NBCRNA Exam Solved Questions
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1. Which anticholinergics cross the BBB?
Atropine
Scopolamine
2. What nerve fibers transmit pain?
A delta - fast pain
C fibers- dull pain
3. Descending inhibitory pain pathway
Begins in periaqueductal gray and rostroventral medulla and projects to
substantia geletanosa (rexed lamina I and II)
Descending pain pathways release NE, 5-HT, and endorphins
4. Opioid mechanism of action
Bind to G protein
Inhibit adenylate cyclase
Decrease cAMP
Decrease calcium influx (decreased NT release)
Increase potassium efflux (hyperpolarize membrane)
5. Mu receptor endogenous ligand
Endorphin
6. Kappa receptor endogenous ligand
Dynorphin
,7. Delta receptor endogenous ligand
Enkephalin
8. Which opioid receptor causes anti shivering
Kappa
9. Which opioid receptors cause pruritis
Mu
Delta
10.Which opioid receptors cause urinary retention
Mu
Delta
11.Which opioid receptor causes bradycardia
Mu
12.Which opioid receptors cause miosis
Mu
Kappa
13.Which opioid receptor causes N/V and constipation?
Mu
14.Effects of kappa stimulation
Antishivering
Miosis
Diuresis
Dysphoria/delirium/hallucinations
15.Effects of delta stimulation
Urinary retention
Pruritis
16.Effects of mu stimulation
Pruritis
17.Opioid CV effects
Bradycardia (mu stimulation)
Minimal effect of BP in healthy patients
Contractility not affected (unless combined with nitrous)
Demerol can increase HR (similar structure to atropine)
18.Immunologic effects of opioids
Histamine release (morphine, meperidine, codeine)
Inhibition of cellular and humoral immune function
Suppression of natural killer cell function
Thermoregulagory effects of opioids
Resets hypothalamic temperature set point: decreased core body temp
19.Which opioids release histamine
morphine, meperidine, codeine
20.Rank opioids from most to least potent
Sufent
Fentanyl = remi
, Alfent
Dilaudid
Morphine
Demerol
21.Compare IV opioids dose relative to morphine
Meperidine 0.1
Morphine 1
Dilaudid 7x
Alfentanil 10x
Fentanyl 100x
Sufentanil 1000x
22.Which opioids have active metabolites and what are their effects?
Morphine (can build up in patient with kidney problems and cause resp
depression)
Meperidine (can build up in patient with kidney problems and cause seizures)
23.Examples of MAOIs
Phenelzine
Isocarboxazid
Tranylcypromine
24.Problem with meperidine and MAOis
Meperidine is a weak serotonin reuptake inhibitor
Can cause serotonin syndrome
25.Symptoms of serotonin syndrome
Hyperthermia
Mental status changes
Huperreflexia
Seizures
26.What antibiotic inhibits alfentanil's metabolism?
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