76 Questions
What is a probable consequence of hypoventilation caused by opioids?
Hypercapnia and increased CBF
What is the mechanism by which opioids cause miosis?
Stimulation of the Edinger-Westphal nucleus in the oculomotor nerve
Which of the following opioids is contraindicated in patients with impaired renal function?
Sufentanil
What is the primary mechanism by which opioids cause nausea and vomiting?
Direct stimulation of the CTZ by acting as a partial agonist at the dopamine (D2) receptor
Which of the following opioids is associated with a higher risk of biliary smooth muscle spasm?
Fentanyl
What is the treatment for opioid overdose?
Airway management and ventilatory support followed by opioid antagonist
What is the effect of increasing concentration of volatile anesthetics on spontaneously breathing patients' respirations?
Decreased alveolar ventilation
What is the effect of cardiovascular depression on the rate of rise of FA/FI?
Increased rate of rise
What is the effect of right-to-left shunt on the induction of anesthesia?
Delayed induction
What is the primary mechanism of biotransformation of inhalation anesthetics?
Minimal metabolism
What is the primary mechanism of opioid-induced ventilatory depression?
Mu receptor activation
What is the effect of opioid-induced histamine release on cardiovascular function?
Decreased venous tone
What is the effect of opioid-induced cough suppression on medullary cough centers?
Depression
What is the primary mechanism of opioid-induced CNS effects?
Increased vagal tone
What is the effect of woodene chest syndrome on laryngeal musculature?
Contraction
What is the effect of nitrous oxide washout on alveolar partial pressures of oxygen?
Decreased oxygen
What is the primary reason for the rapid decrease in plasma concentration of morphine?
Rapid conjugation with glucuronic acid
Which opioid is associated with an increased risk of acute dystonia in untreated Parkinson's disease?
Alfentanil
What is the mechanism of pain modulation by nerve stimulators?
Gate theory
What is the primary mechanism of opioid tolerance?
No increase in the metabolism of opioids
Which opioid has the highest elimination half-time?
Fentanyl
What is the effect of benzos and fentanyl on GA?
Marked synergism in hypnotic and ventilatory depression effects
What is the primary conjugation reaction of morphine in the liver?
Glucuronidation
What is the primary site of pain perception?
Thalamus
What is the primary benefit of regional anesthesia?
Improved analgesia in high-risk patients
What is the decrease in MAC per decade from 1 year of age onward?
6%
What is the primary factor affecting the onset, duration, and potency of local anesthetics?
pKa
Which evoked potential is the most sensitive?
Motor
What is the NIOSH-set exposure limit for volatile anesthetics?
2 ppm nitrous oxide
What is the effect of nitrous oxide on methionine synthetase?
Decreases the activity
What is the most likely place to have a leak in an anesthesia machine?
Between flow meters to common gas outlet check valve
What is the effect of morphine on vagal nuclei in medulla?
Stimulation
What is the primary mechanism by which malignant hyperthermia affects muscle function?
Excessive Ca++ release
What is the recommended observation period for a patient with masseter spasm following succinylcholine administration?
At least 12 hours
What is the primary reason for the increased incidence of malignant hyperthermia when succinylcholine is used with volatile anesthetics?
Volatile anesthetics potentiate the effect of succinylcholine
What is the primary mechanism of metabolism for atracurium?
Hoffman elimination and ester hydrolysis
What is the primary cause of cardiac side effects seen with high doses of atracurium?
Histamine release
What is the effect of administering anticholinesterase drugs, such as neostigmine, prior to succinylcholine?
It increases the duration of succinylcholine's neuromuscular blockade
What is the primary reason for the additive, not independent or synergistic nature of local anesthetics' toxicities?
Similar mechanisms of action
What is the effect of PH adjustment on the onset of local anesthetic block?
Speeds up the onset
Why are spinal nerves and nerve roots more susceptible to local anesthetic-induced toxicity?
They have a slower sodium channel inactivation
What is the primary mechanism of methemoglobinemia induced by topical administration of local anesthetics?
Oxidation of hemoglobin to methemoglobin
What is the primary reason for the increased cardiovascular toxicity of bupivacaine?
Higher affinity for resting and inactive cardiac sodium channels
What is the primary treatment for local anesthetic systemic toxicity (LAST)?
Airway management and seizure suppression
What is the primary mechanism by which non-depolarizing NMBs exert their effect?
Competitive antagonism of Ach binding to the NAChR
What is the primary reason for the contraindication of succinylcholine in otherwise healthy children?
Risk of malignant hyperthermia
What is the purpose of pairing an anticholinesterase with an antimuscarinic for reversal of neuromuscular blockade?
To prevent the unwanted muscarinic effects of increased acetylcholine
What is the effect of volatile anesthetics on non-depolarizing NMBs?
Dose-dependent potentiation
What is the significance of fade on TOF monitoring in non-depolarizing NMBs?
Indicates the degree of fade during repetitive stimulation
What is the significance of clinical assessment of recovery from NM blockade?
It is an unreliable method of assessing recovery
What is the primary determinant of the rate of rise of FA/FI?
Solubility of the anesthetic in blood
What is the effect of increasing cardiac output on the rate of rise of FA/FI?
It decreases the rate of rise of FA/FI
What is the primary mechanism by which the second gas effect accelerates the rate of rise of FA/FI?
It increases the uptake of the first gas, which accelerates the rate of rise of the second gas
What is the effect of decreasing the FRC on the rate of rise of FA/FI?
It increases the rate of rise of FA/FI
What is the primary reason why pediatric inhalation induction is faster than adults?
They have a smaller FRC relative to their minute ventilation
What is the effect of increasing the inspired concentration of the anesthetic on the rate of rise of FA/FI?
It increases the rate of rise of FA/FI
What is the primary mechanism by which the concentration effect accelerates the rate of rise of FA/FI?
It increases the uptake of the anesthetic into the blood, which produces a concentration effect
What is the effect of a competitive antagonist on the potency and efficacy of an agonist?
Decreases potency, does not affect efficacy
What is the effect of decreasing the solubility of the anesthetic in blood on the rate of rise of FA/FI?
It increases the rate of rise of FA/FI
What is the primary mechanism of termination of action of a bolus dose of an induction agent?
Redistribution to other tissues
What is the primary mechanism by which the alveolar to mixed venous partial pressure difference affects the rate of rise of FA/FI?
It increases the uptake of the anesthetic into the blood
What is the meaning of pKa in the context of weak acids and bases?
The pH at which the weak acid is completely non-ionized
What is the volume of distribution (Vd) of a drug?
The amount of drug administered divided by the initial plasma concentration
What is the effect of increasing the fresh gas flow on the rate of rise of FA/FI?
It increases the rate of rise of FA/FI
What is the meaning of the term 'high extraction ratio' (HER) in pharmacokinetics?
The fraction of the drug entering the liver which is removed
What is the primary mechanism of action of propofol?
Increased affinity of the GABAa receptor for GABA
What is the recommended observation period for a patient with masseter spasm following succinylcholine administration?
At least 12 hours
What is the primary mechanism of hepatic clearance of a drug?
Rate of metabolism occurring in the liver is the difference between the concentration entering the liver and the concentration exiting the liver times the blood flow through the liver
What is the primary mechanism of action of non-competitive antagonists?
Binds to an allosteric site, reducing efficacy of the agonist
What is the primary factor affecting the onset, duration, and potency of local anesthetics?
Lipid solubility of the anesthetic
What is the primary mechanism by which malignant hyperthermia affects muscle function?
Excessive Ca++ release
What is the formula for creatinine clearance (ml/min)?
(140-age) X lean body mass (kg)/plasma creatinine concentrationX72
What is the effect of adding succinylcholine to volatile anesthetics?
Markedly increased incidence of malignant hyperthermia
What is the primary reason for the increased duration of succinylcholine-induced neuromuscular blockade after administering an anticholinesterase drug?
Inhibition of butyrylcholinesterase
What is the primary mechanism of atracurium metabolism?
Ester hydrolysis and Hoffman elimination
What is the cardiovascular side effect seen with high doses of atracurium?
Hypotension and tachycardia
This quiz covers the effects of volatile anesthetics on respiratory depression in spontaneously breathing patients. Learn how controlling patient respirations can impact the rate of anesthesia and the safety features of spontaneous respirations. Test your knowledge of anesthesia and respiratory systems.
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