Dissociative anesthetics – Ketamine hydrochloride MCQs With Answer

Dissociative anesthetics – Ketamine hydrochloride MCQs With Answer

Ketamine hydrochloride, a prototypical dissociative anesthetic and non-competitive NMDA receptor antagonist, is essential study material for B. Pharm students. This introduction covers ketamine pharmacology, mechanisms, enantiomers, pharmacokinetics, clinical uses (induction, analgesia, sedation, antidepressant applications), dosing, adverse effects (emergence phenomena, sympathomimetic activity, cystitis), drug interactions, and safety monitoring. Understanding preparations, routes (IV, IM, intranasal), metabolism to norketamine, and implications for special populations strengthens clinical and pharmaceutical knowledge. These SEO-focused keywords—dissociative anesthetics, ketamine hydrochloride, NMDA receptor antagonist, pharmacokinetics, adverse effects, dosing, MCQs—will guide exam readiness. Now let’s test your knowledge with 50 MCQs on this topic.

Q1. Which receptor is primarily antagonized by ketamine to produce its anesthetic and analgesic effects?

• Nicotinic acetylcholine receptor
• Gamma-aminobutyric acid (GABA) A receptor
• N-methyl-D-aspartate (NMDA) receptor
• Mu-opioid receptor

Correct Answer: N-methyl-D-aspartate (NMDA) receptor

Q2. Which stereoisomer of ketamine is generally more potent and often associated with fewer psychotomimetic effects?

• R(-)-ketamine
• S(+)-ketamine
• Racemate has no difference
• Both are equal in potency

Correct Answer: S(+)-ketamine

Q3. What is the typical intravenous induction dose of ketamine for general anesthesia in adults?

• 0.1–0.3 mg/kg
• 0.5–0.8 mg/kg
• 1–2 mg/kg
• 4–5 mg/kg

Correct Answer: 1–2 mg/kg

Q4. Which route of administration has the highest bioavailability for ketamine?

• Oral
• Intramuscular (IM)
• Intranasal
• Rectal

Correct Answer: Intramuscular (IM)

Q5. Ketamine’s major active metabolite formed by hepatic N-demethylation is called:

• Hydroxynorketamine
• Norketamine
• Dehydronorketamine
• Desmethylketamine

Correct Answer: Norketamine

Q6. Which cytochrome P450 isoenzymes are primarily involved in ketamine metabolism?

• CYP1A2 and CYP2D6
• CYP2B6 and CYP3A4
• CYP2C9 and CYP2C19
• CYP2E1 and CYP4A11

Correct Answer: CYP2B6 and CYP3A4

Q7. Which cardiovascular effect is commonly caused by ketamine due to sympathetic stimulation?

• Marked hypotension
• Bradycardia with AV block
• Increase in heart rate and blood pressure
• Severe vasodilation

Correct Answer: Increase in heart rate and blood pressure

Q8. Which of the following is a characteristic clinical feature of ketamine anesthesia?

• Complete loss of airway reflexes
• Deep skeletal muscle relaxation without movement
• Preservation of airway reflexes and spontaneous respiration
• Profound respiratory depression requiring immediate intubation

Correct Answer: Preservation of airway reflexes and spontaneous respiration

Q9. Which adverse phenomenon during recovery from ketamine is most frequently described?

• Delayed wound healing
• Emergence phenomena including vivid dreams and hallucinations
• Severe renal failure
• Prolonged neuromuscular blockade

Correct Answer: Emergence phenomena including vivid dreams and hallucinations

Q10. For analgesia at sub-anesthetic doses, which IV bolus range of ketamine is commonly used?

• 0.01–0.05 mg/kg
• 0.1–0.5 mg/kg
• 1.0–2.0 mg/kg
• 3.0–4.0 mg/kg

Correct Answer: 0.1–0.5 mg/kg

Q11. Which statement about ketamine and intracranial pressure (ICP) is most accurate for clinical exams?

• Ketamine consistently reduces ICP in all patients
• Ketamine has no effect on ICP and is always safe in raised ICP
• Ketamine may increase intracranial pressure and should be used cautiously in patients with elevated ICP
• Ketamine causes cerebrospinal fluid leak

Correct Answer: Ketamine may increase intracranial pressure and should be used cautiously in patients with elevated ICP

Q12. Which property of ketamine contributes to its use as a rapid-acting antidepressant in low doses?

• Opioid receptor agonism
• Long elimination half-life
• NMDA receptor antagonism and downstream glutamatergic modulation
• Strong GABAergic potentiation

Correct Answer: NMDA receptor antagonism and downstream glutamatergic modulation

Q13. What is the approximate elimination half-life of ketamine in adults?

• 10–12 minutes
• 30–60 minutes
• 2–3 hours
• 12–24 hours

Correct Answer: 2–3 hours

Q14. Chronic recreational use of ketamine is characteristically associated with which urological complication?

• Renal tubular necrosis
• Detrusor overactivity leading to hemorrhagic cystitis
• Urinary retention due to neurogenic bladder
• Urethral strictures only

Correct Answer: Detrusor overactivity leading to hemorrhagic cystitis

Q15. Which formulation or additive is commonly used to reduce ketamine-induced psychotomimetic emergence reactions when co-administered?

• Benzodiazepines (e.g., midazolam)
• Beta-blockers (e.g., propranolol)
• Anticholinergics (e.g., atropine)
• Cholinesterase inhibitors (e.g., neostigmine)

Correct Answer: Benzodiazepines (e.g., midazolam)

Q16. Which patient population requires dose adjustment or special caution when administering ketamine?

• Young healthy adults with no comorbidities
• Patients with uncontrolled hypertension or ischemic heart disease
• Patients with functional constipation only
• Patients with mild seasonal allergies

Correct Answer: Patients with uncontrolled hypertension or ischemic heart disease

Q17. Which of the following best describes ketamine’s effect on respiratory drive at typical anesthetic doses?

• Marked respiratory depression with apnea in most cases
• Minimal respiratory depression; spontaneous breathing usually preserved
• Complete abolition of the cough reflex only
• Constant bronchospasm induction

Correct Answer: Minimal respiratory depression; spontaneous breathing usually preserved

Q18. Ketamine’s analgesic mechanism at subanesthetic doses is primarily due to blocking which process?

• Opioid mu receptor activation
• Nociceptive signal transmission via NMDA receptor-mediated central sensitization
• Peripheral sodium channel blockade
• Inhibition of prostaglandin synthesis only

Correct Answer: Nociceptive signal transmission via NMDA receptor-mediated central sensitization

Q19. Which of the following is a commonly reported short-term adverse effect of ketamine on the central nervous system?

• Progressive Parkinsonism
• Transient confusion, disorientation, and hallucinations
• Irreversible coma
• Long-term peripheral neuropathy

Correct Answer: Transient confusion, disorientation, and hallucinations

Q20. Which monitoring parameter is most important during ketamine induction in the anesthetized patient?

• Serum electrolytes every minute
• Continuous cardiovascular and respiratory monitoring (ECG, BP, SpO2)
• Frequent arterial blood gases every 30 seconds
• Hourly liver function tests

Correct Answer: Continuous cardiovascular and respiratory monitoring (ECG, BP, SpO2)

Q21. Ketamine is classified under which schedule of controlled substances in the United States?

• Schedule I
• Schedule II
• Schedule III
• Unscheduled (not controlled)

Correct Answer: Schedule III

Q22. Which laboratory technique is commonly used in pharmaceutical analysis to quantify ketamine in formulations or biological samples?

• Thin-layer chromatography only
• High-performance liquid chromatography (HPLC)
• Nuclear magnetic resonance for routine QC
• Gram staining

Correct Answer: High-performance liquid chromatography (HPLC)

Q23. Which statement about ketamine’s plasma protein binding and volume of distribution is accurate?

• High plasma protein binding (>90%) and very small volume of distribution
• Low to moderate plasma protein binding and large volume of distribution indicating tissue uptake
• No plasma protein binding and confined to plasma
• Irreversible binding to tissue proteins only

Correct Answer: Low to moderate plasma protein binding and large volume of distribution indicating tissue uptake

Q24. Which precaution is most appropriate when using ketamine in a patient taking MAO inhibitors?

• No special precautions; safe in all doses
• Expect reduced analgesic effect only
• Use with caution due to potential exaggerated sympathetic effects and blood pressure rise
• Avoid because it causes severe hypoglycemia with MAOIs

Correct Answer: Use with caution due to potential exaggerated sympathetic effects and blood pressure rise

Q25. Which of the following is a commonly recommended intravenous infusion rate range for ketamine when used for analgesia?

• 0.001–0.005 mg/kg/hr
• 0.1–0.5 mg/kg/hr
• 5–10 mg/kg/hr
• 20–50 mg/kg/hr

Correct Answer: 0.1–0.5 mg/kg/hr

Q26. Which clinical use of ketamine has been increasingly recognized beyond anesthesia?

• Chronic antibiotic therapy
• Rapid-acting treatment for refractory depression
• Long-term antihypertensive treatment
• Primary seizure prophylaxis

Correct Answer: Rapid-acting treatment for refractory depression

Q27. Intranasal ketamine is useful in acute pain management because it provides which advantage?

• 100% bioavailability and no first-pass effect
• Rapid onset and non-invasive route suitable for prehospital or emergency use
• Complete avoidance of psychotropic effects
• Indefinite duration of action

Correct Answer: Rapid onset and non-invasive route suitable for prehospital or emergency use

Q28. Which condition is a relative contraindication to ketamine use due to potential exacerbation?

• Controlled asthma on therapy
• Elevated intraocular pressure (open globe injury)
• History of eczema
• Mild seasonal allergic rhinitis

Correct Answer: Elevated intraocular pressure (open globe injury)

Q29. Which age-related consideration is true for ketamine use in pediatric patients?

• Pediatrics show slower onset than adults for IV dosing
• Pediatrics tolerate IM ketamine well with predictable onset and dosage adjustments by weight
• Ketamine is contraindicated in children under 12 years
• No dosing adjustments are needed regardless of age or weight

Correct Answer: Pediatrics tolerate IM ketamine well with predictable onset and dosage adjustments by weight

Q30. In pharmacy practice, which storage recommendation is generally applicable for commercially supplied ketamine injections?

• Store frozen at −20°C
• Store at controlled room temperature away from light
• Store in direct sunlight to maintain stability
• Store at temperatures above 40°C

Correct Answer: Store at controlled room temperature away from light

Q31. Which pharmacodynamic interaction is expected when ketamine is combined with benzodiazepines?

• Benzodiazepines exacerbate ketamine-induced hypertensive effects
• Benzodiazepines can reduce emergence phenomena and provide anxiolysis
• Benzodiazepines abolish ketamine’s analgesic properties completely
• Benzodiazepines convert ketamine to inactive metabolites

Correct Answer: Benzodiazepines can reduce emergence phenomena and provide anxiolysis

Q32. Which formulation concentration is commonly available commercially for ketamine hydrochloride injections?

• Ketamine 0.1 mg/mL
• Ketamine 10 mg/mL
• Ketamine 100 mg/mL
• Ketamine 1000 mg/mL

Correct Answer: Ketamine 10 mg/mL

Q33. Which laboratory abnormality is most likely with chronic ketamine abuse?

• Marked hypercalcemia
• Urinary tract inflammation with hematuria and reduced bladder capacity
• Persistent neutropenia
• Elevated pancreatic enzymes exclusively

Correct Answer: Urinary tract inflammation with hematuria and reduced bladder capacity

Q34. Which statement about ketamine’s effect on EEG (electroencephalogram) is correct?

• Ketamine produces a burst-suppression pattern like high-dose barbiturates
• Ketamine increases EEG activity and may produce dissociative patterns rather than uniform suppression
• Ketamine abolishes all cortical electrical activity
• Ketamine has no effect on EEG

Correct Answer: Ketamine increases EEG activity and may produce dissociative patterns rather than uniform suppression

Q35. Which is an important counseling point for patients receiving outpatient intranasal ketamine for pain?

• Expect sedating effects; do not drive or operate machinery for several hours
• It is safe to drive immediately after administration
• There are no psychoactive effects to be concerned about
• Repeat dosing every 10 minutes indefinitely

Correct Answer: Expect sedating effects; do not drive or operate machinery for several hours

Q36. Which adverse metabolic or endocrine effect has been associated with prolonged high-dose ketamine exposure in some reports?

• Chronic hyperthyroidism
• Bladder fibrosis and lower urinary tract dysfunction
• Adrenal insufficiency
• Pancreatitis as a common effect

Correct Answer: Bladder fibrosis and lower urinary tract dysfunction

Q37. Which clinical scenario best represents a primary emergency indication for ketamine use?

• Severe hypotension requiring vasopressors
• Prehospital analgesia and sedation where airway preservation is important
• Routine elective colonoscopy in healthy adults
• Maintenance of spinal anesthesia

Correct Answer: Prehospital analgesia and sedation where airway preservation is important

Q38. Which of the following best describes the first-pass effect of oral ketamine?

• Oral ketamine has high bioavailability due to no first-pass metabolism
• Oral ketamine undergoes significant first-pass metabolism resulting in lower bioavailability
• Oral ketamine is entirely excreted unchanged in feces
• There is no hepatic metabolism for oral ketamine

Correct Answer: Oral ketamine undergoes significant first-pass metabolism resulting in lower bioavailability

Q39. Which precaution is appropriate for pharmacists preparing ketamine infusions for hospital use?

• Prepare infusions without aseptic technique since ketamine is antiseptic
• Follow sterile compounding standards, verify concentration and compatibility, and label controlled substance status
• Combine ketamine with alkaline solutions only
• No documentation is required for dispensing

Correct Answer: Follow sterile compounding standards, verify concentration and compatibility, and label controlled substance status

Q40. Which adverse cardiovascular effect can occur with high doses or rapid IV administration of ketamine?

• Profound bradycardia and complete heart block in all patients
• Marked hypertension and potential myocardial ischemia in susceptible patients
• Immediate vasovagal syncope always
• Delayed hypotension only

Correct Answer: Marked hypertension and potential myocardial ischemia in susceptible patients

Q41. Which statement about ketamine’s antimicrobial preservative content in multi-dose vials is correct?

• All ketamine vials are single-use and never contain preservatives
• Some formulations may contain preservatives; always check manufacturer labeling for multi-dose vial stability and preservatives
• Preservatives in ketamine universally cause allergic reactions
• Preservatives increase ketamine potency

Correct Answer: Some formulations may contain preservatives; always check manufacturer labeling for multi-dose vial stability and preservatives

Q42. Which mechanism explains ketamine’s sympathomimetic cardiovascular effects?

• Direct alpha-adrenergic blockade
• Indirect stimulation by releasing catecholamines and inhibiting their reuptake
• Pure parasympathetic activation
• Direct beta-adrenergic receptor antagonism

Correct Answer: Indirect stimulation by releasing catecholamines and inhibiting their reuptake

Q43. How does concurrent use of potent CYP3A4 inhibitors affect ketamine pharmacokinetics?

• It speeds up ketamine clearance, reducing effect
• It may decrease ketamine metabolism, potentially increasing plasma concentrations and effects
• It has no impact because ketamine is not hepatically metabolized
• It converts ketamine into inactive water-soluble metabolites immediately

Correct Answer: It may decrease ketamine metabolism, potentially increasing plasma concentrations and effects

Q44. When teaching B. Pharm students about ketamine, which formulation implication is important for nasal delivery systems?

• Nasal formulations require extremely high osmolality to be effective
• Absorption is influenced by formulation pH, concentration, and delivery device, affecting onset and bioavailability
• Nasal ketamine produces no systemic effects and acts locally only
• Nasal delivery is identical in pharmacokinetics to IV delivery

Correct Answer: Absorption is influenced by formulation pH, concentration, and delivery device, affecting onset and bioavailability

Q45. Which adverse psychiatric effect is important to screen for before administering ketamine in outpatient settings?

• History of major psychotic disorders or uncontrolled schizophrenia
• History of well-controlled seasonal allergies
• Mild transient insomnia only
• Prior uncomplicated spinal anesthesia

Correct Answer: History of major psychotic disorders or uncontrolled schizophrenia

Q46. Which statement best describes the use of ketamine for obstetric anesthesia?

• Ketamine is the first-line drug for all obstetric anesthetic procedures
• Ketamine can be used in select situations for induction when preservation of maternal blood pressure and uterine perfusion are priorities, with neonatal effects considered
• Ketamine is absolutely contraindicated in all pregnant patients
• Ketamine has no placental transfer and is therefore always safe

Correct Answer: Ketamine can be used in select situations for induction when preservation of maternal blood pressure and uterine perfusion are priorities, with neonatal effects considered

Q47. Which of the following best summarizes ketamine’s role in multimodal analgesia?

• Ketamine has no role in multimodal analgesia
• Low-dose ketamine adjuncts can reduce opioid consumption and opioid-related adverse effects postoperatively
• Ketamine increases opioid requirements
• Ketamine only acts as antiemetic in multimodal regimens

Correct Answer: Low-dose ketamine adjuncts can reduce opioid consumption and opioid-related adverse effects postoperatively

Q48. Which outcome is a desirable pharmacological feature of ketamine for emergency airway management?

• Complete suppression of protective airway reflexes
• Preservation of spontaneous respiration and airway reflexes while providing dissociation
• Guaranteed prevention of aspiration in all cases
• Permanent neuromuscular paralysis

Correct Answer: Preservation of spontaneous respiration and airway reflexes while providing dissociation

Q49. Which is a correct statement regarding ketamine’s effect on pulmonary function in bronchodilatory contexts?

• Ketamine has bronchodilatory properties and may be useful in bronchospasm management
• Ketamine always causes bronchoconstriction and should be avoided in asthma
• Ketamine has no effect on airway tone
• Ketamine is contraindicated if nebulized bronchodilators are used

Correct Answer: Ketamine has bronchodilatory properties and may be useful in bronchospasm management

Q50. In terms of pharmacovigilance, which signal should pharmacists report if observed in patients using ketamine recreationally?

• Transient mild headache only
• Severe urinary symptoms, persistent dysuria, or hematuria consistent with ketamine-related cystitis
• Occasional mild thirst without other symptoms
• Intermittent sneezing

Correct Answer: Severe urinary symptoms, persistent dysuria, or hematuria consistent with ketamine-related cystitis

G S Sachin

I am a Registered Pharmacist under the Pharmacy Act, 1948, and the founder of PharmacyFreak.com. I hold a Bachelor of Pharmacy degree from Rungta College of Pharmaceutical Science and Research. With a strong academic foundation and practical knowledge, I am committed to providing accurate, easy-to-understand content to support pharmacy students and professionals. My aim is to make complex pharmaceutical concepts accessible and useful for real-world application.

Mail- Sachin@pharmacyfreak.com