Anesthesia and Respiratory Depression

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Questions and Answers

What is a probable consequence of hypoventilation caused by opioids?

  • Hypercapnia and decreased CBF
  • Hypercapnia and increased CBF (correct)
  • Hypocapnia and increased CBF
  • Hypocapnia and decreased CBF

What is the mechanism by which opioids cause miosis?

  • Inhibition of the Edinger-Westphal nucleus in the oculomotor nerve
  • Blockade of the pupil constrictor muscle
  • Release of histamine in the anterior chamber
  • Stimulation of the Edinger-Westphal nucleus in the oculomotor nerve (correct)

Which of the following opioids is contraindicated in patients with impaired renal function?

  • Fentanyl
  • Morphine
  • Sufentanil (correct)
  • Alfentanil

What is the primary mechanism by which opioids cause nausea and vomiting?

<p>Direct stimulation of the CTZ by acting as a partial agonist at the dopamine (D2) receptor (A)</p> Signup and view all the answers

Which of the following opioids is associated with a higher risk of biliary smooth muscle spasm?

<p>Fentanyl (C)</p> Signup and view all the answers

What is the treatment for opioid overdose?

<p>Airway management and ventilatory support followed by opioid antagonist (D)</p> Signup and view all the answers

What is the effect of increasing concentration of volatile anesthetics on spontaneously breathing patients' respirations?

<p>Decreased alveolar ventilation (A)</p> Signup and view all the answers

What is the effect of cardiovascular depression on the rate of rise of FA/FI?

<p>Increased rate of rise (A)</p> Signup and view all the answers

What is the effect of right-to-left shunt on the induction of anesthesia?

<p>Delayed induction (D)</p> Signup and view all the answers

What is the primary mechanism of biotransformation of inhalation anesthetics?

<p>Minimal metabolism (D)</p> Signup and view all the answers

What is the primary mechanism of opioid-induced ventilatory depression?

<p>Mu receptor activation (B)</p> Signup and view all the answers

What is the effect of opioid-induced histamine release on cardiovascular function?

<p>Decreased venous tone (C)</p> Signup and view all the answers

What is the effect of opioid-induced cough suppression on medullary cough centers?

<p>Depression (C)</p> Signup and view all the answers

What is the primary mechanism of opioid-induced CNS effects?

<p>Increased vagal tone (D)</p> Signup and view all the answers

What is the effect of woodene chest syndrome on laryngeal musculature?

<p>Contraction (B)</p> Signup and view all the answers

What is the effect of nitrous oxide washout on alveolar partial pressures of oxygen?

<p>Decreased oxygen (C)</p> Signup and view all the answers

What is the primary reason for the rapid decrease in plasma concentration of morphine?

<p>Rapid conjugation with glucuronic acid (D)</p> Signup and view all the answers

Which opioid is associated with an increased risk of acute dystonia in untreated Parkinson's disease?

<p>Alfentanil (B)</p> Signup and view all the answers

What is the mechanism of pain modulation by nerve stimulators?

<p>Gate theory (B)</p> Signup and view all the answers

What is the primary mechanism of opioid tolerance?

<p>No increase in the metabolism of opioids (D)</p> Signup and view all the answers

Which opioid has the highest elimination half-time?

<p>Fentanyl (A)</p> Signup and view all the answers

What is the effect of benzos and fentanyl on GA?

<p>Marked synergism in hypnotic and ventilatory depression effects (A)</p> Signup and view all the answers

What is the primary conjugation reaction of morphine in the liver?

<p>Glucuronidation (A)</p> Signup and view all the answers

What is the primary site of pain perception?

<p>Thalamus (A)</p> Signup and view all the answers

What is the primary benefit of regional anesthesia?

<p>Improved analgesia in high-risk patients (A)</p> Signup and view all the answers

What is the decrease in MAC per decade from 1 year of age onward?

<p>6% (A)</p> Signup and view all the answers

What is the primary factor affecting the onset, duration, and potency of local anesthetics?

<p>pKa (B)</p> Signup and view all the answers

Which evoked potential is the most sensitive?

<p>Motor (A)</p> Signup and view all the answers

What is the NIOSH-set exposure limit for volatile anesthetics?

<p>2 ppm nitrous oxide (C)</p> Signup and view all the answers

What is the effect of nitrous oxide on methionine synthetase?

<p>Decreases the activity (C)</p> Signup and view all the answers

What is the most likely place to have a leak in an anesthesia machine?

<p>Between flow meters to common gas outlet check valve (C)</p> Signup and view all the answers

What is the effect of morphine on vagal nuclei in medulla?

<p>Stimulation (A)</p> Signup and view all the answers

What is the primary mechanism by which malignant hyperthermia affects muscle function?

<p>Excessive Ca++ release (D)</p> Signup and view all the answers

What is the recommended observation period for a patient with masseter spasm following succinylcholine administration?

<p>At least 12 hours (D)</p> Signup and view all the answers

What is the primary reason for the increased incidence of malignant hyperthermia when succinylcholine is used with volatile anesthetics?

<p>Volatile anesthetics potentiate the effect of succinylcholine (A)</p> Signup and view all the answers

What is the primary mechanism of metabolism for atracurium?

<p>Hoffman elimination and ester hydrolysis (C)</p> Signup and view all the answers

What is the primary cause of cardiac side effects seen with high doses of atracurium?

<p>Histamine release (B)</p> Signup and view all the answers

What is the effect of administering anticholinesterase drugs, such as neostigmine, prior to succinylcholine?

<p>It increases the duration of succinylcholine's neuromuscular blockade (A)</p> Signup and view all the answers

What is the primary reason for the additive, not independent or synergistic nature of local anesthetics' toxicities?

<p>Similar mechanisms of action (C)</p> Signup and view all the answers

What is the effect of PH adjustment on the onset of local anesthetic block?

<p>Speeds up the onset (C)</p> Signup and view all the answers

Why are spinal nerves and nerve roots more susceptible to local anesthetic-induced toxicity?

<p>They have a slower sodium channel inactivation (D)</p> Signup and view all the answers

What is the primary mechanism of methemoglobinemia induced by topical administration of local anesthetics?

<p>Oxidation of hemoglobin to methemoglobin (A)</p> Signup and view all the answers

What is the primary reason for the increased cardiovascular toxicity of bupivacaine?

<p>Higher affinity for resting and inactive cardiac sodium channels (C)</p> Signup and view all the answers

What is the primary treatment for local anesthetic systemic toxicity (LAST)?

<p>Airway management and seizure suppression (B)</p> Signup and view all the answers

What is the primary mechanism by which non-depolarizing NMBs exert their effect?

<p>Competitive antagonism of Ach binding to the NAChR (A)</p> Signup and view all the answers

What is the primary reason for the contraindication of succinylcholine in otherwise healthy children?

<p>Risk of malignant hyperthermia (C)</p> Signup and view all the answers

What is the purpose of pairing an anticholinesterase with an antimuscarinic for reversal of neuromuscular blockade?

<p>To prevent the unwanted muscarinic effects of increased acetylcholine (A)</p> Signup and view all the answers

What is the effect of volatile anesthetics on non-depolarizing NMBs?

<p>Dose-dependent potentiation (C)</p> Signup and view all the answers

What is the significance of fade on TOF monitoring in non-depolarizing NMBs?

<p>Indicates the degree of fade during repetitive stimulation (D)</p> Signup and view all the answers

What is the significance of clinical assessment of recovery from NM blockade?

<p>It is an unreliable method of assessing recovery (A)</p> Signup and view all the answers

What is the primary determinant of the rate of rise of FA/FI?

<p>Solubility of the anesthetic in blood (B)</p> Signup and view all the answers

What is the effect of increasing cardiac output on the rate of rise of FA/FI?

<p>It decreases the rate of rise of FA/FI (D)</p> Signup and view all the answers

What is the primary mechanism by which the second gas effect accelerates the rate of rise of FA/FI?

<p>It increases the uptake of the first gas, which accelerates the rate of rise of the second gas (A)</p> Signup and view all the answers

What is the effect of decreasing the FRC on the rate of rise of FA/FI?

<p>It increases the rate of rise of FA/FI (D)</p> Signup and view all the answers

What is the primary reason why pediatric inhalation induction is faster than adults?

<p>They have a smaller FRC relative to their minute ventilation (C)</p> Signup and view all the answers

What is the effect of increasing the inspired concentration of the anesthetic on the rate of rise of FA/FI?

<p>It increases the rate of rise of FA/FI (D)</p> Signup and view all the answers

What is the primary mechanism by which the concentration effect accelerates the rate of rise of FA/FI?

<p>It increases the uptake of the anesthetic into the blood, which produces a concentration effect (B)</p> Signup and view all the answers

What is the effect of a competitive antagonist on the potency and efficacy of an agonist?

<p>Decreases potency, does not affect efficacy (D)</p> Signup and view all the answers

What is the effect of decreasing the solubility of the anesthetic in blood on the rate of rise of FA/FI?

<p>It increases the rate of rise of FA/FI (D)</p> Signup and view all the answers

What is the primary mechanism of termination of action of a bolus dose of an induction agent?

<p>Redistribution to other tissues (C)</p> Signup and view all the answers

What is the primary mechanism by which the alveolar to mixed venous partial pressure difference affects the rate of rise of FA/FI?

<p>It increases the uptake of the anesthetic into the blood (C)</p> Signup and view all the answers

What is the meaning of pKa in the context of weak acids and bases?

<p>The pH at which the weak acid is completely non-ionized (A)</p> Signup and view all the answers

What is the volume of distribution (Vd) of a drug?

<p>The amount of drug administered divided by the initial plasma concentration (A)</p> Signup and view all the answers

What is the effect of increasing the fresh gas flow on the rate of rise of FA/FI?

<p>It increases the rate of rise of FA/FI (B)</p> Signup and view all the answers

What is the meaning of the term 'high extraction ratio' (HER) in pharmacokinetics?

<p>The fraction of the drug entering the liver which is removed (C)</p> Signup and view all the answers

What is the primary mechanism of action of propofol?

<p>Increased affinity of the GABAa receptor for GABA (C)</p> Signup and view all the answers

What is the recommended observation period for a patient with masseter spasm following succinylcholine administration?

<p>At least 12 hours (D)</p> Signup and view all the answers

What is the primary mechanism of hepatic clearance of a drug?

<p>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 (C)</p> Signup and view all the answers

What is the primary mechanism of action of non-competitive antagonists?

<p>Binds to an allosteric site, reducing efficacy of the agonist (C)</p> Signup and view all the answers

What is the primary factor affecting the onset, duration, and potency of local anesthetics?

<p>Lipid solubility of the anesthetic (C)</p> Signup and view all the answers

What is the primary mechanism by which malignant hyperthermia affects muscle function?

<p>Excessive Ca++ release (D)</p> Signup and view all the answers

What is the formula for creatinine clearance (ml/min)?

<p>(140-age) X lean body mass (kg)/plasma creatinine concentrationX72 (B)</p> Signup and view all the answers

What is the effect of adding succinylcholine to volatile anesthetics?

<p>Markedly increased incidence of malignant hyperthermia (B)</p> Signup and view all the answers

What is the primary reason for the increased duration of succinylcholine-induced neuromuscular blockade after administering an anticholinesterase drug?

<p>Inhibition of butyrylcholinesterase (C)</p> Signup and view all the answers

What is the primary mechanism of atracurium metabolism?

<p>Ester hydrolysis and Hoffman elimination (D)</p> Signup and view all the answers

What is the cardiovascular side effect seen with high doses of atracurium?

<p>Hypotension and tachycardia (A)</p> Signup and view all the answers

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