Nagelhout Exam Final Questions with 100%
Correct Answers
Flumazenil reverses benzodiazepines, however does it reverse the anterograde
amnesia effects? - ANSWER-Yes, to a degree
Contraindications to giving flumazenil? - ANSWER-Hx of seizures, allergy
How can you estimate the addictiveness of an opiate? - ANSWER-Correlates with the
potency - more potent, more addictive
What is an enkephalin? - ANSWER-endogenous pain relievers
Where are enkephalins found? - ANSWER-CNS sites, GI tract + adrenal medulla
What is Pro-opiomelanocortin a precursor to? - ANSWER-Beta-Endorphin
What is Proenkephalin A a precursor to? - ANSWER-Enkephalins
What is Prodynorphin a precursor to? - ANSWER-dynorphins
What are the three major endogenous pain regulators? - ANSWER-Enkephalins,
Dynorphins, Beta-Endorphins
What are pain receptors called? - ANSWER-nociceptors
Is it preferred to use multiple pain medications or a high dose of a single one? -
ANSWER-Multiple; lower doses of multiple medications produce less overall side
effects
What is the purpose of pain? - ANSWER-Alarm system
What correlates with opioid potency and addiction liability? - ANSWER-Respiratory
depression; increases with the rest of the factors
What receptor do opioids work on? - ANSWER-Mu receptors
Dysphoria and shivering are associated with which pain receptor? - ANSWER-Kappa
What happens when you give a partial agonist with a full agonist? - ANSWER-They
compete for receptors and reduce the overall effect
What are the three groups of pain medications (chemically)? - ANSWER-Phenanthrene
alkaloids, piperidine derivatives, diphenylheptanes
,What does it mean if you're allergic to one phenanthrene narcotic? - ANSWER-You are
allergic to all phenanthrenes
Which drugs cause histamine release? (contraindicated for asthmatics) - ANSWER-
Phenanthrenes + demorol produce histamine release
Which opioid's metabolism is not affected by liver disease? - ANSWER-Remifentanyl is
metabolized by hydrolysis, enzyme catalyzing it is called nonspecific esterases
What drug interaction occurs between MAOIs and demerol? - ANSWER-Deadly
seizures
How do opioids cause respiratory depression with regards to PCO2 and alveolar
ventilation? - ANSWER-Opioids are respiratory depressants because they shift the CO2
response curve to the right (higher levels of PCO2 are required to induce the same
alveolar ventilation)
What two actions of opiates do you not develop tolerance to? - ANSWER-Miosis and
constipation
How to treat shivering? - ANSWER-Demerol
Does pruritus occur from histamine release (with regards to opioids)? - ANSWER-No, it
occurs from histamine and other factors (will occur with non histamine releasing opioids)
How do narcotics affect biliary pressure? - ANSWER-Increase it
What are treatments for increased biliary pressure? - ANSWER-Atropine
(glycopyrrolate), nitroglycerine, glucagon, naloxone, robinul
What correlates with an opioid's effect on biliary pressure? - ANSWER-Dose and
potency
How do narcotics cause biliary pressure? - ANSWER-Constriction of the sphincter of
Oddi
How to treat chest wall rigidity? - ANSWER-Succinylcholine, non-depolarizing muscle
relaxants, paralytics
What increases risk of chest wall rigidity? - ANSWER-High doses of narcotics given
rapidly, N20 co-administration
What is the chemotactic trigger zone? - ANSWER-Triggers vomiting center (immediate
gagging and vomiting)
Does the chemotactic trigger zone have a blood brain barrier? - ANSWER-No; has to
have direct access to the blood to sense O2
, With relation to opioids, when is the risk for nausea and vomiting highest? - ANSWER-
First dose, inhibitory effect on vomiting center tempers the CTZ
Which patient is at higher risk for vomiting, patient who is not on opioids (and is not
being administered opioids), or patient who is on opioids chronically? - ANSWER-
Chronic user
What is the vestibular component of nausea and vomiting? - ANSWER-movement
What is the multimodal therapy for PONV? - ANSWER-Dexamethasone before
induction
Which antiemetics can prolong QT? - ANSWER-Droperidol and Zofran
What is pharmacokinetics? - ANSWER-what the body does to the drug
What is pharmacodynamics? - ANSWER-what the drug does to the body
What is pharmacogenetics? - ANSWER-Genetic influences on and by drugs
What is pharmacogenomics? - ANSWER-Is the science which examines inherited
variations in genes that dictate drug response and explores way that the variations can
be used to predict wether the patient will have a good, bad, or no response to a drug.
How do narcotics affect ICP? - ANSWER-Indirectly through respirations
What is non-competitive binding? - ANSWER-Strong affinity for receptor, usually
covalent, can't be broken
What is the therapeutic index? - ANSWER-LD50/ED50
What is the therapeutic window? - ANSWER-TD50/ED50
What is the order of bond strength? - ANSWER-Covalent --> ionic --> hydrogen -->
hydrophobic --> van der Waals
What does the dose response curve tell us? - ANSWER-Affinity
Efficacy
Variability
Slope
Two medications are available, which one will pass through the placental membrane?
Oral capsule: Acid - pKa 5.1
IV: Basic - pKa 7.5 - ANSWER-IV
When would a basic IV solution be more water soluble? pH: 5 or 10? - ANSWER-5
Correct Answers
Flumazenil reverses benzodiazepines, however does it reverse the anterograde
amnesia effects? - ANSWER-Yes, to a degree
Contraindications to giving flumazenil? - ANSWER-Hx of seizures, allergy
How can you estimate the addictiveness of an opiate? - ANSWER-Correlates with the
potency - more potent, more addictive
What is an enkephalin? - ANSWER-endogenous pain relievers
Where are enkephalins found? - ANSWER-CNS sites, GI tract + adrenal medulla
What is Pro-opiomelanocortin a precursor to? - ANSWER-Beta-Endorphin
What is Proenkephalin A a precursor to? - ANSWER-Enkephalins
What is Prodynorphin a precursor to? - ANSWER-dynorphins
What are the three major endogenous pain regulators? - ANSWER-Enkephalins,
Dynorphins, Beta-Endorphins
What are pain receptors called? - ANSWER-nociceptors
Is it preferred to use multiple pain medications or a high dose of a single one? -
ANSWER-Multiple; lower doses of multiple medications produce less overall side
effects
What is the purpose of pain? - ANSWER-Alarm system
What correlates with opioid potency and addiction liability? - ANSWER-Respiratory
depression; increases with the rest of the factors
What receptor do opioids work on? - ANSWER-Mu receptors
Dysphoria and shivering are associated with which pain receptor? - ANSWER-Kappa
What happens when you give a partial agonist with a full agonist? - ANSWER-They
compete for receptors and reduce the overall effect
What are the three groups of pain medications (chemically)? - ANSWER-Phenanthrene
alkaloids, piperidine derivatives, diphenylheptanes
,What does it mean if you're allergic to one phenanthrene narcotic? - ANSWER-You are
allergic to all phenanthrenes
Which drugs cause histamine release? (contraindicated for asthmatics) - ANSWER-
Phenanthrenes + demorol produce histamine release
Which opioid's metabolism is not affected by liver disease? - ANSWER-Remifentanyl is
metabolized by hydrolysis, enzyme catalyzing it is called nonspecific esterases
What drug interaction occurs between MAOIs and demerol? - ANSWER-Deadly
seizures
How do opioids cause respiratory depression with regards to PCO2 and alveolar
ventilation? - ANSWER-Opioids are respiratory depressants because they shift the CO2
response curve to the right (higher levels of PCO2 are required to induce the same
alveolar ventilation)
What two actions of opiates do you not develop tolerance to? - ANSWER-Miosis and
constipation
How to treat shivering? - ANSWER-Demerol
Does pruritus occur from histamine release (with regards to opioids)? - ANSWER-No, it
occurs from histamine and other factors (will occur with non histamine releasing opioids)
How do narcotics affect biliary pressure? - ANSWER-Increase it
What are treatments for increased biliary pressure? - ANSWER-Atropine
(glycopyrrolate), nitroglycerine, glucagon, naloxone, robinul
What correlates with an opioid's effect on biliary pressure? - ANSWER-Dose and
potency
How do narcotics cause biliary pressure? - ANSWER-Constriction of the sphincter of
Oddi
How to treat chest wall rigidity? - ANSWER-Succinylcholine, non-depolarizing muscle
relaxants, paralytics
What increases risk of chest wall rigidity? - ANSWER-High doses of narcotics given
rapidly, N20 co-administration
What is the chemotactic trigger zone? - ANSWER-Triggers vomiting center (immediate
gagging and vomiting)
Does the chemotactic trigger zone have a blood brain barrier? - ANSWER-No; has to
have direct access to the blood to sense O2
, With relation to opioids, when is the risk for nausea and vomiting highest? - ANSWER-
First dose, inhibitory effect on vomiting center tempers the CTZ
Which patient is at higher risk for vomiting, patient who is not on opioids (and is not
being administered opioids), or patient who is on opioids chronically? - ANSWER-
Chronic user
What is the vestibular component of nausea and vomiting? - ANSWER-movement
What is the multimodal therapy for PONV? - ANSWER-Dexamethasone before
induction
Which antiemetics can prolong QT? - ANSWER-Droperidol and Zofran
What is pharmacokinetics? - ANSWER-what the body does to the drug
What is pharmacodynamics? - ANSWER-what the drug does to the body
What is pharmacogenetics? - ANSWER-Genetic influences on and by drugs
What is pharmacogenomics? - ANSWER-Is the science which examines inherited
variations in genes that dictate drug response and explores way that the variations can
be used to predict wether the patient will have a good, bad, or no response to a drug.
How do narcotics affect ICP? - ANSWER-Indirectly through respirations
What is non-competitive binding? - ANSWER-Strong affinity for receptor, usually
covalent, can't be broken
What is the therapeutic index? - ANSWER-LD50/ED50
What is the therapeutic window? - ANSWER-TD50/ED50
What is the order of bond strength? - ANSWER-Covalent --> ionic --> hydrogen -->
hydrophobic --> van der Waals
What does the dose response curve tell us? - ANSWER-Affinity
Efficacy
Variability
Slope
Two medications are available, which one will pass through the placental membrane?
Oral capsule: Acid - pKa 5.1
IV: Basic - pKa 7.5 - ANSWER-IV
When would a basic IV solution be more water soluble? pH: 5 or 10? - ANSWER-5
