PHARM
Nagelhout Pharm Exam Questions and
Answers Solved Graded A+
What type of compounds does albumin favor binding to? - Correct Ans-acidic
What two proteins favor binding to basic drugs? - Correct Ans-Alpha-1-acid glycoprotein
(AAG) and B-globulin
What is the degree of protein binding for a drug proportional to? - Correct Ans-its lipid
solubility (the more lipid soluble, the more highly protein bound)
What is a clinically significant protein binding level? - Correct Ans-90% or greater (90-
95)
If the percentage of a highly protein bound drug drops below ______, it is clinically
significant? - Correct Ans-90-95%
What is the time necessary for plasma content of a drug to drop to half of its prevailing
concentration after a rapid bolus injection? - Correct Ans-Elimination half-life (t1/2)
Elimination half life is also known as ? - Correct Ans-Beta half life
It takes an average of ______ half-lives to eliminate a drug from the body? - Correct
Ans-4
If you start with 100mg of Drug X, how many mg will be left after 1, 2, 3, and 4 half
lives? - Correct Ans-1: 50mg
2: 25mg
3: 12.5mg
4: 6.25 mg
What 4 categories of patients are commonly cited as having low protein binding due to
low levels of plasma proteins? - Correct Ans-Malnourished, severe liver/kidney disease,
last trimester of pregnancy
What is the ventilation effect? - Correct Ans-the greater the alveolar ventilation, the
faster the patient achieves anesthesia
What is the concentration effect? - Correct Ans-the higher the concentration of
anesthetic delivered, the faster anesthesia is achieved (higher initial dose=faster onset
of action)
PHARM
,PHARM
What is the blood/gas solubility coefficient? - Correct Ans-the indicator of an
anesthetic's SPEED of onset and emergence, the higher the coefficient, the slower the
anesthetic, the lower the coefficient, the faster the anesthetic
Order the anesthetic gases from fastest to slowest onset/emergence? - Correct Ans-
Desflurane, Nitrous, Sevoflurane, Isoflurane
What is the BGPC for each anesthetic gas? - Correct Ans-Des- 0.42
Nitrous- 0.47
Sevo- 0.6
Iso- 1.4
What is the oil/gas solubility coefficient? - Correct Ans-the indicator of an anesthetic's
potency--the higher the coefficient, the more potent the agent
What is the OGPC for each anesthetic gas from most potent to least? - Correct Ans-Iso-
99
Sevo- 50
Des- 18.7
Nitrous- 1.4
What is the second gas effect? - Correct Ans-a phenomenon in which two anesthetics
of varying onset speeds are administered together--a high concentration of fast
anesthetic (NO) is administered with a slower second anesthetic gas. The slower gas
achieves anesthetic levels more quickly than if it had been given alone
What is diffusion hypoxia? - Correct Ans-occurs when high concentrations of N2O are
administered--at the end of the procedure, when N2O is DCd, it leaves the body very
rapidly, causing transient dilution of O2 and CO2 in the lungs. Hypocarbia and hypoxia
may occur. Administration of 100% O2 for 3-5 mins when N2O is DCd alleviates the
problem
What is the cardiac output effect? - Correct Ans-increases in CO decrease the speed of
onset of all anesthetics
What gases speed of onset are more affected by an increase in cardiac output? -
Correct Ans-the more soluble
What is the ventilation-perfusion abnormality effect on anesthetic gases? - Correct Ans-
they reduce the speed of onset of all anesthetics and effect the insoluble agents to a
much greater degree
How do pediatric patients respond to gas anesthetics? - Correct Ans-children achieve
anesthesia more rapidly due to a higher ventilatory rate and vessel-rich group blood
flow--this occurs despite the need for a higher MAC and a higher CO in children
PHARM
, PHARM
How does obesity affect gas anesthetics? - Correct Ans-Minimal clinical effects on
induction, but emergence may be slower due to deposition of anesthetics in fat
All anesthetic gases besides N2O are what? - Correct Ans-halogenated ethers
N2O is the only ______ molecule - Correct Ans-inorganic (not containing carbon)
Halothane is a ________ - Correct Ans-halogenated hydrocarbon
Why is halogenated a good quality? - Correct Ans-it is stable and non-flammable
Ether=______ - Correct Ans-anesthetic
GABA receptors are permeable to what anion? - Correct Ans-Chloride
What receptor do anesthetic agents act on? - Correct Ans-GABA
Anesthetics have a _____ effect - Correct Ans-gaba-mimetic
GABA is a ______ NT - Correct Ans-inhibitory
When a anesthetic drug binds to a GABA receptor, what happens? - Correct Ans-
Chloride channels open up, there is increased chloride conductance into the cell, it
hyperpolarizes, which causes inhibition
What are the effects of anesthetic gases on the central and autonomic nervous system?
- Correct Ans-dose-dependent depression of the CNS and ANS, decreased CMRO2,
decreased IOP, and increased ICP
Why is there increased ICP with volatile anesthetics? - Correct Ans-they cause cerebral
vasodilation and increased CBV
How can you counteract the increased ICP from volatile anesthetics? - Correct Ans-
modest hyperventilation to a pCO2 of 30-35
Use what percent MAC for neuro cases? - Correct Ans-1 MAC or less
What are the benefits of N2O for neuro anesthesia ? - Correct Ans-rapid onset and
rapid termination (good for neuro assessment), good analgesic effect, in/out fast, can
keep a low dose of other IHAs
Other CNS effects of IHAs? - Correct Ans-amnesia, decreases SSEPs, and cerebral
protective effect
How are IHAs cerebral protective? - Correct Ans-they decrease the CMRO2 (cause
hibernation effect)
PHARM
Nagelhout Pharm Exam Questions and
Answers Solved Graded A+
What type of compounds does albumin favor binding to? - Correct Ans-acidic
What two proteins favor binding to basic drugs? - Correct Ans-Alpha-1-acid glycoprotein
(AAG) and B-globulin
What is the degree of protein binding for a drug proportional to? - Correct Ans-its lipid
solubility (the more lipid soluble, the more highly protein bound)
What is a clinically significant protein binding level? - Correct Ans-90% or greater (90-
95)
If the percentage of a highly protein bound drug drops below ______, it is clinically
significant? - Correct Ans-90-95%
What is the time necessary for plasma content of a drug to drop to half of its prevailing
concentration after a rapid bolus injection? - Correct Ans-Elimination half-life (t1/2)
Elimination half life is also known as ? - Correct Ans-Beta half life
It takes an average of ______ half-lives to eliminate a drug from the body? - Correct
Ans-4
If you start with 100mg of Drug X, how many mg will be left after 1, 2, 3, and 4 half
lives? - Correct Ans-1: 50mg
2: 25mg
3: 12.5mg
4: 6.25 mg
What 4 categories of patients are commonly cited as having low protein binding due to
low levels of plasma proteins? - Correct Ans-Malnourished, severe liver/kidney disease,
last trimester of pregnancy
What is the ventilation effect? - Correct Ans-the greater the alveolar ventilation, the
faster the patient achieves anesthesia
What is the concentration effect? - Correct Ans-the higher the concentration of
anesthetic delivered, the faster anesthesia is achieved (higher initial dose=faster onset
of action)
PHARM
,PHARM
What is the blood/gas solubility coefficient? - Correct Ans-the indicator of an
anesthetic's SPEED of onset and emergence, the higher the coefficient, the slower the
anesthetic, the lower the coefficient, the faster the anesthetic
Order the anesthetic gases from fastest to slowest onset/emergence? - Correct Ans-
Desflurane, Nitrous, Sevoflurane, Isoflurane
What is the BGPC for each anesthetic gas? - Correct Ans-Des- 0.42
Nitrous- 0.47
Sevo- 0.6
Iso- 1.4
What is the oil/gas solubility coefficient? - Correct Ans-the indicator of an anesthetic's
potency--the higher the coefficient, the more potent the agent
What is the OGPC for each anesthetic gas from most potent to least? - Correct Ans-Iso-
99
Sevo- 50
Des- 18.7
Nitrous- 1.4
What is the second gas effect? - Correct Ans-a phenomenon in which two anesthetics
of varying onset speeds are administered together--a high concentration of fast
anesthetic (NO) is administered with a slower second anesthetic gas. The slower gas
achieves anesthetic levels more quickly than if it had been given alone
What is diffusion hypoxia? - Correct Ans-occurs when high concentrations of N2O are
administered--at the end of the procedure, when N2O is DCd, it leaves the body very
rapidly, causing transient dilution of O2 and CO2 in the lungs. Hypocarbia and hypoxia
may occur. Administration of 100% O2 for 3-5 mins when N2O is DCd alleviates the
problem
What is the cardiac output effect? - Correct Ans-increases in CO decrease the speed of
onset of all anesthetics
What gases speed of onset are more affected by an increase in cardiac output? -
Correct Ans-the more soluble
What is the ventilation-perfusion abnormality effect on anesthetic gases? - Correct Ans-
they reduce the speed of onset of all anesthetics and effect the insoluble agents to a
much greater degree
How do pediatric patients respond to gas anesthetics? - Correct Ans-children achieve
anesthesia more rapidly due to a higher ventilatory rate and vessel-rich group blood
flow--this occurs despite the need for a higher MAC and a higher CO in children
PHARM
, PHARM
How does obesity affect gas anesthetics? - Correct Ans-Minimal clinical effects on
induction, but emergence may be slower due to deposition of anesthetics in fat
All anesthetic gases besides N2O are what? - Correct Ans-halogenated ethers
N2O is the only ______ molecule - Correct Ans-inorganic (not containing carbon)
Halothane is a ________ - Correct Ans-halogenated hydrocarbon
Why is halogenated a good quality? - Correct Ans-it is stable and non-flammable
Ether=______ - Correct Ans-anesthetic
GABA receptors are permeable to what anion? - Correct Ans-Chloride
What receptor do anesthetic agents act on? - Correct Ans-GABA
Anesthetics have a _____ effect - Correct Ans-gaba-mimetic
GABA is a ______ NT - Correct Ans-inhibitory
When a anesthetic drug binds to a GABA receptor, what happens? - Correct Ans-
Chloride channels open up, there is increased chloride conductance into the cell, it
hyperpolarizes, which causes inhibition
What are the effects of anesthetic gases on the central and autonomic nervous system?
- Correct Ans-dose-dependent depression of the CNS and ANS, decreased CMRO2,
decreased IOP, and increased ICP
Why is there increased ICP with volatile anesthetics? - Correct Ans-they cause cerebral
vasodilation and increased CBV
How can you counteract the increased ICP from volatile anesthetics? - Correct Ans-
modest hyperventilation to a pCO2 of 30-35
Use what percent MAC for neuro cases? - Correct Ans-1 MAC or less
What are the benefits of N2O for neuro anesthesia ? - Correct Ans-rapid onset and
rapid termination (good for neuro assessment), good analgesic effect, in/out fast, can
keep a low dose of other IHAs
Other CNS effects of IHAs? - Correct Ans-amnesia, decreases SSEPs, and cerebral
protective effect
How are IHAs cerebral protective? - Correct Ans-they decrease the CMRO2 (cause
hibernation effect)
PHARM
