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53 Cards in this Set
- Front
- Back
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Mu opioid receptors:
Answer Are linked to G-proteins close presynaptic voltage gated Ca++ channels open postsynaptic K+ channels decrease transmitter release all of the above are correct |
all of the above are correct
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Which of the following could precipitate withdrawal in a morphine dependent patient?
Answer dextromethorphan (Robitussin) codeine alfentanyl (Alfenta) buprenorphine (Buprenex) |
buprenorphine (Buprenex)
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For long-term treatment of heroin addicts, buprenorphine and naloxone are combined in a sublingual preparation (Suboxone). The addition of naloxone to buprenorphine in the sublingual preparation will:
Answer enhance absorption of buprenorphine decrease respiratory depression caused by buprenorphine increase the half life of buprenorphine render buprenorphine ineffective when the preparation is dissolved and injected i.v. antagonize the effect of heroin used concomittantly |
render buprenorphine ineffective when the preparation is dissolved and injected i.v.
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Which of the following is the most serious and dose-limiting adverse effect of morphine?
Answer extreme sedation increased intracranial pressure decreased respiration decreased myocardial conductivity decreased blood pressure |
decreased respiration
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Which of the following drugs will reduce the rate of absorption of aspirin
Answer antacids indomethacin (Indocin) sulfinpyrazone (Anturan) probenecid (Benemid) heparin |
antacids
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Which statement is not true regarding sumatriptan (Imitrex)
Answer produces vasoconstriction may produce coronary vasospasm contraindicated in seizures potent analgetic may cause abdominal pain and bloody diarrhea |
potent analgetic
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A 47-year-old woman with no medical insurance presents with typical signs and symptoms of rheumatoid arthritis. Her doctor prescribes aspirin (2 g daily), which she stops taking after only one week because of stomach pains. Choose the best course of action.
Answer continue aspirin therapy but at a lower dose switch from aspirin to acetaminophen (Tylenol) switch from aspirin to ibuprofen (Motrin) or naproxen (Naprosyn) switch from aspirin to penicillamine (Cuprimine) continue aspirin therapy but include atropine for stomach pain |
switch from aspirin to ibuprofen (Motrin) or naproxen (Naprosyn)
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A 47-year-old female has had rheumatoid arthritis for 15 years. Symptoms are controlled reasonably well with NSAIDs, however she has significant gastropathy when taking NSAIDS. Which of the following would you expect to have the least amount of GI side effects and still control the symptoms of RA?
Answer acetaminophen (Tylenol) rofecoxib (Vioxx) naproxen (Naprosyn) diclofenac (Voltaren) ketorolac (Toradol) |
rofecoxib (Vioxx)
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A 44-year-old female has active progressive erosive rheumatoid disease that has not responded to conservative therapy. Her physician prescribes a Disease-Modifying Antirheumatic Drug (DMARD). The drug selected is a chelating agent and also used in the treatment of Wilson's Disease. This drug is?
Answer hydroxychloroquine (Plaquenil) sulfasalazine (Axulfidine) aurothioglucose (Solganal) penicillamine (Cuprimine) micophenolate mofetil (Cellcept) |
penicillamine (Cuprimine)
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Known side effects for NSAIDS include all of the following except:
Answer GI hemorrhage miosis hypersensitivity reactions increased bleeding time renal damage |
miosis
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Single daily dose is sufficient for antiinflammatory therapy
Answer ibuprofen (Motrin) naproxen (Naprosyn) acetaminophen (Tylenol) aspirin diclofenac (Voltaren) |
naproxen (Naprosyn)
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This drug binds to and inactivates tumor necrosis factor (TNF)
Answer sulfasalazine (Azulfidine) mycophenolate mofetil (Cellcept) etanercept (Enbrel) leflunomide (Arava) penicillamine (Cuprimine) |
etanercept (Enbrel)
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Which of the following drugs decreases the plasma concentration of uric acid by converting uric acid to allantoin?
Answer allopurinol (Zyloprim) sulfinpyrazone (Anturane) etanercept (Enbrel) rasburicase (Fasturtec) diclofenac and misoprostol (Arthrotec) |
rasburicase (Fasturtec)
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Which of the following drugs is expected to have the least effect on the renal excretion of uric acid?
Answer furosemide (Lasix) probenecid (Benemid) sumatriptan (Imitrex) ethacrinic acid (Edecrin) aspirin |
sumatriptan (Imitrex)
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56-year-old male patient ahs been diagnosed with gouthy arthritis for 3 years. He is complaining about excruciating pain in his left big toe. He tells his physician that the last time he took colchicine his diarrhea and abdominal cramping was so severe he had to stop taking the drug before his gout attack stopped. Your choice of drug for this patient would be:
Answer ibuprofen (Motrin) sulfinpyrazone (Anturan) meperidine (Demerol) sumatriptan (Imitrex) allopurinol (Zyloprim) |
ibuprofen (Motrin)
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A patient is being anesthetized with inhaled anesthetics. You give 0.5 MAC of nitrous oxide. What concentration, in percent, would you give of sevoflurane (Ultane) as a second gas with MAC = 1.8%?
Answer 3.30% 1.20% 0.60% 0.90% 3.60% |
0.90%
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Which of the following drugs is MOST potent (MAC is in brackets)?
Answer N2O (104) Halothane (0.75) Enflurane (1.63) Isoflurane (1.17) Sevoflurane (1.80) |
Halothane (0.75)
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A 12-year-old girl is in an auto accident as her family returns from dinner at a fast food restaurant. She needs emergency surgery. What would be a good choice for anesthesia that minimizes risk of vomiting?
Answer Isoflurane (Forane) Halothane (Fluothane) Sevoflurane (Ultane) Desflurane (Suprane) Ketamine (Ketalar) |
Ketamine (Ketalar)
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Drug which has been implicated in development of hepatitis, especially upon repeated use?
Answer Midazolam (Versed) Halothane (Fluothane) Propofol (Diprivan) Isoflurane (Forane) Nitrous Oxide |
Halothane (Fluothane)
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Propofol (Diprivan) has become a very popular anesthetic because of:
Answer Lack of respiratory depression when combined with opiods Long duration of action Ability to cause neuroleptic anesthesia Rapid induction and recovery Low incidence of allergic reactions |
Rapid induction and recovery
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Which statement about ketamine (Ketalar) is NOT CORRECT?
Answer It causes dissociative anesthesia It blocks the glycine site of the NMDA receptor It is used in children It's effect is very pleasant in adults, especially during wakening It is an abused drug |
It's effect is very pleasant in adults, especially during wakening
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All of the following drugs used in anesthetic regimens enhance the action of GABA at the GABAA receptor EXCEPT:
Answer Thiopental (Pentothal) Midazolam (Versed) Propofol (Diprivan) Fentanyl (Sublimaze) |
Fentanyl (Sublimaze)
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Nitrous oxide:
Answer Is frequently used in dentistry Is used for short procedures to cause amnesia and deep anesthesia Is very soluble in blood and can be used to prevent diffusion hypoxia Causes profound hypotension Has no significant toxicity, even when used chronically |
Is frequently used in dentistry
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Below are several blood:gas coefficients. Which one is likely to belong to a drug that has a very rapid induction?
Answer 0.43 0.98 1.66 3.72 8.10 |
0.43
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What is the mechanism of action of phenytoin (Dilantin)?
Answer Blocks Ca++ channels in the thalamus Blocks NMDA receptors Prolongs inactivation of Na+ channels Enhances effects of GABA at the GABAA receptor Inhibits GABA transaminase |
Prolongs inactivation of Na+ channels
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Gabapentin (Neurontin):
Answer Has a very narrow therapeutic range and blood levels must be monitored Inhibits its own metabolism as the dose increases Is the drug of first choice for absence seizures Is used for adjunct treatment of partial seizures, neuropathic pain, and bipolar disorder Frequently causes aplastic anemia when used to treat trigeminal neuralgia |
Is used for adjunct treatment of partial seizures, neuropathic pain, and bipolar disorder
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All known addictive drugs cause a release of dopamine in the pathway originating in the ventral tegmental area and terminating in the:
Answer Cerebellum Red nucleus Lamina V of Rexid Nucleus accumbens Trigeminal nucleus |
Nucleus accumbens
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Correct statement regarding treatment of addiction:
Answer Patients should exert more willpower and just stop using drugs It is not necessary to monitor drug use once a patient is in treatment Use of methadone will just prolong the addiction and decrease ability to stop using heroin Addiction is a chronic disease and recovery is a long-term process Medications, especially antidepressants, should not be used in patients being treated for addiction |
Addiction is a chronic disease and recovery is a long-term process
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A patient comes to your office. She was stopped on New Year's Eve for driving with a blood alcohol concentration of 0.10. Which of the following would indicate an addiction rather than just abuse of alcohol?
Answer She has had a DUI, so she must be addicted She has social problems, or she wouldn't have had so much to drink Withdrawal symptoms occur when she stops drinking She usually doesn't drink more than she plans to in an evening There is no family history of alcohol use |
Withdrawal symptoms occur when she stops drinking
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This is the most widely used local anesthetic and is also used as a Class-1B anti-arrhythmic agent:
Answer Procaine (Novacaine) Lidocaine (Xylocaine) Tetracaine (Pontocaine) Benzocaine (Americaine) Prilocaine (Citanest) |
Lidocaine (Xylocaine)
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This local anesthetic is metabolized to toluidine and can thus cause methemoglobinemia:
Answer Cocaine Lidocaine (Xylocaine) Ropivacaine (Naropin) Benzocaine (Americaine) Prilocaine (Citanest) |
Prilocaine (Citanest)
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Which of the following is TRUE about local anesthetics (LA's)?
Answer Inflammation increases LA's effects by increasing permeability of the drug into the nerve fiber. LA's have a greater effect on large-diameter nerve fibers because of greater conductance. Decreased pH increases LA's ionization, thus decreasing their permeability but increasing their affinity for the sodium channel. Carbonation of preparations lowers pH and increases LA binding to the outside of the sodium channel. Rapidly firing neurons deplete LA's more rapidly and are thus less affected |
Decreased pH increases LA's ionization, thus decreasing their permeability but increasing their affinity for the sodium channel.
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Correct statement about drug abuse:
Answer Anyone who develops tolerance to a drug is addicted. Development of physical dependence is equivalent to addiction. Drugs which are commonly abused have a slow onset of action. Prescription drugs, by definition, are not drugs of abuse. Abuse is characterized by harmful use of a psychoactive substance. |
Abuse is characterized by harmful use of a psychoactive substance.
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In an emergency room setting, which of the compounds listed below would be most useful in treating a drug overdose in a patient exhibiting coma, decreased respiration, and pinpoint pupils, but no other remarkable signs?
Answer Nalolxone (Narcan) Flumazenil (Mazicon) Haloperidol (Haldol) Phenytoin (Dilantin) Ketamine (Ketalar) |
Nalolxone (Narcan)
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Used mainly for mild to moderate pain, with aspirin or acetominophen, and as a cough suppressant
Answer methadone meperidine (Demerol) codeine oxycodone (Oxycontin) |
codeine
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correct statement regarding strong opioid agonists (e.g. morphine)
Answer analgesia occurs through binding to delta receptors they do not cross the blood brain barrier they bind to mu receptors and inhibit respiration tolerance to the analgesic effect does not develop tolerance develops to constipation and miosis |
they bind to mu receptors and inhibit respiration
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A cancer patient has been treated with transdermal fentanyl for 4 months. To which mu receptor mediated side effect will he not develop tolerance?
Answer constipation cough suppression euphoria respiratory depression |
constipation
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A 59-year old woman is treated with a drug that has some opioid agonist activity and also inhibits reuptake of NE and 5HT. This is most likely:
Answer gabapentin (Neurontin) Codeine amitripyline (Elavil) prophoxyphene (Darvon tramadol (Ultram) |
tramadol (Ultram)
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Primary cause of death in opioid overdose:
Answer stroke renal failure respiratory depression hepatotoxicity |
respiratory depression
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A patient is given emergency general anesthesia. Two days later he tells you that he had bizarre, vivid dreams for the past two nights, dreams that were terrifying to him. He says that whatever you treated him with, please don't ever use that drug on him again! What drug was most likely responsible for these effects?
Answer Halothane (Fluothane) Nitrous oxide Propofol (Diprivan) Ketamine (Ketalar) Midazolan (Versed) |
Ketamine (Ketalar)
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If an anesthesiologist uses 3.3% Desflurane (MAC 6.6%), how much nitrous oxide (MAC 105%) would be added to produce 1 MAC?
Answer 21% 52.5% 102% 97.7% 7.5% |
52.5%
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Inhaled anesthetic of choice for neurosurgical operations because it is not likely to increase intracranial pressure:
Answer Midazolam (Versed) Isoflurane (Forane) Nitrous oxide Propofol (Diprivan) Ketamine (Ketalar) |
Isoflurane (Forane)
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Will attenuate the drop in blood pressure seen with many anesthetics:
Answer Midazolam (Versed) Isoflurane (Forane) Nitrous oxide Propofol (Diprivan) Ketamine (Ketalar) |
Nitrous oxide
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An anesthesiologist is planning surgery using 70% N2O (MAC 105), with the remainder of his drug being Sevoflurane (Ultane). The MAC of sevoflurane is 1.80. Assuming that he wanted to use a total of 1 MAC for this patient, approximately what concentration of sevoflurane would be add?
Answer 0.2% 3% 0.6% 1.4% 9% |
0.6%
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Several blood:gas perfusion coefficients are listed below. A gas with which of the following coefficients, used as a second gas, will cause the fastest induction when combined with halothane (blood:gas coefficient 2.54)?
Answer 9.3 1.6 0.3 4.1 2.3 |
0.3
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How does pH affect the action of local anesthetics?
Answer Decreased extracellular pH increases potency Increased pH accelerates metabolism Decreased extracellular pH reduces penetration into nerves Increased intracellular pH reduces potency by hyperpolarizing the neuronal membrane pH does not affect the action of local anesthetics |
Decreased extracellular pH reduces penetration into nerves
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A recovering alcoholic who has been sober comes to your office with severe chronic pain. Which of the following statements regarding this situation is correct?
Answer He should not be treated with opioids If the patient is treated with opioids and he needs more due to continuting pain, he has become addicted Ibuprofen (Motrin) should not be used because of the high risk of liver damage An antidepressant that inhibits norepinephrine reuptake (e.g., Venlafaxine; Effexor) may help with chronic pain Long-acting opioids will increase the likelihood of developing addiction |
An antidepressant that inhibits norepinephrine reuptake (e.g., Venlafaxine; Effexor) may help with chronic pain
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Which of the following statements regarding pain management is false?
Answer Physicians often fear legal consequences for prescribing narcotics Tolerance does not develop to constipation from opioids Constipation should be treated after symptoms begin Tolerance often develops to euphoria from opioids Detailed pain documentation is always needed in patient charts |
Constipation should be treated after symptoms begin
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Which of the following drugs is preferentially used for postsurgical analgesia:
Answer acetylsalicylic acid (Aspirin) celecoxib (Celebrex) rofecoxib (Vioxx) ketorolac (Toradol) ibuprofen (Motrin) |
ketorolac (Toradol)
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Which of the following NSAID has the best side effect profile?
Answer indomethacin (Indocin) acetylsalicylic acid (Aspirin) ipuprofen (Motrin) ketorolac (Toradol) naproxen (Naprosyn) |
ipuprofen (Motrin)
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Which of the following drug is an antagonist of the human Interleukin-1 receptor?
Answer anakinra (Kineret) mycophenolate mofetil (Cellcept) etanercept (Enbrel) leflunomide (Arava) adalimumab (Humira) |
anakinra (Kineret)
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Colchicine is effective in the acute treatment of gout because it causes
Answer xanthine oxidase inhibition uricosuria cyclooxygenase inhibition decreased phagocytic action of neutorphils in joint fluid immunosuppression after a 2 to 3 month latency period |
decreased phagocytic action of neutorphils in joint fluid
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Probenecid is effective in the treatment of gout because it
Answer inhibits the renal tubular reabsorption of uric acid blocks the renal tubular secretion of oxypurines specificially inhibits xanthine oxidase inhibits the local inflammatory response in joints B and D |
inhibits the renal tubular reabsorption of uric acid
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