Practice questions covering drug metabolism, barbiturate pharmacology, individual drug responses and related topics.

Anesthesia Pharmacology: Pharmacokinetic Practice Questions

Choose the correct answer(s) for each question.

Phase II non-microsomal reaction type/types:
1. conjugation
2. hydrolysis
3. oxidation
4. reduction
Drug/drugs susceptible to hydrolysis by enzymes localized either liver, plasma or gastrointestinal tract
1. succinylcholine (Anectine)
2. esmolol (Brevibloc)
3. amide-type local anesthetics
4. mivacurium (Mivacron)
5. atracurium (Tracrium)
Chemical characteristics/characteristics of phase II conjugates:
1. generally less polar compared to parent compound
2. usually excreted with difficulty
3. retains biological activity
4. none of the above
Very high dose acetaminophen (Tylenol, Panadol) can result in hepatotoxicity as a result of saturation of glucuronidation of sulfation pathways.
1. true
2. false
Individual variation drug responses-due to altered
1. renal function
2. hepatic function
3. differences in patient's age
4. variation in patient to patient cardiac function
5. differences in patient to patient drug bioavailability
Atypical cholinesterase
1. predisposition to attacks of porphyria
2. may prolong mivacurium (Mivacron)-induced neuromuscular-blockade
3. both
4. neither
Dantrolene (Dantrium):
1. porphyria management
2. malignant hyperthermia management
3. sparingly soluble in aqueous medium
Safe drugs for use in patients with acute intermittent porphyria, hereditary Coporphyria or variegate porphyria
1. sulfonamide antibiotics
2. ethchlorvynol (Placidyl)
3. hydrocodone
4. phenothiazines
5. atropine
Acute intermittent porphyria: clinical management
1. support treatment
2. dextrose infusion
3. high carbohydrate intake
4. Hematin infusion
5. all the above
Age vs. drug duration
1. increase duration of action of fentanyl (Sublimaze) due to reduced hepatic perfusion
2. increased apparent volume of distribution may prolong clearance
3. increased protein binding
4. decreased renal function may prolong duration
5. all of the above
Advantageous characteristic/characteristics of thiopental (Pentothal) and methohexital (Brevital):
1. rapid onset
2. short duration of action
3. both
4. neither
Concerning barbiturates: hypnotic properties as well as duration of action potency are affected by substitutions at position 5
1. true
2. false
Probable reason for thiopental (Pentothal) and thioamylal exhibiting a shorter duration inaction and a more rapid onset compared to secobarbital (Seconal) and pentobarbital (Nembutal): substitution in position 2 of the barbiturate core structure
1. true
2. false
Primary structuraldifference between pentobarbital (Nembutal) and sodium Pentothal: substitution of an oxygen (pentobarbital (Nembutal)) with the S in Pentothal
1. true
2. false
Factor/factors that influence thiopental (Pentothal) uptake:
1. lipid solubility
2. concentration gradient between blood and tissue
3. cardiac output (perfusion)
4. A & C
5. B & C
Barbiturate pharmacology:
1. reduce sensitivity to pain
2. increase in cerebral metabolism
3. decreased cerebral blood flow
4. reduced intracranial pressure
5. all the above
Barbiturate pharmacology:
1. myocardial stimulation
2. bradycardia
3. both
4. neither
Barbiturate pharmacology: pulmonary effects
1. respiratory depression
2. laryngospasm
3. both
4. neither
Barbiturate pharmacology:
1. increased urine output
2. vasodilation
3. appropriate to use in the management of porphyria
4. all the above
Effective anesthesia induction agent/agents:
1. thiopental (Pentothal)
2. propofol (Diprivan)
3. both
4. neither
Pharmacological property/properties benzodiazepines:
1. anxiolytic effects
2. amnestic effects
3. both
4. neither
Midazolam (Versed) pharmacology:
1. probably exerts its pharmacological effects or interaction with cholinergic receptor systems
2. increased lipid solubility a pH < 4
3. both
4. neither
Benzodiazepine pharmacokinetics:
1. In the anesthesia setting, single bolus benzodiazepine injection effects are primarily terminated by ester hydrolysis
2. benzodiazepines are metabolized by phase I and phase II drug metabolizing systems
3. both
4. neither
No active metabolites:
1. diazepam (Valium)
2. flurazepam (Dalmane)
3. midazolam (Versed)
Benzodiazepine pharmacology: CNS effects
1. increase in cerebral oxygen metabolism
2. increase in cerebral blood flow
3. protects against cerebral hypoxia
4. effective anticonvulsant agents against anesthetic-caused seizures
Benzodiazepine pharmacology: pulmonary systems
1. respiratory depression following IV administration > that observed with barbiturates or opioids
2. Respiratory depression associated with benzodiazepines may be increased by concurrent administration of fentanyl (Sublimaze)
3. both
4. neither
Reversal of benzodiazepine action:
1. naltrexone (ReVia)
2. naloxone (Narcan)
3. flumazenil (Romazicon)
4. all of the above
Flumazenil (Romazicon)'s half-life a shorter than that exhibited by benzodiazepines
1. true
2. false
High clearance
1. midazolam (Versed)
2. diazepam (Valium)
3. both
4. neither
Will last longer when redistribution mechanisms are not prominent, such as following repeated doses:
1. midazolam (Versed)
2. diazepam (Valium)
3. equal

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