ANZCA Pharm MCQ Primary July 12

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  1. If a drug has a Vd of 0.6L/kg, it is reasonable to assume:
    A. It distributes throughout the TBW, and it is not lipid soluble
    B. Something about Vd equals body water volume
    • .
    • .
    • Unknown
  2. G proteins
    A. binds 4 sites
    B. has 2 alpha subunits
    • .
    • .
    • Unknown
  3. Which one is not a second messenger

    A. c-AMP
    B. c-GMP
    C. Ca2+
    D. G Proteins
    E. Nitric Oxide
    • .
    • .
    • ? D. G Proteins (my own guess)
  4. ED95 in regards to neuromuscular blockers means
    A. Dose required to cause twitch height depression to 95% of control value
    B. Dose required to cause twitch height depression of 95% of control value
    C. 95% of patients will be paralysed at this dose
    • .
    • .
    • B. Dose required to cause dep OF 95%
  5. The units of rate constant k are?

    A. mg/min
    B. mcg/kg/min
    C. min
    D. min-1
    E. ml-1
    • .
    • .
    • D. min-1

    Assuming that it is first order kinetics, the answer will always be time-1
  6. Which of the following is NOT metabolised by plasma cholinesterase?

    A. Heroin
    B. Mivacurium
    C. Suxamethonium
    D. Remifentanil
    E. Procaine
    • .
    • .
    • D. Remifentanil !!

    • Heroin is hydrolysed by pseudocholinesterase to 6-acetylmorphine
    • Mivacurium by PChE to quaternary alcohols and esters all inactive
    • Sux obviously
    • Procaine to PABA and diethylaminoethanol
  7. Desflurane is better in obesity because:    OR
    Of the following what feature of Des makes it most suitable for bariatric anaesthesia?
    A. Mac 6.6%
    B. blood:gas coeff 0.42
    C. saturated vapour pressure 669mmHg
    D. oil:water coeff 346
    E. ?
    • .
    • .
    • ? D. oil:water coeff 346 ?
  8. Isoflurane
    A. Is a halogenated methyl ethyl ether
    B. is an enantiomer of enflurane
    C. has a boiling point higher than sevoflurane
    D. is odourless
    • .
    • .
    • A. is a halogenated methyl ethyl ether
  9. Metabolites of Isoflurane
    A. 2% to hexafluroisopropyl
    B. 0.2%
    C. 0.2% via renal conjugation
    D. 0.5% ...
    E. 2% fluoride
    • .
    • .
    • ? B. 0.2%

    • Iso oxidative metab by CYPP450 2E1 to trifluoroacetic acid (TFA) and Fluoride ion (F-)
    • Lacks intrarenal metabolism (unlike Methoxyflurane)
  10. Second gas effect seen with nitrous oxide because:
    A. it is used in high concentrations
    B. it is relatively insoluble
    C. Reaches equilibrium faster than the more soluble second gas
    D. larger volume
    E. because it's MAC is additive with other agents
    F. it is less soluble than the volatile it is mixed with
    • .
    • .
    • A. it is used in high concentrations

    It is also in part that it is a larger volume according to stoelting p25
  11. Mechanism of IMMOBILITY with volatiles / specific volatile?
    A. stimulation of GABAa receptors
    B. Stimulation of glycine receptors
    • .
    • .
    • ??
    • A. GABAa???
  12. Question about the amount of thiopentone remaining in brain 30 mins after administration?
    A. 10%
    B. 20%
    C. 30%
    D. 40%
    E. 50%
  13. Thiopentone contains:
    A. Commercial preparation contains sodium (something but not carbonate)
    • .
    • .
    • who knows as unfinished question.
  14. Thiopentone is
    A. antanalgesia in sub-therapeutic doses
    • .
    • .
    • ? A. antanalgesic in sub-therapeutic
  15. Propofol preferred to Thiopentone in TIVA because:
    A. Low therapeutic index
    B. T1/2 keo
    C. high clearance
    D. something about lipid solubility
    • .
    • .
    • ???
  16. Propofol is suitable for long infusions mostly thanks to its:
    A. low Vd
    B. high clearance
    C. high plasma protein binding
    • .
    • .
    • ? B. high clearance
  17. Which of the following is not an ester local anaesthetic?
    A. Prilocaine
    B. Procaine
    C. Amethocaine
    D. Tetracaine
    • .
    • .
    • A. Prilocaine 

    all others are ester LA's
  18. Cocaine effects are the result of:
    A. Direct sympathomimetic
    B. Significant dopaminergic central effects
    • .
    • .
    • B. significant dopaminergic central effects?

    most ester LA's are mainly hydrolysed by PChE but Cocaine is the exception - mostly liver metabolism with some minor PChE involvement.
  19. Something about lignocaine blocking certain channels:
    A. G-protein mediated
    B. v-gated K channels
    C. V-gated Na channels
    D. V-gated Ca Channels
    E. V-gated Mg channels
    • .
    • .
    • C. v-gated Na channels likely correct answer
    • lignocaine blocks V-gated Na channels and acts as a LA as well as a Class 1b Antiarrhythmic
  20. Naloxone
    C. well absored orally
    E. refractory respiratory depression may occur with a single dose
    • .
    • .
    • Naloxone is not well absorbed orally - Naltrexone is
    • ? refractory resp depression? unlikely?
    • Naloxone is competitive opioid antag. PPB 50 %, Vd 2L/kg
  21. Buprenorphine
    A. Transdermal is used as an effective acute pain strategy
    B. Plasma concentration rises rapidly when injected IV
    C. Maybe an option to do with it's pKa
    D. Semisynthetic derivative of thebaine
    • .
    • .
    • ? D. semisynthetic derivative of thebaine

    Buprenorphine is a partial mu agonist and a kappa antagonist
  22. Phentolamine
    A. is a selective alpha 1 antagonist
    B. binds covalently to the alpha receptor
    C. causes bradycardia
    D. is a selective alpha 2 antagonist
    E. increases cardiac output
    • .
    • .
    • Phentolamine is a non-selective, competitive antag at alpha 1 & 2. It causes reflex tachy.
    • So A, B, C, D are all incorrect
    • E. Increases CO is correct
  23. Highest bioavailability of beta-blockers:
    A. Propranolol
    B. Labetalol
    C. Sotalol
    D. Atenolol
    E. Metoprolol
    F. Carvedilol
    G. Esmolol
    • .
    • .
    • C. Sotalol
    • Taken from katzung/wiki:
    • Sotalol: >90 - 100%
    • Atenolol 40 - 50%
    • Metoprolol 50%
    • Labetalol 30%
    • Carvedilol 35%
    • Propranolol 12 - 30%
    • Esmolol 0%
  24. Phenylephrine and Metaraminol both
    A. Poor substrates for breakdown by COMT
    B. cause coronary vasoconstriction
    C. are direct acting agents
    D. ? increase HR ? decrease HR
    E. ? something about bradycardia
    • .
    • both indirect and direct acting agents
    • tend to decrease HR
    •  ?  coronary vasoconstriction minimal but some does occur ?
    • A. poor substrates for breakdown COMT
  25. Ventricular fibrillation in an adult:
    A. lignocaine 1.5mg/kg is first line treatment
    B. high dose adrenaline (100mcg/kg) improves outcome in "hospital cardiac arrest"
    C. bicarbonate indicated if pH < 7.2
    D. vasopressin increase coronary and cerebral perfusion via its action at V1 receptors
    E. caution with use of amiodarone as it may cause Torsades
    • .
    • E caution with use of amiodarone as it may cause Torsades?
  26. Esmolol
    A. is broken down by plasma cholinesterases
    B. has significant membrane stablising effects
    C. has inactive metabolites
    D. has minimal sympathomimetic properties
    E. is a selective agent
    • .
    • Esmolol rapid acting, selective B1 agent, not broken down by PChE, but red cell esterases, stabilising effects?, has weakly active metabolites
    • E. is a selective agent
  27. With regards to SNP toxicity
    A. treated with sodium thiosulphate
    B. treated with GTN
    C. one SNP molecule releases four CN- ions
    • .
    • .
    • A. treated with sodium thiosulphate - which produces thiocyanate which is > 100x less toxic
    • not treated with GTN duh! Releases 5 CN- not 4
  28. Which of the following is true regarding action on platelets
    A. Non-selective COX inhibitors act irreversibly
    B. Clopidogrel acts reversibly
    D. Abciximab acts reversibly
    • .
    • A is incorrect - Ibuprofen is non selective and is reversible
  29. Rocuronium has a Vd of 0.3L/kg. From this info you might expect?
    A. low lipid solubility
    B. high plasma protein binding
    C. Distributed in the extracellular space
    D. ?
    • .
    • .
    • maybe both A and C
  30. Dibucaine number in a Ea:Ea genotype is?
    A. 0
    B. 20
    C. 35
    D. 45
    E. 60
    • .
    • .
    • B. 20

    • Dibucaine no of normal Eu:Eu is 80
    • atypical Ea:Ea is 20
    • everything else is inbetween
  31. In Pseudocholinesterase deficiency which two drugs will have a prolonged effect?
    A. procaine and sux
    B esmolol and remi
    C. remi and mivacurium
    D. something and esmolol
    E. something and remi
    • .
    • .
    • A. procaine and suxamethonium

  32. Treatment of anticholinergic syndrome:

    A. Pyridostigmine
    B. Neostigmine
    C. Physostigmine
    D. Pralidoxime
    E. Atropine
    • .
    • .
    • C. Physostigmine
  33. Mechanism of action of ondansetron?

    A. blocks ligand gated ion channel
    B. peripheral blockade 5HT3
    C. Blockade 5HT4
    D. Increases amount of serotonin in CTZ
    • .
    • .
    • B. peripheral blockade 5HT3

    don't think A, doesn't do 5HT4
  34. Which is not true of Midazolam?
    A. open ring structure above pH 4
    B. poor oral bioavailability so less than 50% reaches systemic circulation
    C. has approximately the same affinity for GABA receptor which is similar to diazepam
    • .
    • .
    • B. poor oral bioavail < 50% reach sys circ

    • ring is closed above pH 4, open below pH 4 and ionised
    • has twice affinity for GABA of diazepam
  35. Which is descriptive statistic?
     stems not remembered
  36. A drug that has reached stage 2 of a clinical trial
    A. looks for pharmacokinetic information
    B. to be tested on target population
    • .
    • .
    • ??????
  37. Meta-analysis
    A. more detailed study
    B. more data referenced
    C. more statistically significant result than source material
    D. analysis of the results of ALL trials
    E. pooled analysis of other study results
    • .
    • .
    • ? not really more detailed
    • E pooled analysis of other study results ??
  38. Regarding Wafarin?
    A. Affects platelet function
    B. Increases the action of vitamin K epoxide reductase
    C. More effective when given as an intravenous dose
    D. Doesn't cross placenta
    E. Peak effect 36 - 72 hours following dose
    • .
    • .
    • ?? E. Peak effect 36 - 72 hrs following dose
  39. Phenytoin
    A Half life is 12 hours
    B. Used as an antiarrhythmic drug
    C. Toxicity produces megaloblastic anaemia due to vitamin B12 deficiency
    • .
    • .
    • ? B. Used as an antiarrhythmic drug
  40. Drug given optimally as racemic mixture
    A. Noradrenaline
    B. Morphine
    C. Methadone
    D. Bupivacaine
    E. Dexmedetomidine
    • .
    • .
    • C. Methadone
    • one isomer is NMDA antag, one is opioid effects
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ANZCA Pharm MCQ Primary July 12
2013-02-08 11:46:18
anaesthetic primary pharm

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