ANZCA MCQ SAQs VIVAQuestion Bank

Pharmacology including Statistics

Updated Feb 2008

MCQ-General PharmacologyFrom Anaesthesia_MCQBack to: Primary Pharmacology Black Bank

GP01 [Mar96] A drug is given at a dose of 50 mg/kg to a 70 kg man. The plasma concentration after giving it is 10 mg/ml. The elimination half-life is 8 hours. Clearance would be: A. 1.3 l/h B. 3 l/hr C. ? D. 125 l/hr

GP02 [Mar96] A drug is given orally and 95% absorbed. Only 25% reaches the general circulation due to hepatic first pass metabolism. If hepatic blood flow is 1500 mls/min, the hepatic clearance is: A. 400 mls/min B. ? C. 1100 mls/min D. ? E. 1425]] mls/min

GP03 [Jul97] Histamine release (no other details)

GP04 [Jul97] Rectal administration of drugs: A. Gives predictable blood levels B. From lower 1/3rd avoids first pass & upper 2/3rds doesn’t C. None undergoes first pass metabolism D. All of it undergoes first pass metabolism

GP05 [Mar99] [Jul00] [Apr01] [Jul04] LD50 is: A. Median lethal dose B. Determined in phase I clinical trial C. Determined from log-dose response curve D: Dose causing death in 50% of animals within ?1/?4 hours E. Half the mean lethal dose. F. Best expressed as ratio of lethal dose in 50% of animals to effective dose in 50%

GP06 [Mar99] [Feb00] [Jul02] [Mar03] Which ONE of the following crosses the blood-brain barrier? A. GABA B. Propranolol C. Suxamethonium D. Edrophonium E. Dopamine

GP07 [Jul98] [Jul99] [Apr01] With regard to drug-receptor binding: A. A competitive antagonist has no intrinsic activity B. A partial agonist has less receptor affinity than a full agonist C. KD is maximal intrinsic efficacy

GP07b [Feb00] [Feb04] [Jul04] A partial agonist: A. Always antagonises a full agonist B: Can never be used to antagonise a full agonist

C: Has a dose response curve similar to that of a full agonist in the presence of a non-competitive antagonist. D. ?

GP08 [Jul98] [Jul01] [Mar02] Placental transfer of drugs: A. Increases in late pregnancy B. Increases late because of decreased albumin C. Do not cross if MW > 600 daltons D. Lipid soluble drugs diffuse through placenta depending on concentration gradient E. Icreased diffusion if greater plasma protein binding in fetus

GP09 [Jul98] [Jul99] Regarding pharmacokinetics: A. ? B. Half-life is inversely proportional to clearance C. ? D. Half-life is proportional to steady-state E. B & D

GP10 [Jul99] [Jul04] An ether bond: A. Formed from condensation of 2 alcohols B. Hydroxyl group on middle bond C. ?

GP11 [Feb00] [Mar03] The NMDA receptor A. Ketamine is an agonist B. Requires glycine as a modulating protein (“YES PROTEIN ! ”) to have its effect C. Mg+2 blocks the receptor D. Is not permeable to Calcium

GP12 [Feb00] [Jul02] Activated charcoal: A. Should be given with sorbitol B. Is not effective against theophylline C. Should be given with ipecac D. Should be given in a drug:charcoal ratio of 1:10

GP13 [Apr01] [Jul04] Therapeutic index: A. Easy to determine in humans B. ? C. D. E. Derived from LD50/ED50

GP14 [Apr01] [Jul04] (A Basic drug with a pKa of 8.7) A. ? B. ? C. Will be predominantly ionised at plasma pH

GP15 [Apr01] [Jul02] [Mar03] Oxygen toxicity A. Causes convulsions at less than 100 kPa B. Causes lipid peroxidation at less than 100 kPa

GP16 [Jul01] With regard to log/dose response curves: A. The response is fairly linear over the 20-80% range. B. The Dose is fairly linear over the 20-80% range C. The ED50 and slope are characteristic for each drug D. ?

E. ?

GP17 - renumbered to another section.

GP18 [Jul01] With regards to diffusion through a membrane: A. Directly proportional to thickness B. Inversely proportional to thickness C. Inversely proportional to Surface area D. Inversely proportional to concentration difference E. ?

GP19 [Mar02] [Mar03] Which of following act via ligand gated channel? A. ? B. ? C. Morphine D. Vecuronium E. ?

GP20 [Jul02] Zero order kinetics means: A. ? B. ? C. Drug is eliminated at a constant rate regardless of dose. D. Elimination half time will vary according to dose. E. ?

GP21 [Feb04] All exist as Racemic mixtures except: A. Thiopentone B. Lignocaine C. Bupivucaine D. Isoflurane E. Enflurane

GP22 [Feb04] Clearance of a drug with a high hepatic extraction will be: A. Decreased in shock ??? B. Increased in high output states ???

GP23 [Feb04] Chemoreceptor trigger zone A. Contains 5HT3 and D2 receptors B. Not involved in inner ear mediated nausea C. ?

GP24 [Feb04] [Jul04] Glutamate A. Dissociates slowly from the NMDA receptor B. Does not act at AMPA and kainite receptors C. Inhibitory neurotransmitter in CNS D. ?

GP25 [Feb04] Regarding pharmacokinetics in pregnancy: A. paracetamol uptake increased B. increased sensitivity and faster onset with thiopentone C. hepatic clearance decreased by decreased protein binding

GP26 [Jul04] Which is an antagonist at the NMDA receptor?

A. Dexamethasone B. Dextropropoxyphene C. Dexmedetomidine D. Dextromethorphan E. Dexmethamphetamine

GP27 [Jul04] Comparing dexamethasone and hydrocortisone: A. Both are endogenous hormones B. Dexamethasone has 8x potency of hydrocortisone C. Both have mineralocorticoid activity D. Dexamethasone is the only water-soluble compound

MCQ-General Anaesthetics - InhalationalFrom Anaesthesia_MCQBack to: Primary Pharmacology Black Bank

IN01 [Mar96] Which compound(s) is/are broken down in soda-lime? A. Nitrous oxide B. Halothane C. Sevoflurane D. Desflurane E. All of the above

IN02 [Mar96] Regarding nitrous oxide at 70%: A. Synthetised from ? & N2 at 273C B. Decreases muscle blood flow by 30% C. Decreases cerebral autoregulation 24% D. ?

IN02b [Jul97] Nitrous Oxide: A. ?Increases/decreases CBF B. Is an effective oxidant C. Is made by heating nitrogen and oxygen in an iron retort D. Decreases pulmonary artery pressure in neonates

IN03 [Mar96] [Jul96] [Jul97] [Jul98] [Jul99] The following drugs are (potent) triggers for malignant hyperthermia EXCEPT: A. Decamethonium B. Suxamethonium C. Isoflurane D. Halothane E. Calcium F. Sevoflurane G. Tubocurarine H. Nitrous oxide (Different options on different papers)

IN04 [Mar96] [Mar03] IPPV with isoflurane at 1 MAC results in: A. Depresses cardiovascular reflexes more than halothane B. Causes decreased conduction velocity C. Maintains cerebral autoregulation D. Equal respiratory depression to enflurane E. Reduction in cardiac output by 25% F. Increased vasodilatation

IN05 [Mar96] [Mar98] The effect of increased cardiac output on Pa versus time for volatile agents is: A. No effect B. Decrease slope C. Decrease then increase slope D. Increase then decrease slope

IN06 [Mar96] [Jul97] [Apr01]

Nitrous oxide (N2O): A. Supports combustion B. Is flammable C. Causes muscle rigidity D. In tissues is slower to reabsorb than oxygen E. Has a partition coefficient of 0.76 F. All of the above G. Is formed by heating oxygen & nitrogen H. Induces methionine synthetase I. Oxidises the cobalt in vitamin B12

IN06b [Mar98] [Jul98] Nitrous oxide: A. Has MW of 42 B. Critical temperature 32 C C. Formed by using iron as a catalyst D. Does not support combustion E. ?? has saturated vapour pressure of 24]] kPa F. Produced using ammonium sulphate in an iron retort G. Boiling point 32C H. ??. . . ammonium nitrate . . . copper vessel ?? (Multiple options as this represents 2 separate N2O questions on Mar98 paper)

IN07 [Mar97] [Mar03] Desflurane A. Takes 5 minutes to reach equilibrium B. Is fastest to approach equilibrium of any inhaled anaesthetic agent C. Is a fluorinated diethyl ether D. ?

IN08 [Mar97] [Jul97] Regarding sevoflurane: A. The vapour pressure is less than enflurane B. The vapour pressure is greater than isoflurane C. Cardiovascular side effects are similar to isoflurane D. Molecular weight less then isoflurane E. Boiling point greater than enflurane

IN08b [Jul97] [Feb00] Sevoflurane: A. Is a methylethyl ether B. Is odourless C. Is stable in soda lime at 37 degrees D. Has a boiling point higher than enflurane E. Has a molecular weight lower than desflurane

IN08c [Jul98] [Jul99] Sevoflurane: A. Molecular weight greater then enflurane B. MAC less than enflurane C. Contains Cl & F D. SVP > enflurane

IN09 [Mar97] [Jul98] [Jul00] Uptake of N2O when breathing 70%: A. More than one litre absorbed in the first minute B. Equilibrium (?90%) is achieved in 3mins C. Absorb 10 litres ?at time of ?90% equilibration / ?in first 3 mins D. At steady state, uptae is 200mls/min E. Produces surgical anaesthesia

IN10 [Mar97] [Jul98] [Mar99] [Jul01] [Jul04] N2O causes the second gas effect because: A. It is relatively insoluble B. Reaches equilibrium faster than the more soluble second gas C. Larger volume D. Its high concentration

IN11 [Jul97] Desflurane: A. Is non-irritant to the airways B. Is more/less potent than sevoflurane C. Has a higher molecular weight than ?isoflurane/?enflurane D. Is a chlorinated methyl ethyl ether

IN12 [Jul97] [Apr01] Effects of volatile agents include: A. Halothane increases hepatic artery and portal blood flow B. Isoflurane causes hypotension by reducing cardiac output C. ? D. ?

IN12b [Feb04] Volatile agents: A. Halothane causes less cerebral vasodilation than enflurane B. Isoflurance causes less cerebral vasodilation than halothane

IN13 [Jul97] [Jul98] [Jul99] [Apr01] Problems with MAC: A. Large interspecies variability B. Affected by temperature and other factors C. Affected by obesity D. ?

IN13b [Mar96] [Jul98] [Feb00] [Jul01] MAC: A. Is decreased in the elderly B. Is unchanged throughout pregnancy C. Increases in hypothermia D. ?Decreased/?increased with hyper/hypo-kalaemia E. ? Alt version (Jul 01) All the factors decrease MAC except: A. Pregnancy B. Hyperthermia C. Hypothermia D. Hypoxia E. ?

IN13c [Mar99] [Apr01] [Jul01] MAC: A. Highest between ages 2 to 5 yrs B. Increases with pregnancy C. MAC BAR is concentration at which 95% do not move D. Is 0.2% halothane in 70% N2O E. ? Jul 01 version: With regards to MAC: A. The MAC of Halothane with 70%N2O is 0.29

B. Concentration at which 95% of patients don’t move after a surgical stimulus C. MAC- BAR ?? D. Decreased by increased CO2 E. ?

IN14 [Mar98] [Mar99] Systemic vascular resistance is LEAST changed with: A. Isoflurane B. Sevoflurane C. Desflurane D. Enflurane E. Halothane

IN15 [Mar98] [Jul98] [Mar99] MAC awake during emergence when patient will respond to command: A. 0.1 B. 0.2 C. 0.3 D. 0.5 E. ?0.7 ?0.8

IN16 [Jul98] [Jul99] Isoflurane & enflurane are: A. Structural isomers B. Enantiomers C. Diastereomers D. Optical isomers E. Configurational isomers

IN17 [Mar96] [Jul96] Sevoflurane: A. Is broken down in the body to Compound A which has been shown to be toxic to rats B. Has a blood:gas partition coefficient of 2.3 C. Is a irritant causing coughing on induction D. Has a boiling point of 24]] degrees centigrade E. Has Cl & F atoms in its structure F. None of the above (Note: Compound A is a breakdown product produced in the CO2 absorber; it is not produced by biotransformation)

IN18 [Mar99] [Feb00] With isoflurane anaesthesia, MAC awake is: A. 0.1% vol B. 0.3% vol C. 0.5% vol D. 0.5% vol E. 1% vol

IN19 [Mar99] [Jul04] Isoflurane: A. Is a halogenated methyl ethyl ether B. Higher boiling point than sevoflurane C. No odour D. Enantiomer of enflurane

IN20 [Mar99] MAC of halothane with 70% N2O is: A. 0.25% B. 0.5% C. 0.75% D. 1.0%

IN21 [Mar99] All reduce MAC except: A. Aminopyridine B. ?

IN22 [Jul98] N2O is NOT relatively contra-indicated with: A. Pneumothorax B. Ear surgery C. Postop nausea & vomiting D. Renal failure

IN23 [Jul99] [Jul02] [Mar03] [Jul04] Which of the following does NOT affect the speed of induction with a volatile agent? A. FRC B. Obesity C. pCO2 D. Cardiac output E. Body mass F. MAC Alt version: Regarding the time constant for volatile anaesthetic uptake in the lungs A. Affected by agent concentration B. Affected by obesity C. Not affected by FRC D. Affected by restrictive lung disease

IN24 [Feb00] 22g of Nitrous oxide at STP occupies a volume of: A. 3.6 L B. 11.2 L C. 22]] L (? or 22.4 L) D. 44.1 L

IN25 [Jul00] [Mar03] [Jul04] Wash in (? washout) of volatile anaesthetics is reduced in neonates because: A. Reduced FRC B. Increased cardiac index C. Decreased plasma protein levels? D. (Something about blood:gas partition coefficients being different in neonate)

Alt version which probably is the same question remembered differently: The washout of inhalational anaesthetics A.. Increases with elimination by the liver B.. Related considerably with the duration of anaesthesia C. Increases in the neonates compared to an adult

IN26 [Jul01] With regard to compound A: A. Increased production in Baralyme compared to sodalime B. More likely in children C. Sevofluranes metabolites cause hepatotoxicity D. Sevoflurane is METABOLISED to Compound A in the liver E. ?

IN27 [Jul01] Concerning the effects of various volatile

agents on cerebral blood flow under conditions of 1 MAC and normocarbia: A. Halothane produces greater increase than enflurane B. Isoflurane produces greater increase than enflurane C. Any change produced depends upon cerebral metabolic rate D. Change in CBF is due to change in cardiac output E.

IN28 [Jul01] Which of the following drugs is NOT associated with EEG epileptiform activity A. Propofol B. Enflurane C. ? D. ? E. ?

IN29 [Jul04] Which does not increase risk of increased carboxyhaemoglobin in blood during anaesthesia? A. Dry absorbent B. Baralyme C. Low flows D. Desflurane E. Halothane

IN30 [Jul04] The concentration effect for N20 is due to A. Increased conc of N20 B. Faster eqilibrium of N20 than the second soluble second gas C. ? D. ?

MCQ-General Anaesthetics - IntravenousFrom Anaesthesia_MCQBack to Primary Pharmacology Black Bank | Jump to IV05 IV10 IV15 IV20 See also Finals Black Bank for MCQs in this area: MCQ-Intravenous anaesthetics

IV01 [Mar96] [Mar97] [Jul97] Propofol: A. Has a pKa of 7 B. Has a pH of 11 C. Causes hypotension due to myocardial depression D. Has 98% protein binding E. ?

IV02 [Mar96] [Jul97] [Apr01] Thiopentone causes a decrease in BP by: A. Direct decrease in myocardial contractility B. Fall in systemic vascular resistance C. Decrease in venous tone D. ?

IV03 [Mar96] [Jul96] [Jul97] [Mar99] Ketamine: A. Is a direct inotrope B. Causes bronchodilatation C. Less likely to see emergence delirium (?psychotomimetic effects) in ?older/?younger females D. Reduces pharyngeal secretions E. Leaves airway reflexes reliably intact (See IV17 for another Ketamine Q)

IV04 [Mar96] [Apr01] With regards the action of midazolam: A. Ring closure occurs immediately on injection B. ? C. ?

IV05 [Jul97] [Mar99] [Jul99] [Apr01] Propofol depresses cardiac output predominantly by: A. Direct depression of myocardial contractility B. Decreased SVR C. ? D. ?

IV06 [Jul97] [Apr01] Methohexitone: A. Has a molecular weight of 285 B. Has a melting point of 158 degrees C. A 2.5% solution is isotonic D. Is yellow E. Has 4 isomers

IV06b [Mar02] Methohexitone A. Is a oxythiobarbiturate B. Breakdown is principally by splitting of ring C. “Longer duration than thio/ or maybe greater protein binding compared to thio??” D. ? E. ?

IV07 [Mar98] Benzodiazepine binding site on GABA receptor is:

A. Near Cl- channel B. Inside the channel C. Outside the channel D. On the alpha subunit

IV08 [Mar98] [Jul01] The drug with the largest volume of distribution at steady state is: A. Propofol B. Midazolam C. Etomidate D. Thiopentone E. Methohexitone

IV09 [Jul98] [Jul04] GABA: A. Is the principal inhibitory neurotransmitter in the spinal cord B. Barbiturates decrease the dissociation time between GABA and its receptor C. ??A & B types?? D. ? (see also IV18 )

IV10 [Mar96] Propofol is structurally related to: A. Althesin B. Etomidate C. Ketamine D. ? E. None of the above

IV11 [Mar99] [Feb00] Midazolam: A. Water soluble at physiological pH B. Undergoes oxidative metabolism C. More lipophilic than lorazepam D. Causes hypotension E. Has a pKa of 7.4 (or ? 8.1) F. Causes retrograde amnesia

IV12 [Jul98] Thiopentone: A. Is the sulphur analogue of phenobarbitone B. Has higher protein binding than its oxy analogue C. ? 6% sodium bicarbonate D. Isotonic at 2.5% concentration

IV13 [Jul98] Propofol clearance is significantly increased in: A. Elderly B. Metabolic acidosis C. Pregnancy D. ? (See also IN13b)

IV14 [Feb00] [Jul04] Thiopentone: A. 100% reabsorbed in renal tubule B. Does not cross the placenta in significant amounts due to high plasma protein binding C. ??accumulate in the foetus

IV15 [Jul00] Thiopentone: A. ? Tachyphylaxis if multiple administration in short period B. ??

IV16 [Jul00] Propofol: A. 10% eliminated unchanged B. Undergoes oidative metabolism C. Clearance depends on hepatic bloodflow D. No effect / chronic liver disease E. ?

IV17 [Apr01] Ketamine: A. Direct acting negative isotope (“It did say this”) B. ?Indirectly acts on SNS peripherally C. Directly on the sympathetic ganglia D. ? E. ?

Alt version: Ketamine: A. Is a negative isotope (“it was isotope and not inotrope”) B. ? C. Directly stimulates autonomic ganglia D. Is a competitive antagonist at NMDA receptors E. Directly stimulates alpha and beta receptors? Comments: [1] Both independently submitted versions of this MCQ contained a comment that one of the options was ‘negative isotope’ - ??? [2] Using the information contained in these 2 submitted versions, we can attempt to reconstruct the whole question as below. However, the question still does not look right: for example 3 options say ‘directly’ and only one says ‘indirect’ & the other does not use either term, so by ‘frequency analysis’, this suggests that one of A, C or E is correct. The problem with this is the College has in recent times been going through their whole MCQ Bank trying to eliminate this type of “design problem” where you can guess or narrow in towards the answer by looking at the frequency of numbers or words in the different options.

Reconstructed IV17: Ketamine: A. Direct acting negative isotope B. ?Indirectly acts on sympathetic nervous system peripherally C. Directly on the sympathetic ganglia D. Is a competitive antagonist at NMDA receptors E. Directly stimulates alpha and beta receptors

IV17a [Jul04] Ketamine: A. Is a NON-competitive antagonist at NMDA receptors B. ?Direct acting negative inotrope C. ?Indirectly acts on sympathetic nervous system peripherally D. ?Directly on the sympathetic ganglia E. ?Directly stimulates alpha and beta receptors

IV18 [Jul01] With regard to GABA receptors: (OR: Which of the following is INCORRECT about GABA neurotransmission:) A. GABA-A found all over the body B. Is an excitatory transmitter in 20% of CNS synapses

C. GABA-B is predominately post-synaptic D. GABA receptor located in spinal cord, medulla and rest in Cortex. E. Is metabolised by deamination F. Is metabolised by transamination by ?GABA transaminase G. Stimulated by benzodiazepines H. Opposes action of glycine (Above is a composite of options from two GABA questions which were on the Jul 01]] paper.)

IV19 [Jul01] Propofol A. Causes decreased hepatic blood flow to influence its own clearance B. Relatively low clearance in Children C. Has a high rate of transfer from the peripheral to the central compartment on ceasing an infulsion D. Has clinically significant metabolites E. Elimination halflife of 5 minutes

[[IV20 [Mar02] Which one of the following induction agents does NOT exert its main effect via the GABA receptor? A. Ketamine B. Thiopentone C. Propofol D. Midazolam E. Methohexitone

IV21 [Feb04] Sodium carbonate added to Thiopentone: A. As a bacteriostatic agent B. To neutralise Thiopentones acidity C. To increase ionised portion D. Enhances activity

IV22 [Jul04] Which agent does not cause increased heart rate on induction of anaesthesia? A. Thiopentone B. Etomidate C. Propofol D. Ketamine E. Methohexitone

IV23 [Jul04] Benzodiazepine receptor has A. Two glycine binding sites B. ? IV24 [Jul04] Midazolam A. Bioavailability 10% B. Bioavailability 50% C. Elimination t1/2 30]] min D. Elimination t1/2 30]] hours E. ?

MCQ-Local AnaestheticsFrom Anaesthesia_MCQBack to Primary Pharmacology Black Bank | Jump to LA10 LA15 LA20

LA01 [Mar96] [Mar97] [Jul97] [Mar99] [Jul01] Lignocaine has a pKa of 7.9 At pH 6.9, the percentage ionised is: A. 1% (or 5%) B. 10% C. 50% D. 90% E. 99% (Also remembered as: With a pKa of 7.9, what percent of lignocaine is ionised at intracellular pH?)

LA02 [Mar96] [Jul04] Cocaine: A. Blocks reuptake of dopamine and noradrenaline B. Central effects are due to noradrenaline C. Crosses lipid soluble membranes because its pKa is 2.8 D. Is not metabolised by plasma pseudocholinesterase E. Rapidly absorbed by nasal mucosa

LA03 [Mar96] [Mar03] Ropivacaine: A. Produces greater motor block than bupivacaine B. Is prepared as the R enantiomer C. Is less lipid soluble than lignocaine D. Has the same cardiotoxicity as lignocaine

LA03b [Mar97] [Feb00] Ropivacaine A. Is a pure R isomer B. Is an isomer of bupivacaine C. Provides more motor block than bupivacaine D. Has more toxicity than bupivacaine E. Has similar physico-chemical properties to bupivacaine

LA03c [Mar98] [Jul98] Ropivacaine differs from bupivacaine mainly by: A. More motor blockade than bupivacaine B. Mainly affecting A beta rather than A delta fibres C. Lower cardiac toxicity than bupivacaine D. ? E. None of the above

LA04 [Mar96] [Mar99] Bupivacaine: A. Is an aminoester local anaesthetic B. Is formed by substituting butyl for methyl on amino group of mepivacaine C. ?Less/more toxic than tetracaine D. Adrenaline solution contains sodium metabisulphite E. Equipotent to etidocaine in causing motor block

LA05 [Jul97] With regard to molecular weight of local anaesthetics, which is the correct sequence? A. Cinchocaine > bupivacaine > lignocaine > prilocaine B. Bupivacaine > lignocaine > cinchocaine > prilocaine C. Bupivacaine > lignocaine > prilocaine > cinchocaine D. Prilocaine > bupivacaine > cinchocaine > lignocaine E. Lignocaine>bupivacaine>prilocaine>cinchocaine

(see also LA09, LA10)

LA06 [Jul97] [Jul04] Lignocaine works by: A. Altering Na+ permeability B. Altering membrane structure C. Reduced Ca++ permeability D. Increased K+ permeability E. Ca++ binding to tropomyosin

LA07 [Jul97] Lignocaine: A. Has ?% uptake in lung B. Is 24% ionised at physiological pH C. Reduces Na+ conductance (?) D. ?

LA08 [Jul97] Lignocaine: A. Has active metabolites B. Metabolism faster in females because of progesterone C. Metabolism is independent of liver blood flow D. ?

LA09 [Mar98] [Feb00] Protein binding of local anaesthetics (in decreasing order): A. Procaine > bupivacaine > lignocaine > prilocaine B. Bupivacaine > lignocaine > prilocaine > procaine C. Prilocaine > bupivacaine > lignocaine > prilocaine D. Lignocaine > bupivacaine > prilocaine > procaine E. Bupivacaine > lignocaine > procaine > prilocaine F. Bupivacaine>procaine>lignocaine>prilocaine

LA10 [Mar98] Local anaesthetics are metabolized in the following order: A. Bupivacaine>ropivacaine>lignocaine>prilocaine>procaine B to E. (The above in different orders)

LA11 [Mar98] Saxitoxin site on sodium channel is: A. Inside channel B. Outside channel C. On membrane outside D. ?

LA12 [Jul98] The site of action of benzocaine is: A. Same site as saxitoxin B. Inside Na+ channel /OR: At the channel mouth C. At axoplasmic end of Na+ channel D. At Ca++ channel E. In the cell membrane

LA13 [Jul98] EMLA cream contains: A. Soluble in water at >16 degrees C B. 20% ionised at pH ?? C. 80% ionised at pH ??.. OR: Base contains 80% local anaesthetic D. ?? amount of ionised drug E. All of the above

LA14 [Mar99] [Mar03] What factor (?does not)

influence the peak plasma levels after epidural injection of local anaesthetic? A. Vasoconstrictor B. Natural vasoconstrictor activity of the drug C. Hepatic clearance D. Renal clearance

LA15 [Mar99] [Mar03] Which ONE of the following is an amide? A. Tetracaine B. Procainamide C. Procaine D. Prilocaine E. Cinchocaine

LA15b [Jul01] The following are all amides except: A. Bupivicaine B. Prilocaine C. Etidocaine D. Tetracaine E. Dibucaine

LA16 [Jul99] Lignocaine: A. Anti-arrhythmic effect - ??Na channel /open & inactivated state B. Prolongs QRS C. ? D. ?

LA17 [Jul99] [Feb00] [Jul00] [Jul01] [Jul03] A solution of local anaesthetic contains 1:100,000 adrenaline. How much adrenaline has been added? A. 0.01% B. 0.1% C. 10 mcg/ml D. 100 mcg/ml E. 1000 mcg/ml

LA18 [Feb00] Regarding the addition of adrenaline to a local anaesthetic administered epidurally, which of the following is NOT true? A. Significantly prolongs the duration of action of bupivacaine B. Causes tissue acidosis at the site of injection C. Causes vasoconstriction D. ?

LA19 [Jul00] [Jul01] Regarding local anaesthetic plasma protein binding A. Is predominantly by albumin B. Is predominantly by alpha-1 acid glycoprotein C. Is greater for tetracaine than for bupivacaine D. Neonates have a greater number of binding sites E. Plasma binding is directly proportional to local anaesthetic concentration. (Comment: wording in option E was 'plasma binding' & not 'plasma protein binding')

LA20 [Jul01] For a local anaesthetic agent at a given concentration:

A. Effect is NOT dependent on resting membrane potential B. Faster onset with increasing frequency of stimulation of nerve C. Unionised form blocks the surface receptor D. Agent blocks the channel in the activated state E. Faster onset with more negative resting membrane potential.

LA21 [Feb04] Lignocaine A. Over 50% unionised at pH 7.4 ?? B. Decreased metabolism with GA ?? C. ? D. ?

MCQ-Muscle Relaxants & AntagonistsFrom Anaesthesia_MCQPrimary Pharmacology Black Bank

These MCQs were previously coded with the MR prefix but this has been changed to MB to avoid conflict with the MR coded 'Medicine-Respiratory' Part 2 Black Bank MCQs.

MB01 [Mar96] [Jul97] With regard to tetanic stimulation by a nerve stimulator: A. Used to determine residual curarisation B. Degree of fade is independent of stimulus duration C. Degree of fade is dependent on stimulus intensity D. Used to check depth of anaesthesia

MB02 [Mar96] [Apr01] Hyperkalaemia with suxamethonium is associated with: A. Abdominal infection B. Parkinson's disease C. Meningomyelocoele D. Cerebral palsy E. Myotonic dystrophy

MB03 [Mar96] [Jul96] [Jul97] [Mar98] [Mar99] [Jul99] [Feb00] Which of the following is NOT metabolised by plasma cholinesterase? A. Procaine B. Cocaine C. Dibucaine D. Suxamethonium E. Esmolol F. Mivacurium

MB03b [Mar98] [Apr01] Which of the following is metabolised by plasma cholinesterase? A. Remifentanil B. Procaine C. Esmolol D. ? E. All of the above

MB03c [Jul98] [Feb00] Esterases metabolise all EXCEPT: A. Remifentanil B. Dibucaine C. Pyridostigmine D. ?

MB03d [Feb04] Which drug has a significantly prolonged duration of action in plasma cholinesterase deficiency? A. Remifentanil B. Procaine C. Mivacurium D. Rocuronium E. Cocaine

MB04 [Mar96] [Jul02] The action of nondepolarising neuromuscular blocking agents is PROLONGED by: A. Respiratory acidosis B. Increased temperature C. Increased calcium D. Increased potassium E. Decreased magnesium

MB05 [Mar96] Agents prolonging nondepolarising NMBA by desensitising the post-junctional membrane : A. Phenytoin B. Halothane C. Lignocaine D. Verapamil

MB06 [Mar96] [Jul98] Which drugs (?competitively) inhibit acetylcholinesterase? A. Neostigmine B. Pyridostigmine C. Physostigmine D. Edrophonium E. All of the above

MB06b [Jul00] [Apr01] The activity of plasma cholinesterase is decreased by the following drugs except: A. Neostigmine B. Organophosphates C. THA D. Metoclopramide E. Cimetidine

MB06c [Jul04] Which decrease plasmacholinesterase activity? (remembered options from 2 questions) A. Hepatic disease B. Cyclophosphamide C. Six weeks post partum D. Hyperthyroidism E. Obesity F. Cytotoxic drugs G. Pregnancy E. Dibucaine number of 20

MB07 [Mar97] [Jul98] [Jul99] [Feb00] [Apr01] Regarding vecuronium: A. It accumulates in renal failure B. Is a benzylisoquinolinium C. Is a bisquaternary amine D. Is more lipid soluble than pancuronium E. Is predominantly renally excreted

MB08 [Jul97] [Jul98] [Mar99] [Jul02] [Mar03] In reversing neuromuscular blockade, which of the following combinations is best matched with respect to time of onset? A. Atropine & neostigmine B. Atropine & glycopyrrolate

C. Atropine & edrophonium D. Atropine & physostigmine E. Glycopyrrolate and edrophonium (Comment: Option B is an unusual distractor for this question but it has been confirmed by a couple of people that this is the way it is on the paper)

MB09 [Jul97] [Jul98] [Mar99] [Jul99] [Jul00] [Mar03] Plasma cholinesterase: A. Metabolises dibucaine B. Metabolises esmolol C. Hydrolyses mivacurium at 80% the rate of suxamethonium D. Is unaffected by neostigmine

MB09b [Jul01] [Jul04] Suxamethonium A. Bigger molecule than vecuronium B. Needs to occupy 80% of nicotinic receptors to get effect C. Resistant to hydrolysis by acetylcholinesterase D. ??Is an antagonist at nicotinic receptors E. Increasing dose produces similar block

MB10 [Jul97] [Jul98] With regard to the nerve stimulator in competitive blockade: A. Fade is dependent on stimulating frequency B. TOFC of four is a sign of adequate reversal C. ? D. ?

MB11 [Jul97] Anticholinesterase agents:Both correct A. Carbamates duration of action is related to the time required for dissociation from the anionic site. B. Carbamates act by acetylation of the esteratic site. C. ? (See also [[MB11b, [[MD28)

MB11b [Jul00] [Apr01] [Jul02] [Jul04] Carbamylation of acetylcholinesterase: (Jul02: Phosphorylation of acetylcholinesterase: ) A. Ionic bonding at anionic site B. Ionic bonding at esteratic site C. Covalent bonding at anionic site D. Covalent bonding at esteratic site E. None of above (see also MB27 for similar Q)

MB12 [dgj] [Jul00] [Jul02] [Jul04] Mivacurium: A. Is metabolised at 80% the rate of suxamethonium B. Takes 15 mins from ED95 dose to recovery of 95% twitch height C. Has an ED95 of 1.5 mg/kg D. Trigger for malignant hyperthermia E. ? Duration of action is increased in renal failure

July 2000 version: Mivacurium: A. Twice the ED95 dose is 1.5mg/kg B. is metabolised at 80 to 90% the rate of suxamethonium

C. After 2 x ED95 dose 95% return of twitch height after 15mins

July 2002]] version included the following options: C. Does not usually require reversal D. Duration of action may be prolonged by anti-cholinesterases

MB12b [Jul00] Mivacurium administered at a dose of 2 times the ED95 dose produces relaxation for: A. 10 mins B. 15 mins C. 20 mins D. 25 mins E. None of the above

MB13 [Mar98] [Jul99] [Jul01] The Recovery Index 25% to 75% is 7 minutes for which drug? A. Vecuronium B. Rocuronium C. Mivacurium D. Suxamethonium Also recalled as: A muscle relaxant is administered at twice ED95 for a short dental case. Return of normal TOF ratio occurred at 7minutes. The muscle relaxant used was: A. Suxamethonium B. Vecuronium C. Atracurium D. Rocuronium E. Mivacurium

MB14 [Mar98] [Jul00] [Mar03] Release of acetylcholine at the motor endplate: A. ?? gentamicin B. Botulinum toxin works by ?? C. ? D. ? July 2000 version: Release of acetylcholine at motor endplate: A. Hemicholinium directly interferes with releae B. Only in response to action potential C. Decreased by aminoglycosides / ?? prejunctional effect D. Is Ca2+ dependent process E. Always causes an action potential

MB15 [Mar98] Gentamicin potentiates non-depolarising neuromuscular block by: A. Interfere with Ca++ influx for exocytosis B. ? C. ?

MB16 [Jul98] [Mar99] [Feb00] [Jul01] [Mar03] Rocuronium: A. Monoquaternary at physiological pH B. More lipid soluble than pancuronium C. 30% metabolised (?deacetylated) in the liver D. Rapid onset is due to its high potency E. Fastest onset is with 2 times ED95 dose

F. Is bisquaternary

MB17 [Mar96] Plasma cholinesterase is inhibited 80% by 10 -5 molar dibucaine: A. In late pregnancy B. ? C. ?

MB18 [Mar99] Which of the following do NOT prolong neuromuscular blockade? A. Volatile anaesthetics B. Antibiotics C. Phenytoin D. Beta-blockers E. Hyperthermia (see also MB26)

MB19 [Jul98] Malignant hyperthermia causes: A. Hypertension B. Whole body rigidity C. Tachyphylaxis with a suxamethonium infusion D. ?

MB20 [Jul99] [Jul01] Edrophonium: A. Longer halflife than neostigmine B. Onset slower than neostigmine C. ?Pyridostigmine D. Binds to anionic site of cholinesterase E. Relieves symptoms of myaesthenia gravis F. ? Is reliable in reversing a Phase 2 block

MB20b [Apr01] ("Edrophonium Q about elimination half times and metabolism") A. ? B. ?

MB21 [Jul99] . .? . . with return of ¾ TOF ratio: A. ? B. ? C. ? D. ? E. ?Neostigmine may prolong the action of Mivacurium

MB22 [Jul99] [Apr01] Atracurium: A. Has an active metabolite B. Ester metabolism is a minor pathway of elimination C. Metabolism is by Hofmann elimination which is pH dependent (‘Did not include temperature’) D. ? E. ?

MB23 [Feb00] [Jul04] What muscle relaxant has an active metabolite with a half-life twice that of the parent compound? A. Rocuronium B. Vecuronium C. Pancuronium D. Atracurium or Cisatracurium E. None of the above

F. Mivacurium

MB23b [Jul04] Which of these NDNMB has a metabolite that’s 50-70% as active as its parent drug A. Atracurium B. Vecuronium C. Rocuronium D. dTC E. None of the above

MB24 [Feb00] Succinylcholine can cause: A. Bradycardia B. Histamine release C. Tachycardia D. Hypertension E. All of the above MB25 [Feb00] Neostigmine reversal of nondepolarising neuromuscular block A. Not affected by enflurane at 2 MAC B. Varies depending on use of NDNMA by bolus or infusion C. Is/isn't affected by age D. ?

MB26 [Feb00] Which of the following is associated with a decrease in duration or effect of nondepolarising neuromuscular blocking drugs: A. Volatile anaesthetic alkanes B. Volatile anaesthetic ethers C. Aminoglycoside antibiotics D. Aminopyridine derivatives E. Local anaesthetic esters (see also MB18)

Alt version: Which of the following decreases the duration/depth of neuromuscular blockade? A. Enflurane at 2 MAC B. Aminoglycosides C. Bolus doses versus infusion D. Aminopyridines MB26b [Jul01] Neuromuscular blockade NOT prolonged by: A. Hyperthermia B. Gentamicin C. Volatile agents D. Hypothermia E. ?

MB27 [Jul00] [Apr01] [Jul04] Neostigmine's mechanism of action: A. Binds covalently to esteric site on AChEsterase B. Binds electrostatically to esteric site on AChEsterase C. Binds to anionic site D. Forms complex with AChEsterase with a shorter halflife than acetylcholine E. (“Some other long winded explanation requiring 30 seconds to read and impossible to remember.”)

MB28 [Jul00] With depolarising neuromuscular blocker:

A: Is competitively antagonised by NDMR B: ("Something about tetany & fade") C. ? D. ? E: Shows post tetanic potentiation

MB29 [Jul00] Rocuronium administered in 2 times the ED95 dose: A. Rapid onset, short duration B. Rapid onset, Intermediate duration C. Slow onset, intermediate duration D. Slow onset, long duration E. (“some other combination.”)

MB30 [Apr01] Anticholinesterase drugs A. ? B. ? C. Used in treatment of Glaucoma D. ?

MB31 [Apr01] Neostigmine: A. Tertiary ammonium compound B. ? no, quaternary C. ?

MB32 [Jul01] [Jul04] The dibucaine number for a normal person is: A. 20 B. 40 C. 60 D. 80 E. 100

MB33 [Jul01] Muscle relaxants are less likely to cause anaphylaxis if: A. Injected slowly B. Suxamethonium is the most common cause C. H1 and H2 blockers prevent anaphylaxis D. Always fatal E. ?

MB34 [Jul01] Laudanosine: A. ? B. ? C. ? D. ?

MB35 [q[ All of the following result in prolongation of Vecuronium block except: A. Concomitant insulin and dextrose infusion B. Prior suxamethonium blockade

MB36 [Feb04] Post suxamethonium myalgia: A. Preceeded by transient myoglobinuria B. More common in the elderly C. Can be prevented by pre-treatment with 0.04 mg/kg of D-tubocurarine

MB37 [Feb04] Regarding anticholinesterases: A. Pyridostigmine is a tertiary amine

B. Quaternary ammonium anticholinesterases have a larger volume of distribution than non-depolarising muscle relaxants C. Edrophonium has a slower onset of action than neostigmine D. Neostigmine has a longer duration of action than pyridostigmine E. Edrophonium binds covalently to the esteratic site of acetylcholine

MB37b [Jul04] Regarding Antiacetylcholinesterase A. Given orally to treat glaucoma B. Edrophonium is a long acting AChE inhibitor C. Physostigmine is quarternary ammonium D. ?

MB38 [Jul04] Which is the best indicator of adequate reversal? A. TOF Count of 4 B. No fade on DBS C. No fade to 200 Hz tetanus D. Head lift?? E. Evidence of post-tetanic facilitation

MB38b [Jul04] Residual curarization is best evaluated with: A. TOF 1:4 > 50% B. Equal twitch height on DBS C. ?Degree of fade is independent on stimulus intensity D. ?Used to check depth of anaesthesia E. ?

MB39 [Jul07] Sugammadex binds most avidly to: A. Pancuronium B. Rocuronium C. Vecuronium D. Atracurium E. Cisatracurium

MCQ-Major Analgesics / OpioidsFrom Anaesthesia_MCQPrimary Pharmacology Black Bank

OP01 [Mar96] With regards to pethidine’s physical properties: A. It has an octanol coefficient of 10 B. It has a pKa of 8.4 C. ? D. ? E. ?

OP02 [Mar96] Which factor does NOT predispose to bradycardia with fentanyl in doses of 50 mcg/kg? A. Calcium channel antagonist B. Beta-blocker C. Benzodiazepines D. ? E. Slow injection of drug

OP03 [Mar96] [Mar99] [Jul99] [Feb00] [Apr01] Naloxone: A. Is not an antagonist of agonist-antagonist drugs B. Is not an antagonist at ?mu & sigma receptors C. Causes pulmonary oedema D. Can cause hypotension in experimental shock animal models E. May cause an abrupt increase in sympathetic tone

OP03b [Mar97] Naloxone: A. Is effective at antagonising a full agonist but not a partial agonist B. Causes pulmonary oedema C. ? D. ?

OP04 [Mar96] [Jul99] {Diagram of numbered structure of morphine} Which substitutions correct? A. N17 substitution gives antagonist activity B. C6 methylation produces codeine C. Glucuronidation occurs at C2 D. Diacetylation decreases lipid solubility

Also remembered as: Morphine base structure with questions about substitutions A. C3 and C6 increase lipid solubility B. Acetyl group on ?C3 gives heroine C. N- substitution gives antagonist D. C5 glucuronidation site E. C3 methyl gives codeine

OP05 [Mar96] [Jul98] [Jul00] Pethidine in doses of 2 to 2.5 mg/kg causes all of the following EXCEPT: A. Bradycardia B. Decreased systemic vascular resistance C. ?Normal arterial BP / ?decreased BP D. Increased cardiac output

OP06 [Mar96] Regarding the clearance of morphine: A. Affected by cirrhosis B. Affected by hepatic blood flow C. Shows low hepatic extraction ratio D. ? E. ?

OP07 [Jul97] [Mar99] [Jul99] [Jul00] [Feb04] [Jul04] Fentanyl: A. With pKa 8.4 is 90% ionised at physiological pH B. Has an octanol coefficient of 10 C. Is 1,000 times more potent than morphine D. Has first-pass lung uptake reduced to 20% by propranolol E. Has up to 50% uptake in the lung F. Elimination half-life < 2 hour G. Carried on albumin mostly H. Carried on alpha-1 acid glycoprotein mostly I. Can cause hypertension with MAOI J. Alfentanil acts faster as it has a higher unionised, unbound fraction

OP08 [Jul97] An opioid which can not be used for TIVA: A. Morphine B. Pethidine C. Fentanyl D. Sufentanil E. Alfentanil

OP09 [Mar98] Nalbuphine: A. Works at mu receptor only B. Has same side effects as pentazocine C. ? D. ?

OP10 [Mar98] Pethidine A. 100mg is equal to 10mg morphine in effect B. Increases heart rate C. No effect on cardiac output D. Is preferred to morphine for analgesia E. ?

OP10b [Mar98] Pethidine produces: A. Miosis B. More severe hypotension with comparable dose of morphine C. More biliary spasm than morphine D. ?

OP11 [Mar98] TIVA with morphine causes the following EXCEPT: A. Mydriasis B. Muscle rigidity C. Respiratory depression D. ?

OP12 [Mar98] [Jul98] [Jul02] [Mar03] Codeine: A. Substitution at C6 position of morphine

B. 10% of codeine is metabolised to diacetyl morphine C. IM 100mg is equivalent to 10 mg morphine D. Methyl substitution at the ?C5/?C6 position of morphine E. Can be safely given IV because causes no histamine release F. Has higher first pass effect than morphine

OP13 [Jul98] Morphine metabolism: A. Principally metabolised to morphine-6-glucuronide B. Metabolites have shorter half-life C. Found in extrahepatic sites D. Metabolites freely cross the blood-brain barrier E. ?All have analgesic effect / ? Are 30% renally excreted F. In neonates, predominantly by sulphation G. In adults, mostly to morphine-3-glucuronide

OP14 [Jul98] Buprenorphine: A. Effective orally B. ? C. ?

OP15 [Mar99] [Feb00] [Jul02] Sufentanil: A. 30 times as potent as fentanyl B. < 7% excreted unchanged in urine C. Greater protein binding than fentanyl D. Half-life of elimination between fentanyl & alfentanil E. Predominantly bound by ?albumin/ ? alpha1-acid glycoprotein

OP16 [Mar99] [Jul00] Pethidine is the traditionally favoured opioid in obstetrics because: A. Norpethidine does not cross the placenta B. Does not undergo ion trapping C. Causes less neonatal depression D. It does not cross the placenta E. It is thought to cause less respiratory depression in the neonate.

OP17 [Mar99] Pethidine: A. Better bioavailability than codeine B. ? C. ? D. ?

OP18 [Jul99] Pethidine: A. Norpethidine metabolite B. Pethidine 6-glucuronide C. ?

OP19 [Jul00] Alfentanil is more lipid soluble than fentanyl because: A. Has a pKa of 8.4 & is 90% unionized at physiological pH B. ?“n-Octanol coefficient is [some five digit num] [Jul96] [Mar98] [Jul04].” C. ? D. ?

OP19b [Jul01] [Jul04] Alfentanil works faster than fentanyl because: A. More lipid soluble B. Higher concentration unbound, unionised at physiological pH C. Decreased protein binding D. Larger volume of distribution E. ?

OP20 [Jul00] [Apr01] Methadone: A. Phenanthrene derivative B. ?metabolism C. Peak plasma levels at 3 hours D. Used in chronic cancer pain due to non addictive potential E. ?d & l isomers

OP21 [Apr01] Tramadol: A. Has beta blocking properties B. Blocks noradrenaline reuptake C. Has greater opioid activity than morphine (OR: As potent a mu agonist as morphine) D. Is directly inhibited by yohimbine E. Only the +ve enantiomer is active

OP22 [Jul01] The most unlikely thing to occur with morphine administered in recovery is: A. Constipation B. Respiratory depression C. Sedation D. Nausea and vomiting E. Physical dependance F. Pruritis

OP23 -Deleted

OP24 [Jul01] Extrahepatic de-esterfication of Remifentanil A Occurs in RBC B By Plasma Cholinesterase C NOT in incubated blood D Has (?mean) clearance less than 1L/min E Has an active metabolite Alt options: C. Hydrolysis does not occur in vitro in incubated blood E. The drug is hydrolysed to an active metabolite which undergoes further hydrolysis (Q75 Jul01)

OP25 [Jul01] The following are metabolites of morphine except: A. Morphine-6-glucuronide B. Morphine-3-glucuronide C. Normorphone D. Codeine E. Hydromorphine

OP26 [Jul01] Fentanyl given at dose of 50-150 mcg/kg: A. Causes potent cardiac depression

B. Does not cause muscle rigidity C. Has an elimination half-time of more than 3 hours D. Not enough to relieve the stress response to surgery E. Preserve cardiac output

OP27 [Jul04] Prolonged duration of action of morphine in renal failure is due to A. Morphine 3-glucuronide B. Morphine 6-glucuronide C. Metabolism of morphine D. ? E. ?

OP28 [Jul-06] Which is NOT a side effect of morphine: A. Seizures B. Mydriasis C. Respiratory depression D. Histamine release E. ?

MCQ-Anticholinergics/AntimuscarinicsFrom Anaesthesia_MCQPrimary Pharmacology Black Bank AH01 [Jul97] [Mar98] [Jul98] [Mar99] [Jul99] Glycopyrrolate: A. Has mandelic acid rather than tropic acid B. Tertiary amine C. ? D. ? (See also MB08)

AH02 [Jul98] [Mar99] [Jul00] Hyoscine: A. ? B. Quaternary ammonium compound C. ? D. Causes mdriasis E. Causes confusion in the elderly

AH03 [Jul99] [Feb00] Scopolamine d & l isomers: A. d is active B. Provided as racaemic product C. Doesn't cause central effects D. ?

AH04 [Jul00] Atropine: A. ? B. Increases anatomical & alveolar dead space C. ? D. ?

AH05 [Jul01] [Mar03] Atropine & glycopyrrolate: A. Both are naturally occurring B. Cause confusion in the elderly C. ? D. ? E. ?

AH06 [Jul04] Which of the following is the most toxic effect of atropine in children? A. Hypotension B. Tachycardia C. Hyperthermia D. Hypertension

AH07 [Apr07] The nerve agent sarin: A. should not be treated with anticholinesterase if there is tachycardia B. something about pyridostigmine C. symptoms can include fasciculations and paralysis D. something about pralidoxime unblocking the receptor (a red herring teaser) E. ?

MCQ-Psychotherapeutic DrugsFrom Anaesthesia_MCQPrimary Pharmacology Black Bank

PS01 [Mar96] [Jul98] [Jul01] [Jul02] Benzodiazepines: A. Are all lipid soluble (OR: None are water-soluble) B. Are all renally excreted unchanged C. Causes retrograde amnesia D. Lorazepam is more lipophilic than midazolam E. Block GABA receptors F. Have high therapeutic index

PS02 [Mar97] [Jul97] [Jul99] [Mar03] Which is TRUE regarding monoamine oxidase inhibitors (MAOI)? A. Should/must be ceased for two weeks prior to general anaesthesia B. Cause hypotension and sedation in combination with pethidine C. Inhibit activity of indirect sympathomimetics D. Ingested tyramine causes hypertension due to indirect effects E. Includes doxepin and amitriptyline

PS03 [Jul97] [Jul98] [Jul00] [Jul01] Neuroleptic malignant syndrome: A. Occurs only with chronic use B. 80% (60%) mortality C. ?Treated /? not treated with dantrolene D. Can be caused by acute withdrawal of L-Dopa therapy E. Is treated with bromocriptine

PS04 [Jul97] Inhibitors of monoamine oxidase A A. Allow tyramine to enter the circulation from the gut B. ? C. ? D. ?

PS05 [Jul97] [Feb00] Benzodiazepines: A. Have no analgesic effect B. Have an antanalgesic effect C. Have an analgesic effect D. Have dose-related analgesic and antanalgesic effects

PS06 [Jul98] [Jul99] [Mar03] [Jul04] The benzodiazepine with the longest elimination half-life is: A. Diazepam B. Oxazepam C. Temazepam D. Midazolam E. Lorazepam F. Flunitrazepam

PS07 [Jul98] Fluoxetine: A. Inhibits noradrenaline & adrenaline uptake B. Inhibits serotonin uptake C. ?

D.

PS08 [Mar99] [Jul00] Flumazenil: A. Formulated In propylene glycol in commercial preparation B. Inverse agonist C: Is slowly metabolised making resedation unlikely D. Does not reliably reverse sedation and resp depression (in large agonist dose ?) E. Is a partial agonist at mu opioid receptors Option D has also been remembered as: D. May significantly reverse evidence of sedation whilst hypoxia or hypercapnia persist D. Reliably reverses the sedating effects of benzodiazepines but marked respiratory depression still can occur

PS09 [Mar99] Diazepam: A. Half-life of 5 to 10 hours B. Metabolised to oxazepam & temazepam /?desmethyldiazepam C. ? D. ?

PS10 [Mar99] [Jul99] Droperidol: A. Substituted phenothiazine B. Reliably produces mental tranquility C. Does not act (directly) on CTZ D. Alpha-blockade with hypotension is not a problem with 2mg dose E. Slows alpha rhythm on EEG (Note: Mar 99 paper had 2 questions on droperidol)

PS11 [Mar99] Monoamine oxidase inhibitors (MAOI): A. Moclobemide is a reversible inhibitor B. Interacts with tyramine to cause hypertension C. Interacts with pethidine to cause hypothermia D. ?

PS11b [Feb04] Monoamine oxidase inhibitors A. Mobenclamide is a reversible type B inhibitor B. Prevent hepatic metabolism of tyramine enabling it to enter the circulation and act as an indirect agonist ??

PS12 [Jul99] [Apr01] Metabolites of diazepam, all EXCEPT: A. Temazepam B. Oxazepam C. Desmethyldiazepam D. Lorazepam

PS13 [Jul00] With respect to action of midazolam: A. Acts on GABA-B receptors B. increases duration of opening of Cl – channels C. ? competes with barbiturates for receptor site on GABA receptor D. Metabolism is decreased by cimetidine E. Decreases chloride conductance F. Interacts with the B1 subunit of GABA

PS14 [Jul00] Benzodiazepines - which statement is true ? A. ? B. Midazolam has ?active / ?inactive metabolites C. ? D. All depend on hepatic clearance

PS15 [Jul00] [Mar03] [Jul04] Tricyclic antidepressants: A. Do not cause sedation B. Formed from modification of the phenothiazine ring C. Avoid anti-cholinergic effects compared to other anti-depressants D. Does not decrease reuptake of 5HT ?at 5HT3 R E. Decrease CNS amine levels

PS16 [Jul00] Diazepam 0.1 mg/kg given orally, the percent absorption is: A. 100% B. 94% C. ? D. ?

PS17 [Feb04] Clinical uses of Diazepam include: A. Anticonvulsant B. Skeletal muscle relaxation C. Treatment of Delerium Tremens D. Induction of anaesthesia E. All of the above

MCQ-Cardiovascular DrugsFrom Anaesthesia_MCQPrimary Pharmacology Black Bank

CD01 [Mar96] [Mar98] [Mar99] [Jul01] Milrinone: A. Decreases pulmonary vascular resistance B. Increases systemic vascular resistance C. Is poorly absorbed when given orally D. Chronic use causes thrombocytopaenia

Alt version: Milrinone causes: A. Chronic use causes thrombocytopaenia B. Pulmonary vasoconstriction C. Not effective orally D. ? E. ?

CD01b [Mar97] Milrinone: A. Cannot be given orally B. Is a phosphodiesterase III inhibitor that decreases cyclic AMP C. Decreases peripheral vascular resistance D. Increases pulmonary vascular resistance

CD01c [Feb00] Milrinone A. Is structurally related to thyroid hormone B. Is arrhythmogenic C. Has its effects via cAMP mediated increase in intracellular Ca2+ D. Increases myocardial oxygen consumption

CD02 [Mar96] [Mar03] Sodium nitrite used in cyanide toxicity: A. Increases methaemoglobinaemia B. To produce increased hepatic sulphydryl groups C. Increases conversion to cyanocobalamin (?hydroxycobalamin) D. Displaces cyanide from haemoglobin E. Enhances oxidative phosphorylation (see also CD06, CD37)

CD03 [Mar96] [Jul96] [Jul98] [Jul99] [Feb00] [Apr01] [Mar03] [Jul04] Ephedrine: A. Is resistant to metabolism by MAO B. Is metabolised by COMT C. Action is totally indirect D. Acts via direct & indirect beta effect E. Action is purely alpha agonist

(Alternative versions) Ephedrine: A. Has direct alpha actions only B. Has direct beta actions only C. Has indirect (alpha) actions only D. ? E. Has both indirect & direct actions on alpha & beta receptors

Ephedrine: A. Alpha 1 and 2 and beta 1 & 2 & 3 B. More alpha than beta C. “Indirect this and direct that”

D. “Direct this and indirect that (etc)”

CD03b [Apr01] [Mar02] Ephedrine: A. ?Increases/?decreases skeletal muscle blood flow B. Acts only by indirect effects C. Not metabolised by GIT MAO D. Not metabolised by COMT E. Increase renal blood flow

CD03c [Jul01] [Jul04] Ephedrine has: A. Direct agonist on alpha receptors B. Direct and indirect effects on alpha and beta receptors C. Indirect actions on alpha receptors D. Direct actions on beta receptors E. Indirect actions on beta receptors

CD04 [Mar96] [Jul98] The principal (?urinary) metabolite of adrenaline is: A. Normetanephrine B. Metanephrine C. 3,4-dihydroxy-mandelic acid D. 3-methoxy, 4-hydroxymandelic acid E. 3-Methoxy 4-hydroxy phenylalanine

CD05 [Mar96] [Jul97] [Jul98] [Mar99] [Feb00] [Apr01] [Jul01] [Feb04] Thiazide diuretics: A. Work mainly on PCT B. Not effective if severely sodium depleted C. Action is independent of acid-base balance D. Increase GFR immediately E. Decrease BP by decreasing contractility F. Cause hypoglycaemia G. Interferes with kidney concentrating mechanisms H. Causes hypocalcaemia I. Used to treat hypercalcaemia J. Potentiate hyperglycaemia K. Are effective as antihypertensives by decreasing cardiac output L. Cause hypernatraemia M. Washes out the medullary concentration gradient (Multiple options remembered so possibly an amalgam of 2 questions)

MCQ-17 on July 2001 paper: Thiazide diuretics:- A. Increase calcium excretion in the urine. B. Decreased efficacy in sodium depletion. C. Main site of action is the proximal tubule. D. Cause equivalent amount of diuresis to frusemide E. ?

July 2004 version Frusemide (furosemide), not thiazides

CD06 [Mar96] Sodium nitroprusside in healthy patient: A. Decreases venous more then arterial resistance B. Has no effect on control of pulmonary vascular resistance C. Decreases cerebral blood flow

D. Causes uterine relaxation E. Does not inhibit hypoxic pulmonary vasoconstriction

CD07 [Mar96] [Mar97] [Jul97] [Mar98] [Jul98] [Jul99] [Feb00] [Apr01] [Mar03] Which one of the following statements about clonidine is correct? A. Increase MAC requirements B. Cause transient hypertension with IV administration C. With IV bolus causes hyper- then hypo-tension D. Causes hypotension immediately E. Is not (?administered/absorbed) transdermally (see also [[CD12, [[CD36)

CD08 [Mar97] [Mar99] Regarding Digoxin: A. The aglycone portion causes the cardiac effects B. The glycone portion causes the cardiac effects C. ? D. ?

CD09 [Mar97] [Jul99] Digoxin: A. Decreases ventricular response due to vagal stimulation in AF B. Decreases myocardial oxygen consumption C. Increases the R-T interval D. Decreases AV conduction

CD10 [Jul97] [Jul00] [Apr01] [Jul02] Which of the following ECG changes would be most likely in digoxin toxicity: A. Increased PR interval B. Increased QT interval C. Peaked T waves D. ST elevation E. Ventricular extrasystoles

July 2000 version: Digoxin toxicity: A. Inverted T waves B. Prolonged PR interval C. Xanthopsia D. Prolonged PT interval

CD11 [Jul97] [Jul98] Regarding digoxin overdose/toxicity: A. Serum level > 2.1 ng/ml is toxic B. C. Causes a long PR interval D. Causes xanthopsia (OR: 'causes yellow vision') E. Causes a long QT interval and bigeminy

CD12 [Jul97] [Mar02] [Jul02] [Jul04] Clonidine: A. Elimination half-life of 3 hours (??or 3 to 6 hrs) B. Excreted 50% unchanged in the urine (or 50% renally excreted) C. Oral bioavailability 50% D. Cannot be absorbed topically E. Is highly protein bound

CD13 -Deleted- same Q as CD05

CD14 [Jul97] [Jul98] [Jul00] [Jul04] Adenosine:

A. Slows conduction velocity and increases refractory period B. Is metabolised in plasma C. Decreases urate levels D. Methylxanthines increase response (see also CD34)

CD15 [Jul97] [Jul99] Catecholamine substituition: A. Alpha carbon CH3 substituition gives beta selectivity B. Beta-hydroxy substituition gives increased affinity C. D-dobutamine antagonist, L-dobutamine agonist D. ?

CD16 [Mar96] [Jul96] [Jul97] [Jul98] Esmolol: A. Active at beta-1 & beta-2 receptors B. Half-life < 2 minutes C. Has methanol as a metabolite D. Is metabolised by (?acetyl/?plasma) cholinesterase E. Is excreted unchanged in the urine F. Is a non-selective beta-1 receptor antagonist

CD16b [Feb04] [Jul04] Esmolol A. Is a non-selective beta antagonist B. Has intrinsic sympathomimetic activity C. Does not have membrane stabilising activity D. ?

CD17 [Jul97] [Jul98] [Mar99] [Jul99] [Jul01] [Jul04] Osmotic diuretics (?Mannitol): A. Less sodium delivered to distal tubule B. Hypotonic medulla C. Increased sodium loss D. Urine osmolality > plasma osmolality E. Increased sodium reabsorption / ?causes hytpernatraemia F. ?MW greater than 600 G. Washes out the medullary interstitial gradient (see also MD07)

MCQ-16 on July 2001]] paper: Osmotic diuretics: A. Include mannitol and the dextrans. B. Wash out the medullary osmotic gradient. C. Cause sodium retention D. ? E. Have a molecular weight >600

CD18 [Jul97] Guanethidine: A. Causes sedation as a side effect B. Postural hypotension occurs C. Decreases reuptake of catechols presynaptically D. ?

CD18b [Jul98] [Jul01] (Q24]] on Jul01]] paper) Guanethidine: A. Acts primarily at?/on? the CNS B. Produces anti-hypertensive effect primarily by presynaptically inhibiting release of noradrenaline C. Highly lipid soluble D. Mental depression is a troublesome side effect

E. Orthostatic hypotension is not a prominent side effect

CD19 [Jul97] [Jul99] Labetalol: A. Alpha agonist & beta agonist B. Alpha agonist & beta antagonist C. Alpha antagonist & beta antagonist D. Is a more potent alpha blocker than phenoxybenzamine E. Alpha > beta effect

CD20 [Mar98] [Jul98] [Jul99] [Feb00] [Apr01] [Jul04] Frusemide: A. 30% plasma protein binding B. ??% absorption C. Elimination half-life less than one hour D. Promotes active secretion E. Affects the uricosuric effect of probenecid F. Effects not decreased until large decrease in GFR G. Causes a diuresis which is dependant on GFR over a wide range

Apr 2001 version: Frusemide: A. Has 30% (?35%) protein binding B. Has an elimination half-life less than 1 hour C. 90% excreted in bile D. Increases rate of secretion in the renal tubules

CD20b [Jul00] [Jul02] Frusemide does NOT cause: A. Hyponatremia B. Hypokalemia C. Hypouricemia D. Hypomagnesemia E. Hypocalcemia

CD21 [Mar98] [Jul98] The antiarrhythmic effect of lignocaine: A. Because it incvreases the refractoriness of in cardiac muscle B. Therapeutic level 2-5ng/ml C. ?

CD22 [Jul98] [Feb04] [Jul04] The effects of beta blockers – the following is not true A. Relax uterine muscle B. Increased AV conduction C. Decreased lipolysis D. Increased SVR E. Mask hypoglycaemia F. Negative inotropy G. Opposing effects of insulin H. Lipolysis

CD23 [Mar96] [Jul96] [Jul00] [Apr01] 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

CD24 [Mar96] [Feb00] [Mar03] A non-selective beta-

blocker with low extraction ratio, long half-life and ISA: A. Atenolol B. Propranolol C. Metoprolol D. Labetolol E. ?

CD24b [Mar02] [Jul02] Which ONE of the following is water soluble, half life 6-8hrs, (“and something else”)? A. Esmolol B. Metoprolol C. Propranalol D. ? E. Atenolol

CD25 -Deleted - same Q as [[CD05

CD26 [Jul98] [Mar99] [Mar03] [Feb04] [Jul04] Sotalol: A. Non-selective beta-blocker B. Contraindicated in long QT C. Increases K+ conductance D. Used in the treatment of torsades E. Class II anti-arrhythmic drug F. Is a selective beta 1 antagonist G. Blocks K+ channels

CD27 [Mar99] Trimetaphan: A. Crosses the blood-blood barrier B. Incompatible with thiopentone C. ?

CD28 [Mar99] Diazoxide: A. Has diuretic activity B. Opens ATP-dependent K channels C. Not absorbed orally D. ?

CD29 [ghj] [Jul00] Phenylephrine: A. Metabolised by COMT B. Causes mydriasis C. Metabolised by MAO D. Effect lasts (?same time as/?longer than) noradrenaline E. Acts by indirect method only

CD30 [Jul98] Regarding hydrallazine: A. Fast acetylators have shorter half lives than slow acetylators B. Acts via SNS mechanism C. Slow acetylators decrease half-life D. Has diuretic action E. Clearance > 50ml/kg/min (see also [[CD32, [[CD35)

CD31 [Mar99] Which ONE of the following beta-blockers is selective fore beta-1 receptors? (No other details)

CD32 [Jul99] Which of the following statements about hydrallazine is (?true/false)?: A. Acts via alpha 1 receptors B. ? C. ? D. ? E. Has a duration of action of 1-2 hours

CD33 [Jul99] Concerning Dobutamine A. Levo has alpha 1 antagonist and beta agonist effects B. Levo has partial alpha agonist effect and beta effects C. Is a pure beta agonist D. ?

CD34 [Feb00] [Apr01] [Jul01] Adenosine A. Causes AV block via action at A1 receptors B. Causes bronchoconstriction via A2 receptors C. Causes renal vasodilation D. Causes profound depression of the SA node E. Decreases AV transmission

(see also [[CD14)

CD35 [Feb00] Mechanism of action of hydralazine A. Selective cerebral, coronary, renal vasodilator B. Alpha agonist C. None of the above D. ? (see also [[CD30, [[CD32)

CD36 [Jul00] [Jul04] Clonidine: A. Causes hypertension and tachycardia B. Causes bradycardia C. A single dose given orally is significantly less effective then an intravenous dose D. Counteracts the hypertensive response in phaeochromocytoma E. ? (see also [[CD07, [[CD12)

CD36b [Jul04] Clonidine can cause these, except A. Bradycardia B. Apnoea C. Sedation D.

CD37 [Jul00] [Jul04] The first sign of sodium nitroprusside toxicity is: A. Cyanide toxicity B. Tachyphylaxis C. Hypotension D. ? (see also [[CD02, [[CD06)

CD38 [Apr01] Dexmedetomidine: A. Alpha-1 antagonist B. ? C. Decrease in intraocular pressure D. Partial alpha2 agonist E. Less selective than clonidine

CD39 [Jul01] [Jul04] Amiloride: A. Potassium sparing antidiuretic which blocks the aldosterone receptor B. Blocks luminal sodium channels in the collecting tubules C. Increases potassium excretion. D. Is metabolised by the liver. E. Has a short elimination half time.

CD40 [Jul01] With regard to sodium nitrite in cyanide (CN) toxicity: A. Causes MetHb B. Used to create more hydrocobalamin C. Used to displace CN from Hb D. Creates more sulfhydryl groups

CD41 [Jul01] Methylxanthines: A. (Something about Ca++ currents) B. (Something about K+ currents) C. Inhibit adenosine receptors D. Decrease plasma glucose level E. Cause diuresis by acting on renal tubules F. Physically addictive

CD42 [Feb04] [Jul04] Which is the initial drug to use in the treatment of ventricular fibrillation? A. Amiodarone B. Lignocaine C. Adrenaline D. Magnesium E. Sotalol

CD43 [Feb04] All are side effects of Thiazides except: A. Hypokalaemia B. Hypernatraemia C. Impaired carbohydrate tolerance D. Pancreatitis

CD44 [Feb04] Why do you give adrenaline for VF? A. To coarsen fine VF B. To improve coronary blood flow C. Increase chronotropy

CD45 [Feb04] Nitroprusside toxicity: A. Treat with ??? B. CD46 [Jul04] Which of the following is a sign of SNP toxicity? A. Tachyphylaxis B. Decreased mixed venous PO2 C. Sudden decrease in arterial PO2 D. ?Hypotension

CD47 [Jul04] Dihydropyridine Ca channel blocker causes peripheral oedema due to A. vasodilator causing redistribution of ECF B. has a mild antidiuretic effect, and therefore easily treatable with diuretic

C. salt and water retention due to hypotension D.

CD48 [Jul04] Isoprenaline A. can be used as a substitute to Metaraminol for treatment of hypotension B. used extensively to treat ischaemic heart disease C. cause decrease SVR D. cause bradycardia E. ?

MCQ-Endocrine DrugsFrom Anaesthesia_MCQPrimary Pharmacology Black Bank

EN01 [Mar96] [Jul97] Chlorpropamide: A. Inhibits ADH secretion B. Has a short duration of action (? Half-life < 12]] hrs) C. Increases glucose entry into cells D. Is prolonged in renal failure

EN02 [Jul97] [Jul01] Sulphonylureas: A. High incidence of lactic acidosis B. Good in patients with depleted insulin stores C. Metformin & phenformin are examples D. Increased glucose utilisation in the peripheries E. Are related to sulphonamides

Jul 01 version: With regards to sulfonylureas: A. Work effectively if Insulin stores depleted B. Cause a lactic acidosis C. Tolbutamide, (something else), phenylformin are examples (? Spelling) D. Highly protein bound E. ?

EN03 [Jul01] Glipizide is: A. A biguanide B. Half life 4-6hrs C. Causes metabolic acidosis /lactic acidosis D. Not contraindicated in hepatic failure E. Highly bound to albumin F. Is ineffective in patients with low insulin stores

MCQ-Miscellaneous DrugsFrom Anaesthesia_MCQPrimary Pharmacology Black Bank | Jump to MD10 MD20 MD30 MD40 MD50

MD01 [Mar96] [Jul97] [Mar03] Oxytocin: A. Synthetised in posterior pituitary B. Poorly absorbed orally C. Metabolised by oxytocinase in the liver D. Bolus dose will increase central venous pressure E. Bolus dose will increase systemic vascular resistance F. Metabolised by the liver and kidney (see also EM15)

MD01b [Mar99] [Jul99] Oxytocin: A. Has diuretic effect B. Partially depolarises uterine muscle / ?effect on membrane threshold C. Causes emesis D. Increases threshold of receptors for depolarisation E. Hypertension

MD01c [Feb00] Oxytocin: A. Ringed octapeptide B. Effects on uterus antagonized by beta agonists C. ADH like effect D. ?

MD02 [Mar96] [Mar97] [Jul97] [Jul98] [Jul99] [Feb00] Cisapride: A. Will increase gastric motility in the presence of atropine B. Can be used to treat opioid induced gastric stasis C. Decreases/increases lower oesophageal sphincter tone (?due to atropine) D. Decreases gastric pH E. Increases gastric volume F. Blocks histamine receptors G. Agonist at D2 receptors

MD03 [Mar96] [Jul97] [Jul98] Regarding the plasma half-life of heparin: 7A. Clearance affected by warfarin B. Depends on site of injection C. Less for low MW heparins D. Depends on dose given

MD03b [Jul97] Heparin: A. Has a half life dependent on dose B. Inactivates factors XII, XI, X, IX C. ? D. ? (see also [[MD49)

MD04 [Mar96] [Jul99] [Apr01] Paracetamol: A. Has an active metabolite B. Interferes with renal blood flow C. Does NOT cause gastric irritation D. Causes methaemoglobinaemia E. Maximum adult dose 4g

Apr 2001 version: Paracetamol: A. Frequently causes dyspepsia (?gastric irritation) B. Acid-base abnormalities common with overdose C. Maximum dose 4 grams in adult D. ? E. ?

MD04b [Jul98] [Mar99] [Feb00] [Jul04] Paracetamol: A. Is a powerful anti-inflammatory agent B. Should never be given in a dose > 20 mg/kg to children C. Increased risk of hepatic necrosis in chronic alcoholics D. Sulphate conjugation is major metabolic pathway E. pKa 3.5 F. ?Glutathione conjugation

Alt version remembered from Feb 2000: Paracetamol: A. Has analgesic, antipyretic and anti-inflammatory effects B. Is metabolised to BENZOQUINONIMINE which is inactivated by conjugation to glutathione C. Dose should not exceed 4000mg/day in an adult D. Gastric irritation is common

July 2004 Paracetamol: A. Has analgesic, antipyretic and anti-inflammatory effects B. Is metabolised to N-methyl-p-benzoisopuinonimine conjugated to glutathione C. Toxic dose is 10 times the normal ?daily dose? D. pKa 3.5 E. ?

MD04c [Jul00] Paracetamol: A. Minimum toxic dose 8-12G/day in an adult B.-E. ?

MD05 [Mar96] Aspirin: A. At low doses inhibits prostacyclin B. Reversibly inhibits lipoxygenase C. Irreversibly inhibits cycloxygenase D. Can cause asthmatic reactions

MD06 [Mar97] [Jul97] [Jul99] [Feb00] Serotonin (5-HT) is most common in: A. Platelets B. Enterochromaffin cells C. Cerebral cortex (?neurones) D. Pineal gland E. GIT F. Mast cells

MD07 [Mar97] [Jul97] [Jul98] [Mar99] [Feb00] Mannitol: A. Metabolised in the liver B. Half-life is proportional to GFR C. Increases Na+ D. Excretion is dependent on GFR

E. Urine will be hyperosmolar compared to plasma F. Absorbed orally G. Isotonic H. Clearance dependent on GFR (see also [[CD17)

MD07b [Feb04] Mannitol: A. is a sugar and is not metabolised B. does not increase delivery of sodium to distal tubule

MD08 [Mar97] [Jul97] [Mar99] [Mar03] [Jul04] Gastric drugs: Which is true? A. Sucralfate is a mixture of sulphated sucrose and bismuth that sits in the ulcer B. Gastrin & acetylcholine directly & indirectly inhibit H+ secretion C. Misoprostil decreases gastric acid and causes marked constipation D. Pirenzipine is less effective than H2 blockers E. Omeprazole reversibly inhibits proton pump

MD09 [Mar97] [Feb00] A decrease in renal function might be expected with: A. Gentamicin B. Cis-platin C. Busulphan D. Methotrexate E. All of the above

MD10 [Mar97] [Jul02] Thrombocytopaenia is a side-effect of which ONE of the following: A. Busulphan B. Cis-platin C. Methotrexate D. All of the above E. ?

MD11 [Jul97] [Jul98] [Jul99] Theophylline levels increased with: A. Smoking B. Phenytoin C. Cimetidine D. ?

MD12 -renumbered EN02

MD13 [Jul97] [Feb00] When a beta agonist binds to a G-protein: A. There is a fall in cAMP B. The signal is amplified 108 times (Comment: Several sources indicate that the wording on the paper in July 97 was as above but this doesn't make sense as a beta-agonist does not bind directly to the G protein but to a G-protein coupled receptor) (Comment Mar 2000: This question has now been corrected to read: "When a ligand binds to a receptor linked to a G-protein:") (see also EM18 in Physiol MCQs)

MD14 [Jul97] [Apr01] Dantrolene: A. Is a benzyl-isoquinoline derivative

B. Undergoes oxidative and reductive metabolism C. Inhibits sodium channel activation D. Causes a marked reduction in contractility E. Not effective as prophylaxis because of poor oral bioavailability F. Acts via ryanodine receptor

Alt version: Dantrolene: A. Benzylisoquinolonium B. Undergoes hepatic and renal metabolism C. Profound myocardial depression D. Poor oral bioavailability

MD15 [Jul97] Omeprazole: A. Irreversibly inhibits the parietal cell B. Acts at apical membrane of parietal side C. Acts at the basolateral membrane of the parietal

MD16 [Mar98] Diclofenac: A. Plasma protein binding is ....% B. Percent absorption . . % C. Mechanism of action via increase in endorphins D. ?

MD17 [Mar98] [Apr01] [Jul04] Regarding phenytoin A. Acts via blockade of Na channels and via effect on K channels B. Weak base with pKa 8.3 C. Has active metabolites D. ? E. ?

MD18 [Mar98] [Mar99] [Feb00] [Apr01] [Jul02] [Mar03] Which ONE of the following decrease gastric pH? A. Omeprazole B. Famotidine C. Calcium salts D. Misoprostil E. PGE2

July 2000, 2002 and 2003 version : Which ONE of the following decreases gastric acid secretion?: A. ? B. Misoprostil C. Cisapride D. Na citrate E. Metoclopramide

Apr 2001 version: Decrease gastric pH: A. Calcium salts B. H2 antagonists (?ranitidine) C. Omeprazole D. Pirenzipine E. PGE2

MD19 [Jul98] [Mar99] [Feb00] [Jul01] [Jul04] NSAIDs: A. Exhibit no selectivity for COX 1 & 2

B. Exert renal effects other than effect on afferent arterioles C. Cause renal toxicity separate to inhibition of prostaglandins D. Aspirin & ketorolac irreversibly bind COX1 & 2 E. Directly cause gastrointestinal ulceration Alt version: NSAIDs: A. All inhibit COX 1 B. Aspirin and ketoralac inhibit COX irreversibly C. They can cause renal toxicity by mechanisms other than alterations in renal blood flow by PG mediators.

MD20 [Jul98] [Mar99] [Feb06] Irreversible cardiomyopathy can be due to: (OR: Which of the following causes dose-dependent cardiac toxicity?) A. Vincristine B. Bleomycin C. Danorubicin D. Asparaginase E. Cyclophosphamide F. All of the above

MD21 [Jul98] [Jul99] [Mar02] Streptokinase: A. Acts on circulating plasmin B. ? C. Is antagonised by aminocaproic acid (EACA) D. ? E. ?

MD22 [Mar99] [Apr01] [Mar03] Gastric lavage: A. Not useful if more than one hour has elapsed B. In children, use normal saline instead of water C. Contraindicated if poison corrosive D. Is performed in the right lateral position E. Should not be performed in the unconscious (Comment: The restriction in unconscious patients is they should be intubated for airway protection)

MD23 [Mar99] [Apr01] Long term prednisolone 20mg/day will result in: A. Increased lymphocyte count B. Increased capillary permeability C. Metabolic alkalosis D. ??glucose

MD24 [Mar99] NSAIDs cause gastric side-effects by: A. Direct effects on mucosa B. Indirect effects C. ?

MD25 [Mar99] Phenylbutazone: A. Interferes with heparin metabolism B. Increases warfarin plasma concentration C. Decreases warfarin plasma concentration D. Reduces the elimination of warfarin

July 2000 version: Phenylbutazone's effect on the coagulation system are due to: A. Binding to albumen, displacing warfarin B. Inhibiting warfarin metabolism C. ? some interaction with aspirin D. ? effect on platelets

MD26 [Jul98] [Jul99] With respect to prednisone: A. [[Prednisone] is converted to active prednisolone in the gut B. Prednisone 5mg is equivalent to 100mg cortisol C. Betamethasone has equivalent mineralocorticoid activity D. Methylprednisolone ?

Alternative version of options A & E: A. Prednisone is converted to prednisolone after absorption from the gut. E. Betamethasone has adrenocorticoid and mineralocorticoid activity

MD27 [Jul98] [Jul99] [Jul00] Aspirin: A. Greatest absorption is from the stomach B. Peak plasma level is achieved in 30]] minutes C. Has cross-reactivity with all NSAIDs D. Half-life 4 hours

July 2000 version: Aspirin: A. Plasma half-life 4 hrs B. Peak plasma concentration within 10mins of oral administration C. Requires conversion to salicylic acid for activity D. ? is more ?? than salicylic acid E. Better absorption if food in stomach F. Cross reactive sensitivity with all NSAIDs

MD28 [Jul98] [Mar03] Organophosphates: A. Phosphorylate the esteratic site B. Phosphorylate the anionic site C. ? D. ? (See also MB11, MB27)

MD29 [Mar99] [Feb00] Warfarin affects: A. Factor XIII B. Protein S (? or Protein C) C. ?

MD30 [Jul99] [Feb00] Bleomycin A. Related to nitrogen mustard B. Can cause agranulocytosis (or: frequently causes myelosuppression) C. Causes pulmonary toxicity in 90% of patients D. Is an alkylating agent E. Causes pulmonary oxygen toxicity due to production of superoxide radicals

MD31 [Jul99] Which drug causes the most anaphylaxis? A. Suxamethonium B. High potency non-depolarisers C. ? D. ?

MD32 [Jul99] [Jul04] Syrup of Ipecac: A. Is not effective in phenothiazine overdose B. Has peripheral irritant and direct CTZ action

C. The syrup is more potent than the fluid D. ?

MD33 [Feb00] Regarding antiemetics which drug has anti-5HT3, anti-H1 and anti-D2 actions: A. Ondansetron B. Scopolamine C. Domperidone D. Droperidol E. Prochlorperazine F. Chlorpromazne Alternative versions:

• Which of the following anti-emetics have D2, ACh, 5 HT-3 antagonist

effects? • Which drug is a D2 antagonist, H1 antagonist

and 5HT3 receptor antagonist?

MD34 [Jul99] [Feb00] With regard to nitric oxide A. It is anaesthetic at high concentration B. May improve V:Q mismatch C. Is a liquid in the cylinder, gas at room temperature D. ?

MD35 [Feb00] [Jul01] Ethanol A. About 35% excreted via the lungs B. Concentration falls at a fixed rate with respect to time C. Only 60% is metabolised, the remainder being excreted in expired air D. Is excreted at a rate independent of the plasma concentration E. Constant elimination independent of plasma concentration F. Elimination is not dependant upon amount absorbed from GIT

MD36 [Feb00] Which drugs cause convulsant activity? A. Cocaine B. Lithium C. Norpethidine D. Enflurane E. All of the above

MD37 [Feb00] Metoclopramide A. Increases gastric emptying faster with an oral dose than an IV dose B. Causes diarrhoea in children C. Is a dopamine agonist D. ?

MD38 [Feb00] [Jul00] Physostigmine A. Causes (? excitatory activity / ?alerting response) on the EEG B. Doesn’t cross the blood brain barrier C. Doesn’t cause sedation D. Only has its effects at nicotinic receptors E. Causes amnesia F. Causes excitatory activity on the EEG

G: Is/isn’t a quaternary ammonium that does/doesn’t cross BBB

MD39 [Jul00] Drugs filtered and secreted in the PCT include: A. Penicillin B. Probenecid C. Chlorothiazide D. ? Also remembered as: Which basic drug is secreted by the kidney for excretion? A. Procainamide B. Probenecid C. Penicillin D. Acetazolamide

MD40 [Jul00] Which of the following is bacteriostatic only? A. Penicillin B. Gentamicin C. Vancomycin D. Trimetophan E. ?Cefoxitin /?cefuroxime (see also [[MD40)

MD41 [Jul00] With respect to serotonergic receptor action, which ONE of the following is true? A. Sumiatriptan is a 5HT1 antagonist B. Ondansetron is a 5HT3 agonist C. ?Serotonin is a 5HT3 agonist D. Metoclopramide is a 5HT4 agonist E. ?

MD42 [Jul00] Acetazolamide: A. ? secreted by the renal tubules B. ? diuresis C. ? develop tachyphylaxis

MD43 [Jul00] Best antiemetic for motion sickness: A. Metoclopramide B. Ondansetron C. ? D. ? E. Hyoscine

MD44 [Jul00] Complications of salbutamol used in asthma treatment include the following EXCEPT: A. Tachycardia B. Decreased V/Q mismatch C. Tremors D. Pulmonary oedema E. Hyperkalaemia

MD45 [Apr01] (Antibiotic sensitivities against certain bacteria) A. Penicillin and …? B. Amoxycillin and …staph +? C. Flucloxacillin and G +ve? D. ?cephalosporin and …?

MD46 [Apr01] Aspirin overdose A.Causes metabolic & respiratory acidosis B. Causes metabolic & respiratory alkalosis C. Causes metabolic alkalosis & respiratory acidosis D. Causes metabolic acidosis & respiratory alkalosis

MD47 [Apr01] Atropine overdose in neonates A. Causes hyperpyrexia B. ??

MD49 [Apr01] [Jul01] [Jul02] [Jul04] Low molecular weight heparin A.Has better bioavailability B. Molecular weight 1/10 that of normal heparin C. More protein bound than heparin D. ? E. ?

MD50 [Apr01] [Jul01] [Mar03] [Jul04] Desmopressin A Increases factor X B Increases factor V C Causes sustained severe hypertension D Can be used to improve haemostasis in haemophilia E Increases factor VIII activity F. ?v2B receptors?

MD51 [Jul01] An intravenous infusion of 8.4% sodium bicarbonate to a healthy adult may cause: A. Hypotonicity B. Intracellular Acidosis C. Ionized Hypercalcaemia D. ?Respiratory Alkalosis E. Rebound Metabolic Acidosis

MD51b [Feb04] Bicarbonate A. Complications include intracellular acidosis B. 100ml of 8.4% NaCO3 has 200 milliosmoles C. ?

MD52 [Jul01] [Jul04] Cyclo-oxygenase-1 (COX-1) isoenzyme: A. Is increased by inflamation B. Is ?predominant mode of action of indomethacin C. Is increased by lipopolysaccaride D. Is NOT involved in gastric mucosal protection E. Is increased by cytokines

MD53 [Jul01] Caffeine A. Is a CNS depressant B. Causes cerebral vasoconstriction C. Reduces the acidity of gastric fluid secretion (or: Not a gastric irritant) D. Reduces plasma glucose level E. Is a potent diuretic. F. Has been shown to be dependence producing G. Does not show an improvement in psychomotor function

MD54 [Jul02] Which of the following drug interactions is mediated by serotonin? A. ? B. ? C. ? D: Pethidine & Tranylcypromine E. ?

MD55 [Feb04] Metabolism of which drug is decreased in pseudocholinesterase activity: A. Mivacurium B. Cocaine C. Procaine D. Remifentanil E. Esmolol

MD56 [Jul04] What drugs affecting ganglia ? A. Hexamethonium, B. ?carbachol C. ?

MD57 [Jul04] Which of these agents does not reduce uterine contractions? A. Nifedipine B. Gycerol trinitrate C. Indomethicin D. Isoprenaline E. Phenytoin

MD58 [Jul04] Which of the following is the MOST COMMON side effect of oxytocin? A. Hypotension B. ADH effect C. Supraventricular tachycardia D. Histamine release

MD59 [Jul04] Cause of hypotension during iv Vancomycin administration A. ? B. ? C. ?

MCQ-Statistics & Drug TrialsFrom Anaesthesia_MCQBack to: Primary Pharmacology Black Bank | Jump to: SP05 SP10 SP15 SP19

SP01 [Mar96] [Jul98] [Jul99] [Feb06] Tests that use ranking of data: A. Can be applied to any distribution B. Include the chi square test C. Have greater power than non-ranking tests D. Are preferred when normal distribution cannot be confirmed

SP02 [Mar96] [Feb00] [Jul02] [Mar03] [Feb06] Standard error of the mean: A. Is proportional to N B. Is greater for sample than SD of population C. Measures variance within a sample D. Measures dispersion around population mean E. The difference between the sample mean and the population mean. Alt version: Standard error of the mean: A. Measure of sample variability B. Measure of difference between sample & population mean C. SEM > SD D. ?

SP03 [Mar96] [Jul98] [Mar02] [Jul02] Use of chi-square test inaccurate with: A. 2x2 contingency table B. Expected value of any cell < 5 C. Observed value in any cell < 5 D. ?

Alt version: Chi square contingency tables A. Use Fisher test if observed <5 B. Use Fisher test if expected <5 C. ? D. ?

SP04 [Jul97] The mean in a very large sample: A. Numerically greater than the standard deviation B. Is always equal to the mode C. Is more than the median D. Represents a normal distribution E. Gets larger as the sample size increases

SP05 [Mar98] [Jul02] [Mar03] The standard normal distribution: A. Standard deviation is one B. Mean, median & mode are the same C. Mean is one D. Mode is one

ST06 [Mar98] [Jul00] In a study for depth of epidural catheter insertion, the mean is 4.4 and the standard deviation is 0.3 Which ONE of the following is true? A. If a normal distribution, 68% of values wold lie between 4.1 and 4.7cm

B. None was greater than 5.5 cm (or ?6.8cm) C. The least distance was...?? D. 99% of the sample lies within 1.96 SD of the mean E: 500 patients had catheters at some length.

SP07 [Mar98] Simple linear regression: {graph of straight line crossing y axis at +3} A. y = 3 + 6x B. y = 3 + 0.6x C. ? D. None of the above

SP08 [Jul98] [Mar99] [Jul01] Which one of the following statements regarding the standard deviation is true? A. Mean +/- one SD includes 50% of values B. Mean +/- one SD includes 66.7% of values C. Mean +/- two SDs include 99% D. Mean +/- three SDs include 99.73% E. Mean +/- 1.96 SD includes 99.73%

SP09 [Jul98] Ordinal data: A. Assumes a normal distribution B. ? C. ?

SP10 [Feb00] Paired t-test A. Assumes the normal distribuation B. Is a nonparametic test

SP11 [iq In a clinical trial, a patient either vomits or not. What type of data is this? A. Ordinal B. Nominal C. Ratio D. Interval

SP12 [Feb00] [Jul00] [Apr01] Odds ratio: A. Is prevalence vs. incidence B. Gives an indication of ?? in exposed vs non-exposed patients ??C. Formula is Number of positive outcomes/ Number of negative outcomes ??C. Formula is Number of positive outcomes/ Number of possible positive outcomes D. Gives the prediction of a disease outcome knowing the risk factors E. Gives prediction of risk factors with a known disease outcome

SP13 [Jul00] With respect to 95% confidence intervals: A. Equals mean +/- 1.96 SE B. Will contain the population mean 95% of the time C. Tells variability of sample D. Tells 5% chance of finding sample result E. Assumes a normal distribution

SP14 [Jul01] [Jul04] Students t-test A. Used to compare 2 groups B. Used if groups have different variance

C. For small size samples D. ? E. ?

SP15 [Jul01] [Jul04] All of the following tests EXCEPT one, can all be used to compare two dissimilar groups: A. Chi square B. Mann whitney U test C. Wilcoxon signed ranks sum test D. Spearman rank order E. Kruskall Wallis (Alt version: Tests applied to small groups include all EXCEPT: )

SP16 [Feb04] The central limit theorem states that: A. Long option mentioning mean, median and mode B. Best measure of central tendency is mean C. With repeated sampling, distribution approaches that of normal distribution D. With increasing sample size the sample means approximate a normal distribution. E. If the 95% confidence interval includes zero then it is not statistically significant (Alt: E. 95% confidence interval contains zero )

SP17 [Feb04] [Jul04] What kind of data is the ASA classification? A. Nominal. B. Ordinal C. Interval D. Ratio. E. Parametric.

SP18 [Feb04] [Jul04] Repeated statistical testing: A. Increases alpha (Type I) error B. Increases beta (Type II) error C. Decreases power D. ?

SP19 [Jul04] Question about study [[Statistical power|power] A. Refers to the ability of study to detect a difference if one exists. B. ? C. ?

Primary MCQs-Feb 2007From Anaesthesia_MCQPrimary Physiology Black Bank | Primary Pharmacology Black Bank MCQ papers: Feb06 | Jul06 | Feb07 | Jul07 | Feb08

• This page contains all the MCQs that were posted from the Primary Exam on 26 February 2007.

• Not all the questions have been added to the Black Bank yet.

NOTE* Please classify MCQs into the appropriate area if possible If not, then just place them in the "Unclassified MCQ" section.* Please don't use ALL CAPITAL LETTERS as that is hard to read.Pharmacology General pharmacologyGP05 LD50 is: A. median lethal dose B. determined in phase I clinical trials C. dose causing death in 50% of animals within 1hr D. ... E. ...

Which of the following does NOT decrease ACH release from presynaptic terminal A. aminoglycosides B. magnesium C. acetylcholine D. isoflurane E. ?

GP28 A drug has hepatic extraction ratio of 0.7 and is 30% abosorbed, what is the bioavailability A. 0.3 B. 0.7 C. 0.21 D. 0.09 E. 0.03

GP51Which is an antagonist at the NMDA receptor? A. Dexamethasone B. Dextropropoxyphene C. Dexmedetomidine D. Dextromethorphan E. Dexmethamphetamine

With regards to diffusion through a membrane: A. Directly proportional to thickness B. Inversely proportional to thickness C. Inversely proportional to Surface area D. Inversely proportional to concentration difference E. Directly proportional to molecular size

All exist as racemic mixtures except A. thiopentone B. lignocaine

C. bupivacaine D. isoflurane E. enflurane

G Proteins A. Alpha subunit unit has GTPase activity B. Has seven transmembrane subunits C. G protein RECEPTOR hsa three subunits D. All are second messengers except A. Nitric Oxide B. Ca++ C. cAMP D. cGMP E. G proteins When giving a loading dose prior to an infusion the following is not taken into consideration. A. Volume of distribution. B. Context sensitive half time. C. ?Keo

Which of these is a constituent of Ringer's lactate? A. 150mmol/L Na. B. 150mmol/L K. C. Inhalational anaestheticsIN MAC can be considered as A. measure of median effective dose B. ? C. ? D. ? E. ?

IN02 Nitrous oxide at 70% A. 99% equilibrium at 3 min B. about 10L uptake within first 3 min C. reduces muscle blood flow by 30% D. decrease cerebral autoregulation by 70% E. ...

IN35 Which of the following regarding nitrous oxide and Xenon is true? A. Xenon limited by cost B. Xenon is less lipid soluble than nitrous C. Nitrous and Xenon have MAC of > 100% and < 100% respectively D. Nitrous/both will induce surgical anaesthesia E. Both are synthesised from readily available chemicals Comment: I think the stem was which is FALSE?

Anaesthetic preconditioning: A. Greater that 1 MAC isoflurane required B. Related to effects of adenosine C. Related to K+ ATP channels D. ? E. ? Regarding Isoflurane metabolism: A. 0.02% B. O.2% by CYT P450 2E1.

IV anaestheticsIV Thiopentone vs Propofol A. tachycardia is less with thiopentone B. SVR decrease is more with propofol C. ? D. ? E. ?

IV After an IV bolus of thiopentone, amount remaining in brain after 30min is A. 0.2% B. 0.5% C. 1% D. 10% E. 30% Local anaestheticsLA Order of potency of local anaesthetics: A. Bupivacaine > levobupivacaine > Ropivacaine > Lignocaine B. Bupivacaine = levobupivacaine > Ropivacaine > Ligoncaine C. Ropivacaine> Levobupivacaine > Bupivacaine> lignocaine. D. E.

Lignocaine has pKa of 7.9, the percentage ionised at pH 6.9 is A. B. 11% C. 50% D. 91% E. 99% Muscle relaxants & antagonistsMalignant hyperthermia is not associated with: A. Hyperthermia B. DIC C. Resistance to relaxants D. Respiratory acidosis OpioidsOpioid receptors: A. Mu, kappa and delta receptors are found in all laminae in dorsal horn B. C. D. Drugs with solely delta agonism have no analgesic properties E. Cardiovascular drugsRegarding pharmacologic management of ventricular fibrillation: A. epinephrine at 100mcg/kg improves outcomes in in hospital arrest B. vasopressin improves cardiac and coronary perfusion by action at V1 receptors C. Lignocaine 1.5mg/kg is first line D. Amiodarone increases risk of Torsades

E.

Which is not a side effect of amiodarone? A. cardiomyopathy B. thyrotoxicosis C. corneal microdeposits D. pulmonary fibrosis E. photodermatitis

Dexmedetomidine (repeated) A. MAC sparing for isoflurane by maximal 30% B. can cause bradycardia & sinus arrest C. increases CBF D. ... E. ...

Example of a beta-1 selective antagonist with a plamsa half life of 6-7 hours and renal elimination (repeated) A. propranolol B. metoprolol C. esmolol D. .... E. atenolol

ECG changes associated with digoxin at therapeutic levels (repeated) A. shortened PR interval B. prolonged PR interval C. ST segment changes D. Peaked T- waves E. ?

Which is NOT a side effect of non-selective beta blockade A. urinary retention B. bronchospasm C. hyperglycaemia D. Hyperkalaemia E. ?

Milrinone: A. increased cAMP ? B. alpha 1 adrenergic receptors ??? C. mechanism of action is a cAMP dependent rise in intracellular calcium D. ?increases myocardial oxygen demand E. Thiazide diuretics are not associated with- A. Hyperglycaemia. B. Hypermagnesmia C. Hyperuricaemia. D. Hyponatraemia. E. Hypokalaemia. Miscellaneous drugsWhich one of the following is true about aminoglycosides? A. Does NOT cause ototoxicity B. Does NOT cause nephrotoxcity C. Does NOT potential NMJ blockers D. Contraindicated in Myasthenia gravis

E. Is NOT highly protein bound

Which one of the following is NOT true about aminoglycosides: A. Do cause ototoxicity B. Do cause nephrotoxicity C. Are highly protein bound D. Contraindicated in Myaesthenia gravis E. Potentiate NMJ blockade

Which of the following drugs does NOT reduce uterine tone (repeat MCQ): A. magnesium sulphate B. isoprenaline C. indomethacin D. Nitrates E. phenytoin

With regard to oxgygen (repeat of July 06) A. causes pulmonary toxicity at less than 100kPa B. medical grade is 95% pure C. the only gas that ignite a glowing splint D. some CNS toxicity at 100kPa E. produced by hydrolysis on commercial level?

With regard to drug administration in a neonate (repeat July 06) A. aminoglycosides need to be given in higher relative dose because proportion of water is greater B. concentration of free/unbound drug is lower C. highly protein bound reduces serum bilirubin D. renal clearance is higher in first few days of life compared with the second week E. prenatal maternal drug administration has no effect on neonatal drug metabolism

Which of the following antiemetics does not easily cross the blood brain barrier? A. Metoclopramide B. Ondansetron C. Domperidone D. Prochlorperazine E. Droperidol Which of these anticonvulsants acts on the GABA Receptor. A. Ethosuccimide. B. Carbamezipine. C. Vigabatrin. D. Lamotrigine. E. Phenytoin.

MD60 Which of the following is a non particulate antacid A. Aluminium B. Sodium citrate C. Magnesium D. Cimetidine E. ? Statistics and Drug TrialsA drug that has reached a stage 2 trial:

A. Can be used in a clinically in a teaching hospital B. Has not had pharmacokinetic data determined C. Is to be trialled on the target population D. Has not yet been tested on humans E. ?

SP21 Which is true linear regression: A. Line goes through origin B. Can be used for categorical data C. Calculated by method of least squares D. X and Y axis interchangeable E. ? Standard error- A. Difference between population mean and sample mean Unclassified MCQs

July-2006 Primary MCQsFrom Anaesthesia_MCQPrimary Physiology Black Bank | Primary Pharmacology Black Bank MCQ papers: Feb06 | Jul06 | Feb07 | Jul07 | Feb08

• Please post remembered MCQs from the 17th July 2006 MCQ paper on this page.

• Classify into the appropriate section if you can; if not, just post into the "unclassified" section.

• If the MCQ is a repeat and you know the Black Bank Code, then you can just indicate that code (& note any differences from the Black Bank version)

PHARMACOLOGY MCQsUnclassified Pharm MCQsMCQ-General PharmacologyThe production of toxic metabolites with administration of nitric oxide is maximal under which circumstances? A. FIO2 of greater than 80% B. PEEP > 20 cmH2O C. NO at 40 ppm D. Rapid resp rate? (I forgot this one)/high frequency ventilation E. Polycythaemia with Hb >19g/dL

CM03 With regard to oxygen: A. The only gas that can reignite a glowing splint B. Causes pulmonary (?oxygen toxicity/?hypertension) at less than 100 kPa C. Some CNS toxicity occurs at 100 kPa D. Medical grade is 95% pure E. Produced commercially by hydrolysis of water

MCQ-General Anaesthetics - Inhalational[July 06]The following compound is not degraded by Soda Lime A. Nitrous oxide B. Halothane C. Sevoflurane D. Isoflurane E. Desflurane

[July 06] Regarding 70% nitrous oxide: A. 90% equilibration at 3 minutes B. uptake of 10 liters at 90% equilibration C. decreases muscle blood flow by 30% D. Decreases cerebral autoregulation by 24% E. produces surgical anaesthesia

MCQ-General Anaesthetics - IntravenousMCQ-Local AnaestheticsOrder of protein binding, from highest to lowest A. Bupivacaine>procaine>lignocaine>prilocaine B. ?

C. ? D. Bupivicaine > lignocaine > procaine > prilocaineE. Bupivicaine > procaine > prilocaine > lignocaine

Lignocaine: A. with a pKa of 7.9 is 24% ionised at pH 7.4 B. has a clearance independent of liver blood flow. C. ?

MCQ-Muscle Relaxants & AntagonistsWhich drug has the longest (highest) ED95? A. Pancuronium B. Atracurium C. Rocuronium D. Cisatracurium

Edrophonium: A. has a longer half life than neostigmine B. ?

MCQ-Major Analgesics / OpioidsOP28 [Jul-06] Which is NOT a side effect of morphine: A. Seizures B. Mydriasis C. Respiratory depression D. Histamine release E. Immunosupression.

Mu receptors: A. are present in all laminae of the spine. B. ?

MCQ-Anticholinergics/Antimuscarinics

MCQ-Psychotherapeutic Drugs

MCQ-Cardiovascular DrugsCD24c [Jul06] Which one of the following selective beta blockers has a low extraction ratio and is predominantly excreted in urine? A. Propranolol B. Esmolol C. Atenolol D. Metoprolol

An example of a beta-1 selective antagonist, with a plasma half-life of 6-7 hours, and renal elimination is: A. propranolol B. metoprolol C. esmolol D. atenolol

Nitroprusside A. May cause coronary steal (was it this q or one on GTN?)

B. Cyanide is converted to thiocyanate by rhodenese in the liver and kidney C. ? D. ? E. ?

[Jul06] Which of the following is true regarding vasopressin receptors: A. V1a receptors are the most widespread B. V2 receptors are located in the heart C. V1b receptors are only located in the kidney

MCQ-Endocrine Drugs

MCQ-Miscellaneous DrugsWhich of the following agents has a prolonged duration of action in pseudocholinesterase deficiency? A. MivacuriumB. AtracuriumC. CocaineD. RemifentanilE. EsmololNote: this question appeared twice in almost identical form on the paper. With regards to Fresh frozen plasma, which is not true? A. In treated to inactivate viruses B. ? C. Has a high Sodium load D. Contains all the factors necessary for coagulation excluding platelets E. Is ineffective to treat ATIII deficiency

MCQ-Statistics & Drug TrialsWhich is true about a simple linear regression equation? A. Line goes through origin. B. Slope of line is zero C. Line goes through the mean D. Line describes a cause and effect relationship E. ?

Primary MCQs-Feb 2006From Anaesthesia_MCQPrimary Physiology Black Bank | Primary Pharmacology Black Bank MCQ papers: Feb06 | Jul06 | Feb07 | Jul07 | Feb08

• This page contains all the MCQs that were posted from the Primary Exam on 20 February 2006.

• Not all the questions have been added to the Black Bank yet.

PharmacologyGeneral pharmacologyGP. Which only act at G protein coupled receptors A. acetylcholine B. histamine C. glutamate D. glycine

GP. Regarding the management of poisoning. In what order would you perform the following:

• 1. minimise absorption, increase excretion • 2. ensure safety of health workers • 3. manage airway, B, C • 4. treat pharmacologic and toxicological

effects A. 1,2,3,4 B. 2,3,1,4 C. 2,3,4,1 D. 4,3,2,1 E. 4,2,3,1 Did they intend the word organophosphorous to be there? - It wasnt there

GP. Weak base with pka 8.9, what is percent ionised at pH 7.9? A. 10% B. 20% C. 90% D. 99% Inhalational anaestheticsIN ?? increased sympathetic discharge is likely if increased %absorption of sevoflurane ?? (might have been an option to one of the volatile questions

IN. Uptake of inhaled anaesthetics is not affected by A. age B. MAC C. concentration of agent D. solubility of agent E. cardiac output

IN. MAC what is true A. not affected by changes in sodium B. not affected by changes in potassium C. not affected by pregnancy D. affected by age 40-80

IN Which is true? A. MAC of Des greater than sevo B. Sevoflurane is more rapidly excreted than iso despite having a larger tissue/blood partition coefficient

IV anaestheticsIV. Proprofol: A. substituted isopropylphenol B. 20% egg phosphatide C. 80% protein bound D. causes histamine release

IV. Midazolam: A. two glycine binding sites on GABA receptor B. acts at Gaba B receptors C. stimulates chloride channel opening at GABA B D. agonist at mu opioid receptors

IV. What has the largest volume of distribution? A. thiopentone B. propofol C. dexemedetomidine D. midazolam E. ?

IV. Which agent has no antiemetic effects A. propfol B. midazolam C. scopolamine D. etomidate E. ?

IV -. Thiopentone: A. faster onset with acidosis or B. predominantly ionised in acidotic environment C. mostly bound to albumin after injection D. ? Local anaestheticsLA Cocaine effects... A. Cocaine toxicity is similar to amphetamine toxicity B. Central effects are due to noradrenaline C. Vasodilator D. Maximal effect within 5 minutes E. ?

Muscle relaxants & antagonistsMB Which drug is likely to have prolonged duration in pseudocholinesterase deficiency: A. Mivacurium B. Cocaine C. Procaine D. Esmolol E. Remifentanil

MB. Non-depolarising neuromuscular block prolonged with A. [[Phenytoin}} B. Hypomagnesemia C. Respiratory acidosis D. Hyperkalaemia E. ?

MB Which drugs do not cause prolongation of blockade by inhibiting calcium channel on nerve terminal? A. Aminoglycosides

B. Frusemide C. Ca blockers D. Volatiles E. Magnesium

MB Edrophonium question (repeat) A. Has quicker onset than neostigmine B. Has shorter half life than neostigmine C. Is a tertiary amine (all options same as previous) D. ?

MB Pyridostigmine: A. is a tertiary amine B. ? C. ? D. ? E. May improve symptoms of myaesthenia gravis

OpioidsOP Remifentanil A. is metabolised by red cell esterases B. C. D. E. has active metabolites that are hydrolysed to inactive metabolites

OP Naloxone: A. selective mu antagonist only B. intrinsic activity when given alone C. mu, kappa, delta activity is equal D. causes APO E. half life 6-8 hours

OP Tramadol: A. prevents reuptake of serotonin and noradrenalin B. ? C. ?

OP Opioids A. spinal receptors exist for mu and delta but not kappa B. mu receptors found in all lamina of dorsal horn C. those with only delta agonist activity are not analgesic D. tramadol, codeine and oxycodone metabolised by cyp2d6 to active metabolites E. tramadol, hydromorphone and codeine have active metabolites F. morphine-3-glucuronide is very potent at mu receptors

OP. Which ONE of the following is true? A. oxycodone, codeine and tramadol result in metabolites that are active B. tramadol, morphine and hydromorphone have active metabolites C. ?

OP. Opioids A. phenylpiperidinies are predominately metabolised by reduction in the liver

B. ? C. ?

OP. Regarding tolerance to clinical use of opioids A. Cross tolerance is complete for all opioids B. Mechanism may be Phosphorylation of receptors and internalisation C. Physical dependence is not a problem D. psychological dependence does not always occur E. ? Cardiovascular drugsCD Regarding esmolol: A. is metabolised by red cell esterases B. half life something? C. intrinsic sympathomimentic D. (no option about not being a membrane stabiliser) E. ?

CD. Phenylephrine and metaraminol A. are resistant to metabolism by COMT B. have both indirect and direct effects C. have only direct effects D. ?

CD. Digoxin: A. inhibits Na+/Ca2+ exchange B. has a central effect on vagal nuclei C. Increases atrial refractoriness D. ?

CD Phentolamine: A. Selective alpha-1 antagonist B. Causes bradycardia D. Causes increased cardiac output E. Selective alpha 2 antagonist

CD Dexmedetomidine: A. MAC sparing for isoflurane by maximal 30% B. Causes bradycardia and sinus arrest C. ?

Miscellaneous drugsMD With regard to drug administration in neonate, A. Aminoglycosides need to be given in higher relative dose because proportion of water is greater B. Concentration of free/unbound drug is lower C. Highly protein bound reduces serum bilirubin D. Renal clearance is higher in first few days of life compared with the 2nd week E. Prenatal maternal drug administration has no effect on neonatal drug metabolism

MD. Which drugs increase gastric emptying? A. Omeprazole B. Domperidone C. Prochlorperazine D. Atropine E. Midazolam

MD. Metoclopramide A. Substituted benzamide

B. Phenothiazine c. Half life of: 2 hours

MD. Dexemedetomidine A. Increases CBF B. Decrease MAC of isoflurane up to maximum of 30% C. May cause bradycardia and sinus arrest D. ?

MD. Warfarin: A. Is a racemic mixture B. R isomer is more potent than S isomer C. Doesn't cross placenta D. Onset of action depends on speed of synthesis of coagulation factors

MD. Clopidogrel has its effects by: A. Binding to GP2b3a receptor B. Inhibits uptake and binding of ADP C. Binds to ADP receptor preventing activity D. Plasma levels elevated for about 7 days after ceasing

MD. PGI2 and PGE2 causes all except A. Hypotension B. Abdomial pain C. Fever D. Nausea and vomiting E. Bronchoconstriction

MD. Salbutamol: A. ?? Myosin light chain kinase

MD. Aspirin: A. Uncouples oxidative phosphorylation in skeletal muscle in overdose. B. plasma levels elevated for about 7 days after ceasing. C. something about increasing excretion by changing urine pH D. half life of 6 hours or something

MD. Phenytoin, which is not true? A. actions on Ca2+ channels B. actions on GABA channels C. direct action on membranes D. actions on Na+ channels

MD20 Which of the following causes irreversible cardiotoxicity? A. Vincristine B. Bleomycin C. Asparaginase D. Danorubicin

MD Oxytocin A. t1/2 of 5 min B. Strong antidiuretic effect C. ? StatisticsSP02 Standard error of the mean: A. variability of samples

B. The difference between the sample mean and the population mean. C. ? D. ?

SP01 Tests involving ranking of data: A. Are preferred when normal distribution cannot be confirmed B. Include chi squared test C. something about having more power (but not in those exact words) D. (?? Have more power than parametric tests)

Can't remember which?? General comments about the paper

• "very few MCQ questions in physiology were repeated or slightly altered, most questions were brand new"

. . It seems after the recent successes of >90% passing both physiol and pharm MCQs, the examiners have really dug deep to try and reduce those percentages. got a real shock on the day. not what everyone said it would be like!

Primary MCQs-July2008From Anaesthesia_MCQPrimary Physiology Black Bank | Primary Pharmacology Black Bank MCQ papers: Feb06 | Jul06 | Feb07 | Jul07 | Feb08

• This page contains MCQs that were on the Primary Exam on 21 July 2008.

• Not all the questions have been added to the Black Bank yet.

GUIDELINES*Mark MCQs with *new* if you believe it is a new question, or *repeat* if you believe it to be a repeat.* Please classify MCQs into the appropriate area if possible. If not, then just place them in the "Unclassified MCQ" section.* Please don't use ALL CAPITAL LETTERS as that is hard to read.*If you need help on how to edit a page see here. Unclassified Pharmacology

(newish) Adrenaline added to local anaesthetic at 1:200 000. The concentration is: A: 50 mcg/ml B: 5 mcg/ml C: 0.1 mcg/ml (etc)

Question about Clonidine

(new) Which of the following has it's action related to a ligand gated ion channel? A. Metoclopramide B. Phenylephrine C. Morphine D. Salbutamol E. Vecuronium

Question about NO MOA

(new) Which of the following has the highest oral bioavailability A. Metoprolol B. Esmolol C. Labetalol D. Atenolol E. Carvedilol

(new) Esmolol and Sotalol (not remembered accurately) A. Are both class III anti-arrhythmics B. Both have 90% bioavailbility C. Prolong QT D. Depress SA node and prolong AV E. Decrease refractory period

(new) Nitrous Oxide: A. Inhibits methionine synthetase B. Decreases homo-cysteine levels

C. Increases s-adenyl-methionine levels D. A and B E. B and C

Quantal dose response curves: A. Can be used to determine potency B. Can be used to determine efficacy C. Can be used to determine therapeutic index D. Can be used to deteremine the 50% effective response E.

Ketamine A. Is chemically related to Phencyclidine B. C. Is a competitive antagonist at NMDA receptors D. E. Is antagonised by Mg2+

Most important contraindication for beta blockers A. Asthma B. Heart Failure C. First line treatment in phaeochromocytoma D. Hypertension in Diabetes

ACEi A. Contraindicated in heart failure B. Preferred method of treating hypertension in diabetics C. Something about oedema

(repeat) Which of the following causes least decrease in SVR A. Isoflurane B. Sevoflurane C. Desflurane D. Enflurane E. Halothane

(repeat) Propofol A. Faster blood/brain equilibration than Thiopentone

Fentanyl in a dose of 30mcg/kg which is FALSE (not remembered accurately) A. Will cause hypotension B. Will decrease MAC by 80% C. Decreased sympathetic output

(repeat) Bupivacine has pka of 8.1, what is its pH when ratio of ionised to unionised fraction is 100:1? A. 6.1 B. 5.1 C. 10.1 D. 6.5

(repeat) Which benzodiazepine has the longest terminal elimination half time? A. diazepam B. temazepam C. lorazepam D. oxazepam E. flunitrazepam

(repeat) Propofol clearance is : A. significantly decreased in liver failure B. decreased in pregnancy C. significantly increased in neonates D. significantly decreased in renal failure E. Unchanged in the elderly

(repeat) what antagonises the effect of neostigimine on its reversal of neuromuscular blockade A. hyperkalaemia B. hypomagnemesaemia C. respiratory acidosis D. metabolic acidosis E. respiratory alkalosis

Warfarin A. Depends on the time to produce new clotting factors for onset B. Is clinically used as a racemic mixture C. D. Only the R-isomer is effective E.

Anticholinergic syndrome treated with: A. Atropine B. Pyridostigmine C. Physostigmine D. Neostigmine E. Edrophonium

(new) In regards to AntiChE A. Pyridostigmine has a tertiary amine B. Onset of Edrophonium is longer than Neostigmine C. D. E.

(repeat) Sarin gas A. Causes dry, red skin B. Anticholinergic treatment contraindicated with tachycardia C. D. Causes fasciculation and paralysis

Metoclopramide

A. Is a dopamine agonist B. C. D. E. Increases gastric emptying thorugh it's effect on H1 receptors

(repeat) Central limit theorem (not accurately remembered) A. In a large sample the means will approach a normal distribution B. Something about confidence intervals C. D. E.

Chemoreceptor Trigger Zone (inaccurately remebered) A. Not affected by drugs that cannor cross blood brain barrier B. Receives multiple synaptic, csf and blood inputs C. Contains dopamine and histamine receptors

The beta blocker with the greatest bioavailability is: A. Atenolol B. Metoprolol C. Sotalol D. Labetalol E. Carvedilol Central anticholinesterase syndrome can be treated with: (Not sure about the "incorrect" answers, but physostigmine was definitely there A. Pralidoxime B. Pyridostigmine C. Atropine D. Glycopyrrolate E. Physostigmine Once commenced on an infusion, propofol bottle must be discarded after: A. 6hrs B. 12 hours C. 16 hours D. 24 hours E. 30 hours (12, 24 and 30 were definitely options) Not sure about the other two. a was definately 6hrs

The component that emulsifies propofol is: A. Soy oil B. Glycerol C. Sodium metabilsulphite D. Egg lecithin E. ?? A few repeats:

• MB 37 • PS06

General pharmacology Which of the following is not a ligand gated receptor: A. nicotinic Ach receptor B. alpha 2 adrenergic receptor C. 5HT3 receptor D. ?

IV anaesthetics Propofol clearance is : A. significantly decreased in liver failure B. ncreased/decreased in pregnancy C. significantly increased in neonates D. significantly decreased in renal failure E. Unchanged in the elderly

Bupivacine has pKa of 8.1, what is its pH when ratio of ionised to unionised fraction is 100:1? A. 6.1 B. 5.1 C. 10.1 D. 6.5

Something similar to: What antagonises the effect of neostigimine on its reversal of neuromuscular blockade A. hyperkalaemia B. hypomagnemesaemia C. respiratory acidosis D. metabolic acidosis E. respiratory alkalosis

Primary MCQs-Feb2008From Anaesthesia_MCQPrimary Physiology Black Bank | Primary Pharmacology Black Bank MCQ papers: Feb06 | Jul06 | Feb07 | Jul07 | Feb08 | Jul08

• This page contains all the MCQs that were posted from the Primary Exam on 25 February 2008.

• Not all the questions have been added to the Black Bank yet.

GUIDELINES*Mark MCQs with *new* if you believe it is a new question, or *repeat* if you believe it to be a repeat.* Please classify MCQs into the appropriate area if possible. If not, then just place them in the "Unclassified MCQ" section.* Please don't use ALL CAPITAL LETTERS as that is hard to read.*If you need help on how to edit a page see here.PharmacologyUnclassified Pharmacology

General pharmacologyWhich of the following is not a ligand gated receptor: a)nicotinic Ach receptor b)alpha 2 adrenergic receptor c)HT3 receptor d)? IV anaestheticsPropofol clearance is : a)significantly decreased in liver failure b)increased/decreased in pregnancy c)significantly increased in neonates d)significantly decreased in renal failure e)Unchanged in the elderly

Thiopentone compared to propofol has: a)shorter effect site equilibrium time b)? c)? d)?

Which benzodiazepine has the longest terminal elimination half time? a)diazepam b)temazepam c)lorazepam c)oxazepam Local anaestheticsBupivacine has pka of 8.1, what is its pH when ratio of ionised to unionised fraction is 100:1? a)6.1 b)5.1 c)10.1 d)6.5

Which of the following is an amide local anaesthetic:

a)dibucaine b)cocaine c)procaine d)amethocaine e) Procainamide (I think) Muscle relaxants & antagonistsWhich neuromuscular blocking agent is the least metabolised: A) Vecuronium B) Rocuronium C) Cisatracurium D) Atracurium E) Pancuronium

what antagonises the effect of neostigimine on its reversal of neuromuscular blockade a)hyperkalaemia b)hypomagnemesaemia c)respiratory acidosis d)metabolic acidosis e)respiratory alkalosis

ED95 for neuromuscular blockade means: a)dose where twitch is reduced by 95% b)dose where twitch is reduced to 95% c)dose where 95% of the population is paralysed d)? OpioidsA bolus dose of morphine has a longer duration of action compared with fentanyl (repeat) a)larger volume of distribution b)less lipid solubility c)longer elimination half time

opiod receptors: a)found in all lamina of dorsal horn of spinal cord b)opiods with only delta agonist activity doesn't have analgesic property Cardiovascular drugsAtenolol: a)has higher lipid solubility than propanolol b)is a nonselective beta blocker c) d) Miscellaneous drugsHyoscine can: A) Cause post op confusion in the elderly B) Cause nausea and vomiting C) Has a Quartenary Nitrogen D) ?Is related to Atropine

Which of the following causes reversible inhibition of platelet function? A. aspirin B. heparin C. warfarin D. diclofenac E. clopidogrel

Which following drug is not a serotonin receptor antagonist? a)sumatriptan

b)clozapine c)ketanserin d)ondasetron

Regarding antibacterial agents, which of the following is true? a) Isopropyl alcohol is sporicidal b) chlorhexidine is antibacterial in 1 minute c) povidone iodine is antibacterial in 1 minute d) chlorhexidine is neutralised by skin moisturises e) Isopropyl alcohol is able to penetrate proteins

Metoclopramide: A. Able to reverse opiod induced delayed emptying of the stomach B. Is a H1 antagonist C. Causes constipation D. Increases lower oesophageal sphincter tone E. ? Regarding metformin and glimepiride: a)both don't have therapeutic effects above what insulin offers b)metformin is renally metabolised whereas glimepiride is metabolised totally by the liver c)obesity is a problem side effect d)both cause metabolic acidosis

Which of the following anticonvulsants work by modifying GABA transmission? A. lamotrigine B. vigabatrin C. phenytoin D. ethosuximide E.

Which of the following produces contractions in uterine muscle? a)PGE2 b)beta blockers c)PGF2alpha d)magnesium

Different question to above: BL02 Which one causes bronchodilation? A. PGE2 B-E. some other stems which were all constrictors (NOTE: This seems to be BL02 from the Physiology MCQs though recorded here as a Pharm MCQ (??). Anyone got any other information? In the meantime temporarily code as BL02) Definitely in the pharm paper, only did the pharm paper this sitting!!! Statistics and Drug TrialsOnly 2 stats questions in the whole paper Repeat regarding central mean theory... General comments/opinions about the paperI thought it was a fair paper, nothing too unexpected. Not many repeat MCQ's. Some typographical errors in the paper, which may unfortunately alter some answers.

i thought there was at least 50% repeats!

July 2007 MCQsFrom Anaesthesia_MCQPrimary Physiology Black Bank | Primary Pharmacology Black Bank MCQ papers: Feb06 | Jul06 | Feb07 | Jul07 | Feb08 PHARMACOLOGY MCQs Unclassified Pharm MCQs General PharmacologyHypertonic fluid is used in resuscitation for: A. increase in total body sodium.B. reduction in viscosity.C. improve coagulation.D. reduce intracellular oedema.E. rapid expansion of intravascular volume.

A drug has an ionized to unionized ratio of 100:1. If the pH is x, what is the pKa of the drug? (similar to previous question regarding lignocaine)I remembered it as "if pKa is x, then pH is"A. xB. x-1C. x+1D. x-2E. x+2

Acids Ionised Above pKaBases Ionised Below pKa Ratios: pH-pKa = -2: 99:1 -1: 90:10 -0.5: 75:25 0: 50:50 0.5: 25:75 1: 10:90 2: 1:99Just remember the above and whether the drug is an acid or a base. This question was, bupivacaine has pKa 8.19, if its ionised to unionised ratio was 100:1, what is the pH?A: 5.19B: 6.19C: 7.96D: 8.19E: 10.19As Above, Bupivicaine is a weak base, ionised below pKa (8.19)Ratio 100:1 means pH-pKa = -2Therefore ph = 6.19.(Note this gives 99:1, but ph 5.19 gives ratio 99.9:0.1 therefore I think B most correct.)

GP29 Which of the following drugs cannot cross the BBB?A. OndansetronB. ScopolamineC. MetoclopramideD. DroperidolE. Domperidone

A drug is 30% absorbed, if hepatic extraction is 0.7,

what is the oral bioavailability? (rpt)A. 0.3 B. 0.7 C. 0.21 D. 0.09 E. 0.03 Bioavailability = Absorption X (1-HER)Bioavailability = 0.3 X (1-0.7) = 0.09

GP 28Which is not a ligand gated channel?.A. Alpha-2 ReceptorB. 5HT3 ReceptorC. Nicotinic cholinergic receptorD. GABA receptorE. ?

G proteinsA. Always have 3 subunitsB. Alpha subunit has intrinsic GTPase activityC. One G protein only attached to one G protein coupled receptorD. Spans membrane 7 times

Electrical events in GABA transmissionA. Presynaptically inhibits GABA-AB. Presynaptically inhibits GABA-BC. ?D. ?E. ? General Anaesthetics - InhalationalAnaesthetic preconditioning...A. Sevoflurane and propofol are equally effectiveB. At least 1.0 MAC Isoflurane necessaryC. something about Adenosine receptorsD. thought to be due to closure of KATP channelsE. Opioids do not produce preconditioning

Question regarding isoflurane metabolism (old MCQ):A. 0.2% by CYP2E1B. 0.02%C. ?D. ?E. ?

Therapeutic ratio (or index) of inhalational anaesthetics such as sevoflurane and isoflurane:A. Less than 2B. 2 - 4C. 4 - 8D. 8 - 10E. Greater than 10 General Anaesthetics - IntravenousQuestion comparing CV side-effects of thiopentone and propofol. (same/similar to old MCQ)A. ? B. ? Question regarding propofol clearance A. Undergoes oxidative metabolism.B. age/sexC. liver blood flow

D. 10% urine metabolitesE. chronic liver disease

Propofol clearanceA. The same as hepatic blood flowB. Increased in childrenC. ? Increased/? Decreased in pregnancyD. No change in elderlyE. Decreased in renal dysfunction

What does not occur with dose of thiopentone?A. Decrease in cardiac output & vasodilatationB. ? C. Decreased in CMRO2 by 55%D. ? E. Wakening at increased venous (arm) concentrations of thiopentone with repeated bolusing

Ketamine:A. A racaemic mixture, contains mostly S isomerB. Minimal effect on ICPC. Theta waves ...?...D. Something about infusions & ventilatory response to pCO2 Local AnaestheticsA solution of LA contains 1:200000 adrenaline. How much adrenaline has been added? (same/similar to old MCQ)A. 5 mcg/mLB. 50 mcg/mLC. 500 mcg/mLD. 0.5 mcg/mLE. 0.05 mcg/mL

LignocaineA. Not absorbed via GIT

Systemic absorption of LA given epidurally depended on all except: (old) A. Adrenaline addedB. Intrinsic vasoconstrictor activityC. Hepatic metabolismD. Renal clearance Muscle Relaxants & AntagonistsQuestion regarding active metabolites of the ND NMJBs (same/similar to an old MCQ).A. VecuroniumB. PancuroniumC. RocuroniumD. ?? cis/atracuriumE. ?Definition of the ED95 (with respect to NMJBs):A. Twitch height decreased BY 95%.B. Twitch height decreased TO 95%.C. Percentage paralysed is 95%.D. Percentage not paralysed is 95%.Best Indicator of adequate reversal of NM blockade (same/similar to an old MCQ)A. TOFR > 50%B. PTC of 11

C. No fade on DBSD. No fade with tetany.E. ?MB39 Sugammadex binds most avidly to:A. PancuroniumB. RocuroniumC. VecuroniumD. AtracuriumE. Cisatracurium(???was this in the paper??? I can't remember it.) Which is the LEAST metabolised?A. PancuroniumB. VecuroniumC. RocuroniumD. AtracuriumE. Cisatracurium

Vecuronium:A. Metabolism involves 3- & 17-deacetylationB. ?C. ?

Mechanism of neuromuscular block of suxamethoniumA. Persistent binding on nicotinic cholinergic receptorsB. Inactivates Na+ channelsC. Direct blockade of open channel

A patient is reversed with 50mcg/kg neostigmine and 20mcg/kg atropine then develops laryngospasm and is given 1.5mg/kg suxamethonium. The most likely outcome is:A. Decreased duration of blockB. Increased duration of block Major Analgesics / OpioidsQuestion relating to pethidine:A. Causes serotonin reuptake inhibition.B. ?

Regarding codeine, which is false:A. Less efficacy as an analgesic compared to equipotent doses of morphineB. ?C. ?D. ?

Opioids (rpt Q)A. Tramadol, codeine, oxycodone metabolised by CYP2D to active metabolitesB. Tramadol, codeine, hydromorphone has active metabolites

Single bolus of morhpine 10mg has longer duration of action than single bolus of fentanyl 50 mcg because morphine, when compared to fentanyl has:A. Lower lipid solubiltiyB. Smaller volume of distribution

A 50-100 mcg/kg dose of fentanyl (old Q)A. Elimination half life greater than 3 hrs

B. Does not adequately supress stress response to surgery

Anticholinergics/AntimuscarinicsAH07 The nerve agent sarin:A. should not be treated with anticholinesterase if there is tachycardiaB. something about pyridostigmineC. symptoms can include fasciculations and paralysisD. something about pralidoxime unblocking the receptor (a red herring teaser)E. ? sorry not remembered well but at least you know to look up sarin in your spare time!!

Plasma cholinesteraseA. Hydrolyses succinylcholine to succinylmonocholineB. Large amounts in red cellsC. Metabolises remifentanil

What does not cause decreased plasma cholinesterase activity?A. PregnancyB. PancuroniumC. NeotigmineD. Frusemide Psychotherapeutic Drugsabc Question regarding GABA ion channels and the mechanism of action of AEDs*repeat*

Options included 5 AEDs (1 or 2 of these were 'newer' agents).A. lamotrigineB. vigabatrineC. phenytoinD. gabapentinE.The last option was ethosuccimide Which ONE of these does NOT have anticonvulsant effects?A. lorazepamB. acetazolamideC. phenytoinD. primadoneE. phenindione Cardiovascular DrugsMechanism of action of vasopressin in weptic shock include all except:A. Potentiates action of catecholamines on blood vesselsB. Increases release of noradrenaline from the adrenal medullaC. Preferentially vasoconstricts renal efferent arterioles to maintain GFRD. Acts via V1 receptorsE. Opposes vasodilatory action of nitric oxide

Something about selective alpha adrenoceptor agonists

A.B.C.D. in carcionod treatment phenoxybenzamine used following beta-blockade.E.Non-selective beta blockade causes :A. Increased muscle blood flow.B. Decreased uterine tone.C. hyperglycaemia.D. ?bronchodilationE. ?mydriasis ?miosisWhich inotrope does not act by increasing cAMP? A. MilrinoneB. GlucagonC. DigoxinD. ?E. ?

Nitric oxideA. ?something about PVRB. Does not cause bronchodilatationC. Released in response to actylcholineD. ?E. ?

CD49 Which one of the following is not an adverse effect of Amiodarone? A. Pulmonary fibrosis.B. Photosensitive rash.C. Corneal microdeposits.D. cardiomyopathyE. thyrotoxicosis

Adenosine & amiodarone A. Both class III antiarrhythmicsB. Both decrease conduction through AV node and increase refractory periodC. Both may cause hypotension, chest pain & bronchospasm with bolus dose

MCQ-30 Milrinone A. depresses thyroid function with prolonged use B. antiarrhythmic effects with class 3 properties C. dose dependant increase in coronary oxygen consumption D. exerts its effect via cAMP dependant increase in intracellular calcium E. devoid of arrhythmic effects of catecholamines

PhenylephrineA. increases skin temperatureB. inactivated by COMTC. increases gastric motilityD. causes mydriasisE. has the same duration of action as noradrenaline

1:200000 Adrenaline is equivalent to A. 5%

B. 0.01%C. 5mg/mlD. E. Endocrine Drugs

Miscellaneous DrugsWhich of the following drugs is an NMDA antagonist?A. DexamethasoneB. DextropropoxypheneC. DextromethorphanD. DexmedetomidineE. Dexamphetamine

Which of the following drugs may cause mydriasis?A. Phenylephrine

Which one causes reversible impairment of platelet functionA. AspirinB. diclofenacC. clopidogrelD. heparinE. warfarinAnswer: diclofenac - Aspirin covalently, ie. irreversibly binds to cox-1 - Diclofenac reversibly binds to cox-1 - clopidogrel binds irreversibly to platelet ADP receptors, thus inhibiting ADP activation of the GPIIb/IIIa complex - Heparin does not affect platelet function- is involved in clotting cascade - Warfrin does not affect platelet function - is involved in clotting cascade

Also one about COXIIA. it is inducible with inflammationB. ?C. COXII inhibitors rarely cause cause gastric erosionD. NSAIDS can ihibit the expression of COXIIcaution: I think I haven't remembered this very well..

SerotoninA. Impairs platelet aggregationB. Pulmonary ?vasodilatation/?vasoconstriction

Which produces uterine contractionA. PGF2 alphaB. PGE2c. NSAIEDS

Gentamicin, which is false (rpt Q)A. Causes ototoxicityB. Causes nephrotoxicityC. High plasma protein binding

Thiazide diuretics are not associated withA. Metabolic acidosisB. HypomagnesaemiaC. Hyperuricaemia

D. HyponatraemiaE. Hypochloraemia

With regards to fresh frozen plasma, which is true?A. Is treated to inactivate virusesB. Contains all procoagulants excluding plateletsC. Is ineffective to treat ATIII deficiencyD. Must be crossmatched

Which of the following is a non-particulate antacid?A. Na CitrateB. ?C. ?D. ?E. ?

The minimum daily aspirin dose that causes full platelet inhibition:A. 20mgB. 40mgC. 60mgD. 100mgE. 300mg(I don't think 60mg was an option - I think the options were 10mg 20mg 40mg 100mg 300mg) Statistics & Drug TrialsPower is NOT dependent on: (? repeat)A. number of participantsB. 95% Confidence intervalC. The size of the differenceD. The variability within the samplesE. Type II error

SP20 A drug that has completed phase I trials :A. Has been tested on humans.I actually thought it said something like:A. has not been tested on humansB. next will be tested in target groupC. nothing known about PKD. can be used in large teaching hospitals

Standard error the meanA. Difference between population & sample meanB. Used to derive the range which likely includes the population mean

MISC

GP14 [Apr01] [Jul04] (A Basic drug with a pKa of 8.7)A. ?B. ?C. Will be predominantly ionised at plasma pH CommentsA basic drug will be predominantly ionised at a pH below its pKa For a drug with a pKa of 8.7 undegoing the reaction: B + H+ <-> BH+:

• At pH = pKa we can calculate the following: pH = pKa + log([B]/[BH+]) (Henderson-Hasselbalch equation) If pH = pKa then this simplifies to pKa = pKa + log([B]/[BH+]) log([B]/[BH+]) = 0

Thus, taking anti-logs (easy as log 1 = 0): ([B]/[BH+]) = 1 so [B] = [BH+] -> 50% ionised & 50% unionised

By doing similar calculations using the Henderson-Hasselbalch equation, the ratio B/BH+ can be determined at any pH value. For example:

• For pH = pKa + 1 -> 10% ionised & 90% unionised (approx)

• For pH = pKa -> 50% ionised & 50% unionised

• For pH = pKa - 1 -> 90% ionised & 10% unionised

• For pH = pKa - 2 -> 99% ionised & 1% unionised

LA12 [Jul98] The site of action of benzocaine is: A. Same site as saxitoxin (alt option: At the channel mouth )B. Inside Na+ channel C. At axoplasmic end of Na+ channel D. At Ca++ channel E. In the cell membrane CommentsOption "E In the cell membrane" would be the best answer. Benzocaine is an ester local anaesthetic which is a secondary amine. It is unique among clinically useful LA's. As a weak base with a low pKa (3.5) - therefore at physiological pH exists primarily in an unionized form rendering it lipid soluble (& water-insoluble). Because of this it is suitable for topical anaesthesia of mucus membranes (in concentrations up to 20%). Its systemic toxicity is also diminished because of rapid hydrolysis. It has a very rapid onset Mechanism of action"Certain local anaesthetics (eg benzocaine) are only present in the body as

uncharged, tertiary bases, and must therefore act in a different way. Theyare believed to cause conduction blockade by "membrane expansion" (ie bycausing swelling of the lipoprotein matrix of the Na+ channel. To some extent,other local anaesthetics, which are partly present in the neurilemma as theuncharged base may act in this manner."

- from Calvey & Williams "Principles and Practice of Pharmacology for Anaesthetists" 4th ed 2001, p152-3So option "E In the cell membrane" would be the best answer. Benzocaine is a weak base Potential problems with benzocaine1. Allergic reactions Metabolism to produce para-amino benzoic acid (PABA) so potential for allergic reactions (like other ester LAs) 2. Methaemoglobinaemia Benzocaine can cause methaemoglobinaemia [1] (http://www.jaoa.org/cgi/content/full/105/8/381)(so dose is limited to 200-300mg in adults). Babies are at higher risk [2] (http://www.tiaft.org/tiaft98/thu/p/t_p_29.html) because of their smaller weight (easier to give a high dose) and because of lower levels of the enzymes which convert met-HbF back to Hb. Treatment of symptomatic methaemoglobinaemia is IV 1% methylene blue at a dose of 1-2mg/kg over 20 minutes. Note that with concentrations of 20%, one ml will contain 200mg! Regarding methaemoglobinaemia"Of 198 reported adverse events of all types reported with benzocaine, 132 cases (66.7%)involved definite or probable methemoglobinemia, including 107 serious adverse events (81.1%) and two deaths (1.5%). The formulation implicated was a spray in 123 cases(93.2%), a benzocaine-containing lozenge in two cases (1.5%), and a gel in one case. Ofthe 69 cases that specified a dose, 37 (53.6%) indicated that a single spray was applied,which is approximately the recommended amount.

"Health professionals involved in endoscopy, intubation, bronchoscopy, or similar invasive

procedures using benzocaine-containing sprays should know that (1) administration may causeMHb with potentially serious consequences, (2) identifying the reaction to benzocaineusually requires cooximetry (although it can be implied by symptoms), and (3) treatmentinvolves immediate intravenous administration of 1 to 2 mg/kg of methylene blue."

- from [3] (http://www.medscape.com/viewarticle/481037)

Pharmacology SAQ ListingFrom Anaesthesia_MCQ

Question Coding• 1st 2 numbers: year SAQ was asked • Next value: 'A' for Mar-Apr paper; 'B' for Jul-

Aug paper • Final no: Q number on paper

Example: '93B12" ->question 12 on Jul-Aug 1993 paper EXCEPTION: old Qs just have the year listed (eg '1991') Pharmacology MCQs | Physiology SAQ

A list of Primary FANZCA Short Answer Questions (Pharmacology SAQs). (The percentages are the pass rate for the question at that exam).

Table of contents [showhide]

1 General Pharmacology1.1 Pharmacodynamics1.2 Pharmacokinetics1.3 Other General Pharmacology2 Inhalational Anaesthetic Agents3 Intravenous Anaesthetic Drugs & Antagonists4 Opioid Agonists & Antagonists5 Muscle Relaxants & Antagonists6 Local Anaesthetics7 Autonomic & Cardiovascular Drugs7.1 Autonomic Pharmacology7.2 Adrenoreceptor Drugs7.3 Antihypertensives (incl Diuretics)7.4 Anti-arrhythmic Drugs8 Miscellaneous Pharmacology8.1 Anti-emetic Drugs8.2 Drugs affecting Coagulation8.3 Obstetric Pharmacology8.4 Gastrointestinal Pharmacology8.5 NSAIDs / Paracetamol8.6 Unclassified Drugs9 Statistics

General Pharmacology PharmacodynamicsPharm-08A5 Classify drugs that alter activity at serotonin receptors with examples. Describe their mechanisms of action and clinical indications. Pharm-08A4 Outline the pharmacologic management of bronchoconstriction in acute severe asthma. Include mechanisms of action and potential adverse effects. Pharm-06A1 Outline the pharmacologic management of bronchoconstriction in acute severe asthma. Include mechanisms of action and potential adverse effects. Pharm-06A4 Describe the pharmacodynamic properties of propofol and how this influences its clinical usage. Pharm-05B2 Using opioids as examples, describe and illustrate with graphs what you understand by the terms "potency", "efficacy", "partial agonist", "competitive antagonist" and "therapeutic index". (83% pass rate) Pharm-04B1 Briefly describe how drugs produce their pharmacological effects. Illustrate each mechanism with examples. 67% Pharm-03B3 Outline GABA's role as a neurotransmitter and indicate how its actions may be modified by pharmacological agents. 63% Pharm-01A10 Outline GABA's role as a neurotransmitter and indicate how its actions may be modified by pharmacological agents 53% Pharm-01A9 Briefly describe how drugs produce their pharmacological effects. Illustrate each mechanism with examples. 75% Pharm-00B11 Describe the structure and function of G proteins 50% 1999 Using opioids as examples describe and illustrate with graphs what you understand by the terms 'potency', 'efficacy', 'partial agonist', 'competitive antagonist' and 'therapeutic index'. 77% Pharm-97A9 Briefly describe the pharmacological role of the nicotinic cholinergic receptor 62% 1997 Briefly describe the drug factors that may predispose to thrombophlebitis Pharm-96B12 Briefly describe how drugs may produce their pharmacological effects. Illustrate each mechanism with examples. 30% Pharm-96A16 Define therapeutic index and briefly outline its significance. Describe briefly also the therapeutic ratio and the use of the of the cardiac/cns toxicity ratio (cns = central nervous system) 79% Pharm-95B9 Using opioids as examples, describe and illustrate with graphs what you understand by the terms potency, efficacy, partial agonist , competitive antagonist and therapeutic index. 70% 1994 Briefly explain non-competitive antagonism at receptor sites and give two examples 1994 Briefly describe the possible mechanism of action of general anaesthetics 1993 Briefly outline the chemistry of soda lime and the potential interactions with anaesthetic agents

Pharm-93A2 Define potency, affinity and efficacy illustrating your answer by reference to opioids in clinical use 84% [See also [[Pharm-95B9] 1991 Write short notes on log dose effect curves PharmacokineticsPharm-07A3 Discuss factors contributing to inter-individual variability in the therapeutic response to opioid analgesic medications. 69% Pharm-07A2 After epidural injection in a health term pregnant woman, discuss the factors influencing the distribution of bupivacaine to (a) the maternal CSF and spinal cord; (b) the maternal circulation; (c) the foetus. 46% Pharm-06B3 Describe the factors which contribute to the inter-individual variability in drug response seen with intravenous anaesthetic induction agents. 42% Pharm-05B4 Define the term ‘context sensitive half time’. How does it differ from the half-life typically quoted for a drug? Illustrate this concept by comparing thiopentone vs. propofol and fentanyl vs. remifentanil. 73% Pharm-04A5 Outline the effects of liver failure on drug kinetics and dynamics. 52% Pharm-02B2 Briefly describe the factors affecting the uptake of orally administered medicines 67% Pharm-02A10 Outline the factors that determine recovery (offset of action) after ceasing a drug infusion. 43% Pharm-01B9 What do you understand by the term "clearance". Using propofol as an example, explain briefly the importance of clearance. 77% Pharm-01A11 Define the term 'context-sensitive half time'. How does this differ from the elimination half life? Illustrate your answer by comparing thiopentone vs. propofol, and fentanyl vs. remifentanil 64% Pharm-00A14 Discuss the roles of the plasma esterases on drugs used in anaesthesia 67% Pharm-99B16 Outline the factors that determine recovery (offset of action) after ceasing a drug infusion. 55% Pharm-98A13 Outline the factors that determine recovery (offset of action) after ceasing a drug infusion 37% Pharm-97A10 What do you understand by the term 'clearance'? Using propofol as an example, explain briefly the importance of clearance Pharm-96A13 Describe briefly the factors determining transdermal uptake of drugs and give some examples of drugs that can be administered by the transdermal route. Briefly outline the advantages and disadvantages of transdermal administration of drugs. 79% Pharm-95B2 Describe the clearance of drugs by the kidney Pharm-95B3 Give a brief account of drug protein binding and outline its significance Pharm-95B8 Outline the factors that determine recovery (offset of effect) after ceasing a drug infusion.

Explain the relevance of a drug’s elimination half time. 6% Pharm-95A3 Define Phase I and Phase II reactions in drug metabolism. Provide examples with drugs used in anaesthesia. 70% Pharm-95A2 Define a 'steady state' in pharmacology. List the advantages and disadvantages of a steady state and outline the characteristics of drugs which make them suitable for steady state pharmacology 65% Pharm-95A4 Briefly describe the factors affecting the uptake of orally administered medicines 76% 1994 Discuss the ways in which the consequences of liver disease may influence drug disposition. 1992 Write short notes on binding of drugs to plasma proteins 1992 Write short notes on measurement of whole body drug clearance 1992 Write short notes on zero order kinetics 1992 Write short notes on Hepatic extraction ratios 1991 Write short notes on the clearance of drugs 1991 Write short notes on estimation of apparent volume of distribution of a drug 1991 Write short notes on binding of drugs to plasma proteins 1990 Define bio-availability. Discuss the factors which determine the bio-availability of a drug. Other General PharmacologyPharm-06A2 What is an isomer? Briefly write an account of the types of isomers and their significance in drugs used in anaesthesia. Pharm-03A4 Outline the potential problems associated with additives used to make medicines suitable for intravenous injection. 43% Pharm-00B15 Write brief notes on latex allergy 44% Pharm-00B9 What is an isomer? Briefly write an account of the types of isomers and their significance in drugs used in anaesthesia 67% Pharm-99B15 Briefly describe the preparation of oxygen for medical use. List the physical properties of oxygen. Outline the potential adverse effects associated with its medical use. 50% Pharm-98B16 Write brief notes on latex allergy 30% Pharm-95A5 What is an isomer? Briefly write an account of the types of isomers and their significance in drugs used in anaesthesia 55% 1992 Write short notes on chemical additives to anaesthetic solutions Pharm-92A1 Discuss the factors which influence the administration and dosage of drugs in the elderly. Inhalational Anaesthetic AgentsPharm-08A1 An 80 year old woman is undergoing major emergency surgery. Describe the maintenance inhaled concentration of sevoflurane you would choose and the factors that might influence this. Pharm-07B1 Describe the adverse effects that may occur with the administration of desflurane.

Pharm-06B2 Compare and contrast the clinically significant respiratory, cardiovascular and central nervous system effects of desflurane and isoflurane. 70% Pharm-06A3 List the non-ideal features of nitrous oxide. Pharm-05B1 Describe how isoflurane is metabolised. In your answer give reasons why the overall extent of metabolism of isoflurane is so low. 44% Pharm-04A1 Describe the effects of isoflurane on intracranial metabolism, intracranial haemodynamics, intracranial pressure and the EEG. 71% Pharm-03B8 Outline the pharmacological differences between neonates and adults with reference to sevoflurane, vecuronium and morphine. 42% Pharm-03B2 Describe the potential interactions of sevoflurane, desflurane and isoflurane with carbon dioxide absorbents. 60% Pharm-03B1 Draw and label, on the same X - Y axis, FA/FI curves for the following halothane concentrations in oxygen, showing a 30 minute period from starting administration. a. Halothane 1%, subject breathing spontaneously. b. Halothane 6%, subject breathing spontaneously. c. Halothane 6%, subject paralysed and ventilated. With reference to the major factors determining the shape of FA/FI curves explain the differences between (a) and (b), and (a) and (c). 29% Pharm-03A1 Briefly outline the effects of isoflurane on skeletal, smooth and cardiac muscle tissues. Indicate how these effects are mediated and their clinical significance. 74% Pharm-02B4 Briefly outline the potential interactions between volatile agents and carbon dioxide absorbents 52% Pharm-02B3 Draw a graph comparing the ratio of inspired to alveolar concentrations during the first half hour of administration for nitrous oxide, isoflurane, and halothane. Outline reasons for observed differences between the agents and indicate the effects of increases in alveolar ventilation and cardiac output. 73% Pharm-01B10 Briefly describe the adverse effects of nitrous oxide. 76% Pharm-01A12 Briefly describe the respiratory effects of the volatile agents 58% Pharm-00A9 Compare and contrast the effects of halothane and isoflurane on the heart 65% Pharm-99A14 Briefly outline the pharmacological effects of the volatile anaesthetic agents on the kidneys. 64% Pharm-98A16 Outline the potential for methoxyflurane and sevoflurane to produce toxic effects on the kidney 75% Pharm-97B14 Compare and contrast the effects on the heart of halothane and isoflurane 46% Pharm-97A16 Discuss the possible effect of volatile inhalational agents on the liver

Pharm-96B11 Briefly outline the effects of volatile Inhalational agents on the muscle tissues, indicating postulated mechanisms and clinical significance. 43% Pharm-96A9 Describe briefly the central nervous system effects of isoflurane Pharm-96A12 Define MAC and outline the factors which influence it. Briefly explain MAC-hour, MAC-awake, MAC-bar and the applications of these terms 76% Pharm-95B10 Draw a graph comparing the ratio of inspired to alveolar concentrations during the first half hour of administration for nitrous oxide, isoflurane and halothane. Outline the reasons for the observed differences between the agents and indicate the effects of non-concurrent increases in alveolar ventilation and cardiac output. 52% Pharm-95A7 Explain briefly the potential advantages and disadvantages of SEVOFLURANE 82% Pharm-95B5 Briefly outline the effects of the volatile agents on muscle tissues. Include a description of how these effects are mediated and their clinical significance. 55% 1993 Briefly outline the chemistry of soda lime and the potential interactions with anaesthetic agents 1993 Describe the direct effects of isoflurane on the cardiovascular system 1993 Explain how nitrous oxide may contribute to adverse anaesthetic outcome Intravenous Anaesthetic Drugs & AntagonistsPharm-08A3 Describe the ideal pharmacokinetic and pharmacodynamic properties of agents used for sedation. Outline the pharmacology of midazolam and propofol with reference to these ideal properties. Pharm-07A7 Describe the pharmacology of midazolam including its mechanism of action. 66% Pharm-07A4 Discuss the suitability of ketamine as a total intravenous anaesthetic agent in comparison with propofol. 25% Pharm-05A3 What factors may explain the inter-individual variability in drug response seen with intravenous anaesthetic induction agents? Pharm04-B7 Outline the factors which influence the elimination half life of propofol. 29% Pharm-03B4 Describe how a computer-controlled infusion device targets and maintains constant blood concentrations of propofol. 33% Pharm-03A2 Outline the neuropharmacology of thiopentone, covering only its site of action, EEG changes, effects on cerebral blood flow and intracranial pressure. 80% Pharm-02A16 Briefly outline the pharmacology of flumazenil. 45% Pharm-02A11 Briefly outline the effects of thiopentone and ketamine not mediated via the central nervous system. 77% Pharm-01A13 Outline the NON-ideal features as an intravenous induction agent of the current formulations of propofol 55%

Pharm-00B14 Write short notes contrasting the cardiovascular effects of propofol and ketamine seen clinically 46% Pharm-99B14 Briefly outline the actions of intravenous induction agents not mediated via the central nervous system. 24% Pharm-99A13 Describe the neuropharmacology of thiopentone covering its site of action, EEG changes, effects on cerebral blood flow and intracranial pressure. 78% Pharm-98B9 Write short notes contrasting the cardiovascular effects of propofol and ketamine seen clinically. 63% Pharm-98A10 Outline the NON-ideal features as an intravenous induction agent of the current preparation of propofol. 67% Pharm-97B9 List the properties of an ideal intravenous anaesthetic. To what extent does methohexitone conform to this ideal. 76% Pharm-95A9 Briefly outline the effects of intravenous induction agents not mediated via the central nervous system, as well as their side effects. Include a brief account of the mechanisms by which these side effects are exerted 17% 1994 Describe the ideal intravenous anaesthetic agent. Describe in detail the extent to which propofol approaches this ideal. 1993 Briefly explain how knowledge of the pharmacokinetic properties of propofol would enable it to be used for the induction and maintenance of anaesthesia by continuous infusion. 1992 Write short notes on Methohexitone 1991 Write short notes on Methohexitone 1990 Write short notes on the pharmacokinetics of midazolam Opioid Agonists & AntagonistsPharm-07B3 Outline the important pharmacological considerations concerning choice of opioid and dosage when converting from intravenous morphine to oral opioid analgesia in the post operative period. Pharm-06A7 Briefly outline the pharmacology of naloxone. Pharm-05A2 Outline the acute adverse effects of opioid receptor agonists. Describe the mechanism of the acute adverse effects of opioid receptor agonists. Pharm-04A4 Outline the effects of an opioid injected into the spinal intrathecal space. 64% Pharm04-B4 Write short notes on tramadol. 50% Pharm-03A6 Explain how differences in the pharmacokinetics of alfentanil and fentanyl can influence the way they are administered intravenously. 51% Pharm-02B6 Write brief notes on tolerance and dependence in relation to opioid analgesics. N/A Pharm-01B12 Outline the effects of an opioid injected into the spinal intrathecal space 18% Pharm-00B12 Explain how differences in the pharmacokinetics of alfentanil and fentanyl can

influence the way they are administered intravenously 54% Pharm-00A15 Describe the effects of opioids on the respiratory system 75% Pharm-99A10 Write a brief outline on the pharmacology of remifentanil. 47% Pharm-98B11 Describe briefly the acute unwanted effects of the opioid agonist drugs 53% Pharm-97B15 Briefly outline the pharmacology of naloxone 57% Pharm-96B9 Briefly explain the factors which determine the duration of effect of intravenously administered bolus doses of fentanyl. 70% Pharm-96A11 Describe briefly the pharmacokinetics of pethidine. 60% 1993 Discuss the advantages and disadvantages of administering narcotics by intermittent injection or by infusion. 1992 Write short notes on the cardiovascular effects of narcotics 1991 Write short notes on narcotics administered via the epidural route Muscle Relaxants & AntagonistsPharm-08A7 Describe the terms train-of-four stimulation and double burst stimulation with respect to the peripheral nerve stimulator. Describe their advantages and disadvantages when used to evaluate non-depolarising neuromuscular blockade. Pharm-07B6 Describe how suxamethonium produces neuromuscular blockade. WHat is the mechanism of recovery of neuromuscular function and what mechanisms may be involved in Phase II block? Pharm-07A1 Describe the potential adverse effects of administering neostigmine post operatively. 68% Pharm-06B4 Describe the advantages and disadvantages of rocuronium for rapid sequence induction. 28% Pharm-06A6 Explain the possible mechanism for prolonged neuromuscular blockade after a four hour procedure using a non-depolarising muscle relaxant. Pharm-05A4 Outline the mechanism of action of drugs that inhibit cholinergic transmission at the neuromuscular junction giving examples. 59% Pharm-04A2 Outline the factors determining speed of onset of neuromuscular blocking agents. 71% Pharm-04B6 Compare and contrast neostigmine and the organophosphorus compounds. 52% Pharm-03A8 Describe the onset and offset of neuromuscular block at the diaphragm, larynx and adductor pollicis after administration of 2.5 x ED95 dose of vecuronium. Comment on the differences observed. What are the clinical implications of these differences? 50% Pharm-02B5 Outline the possible reasons for prolongation of paralysis induced by an intravenous dose of 1 mg.kg-1 of suxamethonium. Briefly indicate the consequences of such a prolonged block. 60% Pharm-01B13 Compare and contrast neostigmine and the organophosphorus compounds. 64%

Pharm-01A14 Give examples of drugs that enhance the action of the non-depolarising neuromuscular blocking agents at the neuromuscular junction. Briefly describe the mechanisms of these interactions. Pharm-00B16 Compare and contrast the pharmacology of atracurium and cis-atracurium 26% Pharm-99B10 Outline factors determining speed of onset of neuromuscular blocking agents 58% Pharm-99A12 Explain the phenomena known as fade and post tetanic facilitation associated with the use of neuromuscular blocking agents. 43% Pharm-98B13 Draw and explain the characteristics of a log dose-response curve that describes the major clinical effect of vecuronium. List factors encountered in clinical practice that may alter this curve 46% Pharm-98A15 Compare the metabolism of suxamethonium to that of atracurium. 83% Pharm-97A12 Briefly describe the pharmacological actions of the anti-cholinesterases with reference to edrophonium, neostigmine and the organophosphorus compounds. Indicate the similarities and differences with the 3 drugs Pharm-97B11 Give examples of drugs that enhance the action of the non-depolarising neuromuscular blocking agents at the neuromuscular junction. Briefly describe the mechanisms of their actions. 41% Pharm-96B16 Outline briefly the possible reasons for prolongation of paralysis induced by an intravenous dose of 1mg/kg of suxamethonium. Briefly indicate the consequences of such a prolonged block. 58% 1994 Explain the use of the peripheral nerve stimulator in monitoring muscle relaxants and their offset. 1993 What factors may alter plasma cholinesterase activity and how can this activity be measured 1993 Briefly discuss the side effects of atracurium 1992 Write short notes on atracurium 1990 Write short notes on post tetanic facilitation 1990 Write short notes on dibucaine number Local AnaestheticsPharm-08A6 A surgeon wishes to use topical anaesthetic in the nose before surgery in a 30 year old 70 kg man. He normally uses topical cocaine 5% plus lignocaine 2% with adrenaline 1: 100,000 injection. What volumes of cocaine 5 % and lignocaine can be used safely? What are the potential toxic effects of cocaine and how do lignocaine and adrenaline affect this? Pharm-07B5 Describe the factors which increase the risk of systemic toxicity with amide local anaesthetic agents. Pharm-06A5 Write short notes on factors affecting the speed of onset and durantion of effect of local anaesthetics when used to produce peripheral nerve block. Pharm-05B3 Write brief notes on the physico-chemical properties of lidocaine (lignocaine). 53% Pharm-04A3 Briefly describe the factors that determine skin penetration of local anaesthetics. Briefly

describe the formulation and pharmacology of EMLA cream. 60% Pharm-04B2 Write a brief description of the pharmacology of ropivacaine. 46% Pharm-03B7 Write short notes on factors affecting the speed of onset and duration of effect of local anaesthetics when used to produce peripheral nerve block. 46% Pharm-03A3 Explain how lignocaine prevents the conduction of a nerve action potential. 37% Pharm-02A9 Outline the toxicity of local anaesthetics 57% Pharm-01B11 Describe the required pharmacological characteristics of local anaesthetic formulations intended for topical use. 41% Pharm-00B13 Write short notes on factors affecting the speed of onset and duration of local anaesthetics when used to produce peripheral nerve block 54% Pharm-00A16 Briefly describe the factors that determine skin penetration by local anaesthetics. What is a eutectic mixture? Briefly describe the formulation and pharmacology of EMLA® cream? 73% Pharm-99B11 Outline the toxicity of local anaesthetics 36% Pharm-98B15 Describe the pharmacology of ropivacaine and explain why it may be considered a safer agent than bupivacaine. 42% Pharm-97A13 List the physico-chemical characteristics of bupivacaine. Explain how they influence its pharmaco-dynamic effects at the site of administration Pharm-97B10 Describe the ideal pharmacological characteristics of local anaesthetic agents and formulation intended for topical use, including their clinical applications. 22% Pharm-96B13 Outline briefly the pharmacokinetics and pharmacodynamics of lignocaine. 54% 1995 Outline factors that determine latency (speed of onset) of local anaesthetic drugs 1994 Compare and contrast ropivacaine and bupivacaine 1993 Outline the factors which would make a local anaesthetic agent suitable for use in obstetric practice 1993 Explain with the example of three local anaesthetic agents of your choice, how their physico-chemical properties influence their pharmacological effects 1992 Write short notes on the cardiovascular toxicity of bupivacaine 1991 Write short notes on transdermally administered local anaesthetic agents 1991 Write short notes on the cardiovascular toxicity of bupivacaine Autonomic & Cardiovascular Drugs

Autonomic Pharmacology

Pharm-07A8 List the classes of drugs used clinically to treat chronic left ventricular failure. Outline their mechanisms of action. 65% Pharm-06B1 Describe the use of different sympathomimetics to treat hypotension occurring as a result of subarachnoid block. Outline the advantages and disadvantages of these agents. 73% Pharm-05A7 Outline the main biochemical events involved in noradrenergic transmission. Outline how these may be altered by the use of MAO (monoamine oxidase) inhibitors. 67% Pharm-04A7 Describe the mechanism of action of inotropes and provide examples. 67% Pharm-04B8 List the classes of drugs used clinically to treat chronic left ventricular failure. Outline their mechanisms of action. 25% Pharm-00A11 Outline the main biochemical event involved in noradrenergic transmission, and how these may be altered by the use of MAO (mono amine oxidase) inhibitors 57% Pharm-99A11 Briefly compare and contrast the clinical pharmacology of atropine, hyoscine and glycopyrrolate. 42% Pharm-98A14 Discuss the use of different vasoconstrictors to treat hypotension occurring as a result of subarachnoid block 60% Pharm-97A11 Outline the main biochemical event involved in noradrenergic transmission, and how these may be altered by the use of MAO (mono amine oxidase) inhibitors 1994 Give a brief account of the actions of the alpha-adrenergic agonists and their potential applications in anaesthesia 1990 Write short notes on pyridostigmine Adrenoreceptor DrugsPharm-05B8 Describe the adverse effects of beta adrenoreceptor antagonists. 80% Pharm-05A8 Outline the pathology of acute anaphylactic reactions with reference to the mediators released and their effects. Outline the role of epinephrine and its mechanisms of action in treating anaphylaxis. 43% Pharm-03B6 List the potential clinical uses of an alpha-2 adrenoceptor agonist and outline the limitations of clonidine for each. 60% Pharm-02B7 Outline the potential pharmacological advantages and disadvantages of intra-operative beta-blockade. 76% Pharm-01B15 Outline the potential benefits and disadvantages of peri-operative beta-blockade 47% Pharm-01A15 Compare and contrast the pharmacology of esmolol and propranolol Pharm-99A16 Describe the effects of the alpha 2 adrenoceptor agonists relevant to anaesthesia 63% 1991 Write short notes on Atenolol Antihypertensives (incl Diuretics)

Pharm-08A2 List the classes of drugs that are useful in inducing diuresis clinically. Outline their mechanism of action. Pharm-08A8 Define the mechanisms of action and adverse effects of metoprolol, glyceryl trinitrate and diltiazem when used to manage myocardial ischaemia. Pharm-07B8 Write short notes on anti-hypertensive drugs that exert their action via blocking the effects of angiotensin. Pharm-04A6 Outline the circulatory effects of glyceryl trinitrate. 83% Pharm-03A7 Classify diuretics, briefly explaining their mode of action. 88% Pharm-00B10 Classify diuretics giving examples and briefly explaining their action 79% Pharm-99B12 Briefly describe the mechanism and treatment of the toxicity of sodium nitroprusside. 48% 1994 Write about the pharmacology of captopril 1994 Give a brief account of the pharmacological actions and toxicity of nitric oxide 1994 Write about the pharmacology of nifedipine 1993 Compare and contrast nitroprusside and nitroglycerin 1993 What is meant by the term “calcium channel”? What are the effects of calcium channel blocking agents? 1991 Discuss the mechanisms of action of drugs which may be employed to lower blood pressure during anaesthesia. Anti-arrhythmic DrugsPharm-02A13 What are the side-effects of amiodarone and what problems may develop during concurrent anaesthesia? 44% Pharm-96A15 Describe briefly the pharmacology of adenosine and its potential uses in anaesthesia. 65% 1993 What are the effects of calcium channel blocking agents 1990 Write short notes on calcium channel blocking agents

Miscellaneous Pharmacology Anti-emetic DrugsPharm-05B7 Briefly outline the pharmacology of droperidol, emphasizing its mechanism of action, perioperative use and side effects. 61% Pharm-05A1 Classify anti-emetic drugs. Give examples and describe side effects of each class. Pharm-98B10 Describe the sites of action of antiemetic agents used for postoperative nausea and vomiting 77% Pharm-97B16 Describe the location and function of dopamine receptors. Give some examples of agonist and antagonist drugs. 73% 1994 Write about the pharmacology of Droperidol 1991 What are the properties of the ideal antiemetic? How might such a drug be evaluated clinically?

Drugs affecting CoagulationPharm-07B2 Outline the important pharmacological considerations when stopping warfarin and commencing prophylactic (low dose) low molecular weight heparin (LMWH) in the peri-operative period. Pharm-05A5 List the antiplatelet agents and outline their mechanism of action, adverse effects, mode of elimination and duration of action. 68% Pharm-04A8 Describe briefly the side effects and complications of heparin therapy. 71% Pharm-02A15 Describe the mechanism of the anticoagulant effect of coumarin derivatives and what determines the onset and offset of action. 45% Pharm-99A15 List the drugs used clinically as anti-coagulants and anti-thrombotics. Write short notes on the mechanisms of their actions. 65% Pharm-95B4 Outline the chemistry of heparin. Describe the mechanism of action and list its toxic effects. 58% Pharm-95A8 Describe the mechanism of action of protamine when used to reverse effects of heparin. Outline the side-effects of protamine 43% Pharm-95A10 Outline the importance of vitamin K and the factors determining its uptake 68% 1993 Discuss the pharmacology of drugs used in the control of blood coagulation. 1990 Discuss the pharmacology of drugs used therapeutically to alter coagulation Obstetric PharmacologyPharm-02B1 Outline the influences of pregnancy on pharmacokinetics. 39% Pharm-00A12 Outline the pharmacology of oxytocin 77% Pharm-96B14 Outline briefly the pharmacology of oxytocin 54% Pharm-95B6 Outline the influence of pregnancy on pharmacokinetics 64% 1994 Give a brief account of the pharmacological actions and side effects of prostaglandins used in obstetrics 1992 Write short notes on placental transfer of drugs Gastrointestinal PharmacologyPharm-05A6 Briefly outline pharmacological methods of reducing gastric acidity. Indicate the mechanisms of action and the advantages and disadvantages of each method. 72% Pharm-02A14 Briefly outline pharmacological methods of reducing gastric acidity. Indicate the mechanisms of action and their advantages and disadvantages of each method 59% Pharm-98A12 Classify the drugs which are useful for reducing the volume and acidity of gastric contents, giving an outline of the mechanism of effect for each group. 46% Pharm-96B15 Briefly give an account of the pharmacological methods for reducing gastric acidity.

Indicate the mechanisms and their advantages and disadvantages. 51% NSAIDs / ParacetamolPharm-06B8 Describe the pathogenesis and management of paracetamol toxicity. 86% Pharm-06B5 Briefly explain the mechanisms responsible for non-steroidal anti-inflammatory drug (NSAID) – induced side effects. Outline the advantages and disadvantages of selective cyclooxygenase (COX 2) inhibitors. 62% Pharm-03B5 Describe the pharmacological effects of paracetamol. Outline its toxicity and management. 86% Pharm-02A12 Outline the mechanism of action of non-steroidal anti-inflammatory drugs and their potential adverse effects 72% Pharm-00A10 Briefly describe the pharmacological effects of paracetamol. Outline the mechanisms for its toxicity. 70% Pharm-97B12 Outline the mechanism of action of non-steroidal anti-inflammatory drugs and their potential adverse effects 65% 1995 Briefly describe the pharmacological effects of paracetamol. List its clinical indications and outline the mechanisms for its toxicity. 1993 Write about the pharmacology of ketorolac Unclassified DrugsPharm-07B7 Outline the mechanisms of action and potential adverse effects of the oral hypoglycaemic agents. 47% Pharm-07A6 Briefly outline the acute management of malignant hyperthermia (during a relaxant general anaesthetic). Describe the important aspects of dantrolene pharmacology relevant to treating malignant hyperthermia. 54% Pharm-07A5 Classify non-opioid drugs used for the treatment of neuropathic pain and indicate proposed mechanisms of analgesic action and potential adverse effects. 34% Pharm-06B7 Outline the drug and non-drug treatment of ventricular fibrillation in an adult. Briefly describe their mechanisms of action. (Do not discuss basic life support, airway therapies and oxygen) 44% Pharm-05B5 Outline the advanced life support of ventricular fibrillation in an adult including the mechanism of action and potential adverse effects of these therapies. (Do not discuss basic life support, airway therapies and oxygen). 11% Pharm-05B6 Discuss the therapeutic and unwanted effects of dexamethasone. 67% Pharm-04B3 List the effects of histamine. Write a brief outline on the pharmacology of the H1 blocking drugs. 26% Pharm-02B8 Outline the pharmacological effects of vasopressin 79% Pharm-01B14 Outline the direct effects of endogenously released histamine. 49%

Pharm-98A11 Briefly describe the pharmacological implications of the administration of a single dose of gentamicin during anaesthesia. 75% Pharm-98A9 List the effects of histamine. Write a brief outline on the pharmacology of the H1 blocking drugs. 62% Pharm-96A10 Describe briefly the mechanism of action of dantrolene. List it adverse effects and outline its uses in anaesthesia. 64% 1994 Compare the advantages and disadvantages of synthetic colloids and stable plasma protein solution in volume replacement. StatisticsPharm-07B4 A new clinical test called the "intubation score" has a reported 90% sensitivity and 70% specificity when used to predict difficult intubation. Describe how the accuracy, predictive value and clinical utility of this test can be evaluated. How will the incidence of difficult intubation affect the performance of this test? Pharm-06B6 A new clinical test called the "intubation score" has a reported 90% sensitivity and 70% specificity when used to predict difficult intubation. Describe how the accuracy, predictive value and clinical utility of this test can be evaluated. How will the incidence of difficult intubation affect the performance of this test? 34% Pharm-06A8 In a clinical trial, why is adequate power important? What factors affect the determination of an adequate sample size? Pharm-04B5 What are the strengths and weaknesses of the randomised controlled trial (RCT) study design? 49% Pharm-03A5 Outline the important statistical issues in designing a study to compare the duration of analgesia of two drugs given for post-operative pain relief. 38% Pharm-01B16 Briefly describe correlation and simple linear regression, and explain their differences. What assumptions are common to both? 82% Pharm-01A16 Describe the use of the null hypothesis and P-value in a drug trial 89% Pharm-00A13 Briefly describe correlation and simple linear regression, and explain their differences. What assumptions are common to both? 70% Pharm-99B9 What is meant by '95% confidence interval'? Explain the practical applications of confidence intervals and indicate why they may be preferred to P-values. 48% Pharm-99A9 In a clinical trial why is adequate power important? What factors affect the determination of an adequate sample size? 58% Pharm-98B12 Briefly describe the terms correlation and simple linear regression, and explain their differences. What assumptions are common to both? 34% Pharm-97A14 What is meant by '95% confidence interval'? Explain the practical applications of

confidence intervals and indicate why they may be preferred to P-values. 30% 1997 In a clinical trial why is adequate power important? What factors affect the determination of an adequate sample size? 35% Pharm-96B10 Describe briefly the use of the NULL HYPOTHESIS in a drug trial and how the P-value is relevant 62% Pharm-96A14 Explain briefly the differences between simple linear regression and correlation and indicate the assumptions common to both. Pharm-95B7 What is meant by '95% confidence interval'? Explain the practical applications of confidence intervals and indicate why they may be preferred to P-values. 33% Pharm-95A6 Describe the NULL HYPOTHESIS in a drug trial and how the P-value is relevant 53% 1994 Define Standard Deviation. Explain its application to the use of drugs in clinical anaesthetic practice. 1992 Write short notes on Student’s "t" test 1991 Write short notes on bias in drug trials and how its influence may be reduced. 1991 Write short notes on non parametric statistical tests. 1990 Write short notes on probability

ANZCA Pharmacology VivasFrom Anaesthesia_MCQPlease add what you remember of what you were asked in the Primary Pharmacology Vivas. Indicate what exam (eg Sept 2005) you sat. August 2007 ANZCA

• Ampoule of thio - what's in it, what are they for. Draw graph of %ionized vs pH for thio. Ampoule of 1% lignocaine - same questions, same graph. Then propofol - what additives, what for. But wait, there's more...Vec, Perfalgan, Dantrolene, he had a whole stash under the desk! Wanted to know what the additives were and what their role was. What is pKa - as in what is the Ka, what is the p.

• Factors affecting onset of volatiles. How do we tell if the volatile is working? MAC - definition. How does lack of movement to surgical stimulus help us to know if it's working? (blathered about MACawake). Dose-response curve for volatile vs benzodiazepine.

• Vecuronium compare and contrast with Rocuronium. ED95 definition, relation to intubating dose. Problems with less potent drugs. Neuromuscular monitoring - TOF, PTC, DBS.

• Tell me about Tramadol. Stopped when I mentioned SS/SNRI. What other drugs act on the serotonergic system? Can you give tramadol to someone on MAOI? Serotonin syndrome - what is it? What does tramadol do to seizure threshold? How do the 5HT3 antagonists work? Do you think Tramadol would increase nausea and vomiting? What about SSRI? Do you know any other drugs which are NAdr-reuptake inhibitors? Bell.

1. What is volatile "potency"? What is MAC? What factors change MAC?

2. What are the mechanisms of transfer of substances across the placental barrier? What is the effect of protein binding, specifically in reference to Warfarin.

3. What is tolerance? Draw dose-response curves, and the effect of tolerance. What are the mechanisms of tolerance?Give examples.

4. What are the kinetics of fentanyl? Compare Alfentanil and Fentanyl. I volunteered the graph of CSHT vs Duration.

August 2007 Day 3 Examiner 1

• What influences the uptake of inhalational agents? How do you assess the depth of anaesthesia - how do you know whether the person you are giving an anaesthetic to is not aware? Discussed MAC, MAC_BAR, MAC awake, what is the sensitivity and specificity of MAC? Ideally what would it be, would you rather MAC be more sensitive or more specific?

• Can you classify antiarrhythmics? Gave Vaughan-Williams and "others". Lets talk about others - discussion of adenosine (where are adenosine receptors, what is its half life, how does it work, SE), digoxin and then amiodarone (specifically what is amiodarones half life, how long does it take for a drug to reach steady state, how long does it take amiodarone to reach steady state, how does it fit into V-W classification?

Examiner 2

• Fentanyl vs alfentanil as above, which would you use as an infusion and why - kinetics of both and explain the effects clinically. Draw CSHT vs time for both and explain differeces.

• Lets talk about drugs that act on the uterus - talked about oxytocin/syntometrine/prostaglandins/misoprostol and tocolytics. Discuss oxytocin - MOA, SE, "say a surgeon asks you to give 15U oxytocin as a push, what are you likely to see", discuss the ergots, discuss GTN how does it work?

ANZCA Pharmacology Primary Viva - March/May 2006 Examiner 1

• How do you classify beta blockers? • Tell me about drugs that affect gastric pH?

Examiner 2

• You have a patient with myasthenia gravis who needs a rapid sequence induction, what are your pharmacological concerns?

• Intranasal cocaine is being administered to a patient undergoing sinus surgery, what are the toxic potentials and what patient factors may increase.

ANZCA Pharmacology Primary Viva - August/Sept 2006 Examiner 1

• What are the effects of a 15ml o.5% bupivacaine bolus in a pregnant woman?

• Ropivacaine vs bupivacaine: why different toxic effects? What other different effects?

• What treatment for hypertension intra-operatively?

• Metoprolol vs esmolol Examiner 2

• Difference between anaphylactic/anaphylactoid?

• What common drugs trigger anaphylactic/oid reactions in anaesthesia?

• Treatment of anaphylactic/oid reactons? Why adrenaline?

• Midazolam: use as a pre-med, and pharmacodynamics.

• Fentanyl: use as a premed, pharmacodynamics, and synergy with midzolam.

• Pharmacodynamics of propofol FRCA (UK) Pharmacology Primary Viva - May 2005

• A drug company is manufacturing a new IV anaesthetic agent, what features would you like?

• How would I improve propofol, what are the problems with its use? Which causes more hypotension on induction, propofol or thiopentone, and why?

• You swallow an aspirin. Describe its course. They stopped me when the aspirin got to the systemic circulation.

• Define volume of distribution. • Define bioavailability. • Name a drug that is well absorbed across the

gastric mucosa. • Name a drug that is not well absorbed across

the gastrointestinal wall. • Discuss metabolism in the liver. • Describe the Vaughan-Williams classification

– write down the classes and name a drug in each one and say what they were used for.

ANZCA Pharmacology Primary Viva - August/Sept 2005 Examiner 1

• Define Bioavailability. • Draw conc vs time curve for oral dose. • Define significant parts of curve. • Difference between o/iv conc time curve. • Define Hepatic extraction ratio. • What is HER for morphine. • How do you convert iv to oral morphine dose? • Describe CVS effects of IV induction agents

(STP vs propofol vs Ketamine). • Compare with CVS effects of volatile agents

(Sevo vs Des vs Halo).

• What is the cause of tachycardia associated with desflurane?

Examiner 2

• What are the advantages/disadvantages with Nitrous oxide?

• What are the possible side effects? • Specifics about methionine synthetase and

methionine deficiency. • What's in a bag of Hartmann's, 0.9%NaCl, 5%

Dextrose. • Osmolalities of same bags. • Which compartments do they go to and in

what proportions? • What hormones are involved in the elimination

of these fluids? ANZCA Pharmacology Primary Viva - April 2005

• Nitrous Oxide - Physicochemical characteristics, Side Effects, Production

• Statistics - Phases of a Trial, Power, Size of trial

• Lignocaine - Structure activity of LAs.Blood levels with toxicity, CC:CNS Ratio, CVS effects, Mechanism of cardiac dysryhtmia

• Paracetamol - Identify structure,Metabolism, Pharamacokinetics, toxicity

• Bioavailabilty with panadol as example, Adult/paediatrc dosing

ANZCA Pharmacology Primary Viva - September 2003

• Phenytoin - Pharmacokinetics, Mechanism of action, Therapeutic levels

• Benzodiazepines - Mechanism of action • Diuretics - Draw a nephron, Classes / site of

action, Mode of action, Frusemide as example • Propofol - Target levels with TCI, Effect site

concentration/time curves • MAC Awake • Statistics - Study size, Alpha/beta error, p

value definitions, etc.