NBSTSA Surgical Pharmacology & Anesthesia 5 — Questions and Answers
Question 1: During a procedure, the anesthesia provider administers neostigmine. Which drug must be co-administered to prevent bradycardia?
- Atropine or glycopyrrolate (Correct answer)
- Epinephrine
- Metoprolol
- Adenosine
Correct answer: Atropine or glycopyrrolate
Neostigmine inhibits acetylcholinesterase and can cause bradycardia via muscarinic effects; anticholinergics like atropine or glycopyrrolate are given concurrently to counteract this.
Question 2: Which controlled substance schedule applies to fentanyl under the DEA classification?
- Schedule I
- Schedule II (Correct answer)
- Schedule III
- Schedule IV
Correct answer: Schedule II
Fentanyl is a Schedule II controlled substance, indicating high abuse potential with accepted medical use but severe potential for dependence.
Question 3: A patient receives ketamine for dissociative anesthesia. What is a unique hemodynamic effect of this agent compared to most other anesthetics?
- It causes profound hypotension
- It stimulates the sympathetic nervous system, increasing heart rate and blood pressure (Correct answer)
- It produces bradycardia
- It has no cardiovascular effect
Correct answer: It stimulates the sympathetic nervous system, increasing heart rate and blood pressure
Ketamine is unique among anesthetics in that it stimulates the sympathetic nervous system, typically increasing heart rate, blood pressure, and cardiac output.
Question 4: Which antibiotic class is most commonly used for surgical site infection prophylaxis and is typically given within 60 minutes prior to incision?
- Fluoroquinolones
- Tetracyclines
- First-generation cephalosporins (Correct answer)
- Macrolides
Correct answer: First-generation cephalosporins
First-generation cephalosporins such as cefazolin are the standard for surgical prophylaxis due to their broad-spectrum coverage against common skin organisms and favorable safety profile.
Question 5: Which topical hemostatic agent is derived from bovine collagen and works by activating the coagulation cascade at the wound site?
- Gelatin foam (Gelfoam)
- Oxidized cellulose (Surgicel)
- Microfibrillar collagen (Avitene) (Correct answer)
- Bone wax
Correct answer: Microfibrillar collagen (Avitene)
Microfibrillar collagen (Avitene) activates platelet aggregation and the intrinsic coagulation pathway by direct contact with blood, providing mechanical and biochemical hemostasis.
Question 6: Which drug classification does midazolam belong to, and what is its primary intraoperative use?
- Opioid; used for pain control
- Benzodiazepine; used for preoperative sedation and amnesia (Correct answer)
- Barbiturate; used for induction of general anesthesia
- Alpha-2 agonist; used for hemodynamic stability
Correct answer: Benzodiazepine; used for preoperative sedation and amnesia
Midazolam is a short-acting benzodiazepine commonly used for preoperative anxiolysis and to produce anterograde amnesia, reducing patient recall of perioperative events.
Question 7: The surgeon requests thrombin solution during a liver resection. How should the surgical technologist handle this medication on the sterile field?
- It can be mixed with saline and injected intravenously
- It must only be applied topically and must never be injected intravascularly (Correct answer)
- It can be diluted in heparin solution for better efficacy
- It should be warmed to 37°C before use
Correct answer: It must only be applied topically and must never be injected intravascularly
Topical thrombin must never be injected intravascularly because it can cause rapid widespread clotting, leading to potentially fatal thrombosis.
NBSTSA Surgical Pharmacology & Anesthesia 5
During a procedure, the anesthesia provider administers neostigmine.
Which drug must be co-administered to prevent bradycardia?