Anesthetic Pharmacology



Anesthetic Pharmacology


Mian Ahmad and Ashish Sinha


    1.   Correct statement about metabolism of drugs by the liver is


          A.   For drugs with low extraction ratio, liver blood flow is the rate-limiting step in their metabolism


          B.   For drugs with high extraction ratio, the capacity of the liver to metabolize the drug is the rate-limiting step


          C.   Cytochrome P450 system is highly drug-specific


          D.   Removal of the drug from the blood by hepatic clearance is directly proportional to hepatic blood flow and intrinsic clearance


    2.   When asked to describe the symptoms of her allergy to a local anesthetic that a 26-year-old female had at the dentist’s office, the patient describes a feeling of light-headedness, palpitations, and flushing. This reaction is most likely caused by


          A.   Methylparaben reaction


          B.   Vasovagal reaction


          C.   Para-aminobenzoic acid allergy


          D.   Epinephrine in the local anesthetic


    3.   All of the following drugs increase the mean arterial blood pressure, except


          A.   Dopamine


          B.   Norepinephrine


          C.   Epinephrine


          D.   Isoproterenol


    4.   All of the following drugs increase cardiac output, except


          A.   Dopamine


          B.   Epinephrine


          C.   Dobutamine


          D.   Norepinephrine


    5.   In general, norepinephrine causes increase in all of the following, except


          A.   Mean arterial blood pressure


          B.   Heart rate


          C.   Cardiac dysrhythmias


          D.   Systemic vascular resistance


    6.   Stimulation of α2 receptors causes


          A.   Hypertension


          B.   Bradycardia


          C.   Salivation


          D.   Anxiety


    7.   Labetalol is relatively contraindicated for


          A.   Treatment of hypertension in aortic dissection


          B.   Treatment of hypertension in preeclampsia


          C.   Hypertensive emergencies after cardiac surgery involving second-degree heat block


          D.   Hypertension secondary to clonidine withdrawal


    8.   The best initial treatment for anaphylaxis during general anesthesia is


          A.   Methylprednisolone


          B.   Famotidine


          C.   Diphenhydramine


          D.   Epinephrine


    9.   Compared with thiopental, etomidate causes


          A.   Less nausea


          B.   Increased seizure threshold


          C.   Greater myoclonic activity


          D.   Greater histamine release


  10.   Compared with propofol, ketamine causes


          A.   More depression of respiratory drive


          B.   More depression of airway reflexes


          C.   More bronchodilation


          D.   Less analgesia


  11.   A 65-year-old African American patient is undergoing laparoscopic repair of inguinal hernia under general anesthesia. He has a history of hypertension, diabetes, and depression. His medication list includes lisinopril, hydrochlorothiazide, metformin, and phenelzine. Intraoperative hypotension develops secondary to injury to inferior epigastric artery. Which of the following medications is relatively contraindicated to treat this hypotension?


          A.   Epinephrine


          B.   Norepinephrine


          C.   Ephedrine


          D.   Phenylephrine


  12.   True statement regarding flumazenil is


          A.   It binds irreversibly with benzodiazepine receptor


          B.   It causes hypertension and tachycardia


          C.   It has a shorter duration of action than midazolam


          D.   It reverses opioid-induced respiratory depression


  13.   Midazolam can be administered through all of the following routes, except


          A.   Oral


          B.   Sublingual


          C.   Transcutaneous


          D.   Transnasal


  14.   When sodium bicarbonate is added to lidocaine, more rapid onset of action of lidocaine occurs because of


          A.   Increased nonionized lidocaine concentration


          B.   Increased ionized lidocaine concentration


          C.   Decreased extracellular pH


          D.   Increased intracellular pH


  15.   Which of the following findings suggests current use of cocaine in a patient undergoing preoperative evaluation?


          A.   Bradycardia


          B.   Hypertension


          C.   Pinpoint pupils


          D.   Hypothermia


  16.   Which of the following local anesthetics is an ester?


          A.   Lidocaine


          B.   Prilocaine


          C.   Mepivacaine


          D.   Cocaine


  17.   Which of the statements among the following is true?


          A.   Ropivacaine is more potent than bupivacaine


          B.   Ropivacaine causes more motor than sensory block


          C.   Bupivacaine causes more vasoconstriction than ropivacaine


          D.   Ropivacaine is an S-enantiomer of bupivacaine


  18.   A 75-year-old patient is shivering and has chest pain in the recovery room following exploratory laparotomy for a rupture-obstructed hernia. His heart rate is 123/min, blood pressure is 200/100 mm Hg, and SpO2 is 97% on 2 L of oxygen via nasal cannula. An EKG shows ST-T wave changes, which are treated with nitroglycerine with no effect. Which of the following is the most appropriate next step?


          A.   Administration of hydralazine


          B.   Administration of nitroprusside


          C.   Administration of esmolol


          D.   Application of a warming blanket


  19.   Which of the following statements about the local anesthetics is false?


          A.   They are weak bases


          B.   They contain either ester or amide linkage


          C.   It is their charged form that interacts with the receptor


          D.   They bind the receptor inside the cell


  20.   Local anesthetics cause their effects by


          A.   Increasing the threshold potential


          B.   Altering the resting membrane potential


          C.   Increasing the rate of depolarization


          D.   Decreasing the rate of depolarization


  21.   Lipid solubility of local anesthetics


          A.   Generally correlates directly with the time to onset of action


          B.   Increases as the fraction of ionized form of the local anesthetic increases


          C.   Increases as the fraction of unionized form of the local anesthetic increases


          D.   May be different in in vivo or in vitro systems


  22.   Which is the correct expected duration of anesthesia after infiltration with the following local anesthetics?



















A.   Lidocaine


60 to 120 minutes


B.   Mepivacaine


120 to 240 minutes


C.   Ropivacaine


120 to 180 minutes


D.   Bupivacaine


120 to 180 minutes


  23.   Use of which of the following local anesthetics for spinal anesthesia is controversial?


          A.   Ropivacaine


          B.   Bupivacaine


          C.   Tetracaine


          D.   Lidocaine


The following three questions belong to this clinical situation:


During placement of an interscalene block utilizing 0.5% bupivacaine, a 62-year-old patient suddenly starts experiencing seizures and loses consciousness.


  24.   Which of the following statements regarding local anesthetic toxicity is correct?


          A.   Seizure is a sign of neurotoxicity from high dose of local anesthetic


          B.   Loss of consciousness is a sign of low-dose local anesthetic neurotoxicity


          C.   The seizure threshold is increased by the administration of thiopental


          D.   Seizure may have been caused by injection of the local anesthetic into cervical nerve root


  25.   Which of the following statements is false?


          A.   Seizure may have happened secondary to the injection of local anesthetic into vertebral artery


          B.   Loss of consciousness may be secondary to high epidural anesthesia


          C.   Loss of consciousness may be secondary to high spinal anesthesia


          D.   In general, decreased local anesthetic protein-binding decreases potential CNS toxicity


  26.   Which of the following statements is false?


          A.   Repeated attempts at aspiration would have prevented this complication


          B.   Addition of epinephrine to the local anesthetic may have helped to prevent this complication


          C.   Loss of consciousness means that patient has developed cardiac arrest


          D.   Amiodarone is the first line of treatment for cardiovascular toxicity caused by bupivacaine


  27.   During induction of anesthesia for cesarean delivery in a 22-year-old female, rocuronium is inadvertently substituted for succinylcholine. The neonate does not show any sign of muscle relaxation because rocuronium is


          A.   Highly protein bound


          B.   “Unaffected by ion trapping”


          C.   Lipid soluble


          D.   Highly ionized


  28.   All of the following can lead to hyperkalemic response to the administration of succinylcholine, except


          A.   Burn injury


          B.   Spinal cord injury


          C.   Prolonged ICU stay


          D.   Cerebral palsy


  29.   The dibucaine number in a patient having heterozygous type of plasma cholinesterase will be


          A.   20% to 30%


          B.   30% to 40%


          C.   60% to 80%


          D.   50% to 60%


  30.   Which of the following muscle relaxants is eliminated mostly by the kidneys?


          A.   Rocuronium


          B.   Succinylcholine


          C.   Vecuronium


          D.   Pancuronium


  31.   The correct recommended intubating dose among the following muscle relaxants is



















A.   Vecuronium


0.08 to 0.1 mg/kg


B.   Pancuronium


0.05 to 0.07 mg/kg


C.   Succinylcholine


0.5 to 0.07 mg/kg


D.   Cisatracurium


0.5 to 0.8 mg/kg


  32.   Which of the following drugs is able to cross the blood–brain barrier?


          A.   Physostigmine


          B.   Neostigmine


          C.   Pyridostigmine


          D.   Glycopyrrolate


  33.   All of the following are side effects of anticholinesterase drugs, except


          A.   Excessive salivation


          B.   Increased bowel motility


          C.   Bradycardia


          D.   Bronchodilation


  34.   Which of the following characteristics of electrical stimulation is the correct representation of the stimulus generated by the nerve stimulator used for monitoring the neuromuscular blockade?


          A.   Tetany: A sustained stimulus of 50 to100 Hz, usually lasting 2 seconds


          B.   Twitch: A single pulse 0.5 second in duration


          C.   Train of four: A series of four twitches in 2 seconds (2-Hz frequency), each 0.2 ms long


          D.   Double-burst stimulation: Three short (0.2 ms) high-frequency stimulations separated by a 30-ms interval and followed 1 second later by two or three additional impulses


  35.   Which of the following antibiotics augments the action of nondepolarizing muscle relaxants?


          A.   Penicillin


          B.   Cephalosporin


          C.   Erythromycin


          D.   Streptomycin


  36.   Immediately after induction of general anesthesia for hip replacement surgery, a 56-year-old patient with severe mitral stenosis and a normal ejection fraction develops a blood pressure of 70/35 mm Hg with a heart rate of 90 bpm. Which of the following is the most appropriate initial treatment?


          A.   Dobutamine


          B.   Epinephrine


          C.   Phenylephrine


          D.   Milrinone


  37.   Mechanism of action of droperidol involves antagonism at all of the following receptors, except


          A.   Serotonin


          B.   Dopamine


          C.   α-Adrenergic


          D.   Glutamate


  38.   Which of the following is not seen in acute cyanide poisoning?


          A.   Metabolic acidosis


          B.   Cardiac arrhythmias


          C.   Tolerance to the antihypertensive effect of nitroprusside


          D.   Decreased mixed venous oxygen saturation


  39.   Which of the following medications is associated with extrapyramidal effects?


          A.   Midazolam


          B.   Glycopyrrolate


          C.   Metoclopramide


          D.   Famotidine


  40.   Which of the following medications should be discontinued before the elective surgery?


          A.   Metoprolol


          B.   Monoamine oxidase inhibitors


          C.   Atorvastatin


          D.   Ranitidine


  41.   Administration of magnesium sulfate for preeclampsia results in a decreased dose requirement for each of the following, except


          A.   Succinylcholine


          B.   Rocuronium


          C.   Desflurane


          D.   Lidocaine


  42.   Benefits of epinephrine 1:200,000 added to lidocaine for an epidural injection include all of the following, except


          A.   Prolongation of duration of action of lidocaine


          B.   Better quality of block


          C.   Prophylactic treatment of hypotension associated with the bolus administration of lidocaine


          D.   Delayed absorption into systemic circulation, thereby decreasing probability of local anesthetic toxicity


  43.   Which of the following choices is correct regarding the blood gas partition coefficient?


          A.   Nitrous oxide 0.47


          B.   Desflurane 0.62


          C.   Isoflurane 2.4


          D.   Sevoflurane 0.85


  44.   The use of neostigmine to reverse residual neuromuscular block may slow the metabolism of which of the following drugs administered subsequently?


          A.   Rocuronium


          B.   Cisatracurium


          C.   Pancuronium


          D.   Succinylcholine


  45.   A 45-year-old patient with history of hypertrophic subaortic cardiomyopathy becomes hypotensive. Which of the following drugs is most appropriate for treatment of hypotension?


          A.   Ephedrine


          B.   Amrinone


          C.   Phenylephrine


          D.   Nitroglycerine


  46.   Factors that contraindicate ketorolac administration include all of the following except


          A.   Renal insufficiency


          B.   Factor VIII deficiency


          C.   Active peptic ulcer disease


          D.   Daily ingestion of aspirin


  47.   After receiving massive blood transfusion, a patient anesthetized with isoflurane, fentanyl, and nitrous oxide develops acute pulmonary edema. The drug most likely to help him acutely is


          A.   Isoflurane


          B.   Nitroglycerine


          C.   Digoxin


          D.   Morphine


  48.   A 22-year-old college athlete with a history of prolonged QT syndrome presents for an inguinal hernia repair. Which of the following agents would be least likely to further lengthen the QT interval?


          A.   Ondansetron


          B.   Metoclopramide


          C.   Succinylcholine


          D.   Propofol


  49.   Which of the following statements concerning naloxone is true?


          A.   Elimination half-life is longer than most of the μ-receptor opioids


          B.   It has mixed agonist–antagonist activity


          C.   It relieves opioid-induced spasm of the sphincter of Oddi


          D.   It does not cross the placenta


  50.   Which of the following drugs is most likely to cause tachycardia?


          A.   Fentanyl


          B.   Meperidine


          C.   Morphine


          D.   Sufentanil


  51.   Addition of fentanyl to epidural bupivacaine will cause


          A.   No change in duration of analgesia


          B.   More rapid onset of analgesia


          C.   Increased vagal activity


          D.   Increased sensory block


  52.   Compared with sufentanil, alfentanil is characterized by


          A.   Higher pKa


          B.   Larger unionized fraction at physiologic pH


          C.   Less protein-binding


          D.   Greater lipid solubility


  53.   An inhaled anesthetic has blood/gas partition coefficient of 14.8. Recovery time primarily depends on


          A.   Oil/gas solubility of the agent


          B.   Cardiac output


          C.   Duration of administration


          D.   MAC of the drug


  54.   Nitroprusside therapy for hypertension should be discontinued in the presence of


          A.   Acute myocardial infarction


          B.   Increasing metabolic acidosis


          C.   Mitral regurgitation


          D.   Renal failure


  55.   A 24-year-old man is apprehensive of general anesthesia and prefers a regional anesthetic. Decision is made to conduct spinal anesthesia for the repair of inguinal hernia along with midazolam and fentanyl to allay anxiety. During the procedure, he suddenly loses consciousness. There is profound hypotension with systolic blood pressure of 44 mm Hg and a heart rate of 28 bpm. Cardiopulmonary resuscitation is started. The next most appropriate intervention is administration of


          A.   Atropine


          B.   Ephedrine


          C.   Epinephrine


          D.   Flumazenil


  56.   The effect of gentamycin at the neuromuscular junction is


          A.   Prevented by pretreatment with magnesium


          B.   Potentiated by anticholinesterases


          C.   Decreased by depolarizing relaxants


          D.   Partially reversed by calcium


  57.   Compared with lorazepam (Ativan), midazolam (Versed)


          A.   Has a shorter elimination half-life


          B.   Has more rapid clearance


          C.   Has a larger volume of distribution


          D.   Undergoes slower hepatic metabolism


  58.   The drug that causes dose-dependent EEG evidence of both central nervous system excitation and depression is


          A.   Thiopental


          B.   Lidocaine


          C.   Isoflurane


          D.   Midazolam


  59.   Normal pseudocholinesterase


          A.   Is produced primarily at nerve terminals


          B.   Is antagonized by acetyl cholinesterase


          C.   Resists dibucaine inhibition more than atypical pseudocholinesterase


          D.   Metabolizes succinylcholine by Hofmann elimination


  60.   Succinylcholine has prolonged action in patients carrying homozygous pseudocholinesterase. Which of the following best explains this phenomenon?


          A.   Diffusion away from the neuromuscular junction is slow


          B.   Hepatic clearance of succinylcholine is reduced


          C.   Succinylmonocholine induces neuromuscular block


          D.   An increased proportion of succinylcholine reaches the neuromuscular junction


  61.   Opioid analgesics cause all of the following effects except


          A.   Contraction of smooth muscle of the gallbladder


          B.   Contraction of detrusor muscle of the urinary bladder


          C.   Depress cellular immunity


          D.   Delayed gastric emptying


  62.   Opioids may have more pronounced action in all of the following except


          A.   In men compared to women


          B.   In older than in younger patients


          C.   During liver transplant surgery


          D.   In kidney failure


  63.   Which of the following drugs decreases lower esophageal sphincter tone?


          A.   Succinylcholine


          B.   Glycopyrrolate


          C.   Metoclopramide


          D.   Neostigmine


  64.   A 28-year-old burn patient needs daily wound debridement. Which of the following agents is not appropriate to provide a short duration of anesthesia?


          A.   Nitrous oxide


          B.   Ketamine


          C.   Etomidate


          D.   Midazolam


  65.   Eutectic mixture of local anesthetics (EMLA cream) is sometimes used to numb the skin before attempting an intravenous access in pediatric patients. Which of the following local anesthetics is combined with prilocaine to produce this cream?


          A.   Bupivacaine


          B.   Lidocaine


          C.   Mepivacaine


          D.   Ropivacaine


  66.   A 76-year-old man with history of hypertension and cancer of the colon had colectomy under general anesthesia 24 hours ago. He is receiving an epidural infusion of fentanyl at the rate of 100 micro symbol g/h. Which of the following is least likely?


          A.   Nausea


          B.   Pruritus


          C.   Respiratory depression


          D.   Hypotension


  67.   Which of the following may help in mapping of a seizure focus under general anesthesia by enhancing the EEG activity or inducing the seizure?


          A.   Thiopental


          B.   Ketamine


          C.   Diazepam


          D.   Isoflurane


  68.   Which of the following anesthetic agents is contraindicated for use in patients with intermittent porphyria?


          A.   Ketamine


          B.   Etomidate


          C.   Isoflurane


          D.   Thiopental


  69.   Replacing 10 mg of morphine with 30 mg of ketorolac can increase the risk of


          A.   Respiratory depression


          B.   Analgesia


          C.   Nausea


          D.   Bleeding


  70.   The minimum anesthesia concentration (MAC) of desflurane is decreased by


          A.   Chronic alcohol use


          B.   Respiratory alkalosis


          C.   Chronic anemia with hemoglobin of 7.5 gm/dL


          D.   Hypothermia to 34°C


  71.   A 45-year-old woman has been using heroin for last 20 years. Use of which of the following drugs will cause acute withdrawal symptoms?


          A.   Butorphanol


          B.   Nalbuphine


          C.   Buprenorphine


          D.   Naltrexone


  72.   Ketamine administered in anesthetic doses


          A.   Decreases intracranial pressure


          B.   Causes respiratory depression


          C.   Is metabolized by the liver


          D.   Increases bronchomotor tone


  73.   Which of the following drugs is the most appropriate agent for acute treatment of hypertension in a preeclamptic patient?


          A.   Magnesium


          B.   Labetalol


          C.   Lisinopril


          D.   Nitroglycerine


  74.   Which of the following provides the best estimate of complete reversal of neuromuscular blockade?


          A.   Double-burst ratio of 1


          B.   Train-of-four-ratio of 1


          C.   Absence of fade on tetanic stimulation at 50 Hz


          D.   Absence of fade of single twitch


  75.   Which of the following is contraindicated in a patient with Guillain–Barré syndrome?


          A.   Intrathecal opioids


          B.   Nondepolarizing muscle relaxant


          C.   Epidural local anesthetics


          D.   Succinylcholine


  76.   Which of the following drugs is the most appropriate for management of anesthesia in a patient who needs emergency surgery and admits to using cocaine in last 3 hours?


          A.   Labetalol before induction


          B.   Ketamine for induction


          C.   Propofol for induction


          D.   Ephedrine for treatment of hypotension


  77.   During general anesthesia, which of the following agents is most appropriate to treat an acute episode of cyanosis in a child with tetralogy of Fallot?


          A.   Atropine


          B.   Epinephrine


          C.   Phenylephrine


          D.   100% oxygen


  78.   Rebound hypertension is most likely after sudden discontinuation of which of the following classes of antihypertensive drugs?


          A.   Thiazide diuretics


          B.   Calcium channel blockers


          C.   α-Agonist


          D.   Angiotensin-converting enzyme inhibitors


  79.   A 65-year-old man has nausea and vomiting in the post–anesthesia care unit, needing antiemetic therapy. He develops involuntary facial movements, difficulty swallowing, and torticollis. Which of the following drugs is most likely to be the cause of these symptoms?


          A.   Promethazine (Phenergan)


          B.   Diphenhydramine (Benadryl)


          C.   Metoclopramide (Reglan)


          D.   Granisetron (Kytril)


  80.   Which of the following statements about ketamine is true?


          A.   Tolerance may develop after repeated administration


          B.   It is extensively bound to plasma protein


          C.   Primary site of action is GABA receptor


          D.   Kidney is the primary route of elimination


  81.   Which of the following statements about etomidate is most likely true?


          A.   It causes significant dose-dependent respiratory depression


          B.   It causes cerebral vasodilatation


          C.   It increases frequency of excitatory spikes on the EEG more than thiopental


          D.   Most of the administered dose is excreted unchanged by the kidney


  82.   The MOST likely analgesic mechanism of action of gabapentin for neuropathic pain is


          A.   Antagonism at the GABA receptor


          B.   NMDA receptor inhibition


          C.   Sodium channel blockade


          D.   Calcium channel modulation


  83.   Which of the following properties of local anesthetics is most likely a primary determinant of potency?


          A.   Vasodilation


          B.   pKa


          C.   Protein-binding


          D.   Lipid solubility


  84.   Which of the following statements about etomidate is most likely true?


          A.   It is water soluble at an acidic pH and lipid soluble at physiologic pH


          B.   It may be used as an infusion for sedation in the ICU


          C.   It is related to propofol in its chemical structure


          D.   Awakening from induction dose is secondary to very rapid liver metabolism


  85.   A 64-year-old man is scheduled for an open abdominal aortic aneurysm surgery. Anesthetic plan includes placement of an epidural catheter for postoperative pain relief. On review of his medication list, it is noted that he has been taking clopidogrel for a coronary artery stent that was inserted 2 years ago. Which of the following statements about clopidogrel is most likely true?


          A.   The American Society for Regional Anesthesia recommends that clopidogrel be stopped 3 days before neuraxial anesthesia


          B.   A single dose of clopidogrel may have a clinically significant effect on platelet function


          C.   Clopidogrel is associated with pancytopenia


          D.   Inhibition of platelet function by clopidogrel is reversible


  86.   Which of the following statements about ketamine is most likely true?


          A.   Analgesic efficacy of epidural ketamine is equivalent to epidural morphine


          B.   Ketamine decreases the duration of action of nondepolarizing neuromuscular-blocking drugs


          C.   Ketamine is a direct myocardial depressant


          D.   Ketamine decreases the cortical amplitude of somatosensory-evoked potentials


  87.   A patient has a history of an allergic reaction to a local anesthetic but does not recall the name. Which of the following local anesthetics will most likely be the cause of a true allergic reaction?


          A.   Procaine


          B.   Lidocaine


          C.   Mepivacaine


          D.   Bupivacaine


  88.   Which of the following is most likely the (analgesic) mechanism of action of lidocaine when used for neuropathic pain?


          A.   Inhibition of G-protein–coupled receptors


          B.   Antagonism of NMDA receptors


          C.   Calcium channel blockade


          D.   Sodium channel blockade


  89.   A 45-year-old farmer is brought into the emergency room. He is agitated and confused. On examination, he has dry skin with fever and rapid heart rate. Anticholinergic poisoning is suspected. Which of the following medications is most appropriate to treat his condition?


          A.   Neostigmine


          B.   Pyridostigmine


          C.   Edrophonium


          D.   Physostigmine


  90.   Which of the following medications will prolong the neuromuscular blockade produced by vecuronium?


          A.   Carbamazepine


          B.   Clindamycin


          C.   Quinidine


          D.   Verapamil


  91.   The shorter duration of action of remifentanil compared with fentanyl is primarily due to its


          A.   Rapid redistribution


          B.   Renal elimination


          C.   Metabolism by esterases


          D.   Hepatic extraction ratio


  92.   Which of the following statements about dexmedetomidine is most likely true?


          A.   It has more α2 selectivity than clonidine


          B.   It can increase opioid-induced rigidity


          C.   Context-sensitive half time increases markedly after prolonged infusion of dexmedetomidine


          D.   It has no effect on systemic vascular resistance


  93.   Which of the following can precipitate an episode of myotonia in a patient with myotonic dystrophy?


          A.   Lidocaine administration


          B.   Neostigmine administration


          C.   Nondepolarizing neuromuscular-blocker administration


          D.   Hypothermia


  94.   A 50-year-old woman had cholecystectomy done under general anesthesia. Rocuronium was used as muscle relaxant, and a combination of anticholinergic and anticholinesterase was used for reversal of muscle-relaxant action. The patient is now bradycardic. The combination of reversal agents most likely to cause the bradycardia is


          A.   Atropine and edrophonium


          B.   Glycopyrrolate and edrophonium


          C.   Atropine and neostigmine


          D.   Glycopyrrolate and neostigmine


  95.   A 68-year-old man is undergoing exploratory laparotomy for intestinal obstruction. Cause of obstruction is found to be an ileal carcinoid tumor. Suddenly, the patient develops bronchospasm, and the peak airway pressure increases from 24 to 45 cm of H2O. Which of the following is the best treatment for the bronchospasm in this situation?


          A.   Dexamethasone


          B.   Sevoflurane


          C.   Ketamine


          D.   Somatostatin


  96.   A 15-year-old boy has severe gastroenteritis with nausea, vomiting, and diarrhea for last 3 days. A CT scan of the abdomen shows intussusceptions, which needs exploratory laparotomy for relief of intestinal obstruction. The patient’s systolic blood pressure is 78 mm Hg and heart rate is 112 bpm. Thiopental is selected as the induction agent for general anesthesia. A decreased dose of this agent is recommended in patients with hypovolemic shock primarily because


          A.   Delivery of the drug to the brain is increased


          B.   Hepatic clearance is decreased


          C.   Thiopental is a myocardial depressant


          D.   Thiopental is a vasodilator


  97.   A 75-year-old woman is scheduled for mitral valve repair. High-dose fentanyl is used to induce anesthesia. In order to counteract the bradycardia caused by fentanyl, pancuronium is administered. Pancuronium blocks the bradycardia caused by fentanyl by acting on which of the following?


          A.   β-Adrenergic receptors


          B.   Cardiac muscarinic receptors


          C.   Carotid baroreceptors


          D.   Central vagal nuclei


  98.   Which of the following medications would be most appropriate to treat symptomatic bradycardia 1 month after cardiac transplant?


          A.   Glycopyrrolate


          B.   Phenylephrine


          C.   Atropine


          D.   Isoproterenol


  99.   Which of the following statements about propofol infusion syndrome is most likely false?


          A.   Mortality rate in an established case is very high


          B.   Rhabdomyolysis is one of the diagnostic criteria


          C.   Tachycardia is an early sign of this syndrome


          D.   Cardiac dysfunction is very common in this condition


100.   A patient is undergoing resection of a supratentorial brain tumor. He is normocarbic, and his mean blood pressure is 70 mm Hg. Administration of which of the following is most likely to decrease cerebral blood volume?


          A.   Nitrous oxide at 0.5 minimum alveolar concentration (MAC)


          B.   Desflurane at 1 MAC


          C.   Thiopental 2 mg/kg


          D.   Phenytoin 15 mg/kg


101.   Which of the following classes of drugs is most likely to be responsible for an anaphylactic reaction during general anesthesia?


          A.   Neuromuscular-blocking drugs


          B.   Opioids


          C.   Antibiotics


          D.   Radio contrast dyes


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Jan 28, 2017 | Posted by in ANESTHESIA | Comments Off on Anesthetic Pharmacology

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