CPAN Pharmacology Fundamentals 3 — Questions and Answers
Question 1: Sugammadex reverses neuromuscular blockade by which mechanism?
- Inhibiting acetylcholinesterase
- Encapsulating and binding rocuronium or vecuronium (Correct answer)
- Blocking nicotinic receptors
- Stimulating the neuromuscular junction
Correct answer: Encapsulating and binding rocuronium or vecuronium
Sugammadex is a modified gamma-cyclodextrin that encapsulates steroidal NMB agents (rocuronium, vecuronium), forming a tight complex that renders them inactive.
Question 2: A PACU patient develops shivering post-anesthesia. Which medication is most commonly used to treat postoperative shivering?
- Ondansetron
- Meperidine 25 mg IV (Correct answer)
- Midazolam 2 mg IV
- Dexamethasone 8 mg IV
Correct answer: Meperidine 25 mg IV
Low-dose meperidine (25 mg IV) is the most effective pharmacologic treatment for postoperative shivering, acting on kappa-opioid and alpha-2 receptors in the hypothalamus.
Question 3: Which of the following correctly describes the mechanism of ondansetron in preventing postoperative nausea and vomiting (PONV)?
- Dopamine D2 receptor antagonist
- Serotonin 5-HT3 receptor antagonist (Correct answer)
- Histamine H1 receptor antagonist
- Muscarinic M1 receptor antagonist
Correct answer: Serotonin 5-HT3 receptor antagonist
Ondansetron blocks 5-HT3 (serotonin) receptors in the gut and CTZ, making it one of the most effective agents for PONV prophylaxis and treatment.
Question 4: A patient has a known allergy to sulfa drugs. Which non-opioid analgesic should be used with caution or avoided?
- Acetaminophen
- Ketorolac
- Celecoxib (Correct answer)
- Ibuprofen
Correct answer: Celecoxib
Celecoxib is a COX-2 inhibitor containing a sulfonamide group and may cross-react in patients with sulfa drug allergies.
Question 5: Propofol infusion syndrome (PRIS) is most associated with which clinical finding?
- Hyperglycemia
- Severe metabolic acidosis with cardiac failure (Correct answer)
- Prolonged QT interval
- Hyperkalemia alone
Correct answer: Severe metabolic acidosis with cardiac failure
PRIS is characterized by severe metabolic (lactic) acidosis, rhabdomyolysis, cardiac failure, and renal failure, typically occurring with high-dose prolonged propofol infusions.
Question 6: A patient received intrathecal morphine for postoperative pain. What delayed complication requires monitoring up to 24 hours later?
- Hypertension
- Delayed respiratory depression (Correct answer)
- Hyperthermia
- Hyperreflexia
Correct answer: Delayed respiratory depression
Intrathecal morphine is hydrophilic and can migrate rostrally to brainstem respiratory centers, causing delayed respiratory depression 6–24 hours post-administration.
Question 7: Which inhalational anesthetic is known to trigger malignant hyperthermia in susceptible patients?
- Propofol
- Sevoflurane (Correct answer)
- Ketamine
- Dexmedetomidine
Correct answer: Sevoflurane
All volatile halogenated anesthetics, including sevoflurane, can trigger malignant hyperthermia by causing uncontrolled calcium release from the sarcoplasmic reticulum in genetically susceptible patients.
CPAN Pharmacology Fundamentals 3
Sugammadex reverses neuromuscular blockade by which mechanism?