Pharm Frenzy

The Great Muscle Comeback

100

Which acetylcholinesterase inhibitors in clinical use prolong the duration of action of succinylcholine (SELECT 2)

A - Neostigmine

B - Physostigmine

C - Edrophonium 

D - Pyridostigmine 

A + D (Neostigmine + Pyridostigmine)

200

In the PACU, an 85 year old female who received scopolamine is agitated and confused. What is the BEST intervention at this time?

A - Pyridostigmine 

B - Midazolam 

C - Physostigmine 

D - Reduce environmental stimuli 

C (Physostigmine)

300

Select the BEST statement regarding the use of an anticholinergic agent and edrophonium when used to antagonize neuromuscular blockade. 

A - Atropine is given after edrophonium 

B - Atropine pairs better than glycopyrrolate 

C - Atropine should be avoided because of CNS side effects 

D - Glycopyrrolate should be mixed in the same syringe as edrophonium 

B (Atropine pairs better than glycopyrrolate)

400

The following are well absorbed from the GI tract (EXCEPT)

A - Glycopyrrolate 

B - Scopolamine 

C - Atropine 

D - Physostigmine 

A (glycopyrrolate)

500

Neostigmine antagonizes rocuronium by...

A - Decreasing acetylcholine hydrolysis

B - Potentiating acetylcholinesterase activity

C - Reversibly binding to butyrylcholinesterase 

D - Competing with rocuronium at the nicotinic receptor 

A (decreasing acetylcholine hydrolysis)

Painkillers Paradise

100

Which drugs are MOST effective at reducing opioid-induced hyperalgesia after the administration of remifentanil? (SELECT 2)

A - Ketorolac 

B - Magnesium 

C - Dexmedetomidine 

D - Ketamine 

B + D (magnesium + ketamine)

200

Which opioid side effects are most resistant to tolerance? (SELECT 2)

A - Respiratory depression 

B - Miosis

C - Emetic effects 

D - Constipation

B + D (miosis + constipation)

300

Identify the physiological effects commonly associated with mu receptor stimulation. (SELECT 3)

A - Pruritis 

B - Anti-shivering effect 

C - Dysphonia 

D - Bradycardia 

E - Respiratory depression 

F - Diuresis 

A + D + E (pruritis / bradycardia / respiratory depression)

400

The endogenous pain modulation pathway terminates in the ... 

A - Periaqueductal grey 

B - Ventral root ganglion 

C - Substantia gelatinosa 

D - Rostroventral medulla 

C (substantia gelatinosa)

500

Which opioid inhibits nerve conduction?

A - Morphine 

B - Sufentanil 

C - Meperidine 

D - Hydromorphone 

C (meperidine)

Total System Override

100

Match each muscle with its mechanical action 

Muscle 

- Corrugator supercilii

- Orbicularis oculi 

- Medial rectus 

- Adductor pollicis

Action

- Adducts the eyeball

- Moves the eyebrow

- Adducts the thumb

- Closes the eyelid 

Corrugator supercilii = moves the eyebrow

Orbicularis oculi = closes the eyelid

Medial rectus = adducts the eyeball

Adductor pollicis = adducts the thumb

200

Which agent is associated with the GREATEST amount of rostral spread when injected into intrathecal space?

A - Meperidine 

B - Morphine 

C - Hydromorphone 

D - Fentanyl 

B (morphine)

300

An opioid dependent patient is experiencing intense signs of withdrawal 8 hours after his last dose. Which of the following drugs is the patient MOST likely abusing?

A - Methadone 

B - Fentanyl 

C - Heroin 

D - Morphine 

B (fentanyl)

400

Identify the factors that increase the risk of local anesthetic systemic toxicity (SELECT 2)

A - Hypercarbia 

B - Local anesthetic toxicity 

C - Hypokalemia 

D - Alkalosis 

A + B (hypercarbia + local anesthetic potency)

500

Match the drug to its onset of action. Assume that there is a steady state concentration of nondepolarizing neuromuscular blocker in the plasma. 

DRUG

- Neostigmine 

- Pyridostigmine 

- Edrophonium 

ONSET OF ACTION

- 1 min 

- 10 min 

- 15 min

Neostigmine = 10 min 

Pyridostigmine = 15 min 

Edrophonium = 1 min 

Numbskulls

100

Local anesthetic potency BEST correlates with...

A - Concentration

B - pKa

C - Lipid solubility

D - Duration of action

C (Lipid solubility)

200

How many mL of a 0.5% bupivacaine solution can be safely injected into a child weighing 35kg?

17.5 ml

300

Rank the local anesthetics according to their degree of ionization at physiological pH. (1 = most ionized / 4 = least ionized)

- Bupivacaine

- Chloroprocaine

- Lidocaine 

- Tetracaine 

1 - Chloroprocaine

2 - Tetracaine

3 - Bupivacaine 

4 - Lidocaine

400

Rank the speed of local anesthetic uptake after injection into the following sites (1 = fastest / 4 = slowest)

- Caudal

- Intrapleural 

- Epidural 

- Intercostal 

1 - Intrapleural 

2 - Intercostal

3 - Caudal

4 - Epidural

500

Rank the sensitivity of each nerve fiber type to the physiologic effects of local anesthetics in vivo. (1 = most sensitive / 4 = least sensitive)

- C fibers

- A alpha fibers

- A delta fibers

- B fibers 

1 - B fibers 

2 - C fibers 

3 - A delta fibers 

4 - A alpha fibers 

Paralyzed by Knowledge

100

Which neuromuscular blocking agents are aminosteroid compounds? (SELECT 2)

A - Pancuronium 

B - Vecuronium 

C - Atracurium 

D - Mivacurium 

A + B (pancuronium + vecuronium)

200

Which inhaled anesthetic potentiates the neuromuscular blocking effect of nondepolarizing neuromuscular blockers the MOST?

A - Nitrous oxide

B - Desflurane

C - Isoflurane

D - Sevoflurane 

B (desflurane)

300

Which antibiotics prolong the duration of action of vecuronium? (SELECT 2)

A - Gentamycin 

B - Cefazolin 

C - Clindamycin 

D - Penicillin G

A + C (gentamycin + clindamycin)

400

Which of the following neuromuscular blockers is MOST likely to increase airway resistance?

A - Mivacurium 

B - Pancuronium 

C - Cisatracurium 

D - Rocuronium 

A (mivacurium)

500

Choose the BEST neuromuscular blockers to administer to a patient with hypertrophic cardiomyopathy? (SELECT 2)

A - Atracurium 

B - Vecuronium 

C - Cisatracurium 

D - Pancuronium 

B + C (vecuronium + cisatracurium)