Pharmacology Fundamentals Flashcards

A patient in the PACU receives neostigmine to reverse neuromuscular blockade. Which drug must be given concurrently to prevent bradycardia?

Answer: Atropine

Neostigmine inhibits acetylcholinesterase and increases muscarinic activity, requiring concurrent anticholinergic agents like atropine or glycopyrrolate to prevent bradycardia.

Which opioid is considered safest in patients with renal failure due to its lack of active metabolites?

Answer: Fentanyl

Fentanyl is metabolized to inactive compounds and does not accumulate in renal failure, unlike morphine (morphine-6-glucuronide) or meperidine (normeperidine).

A PACU patient develops laryngospasm. After jaw thrust fails, what drug is the first-line pharmacologic intervention?

Answer: Succinylcholine 0.1–0.2 mg/kg IV

A small 'laryngospasm dose' of succinylcholine (0.1–0.2 mg/kg IV) rapidly relaxes the spastic laryngeal muscles while minimizing full paralysis.

Dexmedetomidine exerts its sedative and analgesic effects primarily through which receptor?

Answer: Alpha-2 adrenergic receptor

Dexmedetomidine is a highly selective alpha-2 adrenergic agonist that produces sedation, analgesia, and anxiolysis with minimal respiratory depression.

A patient is receiving ketorolac (Toradol) in the PACU. Which condition is a contraindication to its use?

Answer: Peptic ulcer disease

Ketorolac is an NSAID that inhibits prostaglandins, increasing the risk of GI bleeding and ulceration, making active peptic ulcer disease a contraindication.

Which reversal agent is used to antagonize the effects of benzodiazepines in the PACU?

Answer: Flumazenil

Flumazenil competitively antagonizes benzodiazepines at GABA-A receptors; its short duration (30–60 min) means resedation is possible.

A patient who received a long-acting opioid during surgery receives naloxone in the PACU. What is the most important nursing concern after administration?

Answer: Resedation and respiratory depression recurrence

Naloxone has a shorter half-life (30–90 min) than most opioids, so resedation and respiratory depression can recur once it wears off, requiring close monitoring.