FANZCA FANZCA Clinical Pharmacology and Anesthesia 3

Question 1

Which opioid analgesic has an active metabolite (morphine-6-glucuronide) that accumulates in renal failure and can cause prolonged respiratory depression?

Accepted Answer

Morphine

Answer

Morphine-6-glucuronide, a potent metabolite of morphine, is renally excreted and accumulates in patients with renal impairment, prolonging analgesic and respiratory depressant effects.

Question 2

What is neostigmine's mechanism for reversing non-depolarizing neuromuscular blockade?

Accepted Answer

Inhibition of acetylcholinesterase, increasing synaptic acetylcholine to compete with the blocker

Answer

Neostigmine inhibits acetylcholinesterase, allowing acetylcholine to accumulate at the neuromuscular junction and competitively displace non-depolarizing blockers from nicotinic receptors.

Question 3

Which benzodiazepine is preferred for procedural sedation in anesthesia due to its short duration, amnesic properties, and water solubility?

Accepted Answer

Midazolam

Answer

Midazolam is the preferred benzodiazepine in anesthesia because of its water solubility (preventing phlebitis), rapid onset, anterograde amnesia, and short duration of action.

Question 4

What is the primary advantage of remifentanil over other opioids for total intravenous anesthesia (TIVA)?

Accepted Answer

It is metabolized by plasma esterases, giving a predictably short context-sensitive half-time regardless of infusion length

Answer

Remifentanil is hydrolyzed by non-specific tissue and plasma esterases, resulting in a context-sensitive half-time of approximately 3–5 minutes regardless of infusion duration.

Question 5

Which drug is used as a specific reversal agent for benzodiazepine-induced sedation and respiratory depression in the perioperative setting?

Accepted Answer

Flumazenil

Answer

Flumazenil competitively antagonizes benzodiazepines at GABA-A receptors, reversing sedation and respiratory depression, though its duration is shorter than most benzodiazepines, requiring monitoring for re-sedation.

(FANZCA) Fellowship of the Australian and New Zealand College of Anaesthetists Practice Test

(FANZCA) Fellowship of the Australian and New Zealand College of Anaesthetists Practice Test

FANZCA FANZCA Clinical Pharmacology and Anesthesia 3