AMERICAN INTERNATIONAL UNIVERSITY OF WEST AFRICA

NURSE ANAESTHESIA PROGRAM

PRINCIPLES & PRACTICES OF ANAESTHESIA III

END OF SEMESTER EXAMS NS 6

EACH STATEMENT MUST BE ANSWERED EITHER BY WRITING ‘T’ FOR ‘TRUE’ OR ‘F’ FOR
‘FALSE’ BESIDES IT.

Morbid Obesity and Gastric Bypass

1) In the United States:

a) 61% of adults have BMI >25 in 1999 T
b) 18% of children are aged 6-11 F
c) 14% of adolescents aged 12-19 T
d) There are 500,000 deaths caused by morbid obesity per year F
2) Deaths and Cost
a) BMI >30 have a 50%-100% increased risk of premature death. T
b) 117 BILLION dollars were spent in 2000 T
c) Less non-Hispanic white women(20%) are obese compared to non-Hispanic
white men(23%) F
d) Most affected-women are of low socioeconomic. T
3) Heart Disease
a) Hypertension twice as common in obese people T
b) There is an increased risk of MI, CHF, Sudden Death, Arrythmias. T
c) In Diabetes, A gain of 11-18 lbs increases the risk of developing Type 2 to
twice that of normal individuals T
d) Less than 80% of people with DM type 2 are overweight or obese F
4) The following Respiratory conditions could be caused by obesity:
a) Sleep Apnea T
b) Obesity Hypoventilation Syndrome T
c) Increased risk of aspiration from GERD (Gastro-intestinal Reflux Disease) F
d) Increased FRC F
5) Other conditions aggravated by obesity include:
a) Arthritis T
b) Reproductive complications T
c) Gallbladder disease. T
d) Depression, Social Discrimination T
6) Indications for surgery for obese patients include:
a) Age 18-60 T
b) BMI < 40 F
c) BMI < 35 with medical problems F
d) Exhausted other venues of weight loss T
8) How do the surgeries work? By:
a) Starvation F
b) Restrictive T
c) Malabsorption T
d) Behavioral modification T
9) Complications of By pass sugeries include:
a) Iinfection, DVT, wound deshicense, anastomotic leaks, etc. T
b) Death 5% after surgery, but higher with other co-morbities. F
c) Irritable bowel syndrome can lead to rectal problems T
d) Hypotension F
10) Pre op assessment
a) Assessment of Mallampati, mouth opening, tongue size are vital T
b) But Thyromental distance, sternomental distance, neck circumference do not
actually matter F
c) Predictibility of difficult intubation is mainly by obesity (size) or BMI. F
d) Difficult laryngoscopy may be predicted by mallampati score of 2 F
11) Physiological changes that take place in an obese pt with OSA (Obstructive Sleep
Apnoea) incluse:
a) Arterial hypoxemia and Polycythemia T
b) Arterial Hyporcarbia F
c) Hypertension T
d) Pulmonary hypotension F
a) The Risk Factors:
12) The risk factors of obese pts with OSA (Obstructive Sleep Apnoea) include:
b) Male and Middle Age T
c) Obesity T
d) Alcohol T
e) Drug Induced Sleep T
13) Obesity Hypoventilation Syndrome is defined as:
a) PaO2 < 70 T
b) PaCO2 < 45 F
c) BMI > 30 kg/m2 T
d) No other respiratory disease of explaining the gas anomaly T
14) Post Op/Extubation of the by pass pt:
a) Only extubate when pt is still sleeping F
b) Recover in head up positioning T
c) Monitoring very important if OSA or OHS T
d) Post operatively, maximun decrease in PaO2 is after 4-5 days F
15) Post op complications include:
a) DVT T
b) Wound infection is rare F
c) Guillain-Barre T
d) Hypertension F
16) Diabetes Mellitus and Anaesthesia
Epidemiology
a) Estimated 345 million people globally F
b) 20% of adult population T
c) 5% of all deaths each year T
d) 50% of people with diabetes live in low and middle income countries F
17) Diabetes is referred to as:
a) Fasting Plasma Glucose < 7.0mmol/l(126mg/dl) F
b) 2 hour plasma glucose ≥ 11.1 mmol/l (200mg/dl) T
c) Impaired Fasting Glucose value is 6.1 – 6.9 mmol/l (110 – 125 mg/dl) T
d) Blood sodium value of 38 mEq/dl F
18) Impaired Glucose tolerance is:
a) Fasting Plasma Glucose 7mmol/l (126mg/dl) T
b) 2 hour glucose 7.8 – 11.1 (140 - 200mg/dl) T
c) Blood potassium – 7 mEq/dl F
d) Blood calcium of 22mEq/dl F
19) Type 1 Diabetes
a) Absolute Insulin Deficiency T
b) Autoimmune destruction of pancreatic β cells T
c) Combination of viral infection superimposed on genetic predisposition T
d) Type 1A – autoimmune markers found T
20) Type 1 Diabetes
a) Type 1B – no autoimmune markers T
b) Signs of diabetes develop when 50% of β cells are destroyed F
c) Rate of decline less when Type 1 diabetes develops later in life. T
d) Caucasians are more vulnerable F
21) Type 2 Diabetes
a) Also a combination of genetic susceptibility and environmental factors T
b) A combination of insulin resistance and relative insulin deficiency, as well as
increased hepatic glucose production T
c) Obesity is associated with insulin tolerance F
d) This type of diabetes begins from early life F
22) Gestational DM
a) Any degree of glucose intolerance with onset during pregnancy T
b) Any degree of glucose intolerance with onset just after pregnancy F
c) Increased risk of pre-eclampsia T
d) Not associated with the development of type 2 diabetes later in life F
23) Physiology of diabetes
a) Inhibitory effects of insulin may be as important as stimulatory effects T
b) Vascular endothelium insulin dependent T
c) But exogenous insulin is harmless F
d) Insulin sensitisers do not improve vascular outcome F
24) Therapy
a) Diet and Exercise T
b) Sulphonylureas T
c) Metformin T
d) Alpha agonists F
25) Complications of diabetes
a) Cardiovascular and Renal T
b) Neuropathy – Peripheral and Autonomic T
c) Musculoskeletal T
d) OculaT
26) To avoid Anaesthetic implications:
a) Avoid hypoglycaemia T
b) Avoid hyperglycaemia T
c) Minimise electrolyte dysfunction T
d) Prevention of lipolysis and proteolysis T
27) Geriatric Anaesthesia
a) Elderly is >60 Years F
b) Fastest growing segment of the population are those 65 years of age or older. F
c) Individuals 65 yrs or older undergo almost 1/3 rd of the 25 million surgical
procedures performed annually. T
d) These individuals consume about ½ of the health expenditure. T
28) Elderly is described a
a) Living longer T
b) Predominantly male F
c) Experiencing change in personal relationship T
d) Being senile F
29) Changes that take place in the Elderly:
a) Increased elasticity F
b) Increase in friability T
c) Pressure ulcer formation because of dehydration, poor nutrition, circulatory
impairment. T
d) Good thermoregulation T
30) Changes that take place in the Elderly:
a) Neither shiver nor vasoconstriction due to cold until temp has fallen, on average
to 35.2 degrees C. T
b) Barrier defenses found in skin increase in number. F
c) Veins and arteries constrict and stretch with decreased strength and elasticity F
d) Peripheral arteries become tortuous and more resilient F
31) Changes that take place in the Elderly:
a) Aorta and large arteries stiffen T
b) Aorta may lengthen and become tortuous T
c) Increase in the responsiveness of β- receptors F
d) Progressive replacement of functional cardiac and vascular tissue by stiff, fibrotic
material T
32) Cardiovascular system and Autonomic Nervous System changes
a) Loss of contractile strength and efficiency, decreased organ perfusion. T
b) Heart valves become fibrotic and sclerotic resulting in thickening and reduced
flexibility. T
c) Decreased cardiac output T
d) 6. Enhanced baroreceptor reflex F
33) Cardiovascular system and Autonomic Nervous System changes
a) Decreased coronary artery blood flow T
b) Decrease in systolic pressure. F
c) Conduction system- Pacemaker cells decreases from 50% in late childhood to less
than 30% at 75 yrs F
d) These factors cause the elderly more capable of defending their CO and BP
against the usual periop challenges. F
34) Respiratory System of the elderly causes:
a) a decline in elasticity of the bony thorax T
b) Decreased residual volume F
c) Decreased vital capacity T
d) Decreased dead space F
35) Respiratory System of the elderly causes:
a) a loss of muscle mass with weakening of the muscles of respiration T
b) FEV1 increases progressively with aging F
c) The ratio of FEV to TLC of the elderly decreases. T
d) The diaphragmatic function declines with age T
36) Respiratory System of the elderly causes:
a) A decrease in alveolar gas exchange surface T
b) A decrease in central nervous system responsiveness T
c) Ventilatory response to hypercapnia and hypoxia is increased in the elderly. F
d) Thus we need to increase FIO2 and tidal volume T
37) Respiratory System of the elderly causes:
a) Intra pleural pressure decreases with age F
b) Progressive loss of vital capacity with age T
c) Progressive increase in residual volume up to 20% per decade F
d) Total lung capacity remains constant T
38) Respiratory System of the elderly causes:
a) Progressive increase in FRC T
b) Closing capacity decreases F
c) Resting PaO2 declines with age at a rate as shown - PaO2=100-(0.4×age)mmHg T
d) Gas exchange efficiency declines with age T
39) Upper Airway Protective Reflexes in elderly:
a) Cough effectivity is reduced in elderly T
b) The mechanism of cough reflex impairment include desensitization of airway
epithelial cough receptors T
c) Laryngeal, pharyngeal and airway reflexes are more effective in older people F
d) Hence less associated with increased aspiration pneumonia F
40) Renal System in the elderly
a) Decreased renal mass, mainly in the cortex T
Decreased renal blood flow
b) Due to pre-renal dysfunction F
c) RPF and GFR↓about 1ml /min/yr or 1-1.5% /yr T
d) Decreased tubular function. Eg.impaired fluid handling T
41) Liver in the elderly
a) Reduced hepatic drug clearance is not common in the elderly F
b) Decrease in liver mass, hepatic blood flow by the age of 80 yrs T
Endocrine System
c) Pancreatic function declines T
d) However, there fast liberation of insulin in response to hyperglycemia F
42)
Endocrine System
a) Increased incidence of diabetes mellitus T
b) Good tolerance to glucose load F
c) Alteration in renin-aldosterone system- increased risk of hyperkalemia T
d) Sub-clinical hypothyroidism-increased TSH T
43) Nervous System in the elderly
a) a slight increase of neuronal substance F
b) a decrease in the number of peripheral neurons T
c) muscles innervated by fewer axons, leading to possible denervation atrophy T
d) conduction velocity is slightly affected by aging (slower) T
44) Nervous System in the elderly
e) reduction in number of fibers in spinal cord tracts T
f) increased insensitivity to opioid analgesics F
g) decreased cell density, lower cerebral oxygen consumption and lower cerebral
blood flow T
h) CNS is target organ for only a few anaesthetic agents. F
45) Musculoskeletal in the elderly
a) Osteoarthritis, osteomalacia, rheumatoid arthritis, gout are uncommon F
b) Degenerative joint disease is common T
c) Loss of disc T
d) Injury due to surgical positioning is rare F
46) Age related pharmacologic changes
Protein binding:
a) Circulating level of serum protein (especially albumin) increases in quantity F
b) Qualitative change of serum protein reduce the binding effectiveness of the
available protein. T
c) This will lead to higher free drug levels and an enhanced delivery of the drug to
the brain. T
Changes in body compartment
d) Age-related changes in body composition include a loss of skeletal muscle and an
increase in percentage of body fat. T
47) Local and Regional Anaesthesia Techniques in the elderly
a) Anatomic changes suggest increased requirement for local anaesthetic drugs F
b) Epidural anaesthesia likely to spread downward F
c) Onset of analgesia is slow F
d) Reduction in blood loss T
48) Local and Regional Anaesthesia Techniques in the elderly cause
a) Amelioration of endocrine stress response to surgery T
b) Increased post op thromboembolic complications F
c) Reduced post op mental confusion T
d) Increased peripheral vasoconstriction F
49) Technical Problems with Regional Anaesthesia in elderly
a) Well defined landmarks F
b) Difficulty of obtaining adequate patient positioning T
c) Paramedian approach is not helpful F
d) Cardiovascular changes are usually limited to fall in arterial BP T
50) Premedication advised to Geriatric patients
a) Elderly patients require higher doses of premedication F
b) Opioid premedication may be valuable T
c) Anticholinergic medication often needed F
d) Pretreatment with H2 antagonist, metoclopramide may be used T
51) Induction Agents for the elderly
a) Administration of IV barbiturates produces the peripheral vasoconstriction with a
moderate BP increase in the elderly. F
b) With a decreased baroreceptor reflex and increased vascular wall
rigidity,barbiturates may cause a dangerous drop in BP. T
c) In the elderly, elimination half-life is 10-15 hrs. F
d) The thiopental dose requirement may decrease 25-75 percent. T
52) Propofol induction for the elderly
a) Propofol produces greater increase in systemic BP than thiopental . F
b) Injecting the propofol slowly with sufficient time can minimize the effect of
cardiovascular depression. T
c) Studies show patients older than 80 exhibit more post-anesthetic mental
impairment with propofol than other agents. F
d) Induction of prpofol using 1.2-1.7 mg/kg in the elderly (versus 2.0-2.5 mg/kg in
younger patients) is recommended. T
53) Muscle Relaxants for the elderly
Aging affects the neuromuscular junction in many ways:
a) The distance of the junction ↑ T
b) The number of ACh vesicle ↓ T
c) Receptors of ACh increase F
d) Sensitivity of ACh receptors increase F
54) Muscle Relaxants for the elderly
a) The response of succinylcholine is grossly altered with aging. F
b) The use of the intermediate-acting agent is prudent T
c) The duration of a single dose of long-acting agent may be too prolonged for the
planned surgery. T
d) A higher dose of non-depolarizing muscle relaxant will be required. F
55) Opioids
a) Increases in potency for alfentanil, fentanyl, and remifentanil were
demonstrated in EEG studies. T
b) A reduction in dosage in the elderly would be recommended. T
Fentanyl
c) Dose should be reduced to 1/3 to achieve the same effect. F
Alfentanil
d) Same recommendation as fentanyl. F
56) Volatile agents
a) Ventilation perfusion mismatch will increase the rate of action. F
b) Decreased cardiac output will make the onset of the action more rapid. T
c) Recovery from anesthesia with a volatile agent may be prolonged because of an
increased volume of distribution (increased body fat). T
d) The MAC of inhalational agents is reduced by 10% per decade of age over 40
years. F
57) Concept of Endotracheal intubation in the elderly
a) Placement of ET tube is easier in elderly. F
b) Facial shape is altered,TM joint dysfunction, loose teeth with cervical arthritis
makes exposure of larynx more difficult. T
c) Care should be taken during laryngoscopic examination to avoid over extension
of neck. T
d) When Rapid Sequence Induction is performed cricoid pressure should be applied
directly over cricoid cartilage T
58) Aspiration During Intubation in the elderly
a) It is not difficult to intubate patients without teeth. F
b) Cervical spine deterioration may not allow for full neck extension T
c) Protective gag reflex is strengthened F
d) Pyloris allows for regurgitation T
59) Intraoperative Hypothermia
a) Shivering T
b) Increased peripheral vascular flow F
There is also
c) Decreased ability to fight infection T
d) Decreased clearance of drugs– anaesthetic effects pronounced and prolonged T
60) DVT and Pulmonary Emboli during anaesthesia could be due to:
a) Prolonged anaesthesia time T
b) Creation and release of microemboli into vasculature T
c) Increased peripheral venous return causing pooling F
d) Neoplasms present in older adults increases risk T
61) Congestive Heart Failure in the elderly may lead to:
a) Fluid overload and Poor contractility T
b) Left ventricle stiffness T
c) Increased cardiac output F
d) Hypertension requiring fluid boluses F
62) Post-op Delirium in the elderly
a) Could be a transient mental dysfunction T
b) May not affect morbidity F
c) Delay functional recovery T
d) Usually seen in PO day 4. F
63) Complications of General Anaesthesia
Signs of Respiratory obstruction
a) Inadequate tidal volume. T
b) Extension ofthe chest wall and of the supraclavicular, infraclavicular and
suprasternal spaces. F
c) Decreased abdominal movement. F
d) Cyanosis T
64) Causes of hypercania
a) Hyperventilation F
b) Increased dead space T
c) Increased CO2 production by tissues T
d) Decreased FiCO2 F
65) Causes of Hypoxemia:
a) Increased FiO2 F
b) Hypoventilation T
c) V/Q mismatch T
d) Decreased O2 utilization by tissues T
66) Hemodynamic Complications
Causes of Hypotension
a) Hypoxemia T
b) Hypovolemia T
c) Increased myocardial contractility (myocardial ischemia, pulmonary edema) F
d) Increased systemic vascular resistance F

67) Causes of Hypotension

 a) Cardiac dysrhythmias T
b) pulmonary embolus T
c) Haemothorax F
d) cardiac tamponade T
68) Postoperative Nausea and Vomiting
Patient Risk factors
a) Long fasting status F
b) Anxiety T
c) young age T
d) Male F
69) Patient Risk factors of PONV
a) Obesity T
b) Gastroparesis T
c) Pain T
d) history of postoperative nausea/vomiting or motion sickness. T
70) Anesthesia-related factors of PONV
a) premedicants (eg atropine) F
b) anesthetics agents (nitrous oxide, inhalational agents, etomidate, methohexital,
ketamine), T
c) anticholinesterase reversal agents, T
d) gastric distention, T
71) Temperature changes
Causes of Hypothermia
a) Drop in ambient temperature. F
b) Central inhibition of thermoregulation. T
Contributing Factors
c) Extremes of age, T
d) cold infusion or irrigation fluids, T
72) Other causative factors of hypothermia
a) muscle relaxants. T
b) prolonged surgery, T
c) weather F
d) Low flow anaesthesia F
73) Malignant Hyperthermia
a) Is a fulminant skeletal muscle hypermetabolic syndrome T
b) Occurs in non genetically susceptible patients F
c) Occurs mainly after exposure to an anesthetic triggering agent. T
d) Triggering anesthetic is Trilene F

74) Early signs include:

 a) Bradycardia F
b) Tachypnea T
c) Stable blood pressure F
d) Arrhythmias T
75) Other signs include
a) Cyanosis T
b) Sweating T
c) slow temperature increase F
d) cola-colored urine T
76) Incidence and mortality of Malignant hyperthermia
a) In children: approx 1:20,000 general anesthetics. F
b) In adults: approx 1:40,000 general anesthetics T
c) When succinylcholine is used; approx 1:220,000 T
d) Mortality: 10% overall T
77) Hepatic Physiology
Liver Blood Flow
a) 25% of Cardiac output T
b) Hepatic artery ~35% of blood flow F
c) Portal vein ~ 75% of blood flow T
d) Hepatic Veins empty into the inferior vena cava T
78) Liver Blood Flow is regulated by:
a) Individual anesthetics T
b) Isoflurane and Sevoflurane preserve Hepatic blood flow T
c) Upper Abdominal Surgery reduces hepatic blood flow by 40 % F
d) Regional Subarachnoid Block of T4 reduces 30% of hepatic blood flow F
79) Functions of the Liver include:
a) Metabolic T
b) Bilirubin conjugation and secretion T
c) Bile formation T
d) Hematologic function T
80) Chronic Liver Disease
Paracentesis of Ascites
a) Not exceed 3 Liters/day for a daily weight loss of 0.5 to 1.0 kg F
b) 1 liter of ascites fluid contains 20 grams of Albumin F
c) Each liter of ascites removed must be replaced by 50 ml of 25% Albumin T
d) Ascitic fluid also contains red cells F

81) Chronic Liver Disease

 a) Hepatorenal syndrome can be precipitated by aggressive paracentesis and
potent diuretics like Zaroxolyn T
b) In hepatic Encephalopathy, Dysarthria, flapping tremor, hyperreflexia occurs T
c) Class C, Surgical risk of Mortality rate 30% F
d) NDMB may not have prolonged duration of action F
82) Post-Op Complications of the diseased liver
a) Irreversible minor changes are common F
b) PostOp Jaundice may be due to hemolysis of transfused blood T
c) Shock Liver syndrome can occur if prolonged hypotension persisted (such as:
marked by severe hepato-cellular necrosis) T
d) ……..and SerumTransaminases levels increased > 4 fold F
83) Anaesthesia & Drug Interactions
a) Drug combinations ar not a useful & necessary part of anaesthesia practice. F
b) No single agent can produce all the desirable components of anaesthesia. T
c) Drug combinations can reduce toxicity & improve efficacy T
d) Majority of patients are already on some medication in preoperative period T
84) Drug interactions
a) Interactions do occur, but they usually do not present a problem T
b) There is no variable response to anaesthetic drugs F
c) The qualitative nature of most anaesthetic interactions is predictable T
d) The magnitude of responses is also known F
85) Drug interactions
a) Drugs that interact to produce a totally unexpected or dangerous effect stand
out because they are common F
b) Changes in drug effect have numerous consequences F
c) Many iv anaesthetic drugs have large safety margin T
d) It is likely that many instances of anaesthetic drug interaction go unrecognised T
86) Outcomes of drug interactions
a) Loss of therapeutic effect T
b) Toxicity T
c) Unexpected increase in pharmacological activity T
d) Beneficial effects e.g. additive & Potentiation or antagonism T
87) Outcomes of drug interactions
a) Chemical interaction only F

Drug interactions can be of three types : (Fill in the blank space)

b) Pharm................................ interaction
c) Pharm................................. interaction
d) Pharm................................. interaction
88) Complete the following:
a) Precipitation of Thiopental by S............
b) Precipitation of B............................... by Soda bicarb.
c) Inactivation of Catecholamines due to alkalinisation by S..... b.....
d) Two drugs may interact chemically to form a toxic compound. Eg. Desflurane
has been shown to interact with dry s..................... or B............................ to
produce CO & heat.
89) Drug interaction
a) If NO is allowed prolonged contact with O2, it forms Nitrogen dioxide (NO2),
which can produce Pulmonary edema & alveolar hemorrhage T
Alteration of absorption may occur because
b) Direct chemical or physical interaction between drugs in the body T
c) One drug alters physiological mechanism governing absorption of the second T
d) Eg :- oral antidiarrheal drugs (kaolin, pectin) absorb d................ & prevents its
absorption.
90) Drug interaction
a) Antacids reduce absorption of acidic drugs like Midazolam. T
b) In 10% 0f patients receive digoxin 20% or more of the administered dose is
metabolized by the intestinal flora F
c) Oral Tetracycline can be inactivated by chelation if given together with antacids
containing polyvalent cation ( Mg++, Ca++). T
d) Delay of gastric emptying produced by drugs such as Opioids & Anticholinergics
may not reduce the absorption of orally administered drugs. F
91) Drug interaction
a) Prolongation of action of Infiltrated LA by addition of ..........................
Distribution
b) Drugs which decrease cardiac output ( beta blockers, vasodilators) decrease the
arterial concentration of other drugs in highly perfused tissues such as brain &
myocardium F
c) Such drugs augments the effects of drugs such as Propofol, Thiopental & Volatile
anesthetics T
d) Drug induced changes in pH in a particular body region or fluid compartment can
alter the distribution of other drugs by “ion traping”. T

92) Distribution
 a) Acidic drugs are unionised at acidic pH T
b) Basic drugs are also unionised at basic pH T
c) And it is only the ionised fraction of the drug which is able to cross the lipid
membranes. F
d) Drugs decreasing the gastric acidity increase gastric absorption of acidic drugs
such as Midazolam F
93) Distribution
a) lipid soluble basic drugs such as Fentanyl can diffuse into stomach from
bloodstream T
b) It is only the unbound fraction of drug that is available for crossing membrane T
c) It is only the bound fraction of drug that is available for crossing membrane F
d) So protein bound, potentially toxic drugs like Warfarin, Phenytoin may not be
displaced by other highly bound drugs F
94) Protein binding
a) The body acts as a buffer against large change in unbound fraction T
b) Any unbound drug in plasma is slowly distributed into peripheral tissues F
Metabolism
c) Administration of Neostigmine intensifies & prolongs the effect of Scoline, by
inhibiting Pseudocholinestrase. T
d) Monoamide oxidase acts to regulate the presynaptic pool of acetylcholine
available for synaptic transmission. F
95) MAOI
a) MAO inhibitors (Phenelzine, Tranylcypromine & Selegiline) are mainly used for
T/t of refractory depression & other mood disorders T
b) MAOI increase the amount of presynaptic transmitter released by Ephedrine,
Amphetamine. T
c) Directly acting sympathomimetics such as Epinephrine, Norepinephrine &
Phenylephrine are affected more by MAOI F
d) Serotonin syndrome may occur in patients taking MAOI who are administered
Meperidine T
96) Hepatic Biotransformation
The removal of drug from the body by hepatic biotransformation is a function of 2
independent variables
a) Hepatic blood flow T
b) Intrinsic clearance T
c) Hepatic blood flow is the rate enhancing factor in hepatic clearance F
d) Clearance is decreased by drugs or factors which decrease hepatic blood flow
such as Beta blockers T
97) Clearance
a) Hepatic enzyme activity is the rate limiting factor in hepatic clearance. T
b) Stimulation or inhibition of enzyme activity do not have direct effect on
metabolism. F
c) Protein binding does not affects clearance F
d) The most important subfamily being CYP3A T
98) Drug elimination
a) Organic anions & cations are actively secreted by separate transporters in the
renal glomeruli. F
b) The cation system handles elimination of Atropine , Isoproterenol , Neostigmine
& Meperidine. T
c) - The anion system is involved in elimination of Salicylates , Penicillin,
cephalosporin & most of potent diuretics. T
d) A weak acid like Phenobarbital (pKa 7.4 ) is largely unionised when urinary pH is 3
F
99) Drug Elimination
a) If the urine pH is raised to 8 or 9 by SodaBicarb ; most of the drug becomes
ionised T
b) If the urine pH is raised to 8 or 9 by SodaBicarb reabsorption decreases &
clearance increases T
c) For a weak base the reverse is true i.e. excretion can be promoted by
acidification of urine T
d) Active tubular secretion occurs in the distal tubules F

100) Drug elimination

a) Probenecid decreases tubular secretion of methotrexate T
b) Interaction of two volatile anesthetics or N2O with volatile anesthetic is additive
T
c) Synergistic interactions occur when drugs of different classes; or those with
different mechanisms, are used to produce the same effect. T
d) Opioids are highly not selective CNS depressants F