NBSTSA Surgical Pharmacology & Anesthesia 4 — Questions and Answers
Question 1: Which neuromuscular blocking agent is classified as a depolarizing agent?
- Rocuronium
- Vecuronium
- Succinylcholine (Correct answer)
- Cisatracurium
Correct answer: Succinylcholine
Succinylcholine is the only clinically used depolarizing neuromuscular blocking agent, mimicking acetylcholine to cause sustained muscle depolarization.
Question 2: A patient undergoing general anesthesia develops sudden hyperthermia, muscle rigidity, and tachycardia. Which drug should be administered immediately?
- Neostigmine
- Dantrolene (Correct answer)
- Naloxone
- Flumazenil
Correct answer: Dantrolene
Dantrolene is the specific treatment for malignant hyperthermia, a life-threatening condition triggered by volatile anesthetics or succinylcholine.
Question 3: Which local anesthetic classification includes bupivacaine?
- Ester
- Amide (Correct answer)
- Glycoside
- Opioid
Correct answer: Amide
Bupivacaine is an amide-type local anesthetic, metabolized by the liver, with a longer duration of action than most esters.
Question 4: The surgical technologist notices the surgeon requests epinephrine added to a local anesthetic solution. What is the primary purpose of this addition?
- To increase the pH of the solution
- To prolong anesthesia duration and reduce bleeding (Correct answer)
- To accelerate onset of anesthesia
- To prevent allergic reactions
Correct answer: To prolong anesthesia duration and reduce bleeding
Epinephrine causes vasoconstriction at the injection site, slowing systemic absorption of the local anesthetic and prolonging its duration while reducing local bleeding.
Question 5: Which reversal agent is used to antagonize the effects of benzodiazepines administered during anesthesia?
- Naloxone
- Neostigmine
- Flumazenil (Correct answer)
- Sugammadex
Correct answer: Flumazenil
Flumazenil is a competitive benzodiazepine antagonist at GABA receptors, used to reverse sedation caused by benzodiazepines such as midazolam.
Question 6: Heparin is administered intraoperatively during vascular surgery. Which medication is used to reverse its anticoagulant effects?
- Vitamin K
- Protamine sulfate (Correct answer)
- Fresh frozen plasma
- Warfarin
Correct answer: Protamine sulfate
Protamine sulfate binds to and neutralizes heparin, reversing its anticoagulant effect; typically 1 mg of protamine reverses approximately 100 units of heparin.
Question 7: Which inhalation anesthetic agent is associated with the highest potential for hepatotoxicity?
- Sevoflurane
- Desflurane
- Halothane (Correct answer)
- Isoflurane
Correct answer: Halothane
Halothane is associated with halothane hepatitis, a rare but potentially fatal immune-mediated hepatotoxicity, which is why its use has largely been replaced by newer agents.
NBSTSA Surgical Pharmacology & Anesthesia 4
Which neuromuscular blocking agent is classified as a depolarizing agent?