Opioid Pharmacology Practice Questions

Anesthesia Pharmacology: Pharmacokinetic and General Practice Questions

Choose the correct answer(s) for each question.

Ketamine (Ketalar):
1. related to phencyclidine structurally
2. significant cardiac depression
3. significant respiratory depression
4. flumazenil (Romazicon) is a specific ketamine (Ketalar) antagonist
Ketamine (Ketalar) pharmacology:
1. associated with emergence hallucinations
2. reduced lipid solubility compared to thiopental (Pentothal)
3. both
4. neither
Ketamine (Ketalar) pharmacokinetics
1. metabolism by hepatic microsomal system, yielding demethylated and hydroxylated products
2. norketamine exhibits biological activity
3. relatively slow onset of action
4. primary mechanism for termination of biological CNS effect = redistribution
5. all of the above
Ketamine (Ketalar) pharmacology:
1. dissociative anesthesia
2. swallow and corneal reflexes present
3. amnestic effects
4. reduced muscle limb tone
5. 80% likelihood of emergence syndrome
Ketamine (Ketalar): cardiovascular effects
1. tachycardia
2. increased cardiac output
3. increased blood pressure
4. ketamine (Ketalar) cardiac effects blocked by clonidine (Catapres)
5. all of the above
Etomidate (Amidate): adverse effects
1. thrombophlebitis
2. myoclonus
3. nausea and vomiting
4. inhibition of steroid synthesis
5. all the above
etomidate (Amidate) metabolism:
1. N-dealkylation
2. ester hydrolysis
3. both
4. neither
Etomidate (Amidate) pharmacokinetics:
1. rapid onset
2. rapid initial redistribution phase
3. low clearance compared to thiopental (Pentothal)
Etomidate (Amidate) pharmacology: CNS actions
1. excellent analgesic
2. probably acts by interacting with GABA-ergic receptor systems
3. reduction in cerebral metabolism
4. reduce cerebral blood flow
5. EEG activation, consistent with possible epileptogenic activity
More likely to require fentanyl (Sublimaze) to reduce hemodynamic effects caused by direct laryngoscopy:
1. propofol (Diprivan)
2. etomidate (Amidate)
Propofol (Diprivan):
1. enhancement of the GABA neurotransmitter system
2. administered as an emulsion
3. not approved in the U.S. for sedation of pediatric ICU patients
4. A & C
5. A, B & C
Propofol (Diprivan) pharmacokinetics:
1. pharmacologic action terminated by redistribution from the brain to other compartments
2. "context-sensitive" halftime is about five hours
3. metabolites: inactive glucuronide and sulfate derivatives
4. B & C
Propofol (Diprivan): organ system effects -- CNS
1. reduced cerebral metabolic rate
2. increased cerebral blood flow
3. increased intracranial pressure
4. EEG changes observed
Propofol (Diprivan) pharmacology-pulmonary effects
1. apnea following IV administration (frequency = 25%-30%)
2. following IV infusion: reduce tidal volume & reduced respiratory rate
3. both
4. neither
Propofol (Diprivan) administration may increase intraoperative wheezing in patients with asthma (causes bronchodilation)
1. true
2. false
Propofol (Diprivan):
1. may induce malignant hyperpyrexia
2. suppresses cortisol synthesis
3. both
4. neither
More likely to be associated with a painful IV administration:
1. thiopental (Pentothal)
2. propofol (Diprivan)
3. etomidate (Amidate)
Contemporary opioid agent/agents used in IV anesthesia:
1. fentanyl (Sublimaze)
2. sufentanil (Sufenta)
3. alfentanil (Alfenta)
4. remifentanil (Ultiva)
5. all of the above
Opioid receptor subtype most likely associated with analgesia and respiratory depression
1. kappa
2. mu
3. sigma
Morphine pharmacokinetics:
1. low lipid solubility compared to fentanyl (Sublimaze)
2. at physiological pH, morphine is primarily un-ionized
3. both
4. neither
Morphine exhibits relatively high plasma clearance (15-40 ml/kg/minute), suggestive of extrahepatic clearance mechanisms in addition to hepatic metabolism
1. true
2. false
Fentanyl (Sublimaze):
1. more lipid-soluble than morphine
2. faster onset compared to morphine
3. at physiological pH, primarily un-ionized
4. all of the above
Sufentanil (Sufenta):
1. rapid onset of action
2. increased respiratory depression bradycardia compared to fentanyl (Sublimaze)
3. both
4. neither
Most likely to be un-ionized (uncharged) at physiological pH:
1. sufentanil (Sufenta)
2. alfentanil (Alfenta)
3. fentanyl (Sublimaze)
Extremely short duration of action may make this agent preferable to block physiological responses to a single, brief intervention such as performing a retrobulbar block
1. fentanyl (Sublimaze)
2. sufentanil (Sufenta)
3. alfentanil (Alfenta)
Unique among the various opioids use in IV anesthesia because of its susceptibility to ester hydrolysis:
1. alfentanil (Alfenta)
2. remifentanil (Ultiva)
3. fentanyl (Sublimaze)
4. sufentanil (Sufenta)

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