MCQ Quiz-Anesthetics

MCQ Quiz: Anesthetics

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Anesthetics are a critical class of drugs used to induce a loss of sensation and/or consciousness, making them essential for surgery and various medical procedures. From general anesthetics used in the operating room to local anesthetics for minor procedures, pharmacists play a vital role in their safe preparation, dispensing, and management. This quiz for PharmD students will test your knowledge of the pharmacology, clinical uses, and toxicology of these potent medications, reflecting the pharmacist’s role in the acute care setting.

1. General anesthesia is best defined as a reversible state that includes:

  • Analgesia only.
  • Unconsciousness, amnesia, analgesia, and immobility.
  • Localized loss of sensation.
  • Sedation and anxiolysis.

Answer: Unconsciousness, amnesia, analgesia, and immobility.

2. Local anesthetics, like lidocaine, primarily exert their effect by blocking which type of ion channel?

  • Potassium channels
  • Calcium channels
  • Chloride channels
  • Voltage-gated sodium channels

Answer: Voltage-gated sodium channels

3. The primary mechanism of action for propofol, a common intravenous general anesthetic, involves potentiation of which neurotransmitter?

  • Glutamate
  • Dopamine
  • GABA (gamma-aminobutyric acid)
  • Serotonin

Answer: GABA (gamma-aminobutyric acid)

4. A major, dose-dependent side effect of propofol that requires close monitoring during administration is:

  • Hypertension and tachycardia.
  • Hypotension and respiratory depression.
  • Hyperglycemia.
  • A severe skin rash.

Answer: Hypotension and respiratory depression.

5. Propofol is formulated in a lipid emulsion, which gives it a milky-white appearance. This formulation characteristic is important because it:

  • Supports bacterial growth, requiring strict aseptic technique.
  • Provides a significant source of calories.
  • Can cause hyperlipidemia with long-term infusions.
  • All of the above.

Answer: All of the above.

6. Which intravenous anesthetic agent is known for providing both analgesia and anesthesia and is unique because it often maintains cardiovascular stability or causes a transient increase in blood pressure and heart rate?

  • Propofol
  • Etomidate
  • Ketamine
  • Midazolam

Answer: Ketamine

7. The mechanism of action of ketamine involves the non-competitive antagonism of which receptor?

  • Mu-opioid receptor
  • GABA-A receptor
  • NMDA receptor
  • Beta-2 adrenergic receptor

Answer: NMDA receptor

8. An “emergence reaction,” characterized by vivid dreams and hallucinations as the drug wears off, is a notable adverse effect of which anesthetic?

  • Propofol
  • Etomidate
  • Ketamine
  • Dexmedetomidine

Answer: Ketamine

9. Why is etomidate often chosen for rapid sequence intubation in hemodynamically unstable patients (e.g., in trauma)?

  • It provides excellent analgesia.
  • It is known for its cardiovascular stability and minimal effect on blood pressure.
  • It has a very slow onset of action.
  • It is a potent bronchodilator.

Answer: It is known for its cardiovascular stability and minimal effect on blood pressure.

10. A significant concern with the use of etomidate, especially with continuous infusions, is:

  • Severe hypertension.
  • Adrenocortical suppression.
  • A high risk of seizures.
  • Nephrotoxicity.

Answer: Adrenocortical suppression.

11. Which of the following is an inhaled (“volatile”) anesthetic?

  • Nitrous oxide
  • Sevoflurane
  • Isoflurane
  • All of the above

Answer: All of the above

12. The potency of an inhaled anesthetic is measured by the:

  • Blood:gas partition coefficient.
  • Minimum Alveolar Concentration (MAC).
  • Oil:gas partition coefficient.
  • Half-life of the drug.

Answer: Minimum Alveolar Concentration (MAC).

13. A low blood:gas partition coefficient for an inhaled anesthetic indicates a ________ onset and offset of action.

  • Slower
  • Faster
  • Variable
  • It does not affect the speed of onset.

Answer: Faster

14. Malignant hyperthermia is a rare but life-threatening reaction that can be triggered by:

  • Opioids and benzodiazepines.
  • Inhaled anesthetics (like sevoflurane) and succinylcholine.
  • Propofol and ketamine.
  • Local anesthetics.

Answer: Inhaled anesthetics (like sevoflurane) and succinylcholine.

15. What is the primary antidote for malignant hyperthermia?

  • Naloxone
  • Flumazenil
  • Dantrolene
  • Sodium bicarbonate

Answer: Dantrolene

16. Neuromuscular blocking agents (NMBAs) are often used as adjuncts to general anesthesia to:

  • Provide analgesia.
  • Provide sedation and amnesia.
  • Cause skeletal muscle paralysis to facilitate intubation and surgery.
  • Reverse the effects of the anesthetic.

Answer: Cause skeletal muscle paralysis to facilitate intubation and surgery.

17. When a patient is paralyzed with an NMBA, it is absolutely essential that they also receive adequate:

  • Analgesia and sedation.
  • Anticoagulation.
  • Antibiotics.
  • Diuretics.

Answer: Analgesia and sedation.

18. Succinylcholine is a depolarizing NMBA that is known for causing which initial side effect?

  • A drop in blood pressure.
  • Muscle fasciculations.
  • A severe rash.
  • A slow heart rate.

Answer: Muscle fasciculations.

19. A patient with a severe allergy to eggs or soy products may have a contraindication to which intravenous anesthetic?

  • Ketamine
  • Etomidate
  • Propofol
  • Midazolam

Answer: Propofol

20. “Local Anesthetic Systemic Toxicity” (LAST) is a medical emergency that can occur with high doses or accidental intravascular injection of a local anesthetic. The treatment of choice is:

  • Intravenous lipid emulsion therapy.
  • Naloxone.
  • Hemodialysis.
  • A fluid bolus of D5W.

Answer: Intravenous lipid emulsion therapy.

21. Epinephrine is often added to local anesthetic solutions to:

  • Increase the risk of systemic toxicity.
  • Cause vasodilation and speed up absorption.
  • Cause local vasoconstriction, which prolongs the duration of the anesthetic block and reduces systemic absorption.
  • Act as a preservative.

Answer: Cause local vasoconstriction, which prolongs the duration of the anesthetic block and reduces systemic absorption.

22. Dexmedetomidine is a unique sedative used in the ICU that acts as a(n):

  • GABA agonist.
  • NMDA antagonist.
  • Alpha-2 adrenergic agonist.
  • Mu-opioid agonist.

Answer: Alpha-2 adrenergic agonist.

23. A key feature of sedation with dexmedetomidine is that:

  • It causes significant respiratory depression.
  • Patients are often easily arousable and cooperative.
  • It provides strong analgesia.
  • It has a high risk of causing delirium.

Answer: Patients are often easily arousable and cooperative.

24. A pharmacist’s role in the “first response” to a trauma patient might involve preparing medications for:

  • Long-term pain management.
  • Rapid Sequence Intubation (RSI).
  • Chronic disease management.
  • A psychiatric emergency.

Answer: Rapid Sequence Intubation (RSI).

25. A pharmacist working in a hospital “operating room satellite pharmacy” is in a practice setting that requires expertise in:

  • The preparation of sterile anesthetic infusions.
  • The management of controlled substances.
  • Providing rapid drug information to anesthesiologists.
  • All of the above.

Answer: All of the above.

26. Which of the following is a benzodiazepine commonly used for procedural sedation due to its amnestic properties?

  • Propofol
  • Fentanyl
  • Midazolam
  • Ketamine

Answer: Midazolam

27. Propofol-related infusion syndrome (PRIS) is a rare but fatal complication of long-term, high-dose infusions, characterized by:

  • Hypertension and bradycardia.
  • Severe metabolic acidosis, rhabdomyolysis, and cardiovascular collapse.
  • Respiratory alkalosis.
  • A positive response to naloxone.

Answer: Severe metabolic acidosis, rhabdomyolysis, and cardiovascular collapse.

28. A key principle of “balanced anesthesia” is the use of:

  • A single anesthetic agent at a very high dose.
  • A combination of different drugs (e.g., an inhaled anesthetic, an opioid, an NMBA) to achieve the desired effects with lower doses of each.
  • Only intravenous anesthetics.
  • Only inhaled anesthetics.

Answer: A combination of different drugs (e.g., an inhaled anesthetic, an opioid, an NMBA) to achieve the desired effects with lower doses of each.

29. The pharmacist’s knowledge of __________ is critical for preparing anesthetic infusions with the correct diluent and concentration.

  • Sterile compounding and pharmaceutics
  • Toxicology
  • Health policy
  • Marketing

Answer: Sterile compounding and pharmaceutics

30. The ultimate goal of anesthesia is to:

  • Ensure the patient remembers the procedure clearly.
  • Provide safe, effective, and reversible unconsciousness and analgesia to allow for medical procedures.
  • Use the most expensive drugs available.
  • Minimize the role of the anesthesiologist.

Answer: Provide safe, effective, and reversible unconsciousness and analgesia to allow for medical procedures.

31. The “MAC” of an inhaled anesthetic is decreased by:

  • The use of other CNS depressants like opioids.
  • Young age.
  • Hyperthermia.
  • Chronic alcohol use.

Answer: The use of other CNS depressants like opioids.

32. A key “human factors” consideration in the operating room is:

  • The design of anesthesia machine displays to be clear and unambiguous.
  • The labeling of syringes to prevent drug swaps.
  • The use of checklists to ensure safety.
  • All of the above.

Answer: All of the above.

33. The use of a “smart pump” drug library for an anesthetic infusion is a safety technology designed to:

  • Prevent dosing and infusion rate errors.
  • Order the drug from the pharmacy.
  • Bill for the infusion.
  • Document the administration of the dose.

Answer: Prevent dosing and infusion rate errors.

34. A key leadership role for a critical care pharmacist is to:

  • Develop institutional protocols for the safe use of sedatives and anesthetics in the ICU.
  • Make all patient care decisions independently.
  • Manage the nursing schedule.
  • Order all lab tests.

Answer: Develop institutional protocols for the safe use of sedatives and anesthetics in the ICU.

35. A “Clinical Decision Support” alert in an EHR might be designed to fire if:

  • A patient with a history of malignant hyperthermia is prescribed succinylcholine.
  • A patient is due for a routine medication.
  • A patient’s insurance information changes.
  • A new lab result is normal.

Answer: A patient with a history of malignant hyperthermia is prescribed succinylcholine.

36. A pharmacist’s knowledge of “toxicology” and “antidotal therapy” is critical for managing:

  • A local anesthetic systemic toxicity (LAST) event.
  • A routine anesthetic case.
  • The financial aspects of the pharmacy.
  • The marketing of a new drug.

Answer: A local anesthetic systemic toxicity (LAST) event.

37. From a “policy” perspective, the high potential for abuse has led to some anesthetic agents like ________ being placed on the DEA’s controlled substance schedule.

  • Sevoflurane
  • Ketamine
  • Propofol (in some states)
  • Both B and C

Answer: Both B and C

38. The use of an “analytics and reporting system” in a hospital could be used to:

  • Track the incidence of adverse drug events related to anesthetics.
  • Monitor compliance with protocols for sedation in the ICU.
  • Analyze the cost-effectiveness of different anesthetic agents.
  • All of the above.

Answer: All of the above.

39. A “forging ahead” mindset in pharmacy means viewing the pharmacist’s role in anesthesia care as:

  • An expanding area of practice requiring specialized knowledge and skills.
  • Limited to the central pharmacy.
  • A role that will be replaced by technology.
  • A temporary phase in the profession.

Answer: An expanding area of practice requiring specialized knowledge and skills.

40. The “human resources” aspect of anesthesia care in a hospital involves:

  • Ensuring all pharmacists and technicians involved in preparing anesthetics have demonstrated competency in sterile compounding.
  • The hospital’s marketing budget.
  • The design of the operating room.
  • The brand of computer used.

Answer: Ensuring all pharmacists and technicians involved in preparing anesthetics have demonstrated competency in sterile compounding.

41. The use of a “negotiation” framework would be helpful when:

  • A clinical pharmacist is discussing with an anesthesiologist the evidence for a more cost-effective but equally efficacious anesthetic agent.
  • A patient is picking up a routine refill.
  • A pharmacist is ringing up a sale.
  • A pharmacist is checking in a medication order.

Answer: A clinical pharmacist is discussing with an anesthesiologist the evidence for a more cost-effective but equally efficacious anesthetic agent.

42. Which of the following is NOT a primary goal of general anesthesia?

  • Amnesia
  • Analgesia
  • Hypnosis (unconsciousness)
  • Hypertension

Answer: Hypertension

43. The “services” a pharmacist provides to an anesthesiology department include:

  • Sterile preparation of infusions.
  • Drug information.
  • Management of drug shortages.
  • All of the above.

Answer: All of the above.

44. A “business plan” for expanding pharmacy services to the operating room would need to include a financial analysis that justifies:

  • The cost of the additional pharmacist labor with improved safety and efficiency outcomes.
  • The high price of all anesthetic drugs.
  • A new marketing campaign for the hospital.
  • The purchase of new surgical equipment.

Answer: The cost of the additional pharmacist labor with improved safety and efficiency outcomes.

45. The “regulation” of anesthetic gases, such as the requirement for specific storage and handling procedures, is overseen by agencies like:

  • The DEA
  • OSHA and various state boards.
  • The FDA
  • CMS

Answer: OSHA and various state boards.

46. A “Dashboard Presentation” in a surgical department could be used to track:

  • Compliance with antibiotic prophylaxis protocols for surgery.
  • The number of surgical cases per day.
  • The turnover time between cases.
  • All of the above.

Answer: All of the above.

47. A pharmacist’s understanding of __________ is critical for calculating the correct infusion rate for an anesthetic drip.

  • Pharmaceutical calculations
  • Health policy
  • Marketing
  • Leadership

Answer: Pharmaceutical calculations

48. An “Electronic Health Record” (EHR) improves the safety of anesthesia care by:

  • Providing a real-time record of drug administration and vital signs.
  • Alerting the team to patient allergies.
  • Allowing for clear and legible order entry.
  • All of the above.

Answer: All of the above.

49. An interprofessional team approach is the standard of care in anesthesia because:

  • The safe delivery of anesthesia requires the coordinated expertise of the anesthesiologist, surgeon, nurse, and pharmacist.
  • It is a requirement for billing.
  • It makes decision-making slower.
  • Each profession can work independently.

Answer: The safe delivery of anesthesia requires the coordinated expertise of the anesthesiologist, surgeon, nurse, and pharmacist.

50. The ultimate principle for a pharmacist’s involvement in the use of anesthetics is to:

  • Ensure the safe, accurate, and evidence-based use of these high-risk medications.
  • Minimize the cost of all procedures.
  • Increase the speed of surgery.
  • Document all adverse events.

Answer: Ensure the safe, accurate, and evidence-based use of these high-risk medications.

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