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Pharmacology 5

Local anesthetics
Question # 1 (Multiple Answer) Advantage(s) of 5% lidocaine (Xylocaine)-prilocaine (Citanest) cream (eutectic mixture)

A) no local irritation
B) even absorption
C) no systemic toxicity
D) higher melting point of combined drug than either lidocaine (Xylocaine) or prilocaine (Citanest) alone

Question # 2 (Multiple Choice) Local anesthetic used in greater than 50% of rhinolaryngologic cases:

A) prilocaine (Citanest)
B) cocaine
C) mepivacaine (Carbocaine)
D) bupivacaine (Marcaine)
E) tetracaine (pontocaine)

Question # 3 (Multiple Choice) Mechanism(s) of local anesthetic action in epidural anesthesia:

A) direct local anesthetic action on nerve roots and spinal cord following local anesthetic diffusion across the dura
B) diffusion of local anesthetic into paravertebral regions through the intervertebral foramina
C) both
D) neither

Question # 4 (Multiple Answer) Rationale for adding epinephrine to a local anesthetic solution:

A) reduced local anesthetic systemic absorption
B) increased anesthetic concentration near nerve fibers
C) reduced duration of conduction blockade
D) all of the above

Question # 5 (Multiple Choice) Zone of differential motor blockade may average up to four segments below the sensory level

A) epidural
B) spinal

Question # 6 (Multiple Choice) Duration of sensory anesthesia is likely to be extended for abdominal regional anesthesia

A) true
B) false

Question # 7 (Multiple Choice) Primary side effect/toxicities associated with local anesthetic use:

A) allergic reactions
B) systemic toxicity
C) both
D) neither

Question # 8 (Multiple Answer) Factors enhancing bupivacaine (Marcaine) toxicity

A) pregnancy
B) presence of calcium channel blockers
C) arterial hypoxemia
D) acidosis
E) hypercarbia

Question # 9 (Multiple Answer) Agents added to local anesthetics that prolonged local anesthetic duration of action

A) epinephrine
B) phenylephrine (Neo-Synephrine)
C) dextran

Question # 10 (Multiple Choice) typically a zone of differential sympathetic nervous system blockade

A) epidural
B) spinal

Question # 11 (Multiple Answer) Preferred local anesthetics for local infiltration:

A) lidocaine (Xylocaine)
B) ropivacaine (Naropin)
C) bupivacaine (Marcaine)

Question # 12 (Multiple Choice) Neurotoxicity associate with local anesthesia: sensory anesthesia, bowell & bladder sphincter dysfunction, paraplegia -- may because by nonhomogeneous local anesthetic distribution

A) anterior spinal artery syndrome
B) cauda equina syndrome
C) transient radicular irritation

Question # 13 (Multiple Choice) Neurotoxicity -- moderate/severe lower back, buttocks, posterior side pain

A) cauda equina syndrome
B) transient radicular irritation
C) anterior spinal artery syndrome

Question # 14 (Multiple Answer) Factors that influence lidocaine (Xylocaine) metabolism:

A) pregnancy-induced hypertension
B) hepatic disease
C) reduced liver blood flow
D) volatile anesthetics

Question # 15 (Multiple Choice) Most common cause of toxic plasma local anesthetic concentrations

A) incorrect dosage
B) accidental direct intravascular injection during peripheral or block or epidural anesthesia

Question # 16 (Multiple Choice) Common eutectic mixture of local anesthetics (EMLA)

A) tetracaine (pontocaine) and epinephrine
B) lidocaine (Xylocaine) and tetracaine (pontocaine)
C) prilocaine (Citanest) and bupivacaine (Marcaine)
D) tetracaine (pontocaine) and bupivacaine (Marcaine)
E) lidocaine (Xylocaine) and prilocaine (Citanest)

Question # 17 (Multiple Choice) Most frequent local anesthetic clinical use:

A) treatment of grand mal seizure
B) analgesia
C) management of cardiac arrhythmias
D) regional anesthetia
E) management of increased intracranial pressure

Question # 18 (Multiple Choice) Lidocaine (Xylocaine) effect on ventilation response to hypoxia

A) enhanced response
B) depressed response
C) no effect

Question # 19 (Multiple Answer) Clinical use(s) of EMLA applications:

A) arterial cannulation
B) venipuncture
C) myringotomy
D) lumbar puncture

Question # 20 (Multiple Answer) Allergic reactions to local anesthetics:

A) common > 10% of adverse reactions due to allergic mechanisms
B) high-risk with ester-type agents which are metabolized to p-aminobenzoic acid-related compounds
C) cross-sensitivity between esters and amide-type local anesthetics are common
D) intradermal testing for possible allergy to local anesthetics should use preservative-free drug

Question # 21 (Multiple Answer) Factors which increase local anesthetic CNS toxicities:

A) hypokalemia
B) rate of injection
C) patient receiving mexiletine (Mexitil) when lidocaine (Xylocaine) is used
D) high PaCO2 (reduced local anesthetic seizure threshold)

Question # 22 (Multiple Choice) Least likely to exhibit cross-sensitivity with amide or ester local anesthetics.

A) lidocaine (Xylocaine)
B) tetracaine (pontocaine)
C) mepivacaine (Carbocaine)
D) bupivacaine (Marcaine)
E) dyclonine (Dyclone)

Question # 23 (Multiple Answer) Factor(s) that reduce lidocaine (Xylocaine) seizure threshold.

A) hypoxemia
B) hyperkalemia
C) acidosis

Question # 24 (Multiple Choice) Local anesthetic which produces localized vasoconstriction and anesthesia

A) tetracaine (pontocaine)
B) lidocaine (Xylocaine)
C) cocaine
D) prilocaine (Citanest)
E) chloroprocaine (Nesacaine)

Question # 25 (Multiple Choice) Agents not recommended for Bier block:

A) chloroprocaine (Nesacaine)
B) mepivacaine (Carbocaine)
C) bupivacaine (Marcaine)
D) all the above

Question # 26 (Multiple Answer) Manifestation of systemic toxicity

A) CNS toxicity
B) cardiovascular toxicity
C) neurological symptoms

Question # 27 (Multiple Choice) Most commonly used local anesthetic for rhinolaryngologic cases

A) ropivacaine (Naropin)
B) bupivacaine (Marcaine)
C) mepivacaine (Carbocaine)
D) cocaine
E) tetracaine (pontocaine)

Question # 28 (Multiple Answer) Commonly use local anesthetics for topical/surface application:

A) chloroprocaine (Nesacaine)
B) lidocaine (Xylocaine)
C) tetracaine (pontocaine)
D) cocaine
E) procaine (Novocain)

Question # 29 (Multiple Answer) Clinical presentations suggestive of local anesthetic allergies:

A) rash
B) laryngeal edema
C) bronchospasm
D) urticaria
E) possibly hypotension

Question # 30 (Multiple Choice) Local anesthetic most likely to cause cyanosis secondary to reduced oxygen transport:

A) lidocaine (Xylocaine)
B) bupivacaine (Marcaine)
C) dibucaine (Nupercainal, generic)
D) prilocaine (Citanest)
E) procaine (Novocain)

Question # 31 (Multiple Choice) This amide-type local anesthetic is used to assess the possible presence of atypical cholinesterase

A) ropivacaine (Naropin)
B) bupivacaine (Marcaine)
C) dibucaine (Nupercainal, generic)
D) procaine (Novocain)
E) chloroprocaine (Nesacaine)

Question # 32 (Multiple Choice) Toxicities associated with systemic epinephrine absorption following local anesthetic use with epinephrine included in the local anesthetic solution

A) hypertension
B) arrhythmias
C) both
D) neither

Question # 33 (Multiple Choice) ropivacaine (Naropin):less cardiotoxic then bupivacaine (Marcaine)

A) true
B) false

Question # 34 (Multiple Answer) Factor(s) which determine extent of systemic local anesthetic absorption:

A) initial dose
B) injection site vascularity
C) intrinsic drug properties
D) whether or not epinephrine was used to provide local vasoconstriction

Question # 35 (Multiple Answer) Lidocaine (Xylocaine) cardiotoxicity -- electrophysiological characteristics

A) ECG -PR interval prolongation
B) increased conduction velocity
C) reduced phase 4 depolarization
D) reduced automaticity

Question # 36 (Multiple Choice) Local anesthetic lipophilicity and effectiveness of epinephrine on local anesthesia:

A) more lipophilic anesthetics benefit most by epinephrine in addition to local anesthetic solutions
B) more lipophilic anesthetics benef ileast by epinephrine in addition to local anesthetic solutions

Question # 37 (Multiple Choice) Neurotoxicity following local anesthesia: lower extremity paresis-- predisposing conditions may include advanced age and peripheral vascular disease

A) transient radicular irritation
B) cauda equina syndrome
C) anterior spinal artery syndrome

Question # 38 (Multiple Choice) Local anesthetic not recommended for peripheral nerve blockade:

A) lidocaine (Xylocaine)
B) bupivacaine (Marcaine)
C) ropivacaine (Naropin)
D) tetracaine (pontocaine)

Question # 39 (Multiple Answer) Frequently used amide-type local anesthetic for Bier block

A) chloroprocaine (Nesacaine)
B) prilocaine (Citanest)
C) bupivacaine (Marcaine)
D) ropivacaine (Naropin)
Question # 1 (Multiple Choice) Duration of action -- subarachnoid injection of ester-type local anesthetics

Answer: (B) extremely long

CSF-no cholinesterase activity BACK

Question # 2 (Multiple Choice) Consequences of vasodilatory local anesthetic property:

Answer: (B) shorter duration of action

Question # 3 (Multiple Choice) Highest local anesthetic blood levels associated with this type of regional anesthesia:

Answer: (D) intercostal

Question # 4 (Multiple Choice) Consequences of fetal acidosis (sometimes associated with prolonged labor) on local anesthetic accumulation in the fetus

Answer: (B) enhanced ion trapping

Question # 5 (Multiple Choice) Plasma concentration of local anesthetics determined by:

Answer: (C) both

Question # 6 (Multiple Choice) Ester-type local anesthetic-most rapid hydrolysis

Answer: (C) chloroprocaine (Nesacaine)

Question # 7 (Multiple Choice) Enhancement of spinal anesthesia by the presence of epinephrine in local anesthetics: Reason(s) --

Answer: (D) none of the above

Question # 8 (Multiple Choice) Ester type local anesthetics are more likely available for significant placental transfer

Answer: (B) false

Question # 9 (Multiple Answer) Propranolol (Inderal) -- local anesthetic effect(s):

(A) inhibits bupivacaine (Marcaine) extraction

(C) decreases bupivacaine (Marcaine) plasma clearance

Question # 10 (Multiple Choice) Duration of action

Answer: (B) Amide-type local anesthetics -- longer duration of action compared to esters

Question # 11 (Multiple Answer) Factor(s) that may reduce plasma cholinesterase activity:

(A) hepatic disease

(B) elevated BUN

(C) parturient patient

Question # 12 (Multiple Choice) Systemic toxicity: ester-type local anesthetics

Answer: (A) inversely proportional to hydrolytic rate

Question # 13 (Multiple Answer) Chemical properties -- local anesthetics

(A) weak bases

(B) may exist as a cation

(C) may exist in uncharged form

(D) most local anesthetics have pKa's ranging from 6.0-7.0

Question # 14 (Multiple Answer) Local anesthetics: chemical properties

(A) many local anesthetics are chiral

(B) S enantiomers are often less toxic than racemates

Question # 15 (Multiple Choice) Higher vascularity -- promotes increased, rapid local anesthetic absorption

Answer: (B) tracheal mucosal

Question # 16 (Multiple Choice) Consequence of clonidine (Catapres) addition to local anesthetic solutions --

Answer: (A) increase local anesthetic effect

Question # 17 (Multiple Choice) Clearance mechanisms for local anesthetics:

Answer: (B) esters-rapid clearance; hydrolysis


Question # 18 (Multiple Choice) Local infection (acidotic conditions) --effect on anesthetic effectiveness

Answer: (B) reduced effectiveness

Question # 19 (Multiple Answer) Factors that influence local anesthetic absorption and distribution:

(A) dosage

(B) presence of epinephrine in the local anesthetic solution

(C) injection site

(D) chemical properties of the drug

Question # 20 (Multiple Answer) Factors influencing local anesthetic distribution and plasma concentrations:

(A) liver function

(B) cardiovascular status

(C) extent of protein binding

(D) patient age

Question # 21 (Multiple Choice) Ester-type local anesthetic:

Answer: (B) tetracaine (pontocaine)

Question # 22 (Multiple Choice) Pulmonary extraction from the venous circulation limits the amount of local anesthetic that will reach the systemic circulation

Answer: (A) true

Question # 23 (Multiple Answer) Amide-type local anesthetic

(D) lidocaine (Xylocaine)
(E) bupivacaine (Marcaine)

© 2019 by Partha Sarathi(Director)