NAGELHOUT PHARMACOLOGY 1 EXAM 2
COMPREHENSIVE TEST QUESTIONS AND
CORRECT ANSWERS COMPLETE SOLUTION
VERIFIED PASS
●● All except nitrous oxide
Answer: What inhalation anesthetics trigger malignant hyperthermia and
are contraindicated?
●● Nitrous Oxide
Answer: This inhalation anesthetic blocks DNA and RNA synthesis.
●● oxidies the Cobalt atom on Vitamin B12
inhibits methionine synthetase
Answer: How does Nitrous Oxide block DNA & RNA production?
●● (1) Nutritional disorders - elderly, vegans, and alcoholics
(2) Malabsorption disorders - prolonged use of proton pump inhibitors
(H2 antagonists), pernicious anemia, atrophic gastritis, postgastrectomy,
Crohn's disease
(3) Infection - bacterial overgrowth, tapeworm
Answer: What patients are at risk with Nitrous oxide due to possible
prior Cobalamin Deficiency?
,●● (1) Known deficiency of enzyme or substrate in methionine synthase
pathway
(2) Potential toxicity from expansion of gas filled space - emphysema,
pneumothorax, middle ear, surgery, pneumocephalus, air embolus
(3) Raised intracranial pressure
Answer: What are the absolute contraindications to Nitrous Oxide?
●● (1) Pulmonary HTN
(2) Prolonged anesthesia (>6 hr)
(3) First trimester of pregnancy (tetragenic)
(4) High risk of PONV
Answer: What are the relative contraindications to Nitrous Oxide?
●● Risk of myocardial ischemia
Answer: What is a putative relative contraindication to Nitrous Oxide?
●● Nitrous oxide (teratogenic in animals)
Answer: What anesthetic is contraindicated in pregnancy?
●● first trimester
Answer: When is nitrous oxide most likely to cause teratogenic effects?
,●● relax the uterus (increase risk of postoperative miscarriage)
Answer: What is the effect of all anesthetics in pregnant women?
●● spinal (less bleeding - inhalation = uterine relaxation and more
bleeding)
Answer: Would it be better to use an inhalation anesthetic or spinal for a
uterine surgery? Why?
●● (1) masks
(2) high-pressure fittings
(3) exhalation valves
Answer: What are the three principle sources of waste anesthetic gasses?
●● <25 ppm
Answer: Regulations in the USA require nitrous oxide levels to be
_________________.
●● <2 ppm
Answer: Regulations in the USA require halogenated gas levels to be
_____________.
●● Nitrous oxide (50% NO = 15 mg IV morphine)
Answer: Which of the inhalation anesthetics has analgesic effects?
, ●● (1) Analgesia
(2) Rapid uptake and elimination
(3) Little cardiac or respiratory depression
(4) Nonpungent
(5) Reduces MAC of the more potent agents
(6) Minimal biotransformation
Answer: What are the advantages of Nitrous Oxide?
●● (1) Expansion of closed air spaces
(2) Requires high concentrations
(3) Amount of oxygen delivered is reduced
(4) Diffusion hypoxia, teratogenic increases
(5) PONV
(6) Supports combustion
(7) Immune suppression
Answer: What are the disadvantages of Nitrous Oxide?
●● (1) Moderate muscle relaxation
(2) Decreases cerebral metabolic rate
(3) Minimal biotransformation
(4) No significant systemic toxicity
COMPREHENSIVE TEST QUESTIONS AND
CORRECT ANSWERS COMPLETE SOLUTION
VERIFIED PASS
●● All except nitrous oxide
Answer: What inhalation anesthetics trigger malignant hyperthermia and
are contraindicated?
●● Nitrous Oxide
Answer: This inhalation anesthetic blocks DNA and RNA synthesis.
●● oxidies the Cobalt atom on Vitamin B12
inhibits methionine synthetase
Answer: How does Nitrous Oxide block DNA & RNA production?
●● (1) Nutritional disorders - elderly, vegans, and alcoholics
(2) Malabsorption disorders - prolonged use of proton pump inhibitors
(H2 antagonists), pernicious anemia, atrophic gastritis, postgastrectomy,
Crohn's disease
(3) Infection - bacterial overgrowth, tapeworm
Answer: What patients are at risk with Nitrous oxide due to possible
prior Cobalamin Deficiency?
,●● (1) Known deficiency of enzyme or substrate in methionine synthase
pathway
(2) Potential toxicity from expansion of gas filled space - emphysema,
pneumothorax, middle ear, surgery, pneumocephalus, air embolus
(3) Raised intracranial pressure
Answer: What are the absolute contraindications to Nitrous Oxide?
●● (1) Pulmonary HTN
(2) Prolonged anesthesia (>6 hr)
(3) First trimester of pregnancy (tetragenic)
(4) High risk of PONV
Answer: What are the relative contraindications to Nitrous Oxide?
●● Risk of myocardial ischemia
Answer: What is a putative relative contraindication to Nitrous Oxide?
●● Nitrous oxide (teratogenic in animals)
Answer: What anesthetic is contraindicated in pregnancy?
●● first trimester
Answer: When is nitrous oxide most likely to cause teratogenic effects?
,●● relax the uterus (increase risk of postoperative miscarriage)
Answer: What is the effect of all anesthetics in pregnant women?
●● spinal (less bleeding - inhalation = uterine relaxation and more
bleeding)
Answer: Would it be better to use an inhalation anesthetic or spinal for a
uterine surgery? Why?
●● (1) masks
(2) high-pressure fittings
(3) exhalation valves
Answer: What are the three principle sources of waste anesthetic gasses?
●● <25 ppm
Answer: Regulations in the USA require nitrous oxide levels to be
_________________.
●● <2 ppm
Answer: Regulations in the USA require halogenated gas levels to be
_____________.
●● Nitrous oxide (50% NO = 15 mg IV morphine)
Answer: Which of the inhalation anesthetics has analgesic effects?
, ●● (1) Analgesia
(2) Rapid uptake and elimination
(3) Little cardiac or respiratory depression
(4) Nonpungent
(5) Reduces MAC of the more potent agents
(6) Minimal biotransformation
Answer: What are the advantages of Nitrous Oxide?
●● (1) Expansion of closed air spaces
(2) Requires high concentrations
(3) Amount of oxygen delivered is reduced
(4) Diffusion hypoxia, teratogenic increases
(5) PONV
(6) Supports combustion
(7) Immune suppression
Answer: What are the disadvantages of Nitrous Oxide?
●● (1) Moderate muscle relaxation
(2) Decreases cerebral metabolic rate
(3) Minimal biotransformation
(4) No significant systemic toxicity
