Chapter
3a
Pharmacology Questions
Question 1
The following agents are examples of racemic mixtures:
a.
b.
c.
d.
e.
Isoflurane
Enflurane
Sevoflurane
Atropine
Levobupivacaine
Question 2
Regarding optical isomers and their properties:
a. S(+)-ketamine produces less intense emergence phenomena than R(–)-ketamine
b. R(–)-ketamine is three times more potent than S(+)-ketamine
c. Levobupivacaine requires a higher plasma concentration to produce myocardial
depression compared to bupivicaine
d. Levobupivacaine is more likely to precipitate excitatory central nervous system effects
compared to bupivicaine
e. S-ropivacaine is more lipid soluble than bupivacaine and this results in reduced penetration of Aβ nerve fibres
Question 3
Regarding drug delivery to cells:
a. The degree of ionization determines the duration of drug action
b. Alfentanil has a more rapid onset of action compared to fentanyl as a result of its lipid
solubility
c. Aspirin has a pKa of 3, meaning that it is wholly unionized at physiological pH
d. Addition of 8.4% sodium bicarbonate to 2% lidocaine raises its pH and therefore
increases the speed of onset
e. Bupivacaine readily crosses the placenta
Question 4
Dose–response curves and log10 dose–response curves are important tools in establishing
the effective range of drug doses both in vitro and in vivo.
a. Dose is on the y-axis and response is on the x-axis
178
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b. On a log10 dose–response curve, if drug A is more potent than drug B, then the curve for
drug A will lie to the left of the curve for drug B
c. On a log10 dose–response curve, if drug A is less efficacious than drug B, then the curve
for drug B will plateau higher than the curve for drug A
d. If A is an antagonist of B increasing the concentration of A will move the log10 dose–
response curve of B to the right
e. The action of a competitive antagonist cannot be overcome by increasing the dose of the
agonist
Question 5
The definition of an agonist is an agent that can bind to a receptor and elicit a biological
response. Antagonists are drugs that decrease the actions of an endogenous ligand or
another drug. The following are drug–receptor interactions:
a.
b.
c.
d.
e.
Phenylephrine is an antagonist at α-adrenergic receptors
Doxazosin is an agonist at α-adrenergic receptors
Ondansetron is an antagonist at 5-HT2 receptors
Ketamine is a competitive agonist at the NMDA receptor
Dexmedetomidine is a selective α1-adrenergic receptor agonist
Question 6
Dose–response curves can be used to determine ED50 (effective dose 50%), as well as the
toxic effect in the form of the LD50 (lethal dose 50%). The ratio of LD50:ED50 is known as the
therapeutic index and can be utilized to estimate drug safety.
a.
b.
c.
d.
e.
For greater safety, a drug should have a low therapeutic index
Warfarin has a high therapeutic index
Penicillin has a low therapeutic index
Ibuprofen has a high therapeutic index
The units of the therapeutic index are usually mg.ml–1
Question 7
Drug–receptor interactions may result in a range of responses:
a. A partial agonist occupies less than half of receptor sites, which results in a submaximal
response
b. An antagonist has no effect on the state of the receptor in the absence of an agonist or
inverse agonist
c. There is a linear relationship between efficacy and affinity
d. A partial agonist can have antagonist activity
e. Buprenorphine acts as an inverse agonist at the μ-opioid receptor
Question 8
Concerning G-protein-coupled receptor pharmacology:
a. When activated, guanylyl triphosphate (GTP) binds the β-subunit of the trimeric
G-protein
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180
b.
c.
d.
e.
Chapter 3a: Pharmacology Questions
Opiates act via stimulation of the Gi subtype of G-protein-coupled receptor (GPCR)
Activation of the Gq subtype of GPCR results in the activation of protein kinase C
α1-Adrenoreceptors are of the Gs subtype
α2-Adrenoreceptors are of the Gi subtype
Question 9
Concerning response to repeated drug doses:
a. Tachyphylaxis refers to the phenomenon of rapid loss of response to repeated doses of
a drug
b. Tolerance occurs when loss of response occurs over a longer period of administration
c. Desensitization occurs when incrementally larger doses of drug are required to produce
the same response
d. Desensitization occurs in chronic opiate abuse
e. Ephedrine displays tachyphylaxis
Question 10
Concerning acetylcholinesterase inhibitors:
a.
b.
c.
d.
e.
Neostigmine prolongs depolarizing neuromuscular blockade
Edrophonium forms a carbamylated complex with acetylcholinesterase
Edrophonium has use in the treatment of myasthenia gravis
Acetylcholinesterase inhibitors have a treatment role in Alzheimer’s disease
Dicobalt ededate is a suitable antidote for organophosphate poisoning
Question 11
Concerning antiarrhythmics and their effect on the action potential:
a. Lidocaine prolongs the refractory period of cardiac muscle
b. Flecainide has no effect on the refractory period of cardiac muscle
c. Verapamil’s primary effect is on the L-type slow voltage calcium channels of the SA and
AV nodes
d. Amiodarone decreases the repolarization rate of the cardiac membrane
e. Amiodarone is a potassium channel activator
Question 12
Regarding mechanisms of drug action:
a. cAMP formed under the regulation of G proteins is broken down by the action of
phosphodiesterases
b. G-protein receptors consist of four subunits – two α and two β
c. The GABAA receptor has a pentameric structure
d. Thyroid hormones act via receptors that are part of the cell membrane
e. Nitrous oxide does not act on the NMDA receptor
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Chapter 3a: Pharmacology Questions
181
Question 13
Regarding adverse drug reactions:
a.
b.
c.
d.
e.
Type A reactions are unpredictable and usually involve the immune system
Type B drug reactions encompass both anaphylactic and anaphylactoid reactions
An idiosyncratic drug reaction is a predictable drug reaction that is dose dependent
An anaphylactoid reaction is mediated by IgE antibodies
Adverse drug reactions should be reported to the Medicines and Healthcare Products
Regulatory Agency (MHRA)
Question 14
The following agents are cytochrome P450 enzyme inhibitors:
a.
b.
c.
d.
e.
Cyclosporin
Amiodarone
Grapefruit juice
Carbamazepine
Chronic alcohol
Question 15
The following drug combinations can potentially cause serious adverse reactions:
a.
b.
c.
d.
e.
Moclobemide and ephedrine
Ramipril and diclofenac
Warfarin and orange juice
Bisoprolol and verapamil
Levodopa and metoclopramide in a patient with Parkinson’s disease
Question 16
The following statements are true regarding drug action/interactions:
a. A synergistic reaction occurs when the net effect of several drugs is the sum of the
individual actions of each drug
b. Reversal of heparin with protamine is a physicochemical interaction
c. The increase in acetylcholine after neostigmine administration is an indirect pharmacodynamic interaction
d. Sodium bicarbonate will make the urine more alkaline and enhance the excretion of
weak acids
e. β-Blockers may decrease the time to onset of fasciculation following the administration
of suxamethonium
Question 17
The following drugs display zero-order kinetics:
a. Aspirin
b. Warfarin
c. Theophylline
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Chapter 3a: Pharmacology Questions
d. Alfentanil
e. Phenytoin
Question 18
Which of these drugs readily penetrate the blood–brain barrier?
a.
b.
c.
d.
e.
Atropine
Glycopyrronium
Benzylpenicillin
Thiopentone
Vecuronium
Question 19
Which of the following statements related to drug handling by the body are true?
a.
b.
c.
d.
The elderly population have a reduced volume of distribution (VD)
The presence of portocaval shunts in hepatic impairment reduces bioavailability
Plasma protein binding tends to be higher in the neonate than in the adult
Patients with renal impairment may have an increased VD and may require a higher
loading dose of drug
e. With regards to lidocaine use in the neonate, the proportion of free drug will be lower
than in the adult
Question 20
The rapid onset of action of thiopentone when administered intravenously is as a result of:
a.
b.
c.
d.
e.
Its pKa of 7.6
Cerebral blood flow
Redistribution to muscle and adipose tissue
Extensive hepatic metabolism
Its degree of lipophilicity
Question 21
Bioavailability:
a.
b.
c.
d.
e.
Is greater by the enteral route than the sublingual route
Is indicated by the area under the plasma concentration–time curve
May be affected by coeliac disease if drugs are given orally
Is low if a drug undergoes minimal first pass metabolism
Is 100% if a drug is given intravenously
Question 22
The following drugs cross the placenta in significant quantities:
a. Isoflurane
b. Diclofenac
c. Thiopentone
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183
d. Morphine
e. Co-amoxiclav
Question 23
The following drugs are predominantly metabolized by the liver:
a.
b.
c.
d.
e.
Propofol
Cisatracurium
Esmolol
Mivacurium
Lisinopril
Question 24
The following drugs are correctly paired with a recognized mechanism by which they enter
cells:
a.
b.
c.
d.
e.
Thiopentone and passive diffusion
Fluconazole and active transport
Iron and pinocytosis
Glucose and passive diffusion
Penicillin G and active transport
Question 25
The following drugs are efficiently removed from the plasma by haemofiltration:
a.
b.
c.
d.
e.
Atenolol
Aspirin
Enoxaparin
Digoxin
Warfarin
Question 26
Regarding drug elimination:
a.
b.
c.
d.
e.
Clearance refers to the amount of drug removed from the body per unit time
Elimination of most drugs follows zero-order kinetics
Elimination is often related to renal function
Rate of elimination is influenced by volume of distribution
A time constant is longer than a half-life
Question 27
Concerning multicompartmental pharmacokinetic models:
a. Peripheral compartments represent less vascular structures
b. A drug can be eliminated from any compartment
c. Catenary models link a central compartment to peripheral compartments
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Chapter 3a: Pharmacology Questions
d. In three-compartment models, equilibration between central and peripheral compartments occurs at different speeds
e. In a tri-exponential decay curve, the sum of the three tangents’ y intercepts is equal to
concentration at the t = 0 (Co) value
Question 28
Concerning the context-sensitive half-life:
a. It is defined as the time for the plasma concentration of a drug to fall by 50% subsequent
to cessation of an infusion after plasma loading
b. Remifentanil displays a context-insensitive half-life
c. Context sensitive half-life predicts time to waking subsequent to termination of infusion
of a hypnotic agent
d. Alfentanil demonstrates context sensitivity after prolonged infusion times
e. Fentanyl demonstrates context sensitivity after prolonged infusion times
Question 29
Concerning total intravenous anaesthesia:
a.
b.
c.
d.
Plasma concentrations are not assessed during anaesthesia
A dedicated cannula for anaesthesia is mandatory
It is indicated in patients with a history of malignant hyperpyrexia
The Schnider pharmacokinetic model is more appropriate for use in elderly patients
undergoing propofol target-controlled infusion
e. No adjunctive analgesia is required in anaesthesia with remifentanil and propofol
Question 30
Regarding prolonged depolarizing neuromuscular blockade (suxamethonium apnoea):
a. 96% of the population is homozygous for the Eu gene
b. Those with the genotype Ea:Ea may have a resultant block, which is prolonged by up to
10 minutes
c. The dibucaine number refers to the direct activity of plasma cholinesterase
d. Those with a homozygous normal genotype and phenotype have a dibucaine number
of 20
e. The alleles responsible for altered plasma cholinesterase activity have been identified on
chromosome 3
Question 31
Regarding genetic differences in drug handling:
a. Malignant hyperpyrexia (MH) has been associated with defects in the ryanodine
receptor on chromosome 17
b. A diagnosis of MH is based on the response of biopsied muscle to 2% halothane and
caffeine
c. Trigger agents for MH include etomidate and ephedrine
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Chapter 3a: Pharmacology Questions
185
d. Drugs that may be affected by acetylator status include hydralazine and isoniazid
e. Up to 90% of oriental populations are ‘fast acetylators’
Question 32
Thiopentone:
a.
b.
c.
d.
e.
Is a methylated oxybarbiturate
Is more protein bound than pentobarbitone
Has a pH of 10.5 in solution
Potentiates the α-subunit of the GABAA receptor
May produce an isoelectric EEG
Question 33
Propofol:
a.
b.
c.
d.
e.
Has a calorie load of 1 kcal.ml–1
Undergoes sulfuronidation within the liver
Commonly precipitates a reflex tachycardia when given at induction doses
May cause greenish discolouration of the hair
Has a terminal elimination half-life of 5–12 hours
Question 34
Ketamine:
a.
b.
c.
d.
e.
May be given rectally
Potentiates the neurotransmitter glutamate at the NMDA receptor
Shows agonist action at OP3 receptors
Increases cerebral blood flow
Is metabolized to norketamine by cytochrome P450 enzymes
Question 35
Etomidate:
a.
b.
c.
d.
e.
Contains 35% v/v ethylene glycol in solution to improve stability
Commonly results in histamine release on injection
Is a hydroxylated imidazole derivative
Inhibits the 17α-hydroxylase enzyme
May precipitate a porphyric crisis
Question 36
Regarding thiopentone:
a.
b.
c.
d.
e.
Rapid emergence from a single bolus dose is due to rapid metabolism
It may cause a reduction in urine output as a result of increased ADH release
Anaphylactic reactions are seen in approximately 1:7500 administrations
It produces a reduction in cerebral metabolic oxygen requirement (CMRO2)
Solubility is dependent on tautomerism
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Chapter 3a: Pharmacology Questions
Question 37
Regarding propofol:
a.
b.
c.
d.
e.
Volume of distribution is approximately 4 l.kg–1
Epileptiform movements are seen in up to 10% of patients
It is 80% bound to plasma albumin
Offset is more rapid than thiopentone following an initial induction dose
Pain on injection can be reduced by the addition of 1% lidocaine to the syringe
Question 38
Benzodiazepine metabolism involves the following reactions:
a.
b.
c.
d.
e.
Hydroxylation
Acetylation
Dealkylation
Glucuronidation
Oxidation
Question 39
Regarding benzodiazepines:
a.
b.
c.
d.
e.
They have low oral bioavailability
They display high protein binding
Their half-life may be prolonged due to genetic variability
They have a small volume of distribution
Midazolam has relatively low clearance compared to other benzodiazepines
Question 40
Metabolism of benzodiazepines occurs in the liver and there may be some active metabolites. In considering metabolism and excretion:
a.
b.
c.
d.
e.
Urinary excretion for benzodiazepines is in the order of 10%
Benzodiazepines are effectively removed by dialysis
Chlordiazepoxide has active metabolites following transformation in the liver
Diazepam has an elimination half-life of over 24 hours
Temazepam has no active metabolites
Question 41
Isoflurane:
a.
b.
c.
d.
e.
Has a molecular weight of 200
Has an oil:gas partition coefficient of 225
Causes greater myocardial depression than halothane
Causes dose-dependent uterine relaxation
Is 2% metabolized
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Question 42
Concerning nitrous oxide:
a. The equilibration of fractional alveolar to fractional inspired concentration (FA/Fi) is
faster with desflurane compared to nitrous oxide
b. It is produced by the heating of ammonium sulfate
c. It reduces uterine muscle tone
d. It causes megaloblastic anaemia with prolonged use
e. Its use is contraindicated in patients with pneumothorax
Question 43
Concerning minimum alveolar concentration (MAC):
a.
b.
c.
d.
e.
MAC is decreased in hyperthyroidism
MAC is decreased in pregnancy
There is an inverse relationship to the oil:gas partition coefficient of agents
The MAC of nitrous oxide is higher than that of halothane
It is defined as a percentage of 1 atmosphere
Question 44
Concerning sevoflurane:
a.
b.
c.
d.
e.
Has a boiling point of 58 °C
Has a saturated vapour pressure of 32 kPa at 20 °C
Has an oil:gas partition coefficient of 97
Approximately 3–5% is metabolized
Compound A, produced from sevoflurane’s reaction with moist soda lime, is nephrotoxic in humans
Question 45
Concerning inhalational anaesthetic potency:
a.
b.
c.
d.
e.
There is inverse proportionality between oil:gas partition coefficients and potency
MAC is directly proportional to potency
Halothane is more potent than sevoflurane
Enflurane is more potent than methoxyflurane
Desflurane’s quick onset and offset is a reflection of its low potency
Question 46
Concerning halothane:
a.
b.
c.
d.
e.
It is unstable in light
It has a saturated vapour pressure of 32 kPa at 20 °C
It is irritant to breathe
It increases myocardial sensitivity to catecholamines
It is 2% metabolized
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Chapter 3a: Pharmacology Questions
Question 47
Regarding the mechanism of action of general anaesthetics:
a.
b.
c.
d.
e.
The proposed mechanism is said to be consistent with the Meyer–Briggs rule
The rule suggests the anaesthetic agent acts by dissolving in the protein bilayer of cells
GABAA and glycine are inhibitory receptors
Glycine receptors belong to the family of ligand-gated ion channels
Hydrophobic anaesthetics are less potent
Question 48
Local anaesthetics are weak bases and poorly soluble. Amongst other factors, the pKa
correlates to the speed of onset of a particular agent. The following are other factors that
affect speed of onset of peripheral nerve blocks:
a.
b.
c.
d.
e.
Degree of local anaesthetic ionization
Lipid solubility of local anaesthetic
Proximity of anaesthetic to the target nerve
Protein binding of the anaesthetic agent
Type of block
Question 49
The following are the maximum recommended doses of each agent:
a.
b.
c.
d.
e.
Bupivacaine with epinephrine 5 mg.kg–1
Bupivacaine without epinephrine 3 mg.kg–1
Lidocaine with epinephrine 7 mg.kg–1
Levobupivacaine without epinephrine 1 mg.kg–1
Ropivacaine without epinephrine 3 mg.kg–1
Question 50
Metabolism of local anaesthetics depends on chemical structure.
a.
b.
c.
d.
e.
Amide local anaesthetics are rapidly metabolized by plasma cholinesterase
Lidocaine has a low extraction ratio
Ester local anaesthetics are rapidly metabolized in cerebrospinal fluid
Metabolites from ester hydrolysis are excreted in the urine
Metabolism of bupivacaine is independent of hepatic function
Question 51
Local anaesthetics are available in various strengths and preparations:
a. Glucose in a concentration of 8 g.ml–1 is added to bupivacaine to increase the baricity of
the solution for use in spinal anaesthesia
b. The preservative methyl parahydroxybenzoate is often added to multidose vials
c. The addition of bicarbonate reduces the amount of the unionized form of the local
anaesthetic
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d. Lidocaine and amethocaine are mixed in equal parts to form a eutectic mixture of local
anaesthetic cream
e. The preparation of bupivacaine as a hydrosulfite salt allows it to be dissolved in water,
forming an acidic solution
Question 52
Local anaesthetics alter nerve function by their action on sodium channels.
a.
b.
c.
d.
Local anaesthetics can also have an effect on calcium channels
Sodium channels in the resting state have a high affinity for local anaesthetic
The sodium channel is composed of a single polypeptide chain with four repeating units
Local anaesthetics bind directly to the extracellular portion of the sodium channel to
exert the effect
e. The binding of bupivacaine to the sodium channel is irreversible
Question 53
The following questions concern intralipid and its role in the treatment of local anaesthetic
toxicity.
a.
b.
c.
d.
e.
Intralipid can be used in the treatment of tricyclic antidepressant overdose
The initial loading dose when treating local anaesthetic toxicity is 15 ml.kg–1
Propofol can be used as a substitute where Intralipid is not available
CPR may have to continue for over a hour after the administration of intralipid
It should only be used in cardiac arrest situations
Question 54
Concerning intralipid and its role in parenteral nutrition:
a.
b.
c.
d.
e.
Soya bean oil is the major constituent
Selenium-induced neurotoxicity can occur with long-term use
Hepatomegaly and jaundice are recognized delayed complications
It should be used with caution in cases of pancreatitis with associated hyperlipidaemia
Thrombocythemia is a recognized complication
Question 55
Regarding patient-controlled epidural analgesia for labour:
a. It is associated with improved maternal satisfaction compared to continuous epidural
infusion
b. Intermittent boluses alone provide superior analgesia to intermittent boluses combined
with a background infusion
c. Increases the likelihood of caesarean section
d. May be associated with more motor block than continuous epidural infusion
e. Can cause maternal fever
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Question 56
Regarding paracetamol:
a.
b.
c.
d.
It has consistently better absorption by the rectal route when compared to the oral route
It is extensively bound to plasma proteins at normal doses
Metabolism is by conjugation in the liver predominantly with glucuronide or phosphate
By one hour after administration, the plasma levels for oral and intravenous routes are
similar
e. At normal doses, 85% of the drug is metabolized by CYP2E1 to produce N-acetylp-benzoquinoneimine
Question 57
Concerning paracetamol:
a. Overdose causes around 50% of fulminant hepatic failure cases in the UK
b. Ingestion of alcohol induces CYP2E1, thus increasing the risk of hepatotoxicity
c. Treatment of overdose consists of early replacement of glutathione either orally or
intravenously
d. There is a reduction in mortality if N-acetylcysteine is given up to 72 hours after
overdose
e. N-acetylcysteine is toxic to the fetus and therefore cannot be used in pregnancy
Question 58
Aspirin:
a.
b.
c.
d.
e.
Is mainly absorbed in the small bowel
Increases oxygen consumption
Irreversibly inhibits cyclo-oxygenase (COX) in the endothelium
May cause hypoventilation, coma and pyrexia in overdose
Excretion may be enhanced by acidification of urine
Question 59
NSAIDs:
a.
b.
c.
d.
e.
Inhibit leukotriene production
Promote sodium retention
Can cause thrombocytopenia
Can cause delayed healing of fractures
Reduce opioid consumption in the perioperative period
Question 60
Regarding NSAIDs:
a. Meloxicam has an increased side-effect profile compared to other NSAIDs
b. Ibuprofen can be used in doses of up to 30 mg.kg–1 in children
c. Indomethacin promotes closure of the ductus arteriosus in infants
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191
d. They are absolutely contraindicated in asthma
e. Celecoxib should not be used in patients with a sulfonamide allergy
Question 61
With reference to specific COX-2 inhibitors:
a.
b.
c.
d.
e.
They affect platelet function, especially in high doses
They have an analgesic efficacy that is lower than comparable non-specific NSAIDs
Cardiac side effects may be increased
The incidence of gastrointestinal side effects appears to be reduced
Concurrent aspirin therapy is safe
Question 62
Tramadol is a synthetic opioid and is an aminocyclohexanol derivative of codeine.
a.
b.
c.
d.
e.
It has a structural resemblance to venlafaxine
Metabolism of tramadol has no pharmacogenetic variability
Tramadol has no action at the NMDA receptor
The main metabolite of tramadol is active at the μ-opioid receptor
Tramadol produces less respiratory depression than other opioids
Question 63
Like morphine, codeine is a naturally occurring derivative of an opium alkaloid.
The following are documented pharmacological characteristics of codeine:
a.
b.
c.
d.
e.
It is poorly absorbed after oral administration
The major metabolite is codeine-3-glucuronide
Morphine is a metabolite of codeine
Codeine metabolism is affected by CYP2D6 polymorphism
The reduction in bowel peristalsis is mediated via kappa receptors
Question 64
Morphine:
a.
b.
c.
d.
e.
Is metabolized to a pharmacologically active compound
Reduces minute ventilation predominantly via reducing tidal volumes
Has a longer half-life than naloxone
Is licensed for intrathecal use
Is an opiate
Question 65
Remifentanil:
a. Exhibits tachyphylaxis
b. Has a predictable dose–response relationship
c. Displays a context-sensitive half-life
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d. Used in combination with propofol (TIVA) reduces the risk of awareness when compared to general anaesthesia with volatile agents
e. Can cause chest wall rigidity
Question 66
Diamorphine:
a.
b.
c.
d.
e.
Is a synthetic opioid formed by joining two molecules of morphine via an ester bond
Has a half-life of 2 to 3 minutes
Is associated with pruritus when used intrathecally
Is given in similar doses whether via intravenous or epidural administration
Causes nausea and vomiting due to smooth muscle contraction in the gastrointestinal
tract
Question 67
When comparing fentanyl to alfentanil:
a.
b.
c.
d.
e.
Fentanyl is more potent than alfentanil
Alfentanil has a higher lipid solubility than fentanyl
The majority of fentanyl is ionized at pH 7.4
Clearance of alfentanil exceeds that of fentanyl
Alfentanil has a smaller volume of distribution than fentanyl
Question 68
Concerning the safety features of patient-controlled analgesia (PCA) devices:
a. If morphine PCA devices are being used in patients, observation of respiratory rate is
mandatory
b. Pumps are designed to detect disconnection from the patient
c. If intravenous PCA devices are not being used via dedicated cannulae, use of a Y
connector with a one-way valve is mandatory
d. PCAs may not be used concurrently with epidural infusions
e. Programmable limits to bolus doses and lock-out times reduce the risk of overdose
Question 69
Concerning drugs used in PCA:
a. Morphine has the greatest efficacy of all the opioid drugs used in PCA
b. Tramadol is widely accepted as a suitable PCA drug
c. Background infusions of morphine with additional patient-controlled boluses provide
superior pain control
d. Ketamine is a recognized non-opiate drug that can be delivered via PCA in addition to
morphine
e. The routine addition of antiemetics in PCA syringes is mandatory
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Question 70
Cisatracurium:
Is derived from the three cis-cis isomers of atracurium
Is eliminated predominantly via Hoffman degradation
Is associated with less histamine release than atracurium
May be preferred over atracurium in epileptic patients as it is not metabolized to
laudanosine
e. Differs from atracurium in that it is more potent, but slower to provide maximal muscle
relaxation (in equipotent doses)
a.
b.
c.
d.
Question 71
Rocuronium:
a.
b.
c.
d.
Is predominantly excreted in the urine (assuming normal renal function)
Can raise arterial blood pressure and heart rate
Should be avoided in asthmatics
Will usually provide intubating conditions within 60 s when given at a dose of
0.6 mg.kg–1
e. Becomes unstable if left at room temperature for more than 24 hours
Question 72
Atracurium:
a. Improves compliance with mechanical ventilation and reduces mortality in ARDS
b. Muscle relaxation may be reversed 2 minutes after an intubating dose by the administration of 16 mg.kg–1 of sugammadex
c. Is less associated with bronchospasm than rapacuronium
d. Consists of 16 isomers
e. Is approximately 99% protein bound in the plasma
Question 73
Regarding suxamethonium:
a.
b.
c.
d.
e.
It is an antagonist at the nicotinic acetylcholine receptor
It should be given in an increased dose for patients with Duchenne muscular dystrophy
Phase 2 block behaves like a non-depolarizing neuromuscular block
It is metabolized by acetylcholinesterase
It can induce bradycardia via its action on muscarinic receptors
Question 74
Concerning suxamethonium:
a. It is formed by combining two acetylcholine molecules
b. It is a trigger for malignant hyperpyrexia
c. Risk of postoperative muscle pain is directly proportional to muscle mass
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Chapter 3a: Pharmacology Questions
d. Patients with myasthenia gravis are likely to require a reduced dose of suxamethonium
e. Risk of anaphylaxis is around 1 in 2000
Question 75
Mivacurium:
a. Is characterized by its rapid onset and offset of action
b. Is preferred to suxamethonium for short-term muscle relaxation in patients with known
suxamethonium apnoea
c. Undergoes urinary excretion
d. Is potentiated by volatile anaesthetics
e. Is safe for use in pregnancy
Question 76
Regarding sugammadex:
a. It is a specific reversal agent for rocuronium
b. It is a modified tertiary amine
c. It can reverse profound neuromuscular blockade from rocuronium within 4 minutes
when given at a dose of 4 mg.kg–1
d. The dose should be reduced for patients with severe renal impairment
e. For obese patients, the dose should be based on actual body weight, not ideal body
weight
Question 77
Neostigmine:
a. May be used in the diagnosis and treatment of myasthenia gravis
b. Is a medium-acting anticholinesterase
c. When given IV to reduce neuromuscular block at the end of surgery, is commonly
associated with a tachycardia
d. Increases smooth muscle contractility
e. Can cause seizures if given at a dose of more than 50 μg.kg–1
Question 78
Atropine:
a. Is a competitive antagonist at all muscarinic receptors
b. Is a parasympathomimetic drug
c. Is given at a standard dose of 3 mg during resuscitation from cardiac arrest with nonshockable rhythms
d. Can cause bradycardia
e. Is useful in the treatment of a cholinergic crisis
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Chapter 3a: Pharmacology Questions
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Question 79
Glycopyrrolate:
a.
b.
c.
d.
e.
Is a more potent antisialogogue than atropine
Is completely ionized at physiological pH
Is associated with amnesia, confusion and excitation in elderly patients
Is a recognized treatment for hyperhydrosis
Is a tertiary ammonium compound
Question 80
Regarding hyoscine:
a. It can reduce the risk of postoperative nausea and vomiting when given preoperatively
via transdermal patch
b. Hyoscine butylbromide crosses the blood–brain barrier
c. It is more sedating than atropine
d. It causes mydriasis
e. It is one of the ingredients of Omnopon
®
Question 81
Regarding phosphodiesterase inhibitors:
a.
b.
c.
d.
e.
They cause peripheral vasoconstriction
They have a positive inotropic action
They increase the intracellular levels of cAMP
Milrinone is a selective PDE III inhibitor
They act by blocking the Na+/K+ pump
Question 82
Dopexamine:
a.
b.
c.
d.
e.
Is structurally similar to dobutamine
Increases splanchnic blood flow
Has a natriuretic and diuretic effect
Has significant α-adrenergic agonist action
Causes bronchodilation
Question 83
The following have positive inotropic activity:
a.
b.
c.
d.
e.
Thyroxine
Digoxin
Aminophylline
Methoxamine
Glucagon
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Chapter 3a: Pharmacology Questions
Question 84
Levosimendan:
a.
b.
c.
d.
e.
Is indicated in the treatment of chronic heart failure
Increases the sensitivity of myocytes to calcium
Closes ATP-sensitive K+ channels to cause vascular smooth muscle contraction
Binds to tropomyosin
Is contraindicated in ventricular outflow tract obstruction
Question 85
The following statements are correct:
a. Adrenaline may increase minimum alveolar concentration and increase peripheral pain
threshold
b. Dopamine reduces pulmonary vascular resistance
c. Isoprenaline may cause hyperglycaemia
d. Dobutamine may be used as an alternative to exercise in cardiac stress testing
e. Inotropes increase the force of myocardial contractility
Question 86
Metaraminol is a vasopressor agent with direct and indirect effects on the sympathetic
system.
a.
b.
c.
d.
e.
It usually results in a negative inotropic effect
It has no action on β-adrenergic receptors
It usually causes an increase in cardiac output
It cannot be administered via the intramuscular route due to intense local ischaemia
It causes a marked decrease in glycogenolysis
Question 87
Vasopressin is a potent vasoconstrictor with the following properties:
a.
b.
c.
d.
e.
Action via α-adrenergic receptors
Causes a significant increase in pulmonary vascular resistance
Has no direct cardiac effects
Has a significant role in maintenance of arteriolar tone in health
Causes greater constriction of renal afferent arterioles compared to efferent arterioles
Question 88
Phenylephrine has been proven to be an effective choice of vasopressor to mitigate the
hypotension seen during spinal anaesthesia for caesarean section. It has the following
characteristics:
a. Structurally similar to epinephrine
b. Significant effects on β-adrenergic receptors
c. It is metabolized by monoamine oxidase (MAO) and catechol-О-methyl transferase
(COMT)
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Chapter 3a: Pharmacology Questions
197
d. Exhibits tachyphylaxis on repeated dosing
e. Administered intravenously it has a duration of action of about 6–8 minutes
Question 89
Concerning vasodilators:
a.
b.
c.
d.
e.
Hydralazine causes arterial and venous dilatation to the same extent
Sodium nitroprusside predominantly causes venodilatation
One of the metabolites of sodium nitroprusside, thiocyanate, is non-toxic
Sodium nitroprusside toxicity is more likely in patients with vitamin B12 deficiency
Vitamin B12 is an accepted treatment for sodium nitroprusside toxicity
Question 90
Concerning nitrates:
a.
b.
c.
d.
e.
Glyceryl trinitrate (GTN) should be used with caution in patients with severe hypoxia
GTN acts by activating adenylate cyclase
GTN has a high oral bioavailability
Isosorbide mononitrate has a high oral bioavailability
GTN can occasionally precipitate methaemaglobinaemia
Question 91
The following drugs decrease pulmonary vascular resistance (PVR).
a.
b.
c.
d.
e.
Epoprostenol
Sodium nitroprusside
Noradrenaline
Isoprenaline
Sevoflurane
Question 92
Thiazide diuretics have the following side effects:
a.
b.
c.
d.
e.
Hypokalaemic hypochloraemic acidosis
Hypercalcaemia
Hypouricaemia
Precipitate pancreatitis
Hyperglycaemia
Question 93
Indications for ACE inhibitors include:
a.
b.
c.
d.
e.
Acute myocardial infarction with left ventricular dysfunction
Essential hypertension
Pregnancy-induced hypertension
Severe heart failure
Diabetic nephropathy
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Chapter 3a: Pharmacology Questions
Question 94
Nifedipine:
a.
b.
c.
d.
e.
Is a dihydropyridine
Undergoes extensive first pass metabolism
Causes a reflex increase in heart rate
Has no effect on coronary blood flow
Increases the MAC of volatile anaesthetics
Question 95
Regarding atenolol:
a.
b.
c.
d.
e.
It is safe in diabetics
It is a non selective β-blocker
It is safe in asthmatics
It is a negative inotrope
The dose should be reduced in renal failure
Question 96
The following antiarrhythmics are correctly matched to the Vaughan-Williams classification:
a.
b.
c.
d.
e.
Class IV – flecainide
Class Ia – procainamide
Class III – amiodarone
Class Ib – quinidine
Class Ic – lidocaine
Question 97
Adenosine:
a.
b.
c.
d.
e.
Has a duration of action of 2 minutes
Is a purine nucleoside
Is a yellow solution
Is contraindicated in second-degree heart block
Should be used with caution in heart transplant patients
Question 98
Side effects of amiodarone include:
a.
b.
c.
d.
e.
Irreversible corneal microdeposits
Photosensitivity
Pneumonitis
Peripheral neuropathy
Raised serum transaminases
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Chapter 3a: Pharmacology Questions
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Question 99
Side effects of furosemide include:
a.
b.
c.
d.
e.
Hypocalcaemia
Hyperglycaemia
Metabolic acidosis
Hypomagnesaemia
Hypotension
Question 100
The following mechanisms are thought to explain the actions of the following types of
diuretic:
a. Bendroflumethiazide and inhibition of sodium–chloride symport channels in the distal
convoluted tubule
b. Furosemide and inhibition of sodium–chloride symport channels in the loop of Henle
c. Amiloride and competitive antagonism of aldosterone
d. Mannitol and increased renal plasma flow
e. Metolazone and inhibition of carbonic anhydrase
Question 101
Regarding bendroflumethiazide:
a.
b.
c.
d.
e.
It is safe to use in pregnancy-induced hypertension
It is the first-line antihypertensive in patients of African or Caribbean family origin
Is available in oral and intravenous preparations
Is ineffective when GFR falls below 30 ml.min–1.1.73 m–2
May be given with amiloride as co-amilozide to reduce the risk of hypokalaemia
Question 102
Spironolactone:
a.
b.
c.
d.
e.
Has a steroidal structure
Is a non-competitive inhibitor of aldosterone
Causes gynaecomastia in males
Is hepatically metabolized and excreted mainly by the kidneys
Can be useful in an Addisonian crisis
Question 103
Warfarin:
a.
b.
c.
d.
e.
Prevents the formation of reduced vitamin K
Is 95% protein bound
Metabolism is reduced by erythromycin
Can be reversed by prothrombin complex concentrates
Metabolism is enhanced by amiodarone
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Chapter 3a: Pharmacology Questions
Question 104
The following statements regarding heparin are true:
a. Low molecular weight heparin has a shorter half-life than unfractionated heparin
b. Unfractionated heparin administration is associated with a lower incidence of heparininduced thrombocytopenia
c. 10 mg of protamine reverses 100 units of heparin
d. Heparin binds to antithrombin and inhibits the action of thrombin
e. Heparin occurs naturally in the liver and mast cell granules
Question 105
Regarding drugs affecting coagulation:
a.
b.
c.
d.
e.
Lepirudin is an indirect thrombin inhibitor
Alteplase is a recombinant tissue-type plasminogen activator
Aprotinin has been withdrawn due to a risk of cardiac arrhythmias
Tranexamic acid enhances the conversion of plasminogen to active plasmin
Rapid administration of protamine may cause acute hypotension, bradycardia and
flushing
Question 106
Central neuraxial blockade is contraindicated in the following:
a.
b.
c.
d.
e.
12 hours following therapeutic LMWH administration
Regular aspirin administration 75 mg once daily
Regular clopidogrel administration 75 mg once daily
Warfarin stopped 3 days ago, INR 1.7 on day of surgery
12 hours following fondaparinux administration
Question 107
Clopidogrel:
a.
b.
c.
d.
e.
Reversibly prevents ADP binding to its platelet receptor
Prevents activation of the glycoprotein IIb/IIIa complex
Has fewer gastrointestinal side effects than aspirin
Needs to be stopped 7 days prior to surgery
Is a coronary vasodilator
Question 108
Dipyridamole:
a.
b.
c.
d.
e.
Inhibits adenosine uptake by platelets
Activates platelet phospodiesterase
Results in lower levels of cAMP in platelets
At low dose potentiates the activity of prostacyclin
Is a monotherapy agent for the prevention of stroke
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Question 109
Concerning antiplatelet agents:
a. Glycoprotein IIb/IIIa inhibitors block platelet adhesion
b. Glycoprotein IIb/IIIa inhibitors are used in conjunction with unfractionated heparin
c. Glycoprotein IIb/IIIa inhibitors are primarily indicated in the treatment of ST elevation
myocardial infarction
d. Epoprostenol is used in the anticoagulation of haemofiltration circuits
e. Dextrans specifically inhibit von Willebrand’s factor to cause their anticoagulant effect
Question 110
Regarding tranexamic acid:
a.
b.
c.
d.
e.
Potentiates the action of plasmin
Is one of the WHO Essential Medicines
Is more efficacious than aminocaproic acid
Should be given as early as possible if used in major trauma
Is contraindicated in patients with thromboembolic disease
Question 111
Aprotinin:
a.
b.
c.
d.
e.
Has a bioavailability of approximately 80%
Affects the extrinsic pathway of the clotting cascade
Is extracted from bovine tissue
Is proven to be safer than tranexamic acid when used during CABG
Is both metabolized and excreted by the kidney
Question 112
Regarding the thromboelastogram (TEG):
a.
b.
c.
d.
It allows a dynamic assessment of the coagulation cascade
The maximal amplitude (MA) can be used to estimate platelet function
Is a form of near patient testing
Can be used to diagnose platelet dysfunction from von Willebrand’s disease or from
platelet inhibitors, e.g. aspirin, clopidogrel
e. Modern versions can distinguish between abnormalities in the intrinsic or extrinsic
pathways
Question 113
Regarding the content of intravenous fluids, the following statements are correct:
a.
b.
c.
d.
e.
500 ml of 20% mannitol contains approximately 100 g of mannitol
500 ml of Gelofusine contains 77 mmol of sodium ions
1000 ml of 6% Volulyte contains 137 mmol sodium ions, 4 mmol potassium ions
1000 ml of 0.9% saline contains 154 mmol of sodium and chloride ions
1000 ml of 8.4% bicarbonate contains 1000 mmol of sodium and bicarbonate ions
®
®
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Chapter 3a: Pharmacology Questions
Question 114
With respect to an infusion of 0.9% saline to an adult patient in the perioperative period:
a. Infusing a 1000 ml bag will distribute 250 ml to the plasma volume and 750 ml into the
interstitial fluid compartment
b. It will result in the development of hyperchloraemic alkalosis
c. It will increase in GFR
d. It will be an infusion of a solution with the same pH as the extracellular fluid of the
patient
e. It can cause hypokalaemia
Question 115
The following statements regarding blood products are true:
a.
b.
c.
d.
e.
Citrate supports red cell metabolism
Platelets are stored at 4 °C
Cryoprecipitate contains factor VIII and fibrinogen
The usual dose of FFP is 15 ml.kg–1
Packed red cells have an increased amount of 2,3-DPG
Question 116
Complications resulting from blood product transfusion include:
a.
b.
c.
d.
e.
Hyperkalaemia
Hypercalcaemia
Metabolic alkalosis
Acute respiratory distress syndrome
Coagulopathy
Question 117
The following fluids are the correct management for the clinical situation described:
a.
b.
c.
d.
e.
Diabetic ketoacidosis and 0.9% saline
Acute upper GI massive haemorrhage and 5% dextrose
Major sepsis and hydroxyethyl starches
Neurogenic diabetes insipidus and 5% dextrose
Severe vomiting and diarrhoea and 0.9% saline
Question 118
The following statements are correct:
a.
b.
c.
d.
e.
Sodium chloride 0.18%/4% glucose contains 50 mmol.l–1 of sodium ions
Human albumin 4.5% is isotonic
Colloids distribute throughout the total body water
1000 ml of Hartmann’s contains 29 mmol of lactate
A 1 litre bag of infused 5% dextrose leaves approximately 85 ml in the intravascular fluid
compartment
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Chapter 3a: Pharmacology Questions
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Question 119
Concerning phenytoin:
a.
b.
c.
d.
e.
It has a membrane stabilizing effect
It is a Class 1c antiarrhythmic agent
It is a cytochrome P450 enzyme inhibitor
It has good oral bioavailability
Skin eruptions and gingival hyperplasia are signs of toxicity
Question 120
Concerning antiepileptic drugs:
a.
b.
c.
d.
e.
Levetiracetam is active at GABA channels
Levetiracetam has a role in the treatment of myoclonic seizures
Sodium valproate is mainly active at GABA channels
Carbamazepine has a role in the management of trigeminal neuralgia
Carbamazepine is a cytochrome P450 enzyme inhibitor
Question 121
Concerning drugs affecting intraocular pressure:
a. Prostaglandin analogues increase the outflow of fluid from the uveal–scleral tract to
decrease intraocular pressure
b. Acetazolomide reduces intraocular pressure by an osmotic effect
c. Timolol acts via a similar mechanism to prostaglandins
d. Suxamethonium increases intraocular pressure
e. Ketamine decreases intraocular pressure
Question 122
Regarding magnesium sulfate:
a.
b.
c.
d.
e.
It is effective in the treatment of polymorphic ventricular tachycardia
It is the first-line antihypertensive treatment for severe pre-eclampsia
Common side effects of treatment include hyporeflexia and muscle weakness
Toxic levels can be reversed by the administration of calcium
It shortens the duration of action of neuromuscular blocking agents
Question 123
With reference to the magnesium ion:
a.
b.
c.
d.
e.
It is one of the most abundant extracellular cations in the body
It promotes thrombin-induced platelet aggregation
It exerts renal vasodilator and diuretic effects
Deficiency may be seen in up to 60% of critically ill patients
It is a powerful bronchodilator
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Chapter 3a: Pharmacology Questions
Question 124
Salbutamol:
a.
b.
c.
d.
e.
Increases intracellular cAMP concentrations
May cause hyperglycaemia
Also has a tocolytic action
Is not a cause of lactic acidosis
Can cross the placenta
Question 125
The following statements regarding the management of acute severe asthma are true:
a. Steroids reduce mortality
b. Combining ipratropium with salbutamol results in significantly greater bronchodilation
than salbutamol alone
c. Heliox is an effective treatment
d. Aminophylline loading dose is 15 mg.kg–1
e. Magnesium sulfate dose is 8 mmol
Question 126
Prednisolone has the following pharmacodynamic and pharmacokinetic properties:
a.
b.
c.
d.
e.
Oral bioavailability 80–100%
Is reversibly bound to albumin in the plasma
Decreases the number of β-adrenoreceptors
Decreases potassium excretion
Stimulates gluconeogenesis
Question 127
Carbocisteine is a mucolytic agent often prescribed to patients with chronic obstructive
pulmonary disease (COPD). The following statements are correct:
a.
b.
c.
d.
e.
Carbocisteine is poorly absorbed orally
Carbocisteine has antioxidant properties
Penetration of lung tissue by carbocisteine is poor
It has no action on gastric mucus levels
N-acetylcysteine is a mucolytic agent
Question 128
Concerning prokinetics:
a.
b.
c.
d.
e.
Erythromycin reduces the effectiveness of warfarin
Erythromycin causes prolongation of the QT interval
Metoclopramide has direct effects on gastric smooth muscle
Metoclopramide has no cholinergic effect
Metoclopramide can precipitate oculogyric crisis
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Question 129
Concerning antacids:
a. Ranitidine acts as a cytochrome P450 enzyme inhibitor
b. Ranitidine is an H1 antagonist
c. Proton pump inhibitors (PPIs) are more effective than histamine antagonists in gastric
acid suppression
d. PPIs inhibit the gastric parietal luminal H+/K+ ATPase enzyme
e. PPIs are prodrugs
Question 130
Concerning antiemetics:
a.
b.
c.
d.
e.
Metoclopramide acts both centrally and peripherally
Motion sickness is best treated by using drugs acting on the chemoreceptor trigger zone
Rapid administration of cyclizine causes tachycardia
Dexamethasone has potent antidopaminergic activity
Cannabinoids have a role in the treatment of chemotherapy-mediated emesis
Question 131
Concerning laxatives:
a.
b.
c.
d.
e.
Lactulose directly stimulates bowel peristalsis
Lactulose has a role in the secondary prevention of hepatic encephalopathy
Sodium docusate is a stimulant laxative
Phosphate enemas should be used with caution in renal impairment
Ispaghula is an ideal agent to use in patients with diverticular disease
Question 132
Concerning antisialogogues:
a. Hyoscine hydrobromide is useful in the treatment of spasmodic gut pain
b. Atropine has greater sedative properties than glycopyrronium bromide
c. Glycopyrronium bromide is administered together with neostigmine to reduce its
nicotinic side effects when reversing neuromuscular blockade
d. Atropine terminates salivary gland secretion to a greater extent than glycopyrronium
bromide
e. Glycopyrronium bromide is less likely than atropine to cause blurred vision
Question 133
Regarding uterotonic drugs:
a. Syntometrine is contraindicated in asthmatics
b. Since 2004, the National Institute of Health and Care Excellence recommend that all
women are given oxytocin 5 IU following delivery to improve uterine contraction and
reduce blood loss
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Chapter 3a: Pharmacology Questions
c. A Syntocinon infusion of 1 IU.h–1 is recommended following caesarean delivery for all
multiparous patients
d. Carboprost can be used before or after delivery to reduce risk of postpartum
haemorrhage
e. Atosiban is more effective than carboprost at reducing postpartum haemorrhage
®
Question 134
The following drugs are recognized tocolytics:
a.
b.
c.
d.
e.
Ritodrine
Magnesium sulfate
Terbutaline
Gylceryl trinitrate
Slow-release nifedipine
Question 135
The following statements with regards to antifungal agents are true:
a.
b.
c.
d.
e.
Amphotericin is nephrotoxic
Azoles all work by stimulating ergosterol synthesis
Posaconazole has the broadest spectrum of activity with fewest drug interactions
Fluconazole has poor activity against yeast infections
Hepatic dysfunction is associated with all of the azoles
Question 136
The following antibiotics are bacteriostatic:
a.
b.
c.
d.
e.
Erythromycin
Clindamycin
Glycopeptides
Ciprofloxacin
Aminoglycosides
Question 137
With regards to antibiotic resistance:
a.
b.
c.
d.
e.
Gene transfer is the main mechanism by which antimicrobials acquire resistance
Mutation is the main mechanism by which antimicrobials acquire resistance
Organisms with intrinsic resistance often have low virulence
The use of broad-spectrum antibiotics generates resistance
Antibiotic misuse of cephalosporins and quinolones has led to more virulent strains of
Clostridium difficile
Question 138
The following statements about antibiotics are true:
a. Ganciclovir is the treatment for CMV in the immunocompromised host
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Chapter 3a: Pharmacology Questions
b.
c.
d.
e.
207
Metronidazole inhibits protein synthesis
Vancomycin does not cause histamine release
Aminoglycosides decrease non-depolarizing muscle relaxant duration of action
Meropenem is a β-lactam antibiotic
Question 139
Insulin:
a.
b.
c.
d.
e.
Is rapidly metabolized by glutathione insulin transhydrogenase
Causes fat deposition in adipose tissue
Has some antihyperglycaemic action when administered orally
Is used in the management of hypokalaemia
Is removed by haemodialysis
Question 140
The following statements are correct:
a.
b.
c.
d.
e.
Sulfonylureas are effective in insulin-dependent diabetics
Metformin lowers plasma cholesterol and triglyceride levels
Action of glibenclamide may be potentiated by atenolol
Metformin can delay glucose uptake from the gut
Use of metformin may be complicated by lactic acidosis
Question 141
Regarding newer hypoglycaemic agents:
a.
b.
c.
d.
e.
Rosiglitazone acts at the PPAR γ1 and γ2 receptors
Thiazolidinediones (glitazones) increase levels of TNFα
Sitagliptin works by blocking the action of incretin
Sitagliptin has agonist action at the DPP4 receptor
Pioglitazone can be used safely in patients with congestive cardiac failure
Question 142
Thyroxine is a thyroid hormone that is also administered exogenously in patients with
hypothyroidism. It exerts a series of physiological effects including the following:
a.
b.
c.
d.
e.
Increases stroke volume
Decreases sweating
Increases neonatal lung maturation
Increases non-HDL cholesterol levels
Alteration in spermatogenesis
Question 143
Carbimazole is a prodrug used in the treatment of hyperthyroidism. Recognized complications of such therapy include:
a. Maculopapular rash
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b.
c.
d.
e.
Chapter 3a: Pharmacology Questions
Myopathy
Agranulocytosis
Cholestatic hepatitis
Type III hypersensitivity reaction
Question 144
There is a range of oral corticosteroids available and these have equivalent anti-inflammatory
doses. Prednisolone 5 mg is equivalent to:
a.
b.
c.
d.
e.
Dexamethasone 4 mg
Hydrocortisone 20 mg
Methylprednisolone 1 g
Triamcinolone 4 mg
Betamethasone 750 μg
Question 145
Endogenous and exogenous glucocorticoids have multisystemic effects and act via intracellular receptors to influence target gene transcription. The following effects are documented
effects of exogenous glucocorticoids:
a.
b.
c.
d.
e.
Suppression of appetite
Excess glucocorticoids stimulate skeletal growth in children
Decrease in libido
Prolongation of rapid eye movement sleep
Decrease in peripheral conversion of thyroxine (T4) to triiodothyronine (T3)
Question 146
Central nervous system (CNS) stimulants have a wide range of clinical uses and are also
important as drugs of abuse. Psychomotor stimulants produce euphoria and excitement.
The following are pharmacological characteristics of these agents:
a.
b.
c.
d.
e.
Caffeine competitively inhibits phosphodiesterase
Caffeine does not cross the placenta
Nicotine does not cross the blood–brain barrier
Amphetamines are metabolized by catechol-O-methyltransferase
Methylphenidate which can be used to treat attention deficit hyperactivity disorder is
a reversible dopamine reuptake inhibitor
Question 147
Doxapram is an analeptic or respiratory stimulant. It has the following characteristics:
a.
b.
c.
d.
e.
Increases the depth but not the rate of respiration
The major metabolite is 2-ketodoxapram
Causes an increase in cardiac output
Volume of distribution is around 1.5 l.kg–1
The intravenous preparation contains 0.9% benzyl acetate
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Chapter 3a: Pharmacology Questions
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Question 148
When considering effects of nicotine and tobacco smoking in the perioperative setting:
a. There is evidence that expired carbon monoxide (CO) concentration, which is an
indicator of recent smoking, is correlated with the frequency of ST depression during
general anaesthesia
b. The incidence of postoperative nausea and vomiting is higher in smokers
c. Nicotine reduces postoperative acute pain
d. The sympathomimetic effects of nicotine on the heart last for longer than 6 hours
e. Short-term abstinence from smoking decreases the incidence of postoperative pulmonary complications
Question 149
The consumption of alcohol both acutely and chronically leads to several important effects
that need to be considered in relation to the provision of general anaesthesia:
a. Ethanol depresses the responses mediated by the γ amino-butyric acid a type (GABAA)
receptor
b. Wernicke’s encephalopathy is a neurological disorder in chronic alcoholics caused by
vitamin B12 deficiency
c. Clonidine should be avoided in chronic alcoholics
d. There is a significant decrease in delayed hypersensitivity that contributes to increased
infection rates postoperatively
e. Plasma testosterone levels are usually elevated in those who are chronically dependent
on alcohol
Question 150
MDMA (3,4-methylenedioxy-N-methylamphetamine) (Ecstasy) and cocaine are widely
abused central nervous stimulants. There are several important pharmacological effects
that need to be considered by the anaesthetist in the perioperative setting:
a. If a vasopressor agent is required in a patient who has used cocaine recently then
phenylephrine should be avoided
b. The use of MDMA can result in excessive production of arginine vasopressin
c. Cocaine use is associated with delayed gastric emptying
d. Hypernatraemia is a common complication of MDMA use
e. β-Blockers are relatively contraindicated in cocaine-induced hypertension
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