CRNA CRNA Pharmacology and Anesthesia Agents 2 — Questions and Answers
Question 1: What is the primary clinical use of dexmedetomidine in anesthesia practice?
- Sedation without respiratory depression (Correct answer)
- Induction of general anesthesia
- Reversal of neuromuscular blockade
- Treatment of malignant hyperthermia
Correct answer: Sedation without respiratory depression
Dexmedetomidine is a selective alpha-2 agonist that provides sedation, anxiolysis, and analgesia with minimal respiratory depression, making it ideal for monitored anesthesia care.
Question 2: Which volatile anesthetic is associated with the highest risk of nephrotoxicity due to Compound A formation?
- Sevoflurane (Correct answer)
- Desflurane
- Isoflurane
- Nitrous oxide
Correct answer: Sevoflurane
Sevoflurane reacts with carbon dioxide absorbents (particularly dried soda lime) to produce Compound A, a potentially nephrotoxic vinyl ether, especially at low fresh gas flows.
Question 3: Ketamine's dissociative anesthetic effect is primarily mediated through which receptor?
- NMDA receptor antagonism (Correct answer)
- GABA-A receptor potentiation
- Opioid receptor agonism
- Alpha-2 receptor agonism
Correct answer: NMDA receptor antagonism
Ketamine produces dissociative anesthesia primarily by non-competitive antagonism of NMDA receptors, blocking glutamate-mediated excitation.
Question 4: Which drug should be immediately available when administering intrathecal opioids to manage the most serious potential complication?
- Naloxone (Correct answer)
- Neostigmine
- Physostigmine
- Flumazenil
Correct answer: Naloxone
Naloxone is the opioid antagonist required to reverse delayed respiratory depression, the most serious complication of intrathecal opioid administration.
Question 5: What is the primary advantage of using sugammadex over neostigmine for reversal of rocuronium-induced neuromuscular blockade?
- Reversal at any depth of blockade without antimuscarinic need (Correct answer)
- Lower cost and wider availability
- Reversal of succinylcholine blockade
- Absence of cardiovascular side effects
Correct answer: Reversal at any depth of blockade without antimuscarinic need
Sugammadex encapsulates rocuronium (and vecuronium) directly, enabling reversal from profound blockade without the muscarinic side effects that require anticholinergic co-administration.
Question 6: A patient develops bronchospasm during general anesthesia. Which inhaled agent, if already in use, provides direct bronchodilation and should be continued?
- Sevoflurane (Correct answer)
- Nitrous oxide
- Halothane
- Desflurane
Correct answer: Sevoflurane
Sevoflurane provides bronchodilation through smooth muscle relaxation and is the preferred volatile agent in patients at risk for bronchospasm.
CRNA CRNA Pharmacology and Anesthesia Agents 2
What is the primary clinical use of dexmedetomidine in anesthesia practice?