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Worksheetspharmaco
Total questions: 40
Worksheet time: 20mins
You plan to anaesthetize 2 year old boy plan for herniotomy with sevoflurane and nitrous oxide as it can fasten the induction time. Which is the best explanation of above choice?
A Sevoflurane has Boiling point of 58.5 C
Sevoflurane has 2% being metabolised in the liver
Sevoflurane has Blood gas partition coefficient BGPC of 0.7
Sevoflurane has vapour pressure of 157mmHg at 20C
Bupivacaine 0.5% is deposited near brachial plexus proximity in achieving anaethesia for upper limb surgery.
Which mechanism best describe its use?
Bupivacaine dissociates into unionised form
Bupivacaine rapidly absorb into systemic circulation.
Bupivacaine has high protein binding.
Bupivacaine is metabolise in the liver.
Regarding non-competitive antagonist:
Binding occurs at the same receptor site as the agonist.
Its effect is overcome by increasing the concentration of an agonist.
It depresses the maximum obtainable response of the agonist
It shifts the log dose-response curve of the agonist to the right
What is true about Ketamine?
is the most protein bound among the intravenous induction agents.
in its racemic form, has been shown to block ATP-sensitive potassium channels.
commonly induces arrhythmias
has antanalgesic properties
Which of the following is not true about sodium thiopentone?
Its pKa of 7.6 means that 60% of free drug is unionized at physiological pH.
It exhibits zero-order kinetic metabolism following a single induction dose.
At hypnotic dose, it is also an anticonvulsant
It decreases intracranial pressure by decreasing cerebral blood volume.
Which of the following about Desfluorane is not true?
has a blood:gas partition coefficient of 0.45.
is less potent compared to sevoflurane
degradation products include carbon dioxide.
can cause laryngospasm during maintenance of anaesthesia
Which of the following is not true regarding rocuronium:
Its metabolite has no significant muscle relaxant activity
It is mainly excreted unchanged in bile
It is an aminosteroid.
Its main mode of metabolism is ester hydrolysis.
Which of the following increase the placental transfer of local anaesthetic ?
it is highly protein bound.
its pKa is high
it is highly lipid soluble.
there is foetal acidosis.
All the following statement is true regarding local anaesthetic activity EXCEPT?
Potency is determined by its lipid solubility.
Onset of action is determined by its pKa.
Duration of action is determined by its protein binding capacity.
R-enantiomers produce less cardiotoxicity
All the following is true regarding local anaesthetics EXCEPT:
The pKa of bupivacaine is higher than the pKa of lignocaine.
At physiological pH, more than 30% of bupivacaine is unionised.
Amides have a higher affinity for binding to a-I acid glycoprotein than albumin
A 30-year-old lady is planned for emergency laparotomy for suspected bleeding ectopic pregnancy. IV ketamine is planned as induction of anaesthesia.
What is the best indication of above drug?
It follows one arm brain circulation time
It stimulates adrenergic systems
It has dissociative phenomena
It depress myocardium contractility
A 40-year-old man sustained extradural hemorrhage and is planned for craniectomy. TCI propofol is planned as maintenance of anaesthesia.
Which pharmacokinetic parameter best describes of its use?
It has shorter half life.
It is rapidly metabolised in the liver
It has high protein binding
It has shorter context sensitive half time
A 72-year-old man with a history of chronic kidney disease (Stage 4) and a previous gastric ulcer is scheduled for hip replacement surgery. The surgical team is planning a multimodal analgesic regimen to minimize opioid use.
Which of the following non-opioid analgesics is the most appropriate choice for this patient's postoperative care?
Ibuprofen
Ketorolac
Paracetamol (Acetaminophen)
Celecoxib
An anesthesiologist is providing anesthesia for a 2-hour-long neurosurgical procedure that requires precise, titratable intraoperative analgesia and a rapid recovery to allow for immediate neurological assessment post-surgery.
Which of the following intravenous opioids has the most suitable pharmacokinetic profile for this clinical scenario?
Morphine
Fentanyl
Sufentanil
Remifentanil
A 34-year-old patient with a history of opioid use disorder requires management for moderate acute pain. The physician wants to prescribe an opioid that provides effective analgesia but has a lower risk of causing significant respiratory depression and has less abuse potential compared to full agonists.
Which medication's mechanism of action as a partial µ-opioid receptor agonist provides a "ceiling effect" for both analgesia and respiratory depression?
Morphine
Buprenorphine
Naloxone
Fentanyl
A 60-year-old patient with end-stage renal disease on hemodialysis requires analgesia for severe pain. The patient is given a standard dose of intravenous morphine. A few hours later, the patient becomes excessively sedated and develops respiratory depression.
This adverse effect is most likely due to the accumulation of which substance?
Morphine-3-glucuronide (M3G)
Morphine-6-glucuronide (M6G)
Norpethidine
Fentanyl
A patient undergoing major abdominal surgery develops acute postoperative pain. To manage the pain, a multimodal approach is used, including an opioid and a non-opioid adjuvant. The anesthesiologist adds gabapentin to the regimen.
What is the primary mechanism of action by which gabapentin provides analgesia?
Non-competitive antagonism of NMDA receptors
Inhibition of cyclooxygenase (COX) enzymes in the CNS
Blocking the reuptake of serotonin and norepinephrine
Binding to the a2δ subunit of voltage-gated calcium channels
During induction and maintenance with an inhalational anesthetic, which of the following parameters does NOT influence alveolar partial pressure?
Cardiac output
Alveolar ventilation
Inspired volatile anesthetic partial pressure
Metabolism of the volatile anesthetic
Suxamethonium is a neuromuscular blockade drug that is used for rapid sequence induction. Which of the following best describes characteristics of this drug?
Hypertonus occurs if the patient has myotonia.
Prolonged blockade occurs with repeated doses.
Progressive increase in the duration of the end-plate potential
reversal agent may be required
Modifying the chemical structure of local anaesthetic alters its pharmacokinetic properties. This is known as structure-activity relationship. Which modification affects the potency of this drug?
Lipid solubility
Rate of metabolism
Protein binding
pKa
Inhalational agents are used frequently to maintain anaesthesia. Which statement is true about its effect?
Sevoflurane increases heart rate at lower concentrations.
Isoflurane causes an increase in cerebral blood flow
Enflurane increases seizure threshold.
Nitrous oxide causes a decrease in blood pressure
Propofol is an intravenous agent that is widely used in anaesthesia and intensive care. Which is true about its physicochemical properties?
The solution is preservative free.
The compound demonstrates chirality
Its emulsifying agent affects plasma triglyceride level
It is a highly soluble drug.
The train-of-four (TOF) test is used to assess residual neuromuscular blockade. Which is true about the use of TOF?
TOF ratio is the force of the first twitch divided by the fourth twitch
TOF ratio is 1 when Suxamethonium is used.
The test is inaccurate if repeated within 2 minutes.
Four stimuli are applied at a frequency of 10Hz.
Meyer-Overton theory describes how volatile agents produce loss of consciousness in anaesthesia practice. Which mechanism of action best describes this theory?
Thickening cell membranes sufficient to reversibly alter function of membrane ion channels.
Fluidising nerve membranes to a point when phase separations in the critical lipid regions disappear.
Dissolving in the fatty fraction and removing fatty constituents of brain cells
Disrupting the structure or dynamic properties of the lipid portions of nerve membranes
Inhaled anaesthetic agents have certain side effects on its administration. Which side effects and agent is correctly paired?
Increase in systemic vascular resistance with desflurane
Airway irritation and bronchospasm with sevoflurane
Diffusion hypoxia following discontinuation of nitrous oxide
High output renal failure with isoflurane
Muscle relaxants interrupt transmission at the neuromuscular junction. Which is true about its effect?
Depolarising neuromuscular blockade is also known as phase II blockade.
Potency is determined by the dose needed to produce 95% suppression of the single twitch response.
Onset of the nondepolarizing blockade is faster at peripheral muscles compared to laryngeal muscles.
Neuromuscular transmission fails when 50% of the nicotinic receptors are blocked.
Inhalational induction of anaesthesia for a neonate will occur at a faster rate than an adult. Which of the following best explains this phenomenon?
Higher cardiac index
Higher alveolar ventilation
Higher body surface area
Higher functional residual capacity
A 58-year-old lady with end-stage renal failure is scheduled for a surgical procedure that requires the use of atracurium. Which pharmacokinetic property is advantageous regarding the use of this drug for this patient?
metabolism via Hoffmann
High renal clearance
Extensive protein binding
Hepatic metabolism via Cytochrome p450 enzymes
A patient with BMI 44kg/m2 is scheduled fr breast lumpectomy. Which inhalational agent is suitable for her?
sevoflurane
isoflurane
halothane
desflurane
Which statement is true?
Isoflurane decreases mean arterial pressure through a dose-dependent decrease in systemic vascular resistance.
Sevoflurane increases bronchiolar airway resistance.
In clinical concentrations, desflurane decreases responsiveness of cerebral circulation to arterial partial pressure of carbon dioxide.
Desflurane causes a dose-dependent decrease in mean arterial pressure through a decrease in cardiac output.
1. A 24-year-old lady plan for laparoscopic appendicectomy under general anaesthesia using inhalational agent. Post surgery her liver enzyme was deranged.
Which inhalational anaesthetic agent is most commonly associated with raised liver enzyme?
Nitrous Oxide
Sevoflurane
Halothane
Isoflurane
1. A 32 year-old G2P1 at 39 weeks, posted for emergency caesarean section for fetal distress under epidural anaesthesia using lignocaine with adrenaline.
What is the maximum recommended dose of lidocaine with adrenaline for this patient?
2 mg/kg
3 mg/kg
7 mg/kg
10 mg/kg
1. A 45-year-old man underwent an open inguinal hernia repair. During the procedure, the surgeon administered a local anaesthetic to the surgical site to manage postoperative pain.
What is the primary mechanism of action of local anaesthetics?
Blocking sodium channels
Blocking potassium channels
Blocking chloride channels
Blocking calcium channels
1. A junior doctor applied eutectic mixture of local anaesthesia (EMLA) cream to a 2-month-old boy on both dorsum region to prevent pain before intravenous access cannulation. Later the boy develop cyanosis, pallor and weakness.
What would be the best cause to explain this condition ?
Overdose of lidocaine
Patient have history of allergy to LA
Development of methemoglobinemia
Local skin reaction cause by EMLA
Tramadol
is a racemic mixture of two enantiomer
enhances noradrenaline neuronal uptake
has an anti-nociceptive action that is fully blocked by naloxone
has a low incidence of nausea and vomiting
The following drugs can be reversed by naloxone, EXCEPT?
Buprenorphine
Codeine
A. Dextropropoxyphene
.Morphine
Which NDMR should be especially avoided in patients with chronic renal failure?
Rocuronium
Mivacurium
Vecuronium
pancuronium
Cisatracurium is isomer af atracurium, it:
Has a duration of action of over 60 minutes
Causes less histamine release than atracurium
Action is potentiated by metabolic alkalosis
Has an initial intubation dose similar to atracurium
Which of the following electrolyte imbalances does NOT enhance neuromuscular block?
Hypokalemia
Hypercalcemia
Hypermagnesemia
Hypocalcemia
Which of the following statements about succinyl- choline is correct?
Succinylcholine does not effectively bind to presyn- aptic acetylcholine receptors.
Succinylcholine is very short-acting, because it is metabolized at the neuromuscular junction
Succinylcholine is metabolized to the inactive com- ponent succinylmonocholine.
Succinylcholine is an antagonist of both muscarinic and nicotinic acetylcholine receptors.
