2012 Pharm II - Quiz 2 - Quiz, Flashcards & Trivia

1. Which of the following is not one of the 3 mechanisms for termination of norepinephrine?

Re-uptake

Diffusion from receptor sites

Irreversible protein binding

Enzyme degredation

2. Which of the following is an appropriate renal dose of dopamine?

2 mcg/kg/min

8 mcg/kg/min

15 mcg/kg/min

All of above

3. What is the preferred medication to raise the BP of an OB patient?

Epinephrine

Amphetamine

Dopamine

Ephedrine

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All of the above

5. Phenylephrine primarily acts upon which receptor?

Beta 2

Alpha 1

Beta 1

Alpha 2

6. Which of the following is an alpha 2 agonist?

Phenylephrine

Norepinephrine

Clonodine

Dopamine

7. Which of the following would be the best choice to increase cardiac contractility in a pt with CHF and CAD?

Phenylephrine

Dopamine

Dobutamine

Norepinephrine

8. What is the mechanism of action of Diltiazem?

Beta 2 agonist

Blocks calcium channels of AV node

Directly relaxes arterial smooth muscle

Imitates cGMP in smooth vasculature

9. Which of the following is would not increase risk for cardiac disarrythmias?

ST elevation on ECG

Low serum K

ABG showing hypoxia

Diabetes

10. Which of the following is not a cardiac effect of alpa 1 receptor activation?

Decrease SVR

Vasoconstriction

Increase LV afterload

Increase arterial BP

11. When Tyrosine is hydroxylated it becomes what?

Dopa

Phenylalanine

Norepinephrine

Epinephrine

12. Stimulation of Beta 1 receptors is likely to have all of the following effects except …

Increase Contractility

Increase HR

Increase CO

Decreased SVR

13. You are having the worst day ever, you have just had to give Dantrolene to a pt (and you know what that means….). When looking over the pts medical history again you find their medication list includes verapimil. GGrrrreeeaaaaaaattt. Now what should you start checking? (Cause you know, your day wasn’t screwed enough already)

Watch your Arterial BP very closely, these drugs together cause profound HTN and increase risk for stroke

Monitor pt for cyanide toxicity

Send serum K levels and watch for arrythmias

Monitor pt for hypoxemia and signs of seizures

14. What is the postsynaptic neurotransmitter of the parasympathetic nervous system?

Acetylcholine

Norepinephrine

Epinephrine

Tyrosine

15. After the breakdown of epinephrine by MAO and COMT, what product is excreted in the urine?

Vanillymandelic Acid

3,7-dicarboxyvandelic acid

Nelson-Mandelic Acid

4,6-Pheocomtic acid

16. Which of the following is a pre-synaptic receptor?

Alpha 1

Alpha 2

Beta 1

Beta 2

17. How do class I antidysrhythmic drugs work?

By antagonizing adrenergic receptors

Through blockade of Na channels.

By blocking the slow inward calcium driven current

By prolonging repolarization

18. Which of the following is release from the adrenal gland in times of stress and acts on alpha and beta receptors?

Dopamine

Norepinephrine

Epinephrine

Acetylcholine

19. Which of the following is not an effect of precedex?

Maintaining respiratory stability

Sedation

Reduces brain Noradrenergic Activity

Increase pt BP

20. What is an appropriate IV starting dose of lidocaine to control frequent PVC’s?

4.5 mg/kg

10 mg/kg

2 mg/kg

5 mg/kg

21. You are caring for Mrs. Undavi who is the ER right now. She takes a wide range of cardiac medications, and is currently complaining of pain in her face (alone jaw, nose and forehead). She has also been been vomiting all day and has not eaten a thing all day due the nausea. What do you thing may be wrong with her?

Digitalis Toxicity

Lidocaine Toxicity

Amiodarone Toxicity

Phenytoin Toxicity

22. Which of the following would be the best choice to prevent vasospasms associated with subarachnoid hemorrhage?

Nifedipine

Diltiazem

Isoproteronol

Nimodipine

23. Activation of Alpha 2 receptors inhibits ______ activity.

Dopa-b hydroxylase

Tyrosine

Adenylate cyclase

COMT

24. Which calcium channel blocker will cause the greatest amount of coronary vasodilation?

Nifedipine

Nicardipine

Nimodipine

Hydralyzine

25. What occurs during Phase 2 of action potential?

Repolarization to resting potential results from outward K current

Rapid phase of repolarization caused by inactivation of Na influx and activation of a transient outward K current

Voltage dependent Na channel opens and rapid sodium influx depolarizes cell

Plateau phase, characterized by low membrane conductance and the activation of slow inward Ca current

Outward K current is deactivated and an inward Na current reduces transmembrane potential

26. Depolarization of cardiac cells mainly has to do with _____, while repolarization has to do mainly with _____.

Calcium, Magnesium

Potassium, Sodium

Magnesium, Calcium

Sodium, Potassium

27. You are the SRNA for Mr. Kodaris who is have open heart surgery today. Which of the following medications would be useful to give pre-op to decrease the incidence of post-op A-fib?

Amiodarone

Lidocaine

Digitalis

Procainamide

28. Which of the following Antidysrhythmic medication may cause seizures?

Phenytoin

Amiodarone

Procainamide

Lidocaine

29. Which of the following would be the best medication to increase the HR on a pt with an amiodarone induced heart block?

Isoproterenol

Phenylephrine

Ephedrine

Calcium Chloride

30. What is the postsynaptic neurotransmitter of the sympathetic nervous system?

Acetylcholine

Norepinephrine

Epinephrine

Tyrosine

31. When a neurotransmitter binds to a postsynaptic receptor it is likely to likely cause which of the following?

Opening of an ion channel

Activation of a second messenger such as cAMP or inositol phosphate

Depolarization

All of above.

32. How do class III antidysrhythmic drugs work?

By antagonizing adrenergic receptors

Through blockade of Na channels.

By blocking the slow inward calcium driven current

By prolonging repolarization

33. What is half life of amiodarone?

29 days

2 months

17 hours

8 days

34. Where is norepinephrine synthesized?

Post-synaptic neurons

Pineal Body

Posterior Lobe of Pituitary

Synaptic Vessicles

35. Epinephrine should be used cautiously in patients with what condition?

Dysrhythmias

Renal Failure

COPD

Hypertensive ischemic heart disease

36. Why do direct acting non-catecholamine have a longer serum half life than catecholamine?

They are not metabolized by MAO or COMT

Higher degree of protein binding

Increase volume of distribution

All of above

37. Which of the following has both direct and indirect sympathomimetic activity?

Norepinephrine

Amphetamine

Ephedrine

Phenylephrine

38. What occurs during Phase 0 of action potential?

Repolarization to resting potential results from outward K current

Rapid phase of repolarization caused by inactivation of Na influx and activation of a transient outward K current

Voltage dependent Na channel opens and rapid sodium influx depolarizes cell

Plateau phase, characterized by low membrane conductance and the activation of slow inward Ca current

Outward K current is deactivated and an inward Na current reduces transmembrane potential

39. Which of the following drugs would be appropriate to treat hypotension in a patient who is taking MAOI’s?

Vifedipine

Epinephrine

Dopamine

Phenylephrine

40. Norepinephrine exerts its greatest action on which receptors?

Alpha

Beta 1

Beta 2

All are equal

41. What dose of dopamine would you give to achieve selective beta 1 agonism?

16 mcg/kg/min

24 mcg/kg/min

5 mcg/kg/min

42. What dose of Dopamine would you give to achieve alpha 1 agonism and an increase in PVR?

16 mcg/kg/min

24 mcg/kg/min

5 mcg/kg/min

43. At which subunit do calcium channel blockers exert their action?

Beta 1

Alpha 1

Alpha 2

Beta 2

44. N-Methyltransferase acts on Norepinephrine in the adrenal medulla to turn it into…

Vanillymandelic acid

Dopa

Epinephrine

Ephedrine

45. What is the mechanism of action of dexmedetomidine hydrochloride?

Beta 2 adrenoreceptor agonist

Alpha 2 adrenoreceptor agonist

Potentiation of GABA

None of above

46. What enzyme acts on Dopamine to turn it into Norepinephrine?

N-methyltransferase

Dopamine B-Hydroxylase

DOPA decarboxylase

Dopamine does not directly turn into norepi… you’re missing a step.

47. How do calcium channel blockers reduce myocardial O2 demand? (two answers)

Through decrease in preload

By decreasing HR

Through a decrease in Afterload

Through alpha 2 antogonist activity

Submit

48. Beta 2 agonism may result in which of the following electrolyte imbalances?

Hypokalemia

Hypochloremia

Hyponatremia

None of above

49. What is an appropriate IV dose of amiodarone?

1.5 mg/kg in NS every 5 min

2 mg/kg rapid IV push

5 mg/kg over 2-5 min

2-6 mg/min IV infusion

50. You are the SRNA for Ms. Nyen, who is having a liver biopsy today. You see her home meds include amiodarone. Knowing about the effects of amiodarone, how will this affect your anesthesia management?

You should not use Isoflurane due to increased risk of sinus arrest

Pt is at an increased risk for aspiration and thus requires RSI

Should not use Sux as pt is likely to be hyperkalemic

Decrease FiO2 to decrease risk of pulmonary alveolitis

51. How do class IV antidysrhythmic drugs work?

By antagonizing adrenergic receptors

Through blockade of Na channels.

By blocking the slow inward calcium driven current

By prolonging repolarization

52. Which of the following is not a direct sympathomimetic?

Phenylephrine

Amphetamine

Isoproterenol

Dobutamine

53. How do class II antidysrhythmic drugs work?

By antagonizing adrenergic receptors

Through blockade of Na channels.

By blocking the slow inward calcium driven current

By prolonging repolarization

54. Which of the following will have the greatest effect on AV node conduction?

Nifedipine

Verapimil

Nimodipine

Diltiazem

55. Norepinephrine is synthesized from ______ which is hydroxylated to form Dopa.

Dopamine

Tyrosine

COMT

Phenylalanine

56. Which medication would be the best choice to suppress SVT in a patient with Wolff-Parkinson White syndrome?

Lidocaine

Amiodarone

Phenytoin

Digitalis

57. Which of the following is not a factor associated with cardiac dysrhythmias?

Altered sympathetic nervous system activity

Venous Hypoxia

Myocardial Ischemia

Bradycardia

58. Which of the following drugs would be the best choice for Mrs. Taliss who is experiencing a ventricular dysrhythmia due to digitalis toxicity?

Phenytoin

Digoxin

Lidocaine

Amiodarone

59. Which of the following neuro-muscular blockers would not have a prolonged effect on a pt taking cardene?

Calcium channel blockers prolong both depolarizing and non-depolarizing agents

Succinylcholine

Rocuronium

Cisatracurium

60. Which of the following would not be an effect of epinephrine?

Increased renal blood flow

Increase rate of phase IV depolarization

Bronchodilation

Increase cerebral perfusion pressure

61. A 1: 10,000 mix of epinephrine contains how many micrograms of epinephrine per ml?

10

5

100

20

62. What effect will ephedrine have on your MAC?

Increase MAC

Decrease MAC

No effect on MAC

63. Free calcium reacts with _______ to increase the number of cross bridges and thus increase strength of contraction.

Troponin

Myosin

Actin

Phosphokinase

64. What would be an appropriate dose of phenytoin to give to a patient in Torsades?

100 mg in D5NS every 5 minutes

5mg/kg over 2 minutes

18 mcg/kg

1.5 mg/kg in NS every 5 min

65. Where does dopa-b hydroxylase act upon dopamine to turn it into norepinephrine?

Mitochondria

Synaptic cleft

Synaptic Vessicles

Storage Vessicles

66. How will Renal impairment effect metabolism of Precedex?

It won’t effect it… only hepatic impairment will.

You will need to decrease the dose

You will need to increase the dose

Pt will be more prone to bradycardia and hypotension

67. What is the mechanism of action of Lidocaine as a Class 1 antidysrhythmic?

Blocks calcium channels

Decreases rate of phase 4 repolarization

Depresses conduction in AV node

Inhibits NA-K-ATPase ion transport system

68. What is the mechanism of action of digitalis?

Blocks calcium channels

Decreases rate of phase 4 repolarization

Depresses conduction in AV node

Inhibits NA-K-ATPase ion transport system

69. Which of the following will not increase the risk of Dig toxicity?

Impaired renal Function

Concurrent administration of Ca Channel blocker

Hypocalcemia

Hypomagnesemia

70. What occurs during Phase 3 of action potential?

Repolarization to resting potential results from outward K current

Rapid phase of repolarization caused by inactivation of Na influx and activation of a transient outward K current

Voltage dependent Na channel opens and rapid sodium influx depolarizes cell

Plateau phase, characterized by low membrane conductance and the activation of slow inward Ca current

Outward K current is deactivated and an inward Na current reduces transmembrane potential

71. Which of the following Class I antidysrhythmics will have little effect on phase 0 depolarization?

Class IB

Class IA

Class IC

All the above have profound effects upon Phase O depolarization.

72. How would you treat bradycardia in a patient who has been given amiodarone?

Transcutaneous pacemaker

Atropine

Gylcopyrolate

Phenytoin

73. What occurs during Phase 4 of action potential?

Repolarization to resting potential results from outward K current

Rapid phase of repolarization caused by inactivation of Na influx and activation of a transient outward K current

Voltage dependent Na channel opens and rapid sodium influx depolarizes cell

Plateau phase, characterized by low membrane conductance and the activation of slow inward Ca current

Outward K current is deactivated and an inward Na current reduces transmembrane potentialt

74. What occurs during Phase 1 of action potential?

Repolarization to resting potential results from outward K current

Rapid phase of repolarization caused by inactivation of Na influx and activation of a transient outward K current

Voltage dependent Na channel opens and rapid sodium influx depolarizes cell

Plateau phase, characterized by low membrane conductance and the activation of slow inward Ca current

Outward K current is deactivated and an inward Na current reduces transmembrane potential

75. Which of the following is not true regarding Terbutaline?

May treat pulmonary edema

May relax the uterus in near term pregnant women

Increases secretion of rennin

Exerts its action primarily on Beta 2 receptors

76. Which of the following is not a direct acting catecholamine?

Epinephrine

Dobutamine

Phenylephrine

Isoproterenol

77. How will a pt who has a history of chronic amphetamine abuse affect your anesthetic requirements?

Increase MAC

Decrease MAC

No Effect

78. What is the most potent activator of alpha adrenergic receptors?

Norepinephrine

Ephedrine

Phenylephrine

Epinephrine

79. Which of the following drugs should not be administered to pts taking Digitalis?

Nicardipene

Amiodarone

Calcium

All the above

80. What would be an appropriate IV infusion dose of procainamide to control v-tach?

2 mg/kg/min

2-6 mg/min

1-3.5 mcg/kg/min

5-15 mg/min

81. What is the appropriate shock and allergic reaction dose of epinephrine?

1:1000 solution .1-.5 ml SQ/IM

0.05 -1mg IV

2-20 ug/min

Racemic inhalation 0.5 ml of 2.25% solution

82. What would be the best choice to suppress SVT caused by reentry phenomenon in the heart?

Procainamide

Phenytoin

Lidocaine

Digitalis

83. Which of the following is not an effect of norepinephrine?

Increase myocardial O2 demand

Increase CO

Bradycardia

Increase Afterload