Key Words -- January 29, 2016

230. Meperidine is contraindicated in patients taking which of the following

drugs for Parkinsons disease?
A. Bromocriptine
B. Levodopa
C. Selegiline (Eldepryl)
D. Amantadine (Symmetrel)
E. Trihexyphenidyl (Artane)
231. Which of the following benzylisoquinoline non-depolarizing
neuromuscular blocking drugs is unique among this class of drugs in that it
does not cause release of histamine?
A. d-Tubocurarine
B. Cisatracurium
C. Rocuronium
D. Atracurium
E. Pipecuronium
232. The most common reason for patients to rate anesthesia with etomidate
as unsatisfactory is
A. Postoperative nausea and vomiting
B. Pain on injection
C. Recall of intubation
D. Myoclonus
E. Postoperative hiccups
233. Which of the following muscle relaxants inhibits the reuptake of
norepinephrine by the adrenergic nerves?
A. Pancuronium
B. Pipecuronium
C. Rocuronium
D. Doxacurium
E. Vecuronium

230. [C]
Selegiline is an MAOI that is sometimes used in the treatment of Parkinsons disease. Meperidine is
contraindicated in patients taking MAOIs because of the possibility of excitation (e.g., agitation, skeletal
muscle rigidity, hyperpyrexia) or depression (e.g., hypotension, depressed ventilation, coma) that may
result.
Meperidine anticholinergic side effects. Tachycardia common (unlike other opioids).
Phenylpiperidine opioid with additional antimuscarinic and serotonin reuptake-inhibiting effects
Can cuase euphoria, but not always sedation
Normeperidine can accumulate (repeat doses) in renal failure and cause seizure.
Weak serotonin reuptake inhibitor..use with MAO-I could cause serotonin syndrome
Common PD treatments:
Bromocritpine Dopamine receptor agonist
Levodopa dopamine precursor
Selegiline -- selective inhibitor of monoamine oxidase type B
Amantadine (Symmetrel) glutamate receptor antagonist
Trihexyphenidyl (Artane) - anticholinergic
231. [B]
There are two major chemical classes of nondepolarizing muscle relaxants, the

Aminosteroids (-onium drugs) ==> Do not cause histamine release

o

Vecuronium

Rocuronium

Pancuronium

benzylisoquinolinium (-urium)
o

Atracurium

Mivacurium

Benzylisoquinoline esters (end in share the property of histamine release, the order of magnitude being:
d-tubocurarine >> atracurium, mivacurium, doxacurium
Cisatracurium absent
H1 & H2 receptor stimulation mast cell degranulation eicosanoids, PGF2
Causes flushing, hypotension and bronchoconstriction
232. [A]
Etomidate, an imidazole derivative, is used most often for induction of general anesthesia, but it also can
be used for maintenance of general anesthesia. Etomidate has a relatively short duration of action and
provides very stable hemodynamics, even in patients with limited cardiovascular reserve. However, it is
associated with several adverse effects. These adverse effects include a high incidence of nausea and
vomiting (greater than after thiopental), pain on injection, thrombophlebitis, myoclonic movements, and,
sometimes, hiccups. Nausea and vomiting constitute the most common reason patients rate anesthesia
with etomidate as unsatisfactory. The addition of fentanyl to etomidate to decrease the pain of injection
also increases the incidence of nausea and vomiting

Common SE of Etomidate:
Nausea/vomiting
Burning on injection due to propylene glycol solution
Myoclonus
Adrenal suppression --- dose dependent inhibition of 11-beta hydroxlase.
Thrombophlebits
233. [A]
Pancuronium has parasympatholytic properties: Heart rate, MAP/CO, little/no change in SVR
Mechanism of Action:
Antagonize cardiac M2 receptors (G-protein linked, open K + channel, cAMP) = TACHYCARDIA
Direct: block neuronal uptake of norepi
Indirect: release of norepi from adrenergic nerve endings
(Miller: Anesthesia, ed 6, p 512 Stoelting: Pharmacology and Physiology in Anesthetic Practice, ed 4, pp
228-230).