CBRN Pharmacology & Medication Management 2 — Questions and Answers
Question 1: Ketamine is frequently chosen for burn wound care procedures because it provides:
- Muscle paralysis with minimal sedation
- Dissociative anesthesia with preservation of airway reflexes and hemodynamic stability (Correct answer)
- Deep sedation without analgesic properties
- Local anesthesia confined to the wound site
Correct answer: Dissociative anesthesia with preservation of airway reflexes and hemodynamic stability
Ketamine provides dissociative anesthesia, analgesia, and amnesia while maintaining airway reflexes and hemodynamic stability, making it ideal for painful burn dressing changes.
Question 2: In a burn patient receiving systemic antibiotics, which physiological factor most significantly alters drug pharmacokinetics compared to non-burn patients?
- Decreased gastric motility reducing oral absorption
- Increased volume of distribution due to massive fluid shifts and edema (Correct answer)
- Reduced hepatic metabolism from burn-related liver damage
- Increased protein binding due to elevated acute-phase proteins
Correct answer: Increased volume of distribution due to massive fluid shifts and edema
Major burns cause massive fluid shifts, edema, and capillary leak, significantly increasing volume of distribution and altering drug pharmacokinetics, often requiring higher or more frequent dosing.
Question 3: Oxandrolone (an anabolic steroid) is used in severe burn patients primarily to:
- Decrease wound infection rates through immune modulation
- Counteract catabolism and preserve lean body mass (Correct answer)
- Enhance procedural pain control
- Reduce hypertrophic scar formation
Correct answer: Counteract catabolism and preserve lean body mass
Oxandrolone is an anabolic steroid used in burn patients to counteract the severe catabolism of the hypermetabolic response, preserving lean body mass and improving overall recovery.
Question 4: Which topical burn wound agent is CONTRAINDICATED in a patient with a documented sulfonamide allergy?
- Silver nitrate solution
- Bacitracin ointment
- Silver sulfadiazine (Silvadene) (Correct answer)
- Petroleum-based gauze dressings
Correct answer: Silver sulfadiazine (Silvadene)
Silver sulfadiazine contains a sulfonamide component and is contraindicated in patients with known sulfa allergies due to the risk of a hypersensitivity reaction.
Question 5: Benzodiazepines and/or melatonin are used in burn ICU patients primarily to address:
- Wound infection prevention through immune enhancement
- ICU-related anxiety, sleep disturbances, and delirium prevention (Correct answer)
- Reduction of the hypermetabolic rate
- Prevention of deep vein thrombosis
Correct answer: ICU-related anxiety, sleep disturbances, and delirium prevention
Burn ICU patients frequently experience sleep disturbances, anxiety, and delirium; sedative agents like benzodiazepines or melatonin are used to manage these complications and improve patient outcomes.
Question 6: Recombinant human growth hormone (rhGH) has been studied in pediatric burn patients to:
- Prevent wound infections by enhancing immune response
- Accelerate wound healing and reduce hospital length of stay (Correct answer)
- Control pain during dressing changes
- Prevent hypertrophic scarring post-healing
Correct answer: Accelerate wound healing and reduce hospital length of stay
Recombinant human growth hormone has been shown to accelerate wound healing, enhance protein synthesis, and reduce hospital length of stay in pediatric burn patients.
Question 7: Which anticoagulation strategy is most commonly used in burn patients for deep vein thrombosis (DVT) prophylaxis?
- Warfarin with daily INR monitoring
- Low molecular weight heparin (LMWH) such as enoxaparin (Correct answer)
- Aspirin 325 mg daily alone
- Direct oral anticoagulants like rivaroxaban
Correct answer: Low molecular weight heparin (LMWH) such as enoxaparin
Low molecular weight heparin (e.g., enoxaparin) is the preferred DVT prophylaxis in burn patients due to predictable pharmacokinetics, no need for frequent monitoring, and effectiveness in the hypercoagulable post-burn state.
CBRN Pharmacology & Medication Management 2
Ketamine is frequently chosen for burn wound care procedures because it provides: