A Practice Test On Anesthesia! Trivia Quiz
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- 1.Which of the following is not one of the Five Principle pharmacological effects of Benzodiazepines?
- A.
Sedation
- B.
Anxiolysis
- C.
Retrograde Amnesia
- D.
Anticonvulsant
- E.
Spinal Cord mediated skeletal muscle relaxation
- 2.Which of the Benzodiazepines reviewed has the slowest onset of action and why?
- A.
Lorazepam- due to lower lipid solubility
- B.
Midazolam- due to its water solubility
- C.
Diazepam- due to rapid redistribution
- 3.While doing a pre-op assessment on an inpatient you find that the pt is currently taking Tagamet (cimetidine) and is on a Heparin regimen. With this knowledge you know to avoid which of the benzodiazepines?
- A.
Lorazepam
- B.
Diazepam
- C.
Midazolam
- D.
Thiopental
- 4.In regards to the adjustments of Benzodiazepines in respect to the elderly patient. Would you expect to have:
- A.
Significant increase in initial dose and anticipate marked decrease in duration of action
- B.
Modest decrease in initial dose and anticipate marked increase in duration of action
- C.
No change in dose or frequency or duration from that of an healthy 25 year old patient.
- D.
None of above
- 5.The dose of Benzodiazepines required to reach a desired clinical end point is increased in the elderly compared to the younger patient.
- A.
True
- B.
False
- 6.Benzodiazepines are extensively protein bound. Therefore, in the presence of renal failure their clinical effect will be:
- A.
Shortened
- B.
Prolonged
- C.
No significant change.
- 7.Define Affinity:
- A.
Inhibit or block responses caused by an agonist
- B.
Drugs which alter the physiology of a cell by binding to plasma membrane or intracellular receptors
- C.
The strength of binding between drug and receptor
- D.
Binds to a site other than the agonist-binding domain
- 8.A drug which alters the physiology of a cell by binding to plasma membrane or intracellular receptors is known as what?
- A.
Antagonist
- B.
Competitive Agonist
- C.
Competitive Antagonist
- D.
Agonist
- 9.What is an antagonist?
- A.
Inhibit or block responses caused by an agonist
- B.
A drug which alters the physiology of a cell by binding to plasma membrane or intracellular receptors
- C.
Biochemical messengers, often called 2ndmessengers
- D.
The strength of binding between drug and receptor
- 10.What is the MOA of Benzo's?
- A.
Blockade of chloride channels leading to depolarization and inhibition of neurotransmitter
- B.
Inhibition of cyclooxygenase activity
- C.
Inhibition of GABA receptor binding which leads to degredation of GABA, preventing it from exerting it's effect.
- D.
Enhances the inhibitory effects of various neurotransmitter by facilitating GABA receptor binding. This opens chloride channels and causes hyperpolarization.
- 11.How do midazolam and diazepam compare to one another?
- A.
Midazolam has 2 times the affinity for benzo receptors
- B.
Diazepam has 3 times the affinity for benzo receptors
- C.
Diazepam is hydrophilic
- D.
Midazolam has a much londer elimination half time
- 12.All benzo's share what similarities?
- A.
All are highly alkaline solutions
- B.
Composed of a benzene ring fused to a seven-membered diazepine ring
- C.
They are safe to be given during pregnancy
- D.
Composed of malonic acid and urea
- 13.How is midazolam unique in comparison to other benzo's?
- A.
It is the only benzo safe to give to pregnant women.
- B.
Is known to cause pain upon injection, but has minimal respiratory depression
- C.
It is hydrophilic and becomes lipid soluble upon exposure to blood.
- D.
It is not highly protein bound like the other benzo's and thus more is available for use by the body.
- 14.Which of the following drugs will cause pain upon injection due to the solvent propylene glycol?
- A.
Lorazepam
- B.
Flumazenil
- C.
Midazolam
- D.
Diazepam
- 15.What is an appropriate oral dose for pediatric pre-medication with midazolam?
- A.
0.5 mg/kg
- B.
1 mg/kg
- C.
2-3 mg
- D.
10 - 20 mcg/ kg
- 16.What would be an appropirate Adult IV induction dose for midazolam?
- A.
0.5 mg/kg
- B.
0.1 mg/kg
- C.
2-3 mg
- D.
4 mg/kg
- 17.You have just given you pt Midazolam, how long would you expect to wait to see onset of the drug?
- A.
3-5 minutes
- B.
20-25 minutes
- C.
30-60 seconds
- D.
2 minutes
- 18.When doing a pre-op evaluation for a pt you notice the pt has low albumin levels. How would this effect the amount of Midazolam given to the pt for pre-medication?
- A.
You would need to increase the amount given in order to reach the desired effect
- B.
You would not change the dose at all.
- C.
You would decrease the amount of drug given since this pt may be at risk for overdose.
- 19.Put these medications in order of shortest elimination half time to longest: Midazolam, Diazepam, Lorazepam
- A.
Midazolam < Diazepam < Lorazepam
- B.
Diazepam < Lorazepam < Midazolam
- C.
Lorazepam < Midazolam < Diazepam
- D.
Midazolam < Lorazepam < Diazepam
- 20.What is the elimination half time of Midazolam?
- A.
21-37 hours
- B.
1-4 hours
- C.
10-20 hours
- D.
5-10 hours
- 21.What is the elimination half time of Lorazepam?
- A.
1-4 hours
- B.
21-37 hours
- C.
10-20 hours
- D.
5-10 hours
- 22.What is the elimination half time of Diazepam?
- A.
5-10 hours
- B.
1-4 hours
- C.
10-20 hours
- D.
21-37 hours
- 23.Describe the metabolism and excretion of the benzodiazepines?
- A.
Metabolized by liver and excreted in the urine
- B.
Metabolized in kidneys and excreted in feces
- C.
Metabolized by liver and excreted in feces
- D.
Metabolized in kidneys and excreted by urine
- 24.What effects do benzodiazepines exert upon the cardiovascular system?
- A.
No effect on cardiovascular system, even at high doses.
- B.
Decrease BP & PVR, especially in hypovolemic pt
- C.
Decrease ABP, CO & HR
- D.
Increase HR and decrease SV
- 25.Benzodiazepines are preferred as a pre-medication for anesthesia because they do not cause any respiratory depression in patients.
- A.
True
- B.
False
- 26.Which of the following is not a cerebral effect of benzodiazepines?
- A.
Reduce CMRO2 & CBF
- B.
Increase the seizure threshold to prevent seizure
- C.
Anti-anxiety & sedative effects
- D.
Direct Analgesic Effects
- 27.Where would you find benzodiazepine receptors?
- A.
Primarily on the postsynaptic nerve endings in the cerebral cortex
- B.
Pre-synaptic nerve endings in the brain stem and spinal cord.
- C.
Brain, spinal cord and peripheral tissue: pre-synaptic and post synaptic.
- 28.What is a non-competitive antagonist?
- A.
A drug which alters the physiology of a cell by binding to plasma membrane or intracellular receptors
- B.
Binds to a site other than the agonist-binding domain
- C.
A drug which really hates playing sports, and instead takes a bunch of art classes.
- D.
A drug which inhibits a normal cellular function by competing with agonists for receptors
- 29.Why should you be cautious when giving both an opioid and a benzo together?
- A.
You increase risk for arrythmias
- B.
Patient may lose respiratory drive
- C.
You may increase ICP & SVR
- D.
You may severely reduce ABP
- 30.What drug would you choose to treat a pt with a benzodiazepine overdose?
- A.
Flumazenil, slow titration of 0.2 mg doses IV
- B.
Narcan, slow titration of 1-4mcg/kg
- C.
Flurazepam 15-30 mg
- D.
Just wait it out.
- 31.Which benzo would be used to treat panic attacks?
- A.
Lorazepam
- B.
Alprazolam
- C.
Flurazepam
- D.
Diazepam
- 32.How much oral midazolam would you give to a child weighing 40 kg?
- A.
40 mg
- B.
4 mg
- C.
20 mg
- D.
60 mg
- 33.You are holding a room temperature bottle of thiopental that was mixed 5 days ago. Can you still use it?
- A.
Yes, still good!
- B.
Nope, it is only stable for 2 days
- C.
If it had been refrigerated it would be good, but now it is not. Don't use.
- 34.How long can Methohexital be refrigerated and stable for after mixing?
- A.
2 weeks
- B.
6 weeks
- C.
6 days
- D.
1 month
- 35.Substitutions on the carbon atoms of barbituates determine all of the following except:
- A.
Hypnotic potency
- B.
Anti-convulsant properties
- C.
Protein binding
- D.
Duration of action
- 36.A barbituate with an oxygen atom on the #2 carbon would be called a...
- A.
Thiobarbituates
- B.
Malobarbituates
- C.
Pentabarbituates
- D.
Oxybarbituate
- 37.A Barbituate with a sulfur atom on the #2 carbon is called a...
- A.
Thiobarbituates
- B.
Oxybarbituates
- C.
Pentabarbituate
- D.
Sulbarbituates
- 38.What is the MOA of barbituates?
- A.
Act at stereospecific receptors at presynaptic and postsynaptic sites in the central nervous system– brain(periaqueductal gray, amygdala, corpus striam, and hypothalmus) and spinal cord(substanstantia geltinosa) and in the peripheral tissues.
- B.
Depression of the reticulcar activating system, suppression of excitatory neurotranmitters and enhancement of inhibitory neurotransmitters.
- C.
Receptor binding enhances the inhibitory effects of various neurotransmitter by facilitating GABA receptor binding. This opens chloride gating channels, producing hyperpolarization of post synaptic cell membranes and rendering post synaptic neurons more resistant to excitation.
- 39.Distribution of barbituates depends on all of the following except...
- A.
Lipid Solubility
- B.
Protein binding
- C.
Hepatic oxidation
- D.
Degree of ionization
- 40.Duration of action of highly lipid soluble barbituates is determined by...
- A.
Hepatic Oxidation
- B.
Lipid Solubility
- C.
Renal Excretion
- D.
Redistribution
- 41.How much methohexital would you expect to find excreted unchanged in the urine?
- A.
< 1%
- B.
1-3 %
- C.
5-10 %
- D.
95%
- 42.The elimination half time of Methohexital is ~4 hours.
- A.
True
- B.
False
- 43.What is responsible for the quick awakening associated with a single dose of thiopental?
- A.
Rapid hepatic oxidation
- B.
Rapid renal excretion
- C.
Redistribution
- D.
Patient respiratory rate
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