This has no effect on local anesthetics, only on succinylcholine.

    • Administer local anesthesia with Procaine

    • Patient may not receive any local anesthetics

    Correct Answer
    A. Administer local anesthesia with Bupivacaine
  • 42. 

    Which of the following is appropriate treatment for CNS toxicity associated with Local anesthetics? PICK TWO

    • Hyperoxygenate, Lipid rescue

    • Intubate the pt and wait it out, no treatment available

    • Tx seizures with benzos

    • Give Bretylium 20 mg/kg IV

    Correct Answer(s)
    A. Hyperoxygenate, Lipid rescue
    A. Tx seizures with benzos
  • 43. 

    What is the max dose of bupivacaine with epi to give to a pt weighing 60 kg?

    • 180 mg

    • 150 mg

    • 300 mg

    • 90 mg

    Correct Answer
    A. 180 mg
  • 44. 

    Which of the following is not true regarding ACE inhibitors?

    • May cause left ventricular hypertrophy to decrease

    • Delay progression of diabetic renal disease

    • First line treatment for HTN and mitral regurge

    • Commonly used to treat renal stenosis

    Correct Answer
    A. Commonly used to treat renal stenosis
  • 45. 

    Which of the following may cause methemoglobinemia?

    • Lidocaine

    • Prilocaine

    • Bupivacaine

    • Cocaine

    Correct Answer
    A. Prilocaine
  • 46. 

    Which of the following is NOT considered to be a safe dose of Nipride?

    • Bolus dose of 2 mcg/kg

    • Pt on IV Nipride 3 mcg/kg/min for past 12 hours

    • Pt on IV Nipride 11 mcg/kg/min for past 4 hours

    • All the above are safe doses

    Correct Answer
    A. Pt on IV Nipride 11 mcg/kg/min for past 4 hours
  • 47. 

    Which of the following medications would be appropriate to control autonomic hyperreflexia?

    • Hydralizine

    • Trimethapan

    • Sodium nitroprusside

    • Nimotop

    Correct Answer
    A. Trimethapan
  • 48. 

    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?

    • Epinephrine

    • Metoprolol

    • Phenylephrine

    • Ephedrine

    Correct Answer
    A. Phenylephrine
  • 49. 

    Which of the following side effects is not usually associated with thiazide diurectics?

    • Hypokalemia

    • Metabolic Alkalosis

    • Skeletal muscle weakness

    • Hemodilution

    Correct Answer
    A. Hemodilution

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