CSFA Surgical Pharmacology and Anesthesia 2 — Questions and Answers
Question 1: Which reversal agent is used to antagonize the effects of non-depolarizing neuromuscular blocking agents?
- Flumazenil
- Neostigmine (Correct answer)
- Naloxone
- Sugammadex only
Correct answer: Neostigmine
Neostigmine is an acetylcholinesterase inhibitor that reverses non-depolarizing NMBAs by increasing acetylcholine at the neuromuscular junction.
Question 2: A patient receives succinylcholine and develops jaw rigidity combined with a rapid rise in end-tidal CO2. The CSFA should prepare for which emergency?
- Anaphylaxis
- Malignant hyperthermia (Correct answer)
- Laryngospasm
- Hyperkalemia
Correct answer: Malignant hyperthermia
Masseter spasm combined with rising end-tidal CO2 after succinylcholine is a classic early warning sign of malignant hyperthermia.
Question 3: Which local anesthetic has the LONGEST duration of action and is commonly used for postoperative pain blocks?
- Lidocaine
- Prilocaine
- Bupivacaine (Correct answer)
- Chloroprocaine
Correct answer: Bupivacaine
Bupivacaine is an amide local anesthetic with a long duration of action (4–12 hours), making it ideal for postoperative regional analgesia.
Question 4: Ketamine's primary mechanism of action as an anesthetic involves blocking which receptor?
- GABA-A
- NMDA (Correct answer)
- Mu-opioid
- Alpha-2 adrenergic
Correct answer: NMDA
Ketamine produces dissociative anesthesia by blocking NMDA (N-methyl-D-aspartate) glutamate receptors in the CNS.
Question 5: When assisting with a case requiring heparin anticoagulation, which agent is used for reversal of heparin?
- Vitamin K
- Protamine sulfate (Correct answer)
- Phytonadione
- Fresh frozen plasma
Correct answer: Protamine sulfate
Protamine sulfate binds and neutralizes heparin, reversing its anticoagulant effect within minutes.
Question 6: Which volatile anesthetic agent is CONTRAINDICATED in patients with a known or suspected susceptibility to malignant hyperthermia?
- Nitrous oxide
- Sevoflurane (Correct answer)
- Ketamine
- Propofol
Correct answer: Sevoflurane
Sevoflurane (and all halogenated volatile agents) can trigger malignant hyperthermia in susceptible patients and must be avoided.
Question 7: A patient develops bronchospasm during anesthesia induction. Which drug class is the FIRST-LINE bronchodilator used intraoperatively?
- Corticosteroids
- Anticholinergics
- Beta-2 agonists (Correct answer)
- Antihistamines
Correct answer: Beta-2 agonists
Beta-2 agonists such as albuterol are first-line agents for acute bronchospasm because they rapidly relax bronchial smooth muscle.
CSFA Surgical Pharmacology and Anesthesia 2
Which reversal agent is used to antagonize the effects of non-depolarizing neuromuscular blocking agents?