CSFA Surgical Pharmacology and Anesthesia 3 — Questions and Answers
Question 1: Which medication is administered to prevent bradycardia when succinylcholine is used in pediatric patients?
- Epinephrine
- Atropine (Correct answer)
- Glycopyrrolate
- Neostigmine
Correct answer: Atropine
Atropine is given prior to succinylcholine in children to prevent the profound bradycardia that succinylcholine can cause in the pediatric population.
Question 2: Dantrolene's role in treating malignant hyperthermia is to:
- Block NMDA receptors in the brain
- Inhibit calcium release from the sarcoplasmic reticulum (Correct answer)
- Antagonize volatile anesthetic binding
- Increase renal excretion of potassium
Correct answer: Inhibit calcium release from the sarcoplasmic reticulum
Dantrolene prevents the uncontrolled release of calcium from the sarcoplasmic reticulum of skeletal muscle, halting the hypermetabolic cascade of MH.
Question 3: Which opioid is associated with 'wooden chest syndrome' (chest wall rigidity) when given in large or rapid IV doses?
- Morphine
- Fentanyl (Correct answer)
- Hydromorphone
- Meperidine
Correct answer: Fentanyl
Fentanyl and other potent synthetic opioids can cause rapid-onset chest wall rigidity, impairing ventilation and requiring NMB agent treatment.
Question 4: The anesthesia provider asks the CSFA to irrigate the wound with epinephrine-containing solution. The PRIMARY reason for epinephrine in local anesthetic solutions is to:
- Increase rate of drug absorption
- Produce vasoconstriction and prolong analgesia (Correct answer)
- Prevent allergic reactions
- Accelerate wound healing
Correct answer: Produce vasoconstriction and prolong analgesia
Epinephrine causes local vasoconstriction, which slows absorption of the local anesthetic, prolongs its effect, and reduces systemic toxicity.
Question 5: Which class of drugs is used to treat intraoperative hypertension by relaxing vascular smooth muscle through direct nitric oxide release?
- Beta-blockers
- Calcium channel blockers
- Nitrates (Correct answer)
- ACE inhibitors
Correct answer: Nitrates
Nitrates (e.g., nitroglycerin, sodium nitroprusside) release nitric oxide, causing vasodilation and rapid reduction of blood pressure.
Question 6: A patient on chronic warfarin therapy requires emergent surgery. Which product provides the FASTEST reversal of warfarin's anticoagulant effect?
- Vitamin K (oral)
- Fresh frozen plasma
- 4-factor prothrombin complex concentrate (PCC) (Correct answer)
- Platelet transfusion
Correct answer: 4-factor prothrombin complex concentrate (PCC)
4-factor PCC provides immediate replenishment of all vitamin K-dependent clotting factors, offering faster reversal than FFP or oral vitamin K.
Question 7: Which neuromuscular blocking agent is classified as DEPOLARIZING?
- Rocuronium
- Vecuronium
- Succinylcholine (Correct answer)
- Cisatracurium
Correct answer: Succinylcholine
Succinylcholine is the only clinically used depolarizing NMBA; it binds acetylcholine receptors and causes prolonged depolarization of the motor end plate.
CSFA Surgical Pharmacology and Anesthesia 3
Which medication is administered to prevent bradycardia when succinylcholine is used in pediatric patients?