Key Words -- January 29, 2016
230. Meperidine is contraindicated in patients taking which of
the following drugs for Parkinsons disease?A. BromocriptineB.
LevodopaC. Selegiline (Eldepryl)D. Amantadine (Symmetrel)E.
Trihexyphenidyl (Artane)
231. Which of the following benzylisoquinoline non-depolarizing
neuromuscular blocking drugs is unique among this class of drugs in
that it does not cause release of histamine?A. d-TubocurarineB.
CisatracuriumC. RocuroniumD. AtracuriumE. Pipecuronium
232. The most common reason for patients to rate anesthesia with
etomidate as unsatisfactory isA. Postoperative nausea and
vomitingB. Pain on injectionC. Recall of intubationD. MyoclonusE.
Postoperative hiccups
233. Which of the following muscle relaxants inhibits the
reuptake of norepinephrine by the adrenergic nerves?A.
PancuroniumB. PipecuroniumC. RocuroniumD. DoxacuriumE.
Vecuronium
230. [C]Selegiline is an MAOI that is sometimes used in the
treatment of Parkinsons disease. Meperidine is contraindicated in
patients taking MAOIs because of the possibility of excitation
(e.g., agitation, skeletal muscle rigidity, hyperpyrexia) or
depression (e.g., hypotension, depressed ventilation, coma) that
may result.
Meperidine anticholinergic side effects. Tachycardia common
(unlike other opioids). Phenylpiperidine opioid with additional
antimuscarinic and serotonin reuptake-inhibiting effects Can cuase
euphoria, but not always sedation Normeperidine can accumulate
(repeat doses) in renal failure and cause seizure. Weak serotonin
reuptake inhibitor..use with MAO-I could cause serotonin
syndrome
Common PD treatments: Bromocritpine Dopamine receptor agonist
Levodopa dopamine precursor Selegiline -- selective inhibitor of
monoamine oxidase type B Amantadine (Symmetrel) glutamate receptor
antagonist Trihexyphenidyl (Artane) - anticholinergic
231. [B]There are two major chemical classes of nondepolarizing
muscle relaxants, the Aminosteroids (-onium drugs) ==> Do not
cause histamine release Vecuronium Rocuronium Pancuronium
benzylisoquinolinium (-urium) Atracurium Mivacurium
Benzylisoquinoline esters (end in share the property of
histamine release, the order of magnitude being: d-tubocurarine
>> atracurium, mivacurium, doxacurium Cisatracurium
absent
H1 & H2 receptor stimulation mast cell degranulation
eicosanoids, PGF2 Causes flushing, hypotension and
bronchoconstriction
232. [A]Etomidate, an imidazole derivative, is used most often
for induction of general anesthesia, but it also can be used for
maintenance of general anesthesia. Etomidate has a relatively short
duration of action and provides very stable hemodynamics, even in
patients with limited cardiovascular reserve. However, it is
associated with several adverse effects. These adverse effects
include a high incidence of nausea and vomiting (greater than after
thiopental), pain on injection, thrombophlebitis, myoclonic
movements, and, sometimes, hiccups. Nausea and vomiting constitute
the most common reason patients rate anesthesia with etomidate as
unsatisfactory. The addition of fentanyl to etomidate to decrease
the pain of injection also increases the incidence of nausea and
vomiting
Common SE of Etomidate: Nausea/vomiting Burning on injection due
to propylene glycol solution Myoclonus Adrenal suppression --- dose
dependent inhibition of 11-beta hydroxlase. Thrombophlebits
233. [A]Pancuronium has parasympatholytic properties: Heart
rate, MAP/CO, little/no change in SVRMechanism of Action:
Antagonize cardiac M2 receptors (G-protein linked, open K+ channel,
cAMP) = TACHYCARDIA Direct: block neuronal uptake of norepi
Indirect: release of norepi from adrenergic nerve endings
(Miller: Anesthesia, ed 6, p 512 Stoelting: Pharmacology and
Physiology in Anesthetic Practice, ed 4, pp 228-230).
