Question 1

Your 20-year-old patient has just been admitted through the emergency department with a blood alcohol level of 520 mg/dl.What potential side effect of alcohol overconsumption should you be most concerned about?

Accepted Answer

At toxic levels (400 to 600 mg/dl blood alcohol level),the respiratory center is affected,and death as a result of respiratory arrest is likely.

Question 2

You are working in the ED when EMS brings an 83-year-old female who was found unresponsive by her husband.She recently broke her ankle and was prescribed Dilaudid.Her husband states she also takes Vicodin for arthritis pain.What medication should you administer?

Accepted Answer

Naloxone is an opioid receptor antagonist given to reverse the effects of opiates.

Question 3

Guidelines for conscious sedation suggest which of the following?
1)At least three qualified people must be continually present during the sedation period.
2)One person must have sole responsibility of monitoring of the patient and recording vital signs.
3)Resuscitation equipment must be immediately available.
4)Assessment of oxygenation,ventilation,and temperature maintenance is necessary.

Accepted Answer

All published conscious sedation standards insist on the presence of more than one person during the period of sedation (at least the operator and a monitoring assistant).Several guidelines suggest that deep sedation and general anesthesia are indistinguishable and that at least three qualified people must be continually present during the sedation period.The standards also suggest that one person must have as his or her sole responsibility continual monitoring of the patient and recording of vital signs.When providing conscious sedation,it is necessary continuously to assess and ensure oxygenation,ventilation,and temperature maintenance.Although some conscious sedation guidelines suggest how to monitor these vital functions,the decision to use a particular device and frequency of repeated observations is left to the responsible clinician.What is not left to the discretion of the clinician is the number of personnel necessary and that they must be specially qualified and assigned only to monitor one patient's vital functions and the progress of sedation.Resuscitation equipment must be immediately available,and individuals must be trained to use it.To be competent at providing conscious sedation requires a didactic understanding of the pharmacology of the drugs discussed in this chapter and a performance-based competency including intravenous therapy,monitor use,and supervised clinical practice.

Question 4

________ refers to the pharmacologic modification of painful and frightening experiences during medical procedures.

Accepted Answer

Besides general anesthesia,many approaches are available to modify the unpleasant experience of diagnostic and therapeutic procedures.Patient preparation,education,relaxation exercises,hypnosis,and drugs may be useful.Conscious sedation refers to the pharmacologic modification of painful and frightening experiences during medical procedures.Sedated patients remain conscious and able to communicate,protect their own airway,and breathe adequately.Improved patient comfort and outcome are the goals of conscious sedation.

Question 5

Your 75-year-old patient with a history of chronic obstructive pulmonary disease (COPD)and bipolar disorder is experiencing tremors,cognitive slowing,and polyuria.His medications include Combivent,Advair,and lithium.Which drug is most likely to be causing his symptoms?

Accepted Answer

Medical treatment of any degree of bipolar disorder must begin with a mood stabilizer.These drugs include lithium;anticonvulsants such as valproic acid,carbamazepine,gabapentin,and lamotrigine;and antipsychotics.The main side effect of these drugs except for lithium is sedation.Lithium has a narrow therapeutic window and consequently must be used judiciously.Lithium can cause tremor,cognitive slowing,hypothyroid,renal insufficiency,leukocytosis,polyuria,and polydipsia.Lithium toxicity can result in coma.

Question 6

Analeptic drugs would be used for treatment of which of the following?
1)Respiratory failure
2)Narcolepsy
3)Barbiturate overdose
4)Obesity
5)Attention-deficit/hyperactivity disorder (ADHD)

Accepted Answer

Some drugs can increase activity of the brain rather than depress it.Such drugs are termed analeptic drugs.If the effects are primarily on the respiratory center,the agent may be a respiratory or ventilatory stimulant.Stimulant drugs are used for treatment of narcolepsy,ADHD,obesity,and,to a lesser extent,respiratory failure.

Question 7

Your 68-year-old patient with coronary arteriosclerotic heart disease (status post-coronary artery bypass graft surgery)has a history of gastric ulcers.Which nonsteroidal antiinflammatory drug (NSAID)could you safely recommend he use at home?

Accepted Answer

Gastric irritation and ulceration are major problems with administering NSAIDs.Renal injury can result from prolonged use and high dosages of these medications.NSAIDs also inhibit platelet aggregation,and this compounds the problem of gastrointestinal bleeding.Acetaminophen (Tylenol),although a weak inhibitor of the cyclooxygenase system,has no significant antiinflammatory effects but is effective in relieving mild to moderate pain.It does not inhibit platelets or cause gastric ulcers.

Question 8

Your 82-year-old patient has just been discharged from the hospital with a prescription for oxycodone.About what potential side effects of opioids should you advise her?
1)Respiratory depression
2)Nausea and vomiting
3)Constipation
4)Uncontrollable coughing

Accepted Answer

The µ-receptor is responsible for the analgesic effects in the central nervous system and spinal cord.It also accounts for respiratory depression,constipation,nausea and vomiting (from the chemotactic trigger zone receptors),and antitussive effects.

Question 9

Pain control by blocking transmission of the pain impulse from the damaged area is achieved through the use of

Accepted Answer

Pain treatment can be achieved by blocking transmission of the pain impulse from the damaged area.Local anesthetics are used to interrupt these nervous signals.

Question 10

Your 24-year-old patient has just been admitted through the emergency department with a drug overdose.You observe the physician administering flumazenil.What possible drug did your patient overdose on?

Accepted Answer

Benzodiazepines are excellent induction agents when providing general anesthesia and are useful in preventing unpleasant recall during uncomfortable interventions.They may be used as somnifics.These agents are used to terminate seizures and elevate seizure threshold.Benzodiazepines exert their effects by binding to benzodiazepine receptors in the F1F1F1S1F1F1F10-aminobutyric acid (GABA)receptor complex on neurons,increasing the GABA chloride channel permeability,which hyperpolarizes the neuron,making depolarization less likely.A specific antagonist,flumazenil (Romazicon),can reverse the sedative effects of benzodiazepines.

Question 11

________ refers to the use of a mixture of agents to achieve the anesthetic state.

Accepted Answer

The use of a mixture of agents to achieve the anesthetic state is often referred to as balanced anesthesia,in which each element is provided in balance and by a different drug.Conscious sedation is the term applied to the pharmacologic modification of painful and frightening experiences during medical procedures.As implied in the name,sedated patients remain conscious and able to communicate,protect their own airway,and breathe adequately.The state of general anesthesia is a drug-induced absence of perception.Pain treatment can be achieved by blocking transmission of the pain impulse from the damaged area.Local anesthetics are used to interrupt these nervous signals.

Quiz 20: Drugs Affecting the Central Nervous System

Your 20-year-old patient has just been admitted through the emergency department with a blood alcohol level of 520 mg/dl.What potential side effect of alcohol overconsumption should you be most concerned about?

You are working in the ED when EMS brings an 83-year-old female who was found unresponsive by her husband.She recently broke her ankle and was prescribed Dilaudid.Her husband states she also takes Vicodin for arthritis pain.What medication should you administer?

________ refers to the pharmacologic modification of painful and frightening experiences during medical procedures.

Your 75-year-old patient with a history of chronic obstructive pulmonary disease (COPD) and bipolar disorder is experiencing tremors,cognitive slowing,and polyuria.His medications include Combivent,Advair,and lithium.Which drug is most likely to be causing his symptoms?

Analeptic drugs would be used for treatment of which of the following? 1) Respiratory failure 2) Narcolepsy 3) Barbiturate overdose 4) Obesity 5) Attention-deficit/hyperactivity disorder (ADHD)

Your 68-year-old patient with coronary arteriosclerotic heart disease (status post-coronary artery bypass graft surgery) has a history of gastric ulcers.Which nonsteroidal antiinflammatory drug (NSAID) could you safely recommend he use at home?

Your 82-year-old patient has just been discharged from the hospital with a prescription for oxycodone.About what potential side effects of opioids should you advise her? 1) Respiratory depression 2) Nausea and vomiting 3) Constipation 4) Uncontrollable coughing

Pain control by blocking transmission of the pain impulse from the damaged area is achieved through the use of

Your 24-year-old patient has just been admitted through the emergency department with a drug overdose.You observe the physician administering flumazenil.What possible drug did your patient overdose on?

________ refers to the use of a mixture of agents to achieve the anesthetic state.