Preparing for the CRNA (Certified Registered Nurse Anesthetist) exam? Pharmacology is one of the areas our deck drills hardest: 150 of its 1050 flashcards focus on pharmacology. Try the sample questions below — every card is a real question-and-answer pair from the full deck.
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A patient undergoing a carotid endarterectomy experiences sudden hypertension. You choose Esmolol for its rapid onset and short duration. What is the specific metabolic pathway of Esmolol, and how does this affect its clinical use in patients with renal or hepatic impairment?
Show answer →Esmolol is metabolized via hydrolysis by red blood cell (RBC) cytosol esterases, NOT by plasma cholinesterase or organ-based enzymes. Rationale: Because it does not rely on the liver or kidneys for clearance, its half-life (approx. 9 minutes) remains consistent even in patients with hepatic or renal failure. Exam Strategy: NBCRNA frequently tests the RBC esterase metabolism to distinguish Esmolol from Succinylcholine/Remifentanil. Distractor: Do not confuse RBC esterases with pseudocholinesterase (butyrylcholinesterase).
During induction, what does the knee of the Fa/Fi curve represent, and how does agent solubility affect the rate at which the Fa/Fi ratio approaches 1.0?
Show answer →The Fa/Fi ratio represents Alveolar (Fa) to Inspired (Fi) concentration. The knee represents the transition from the initial rapid rise (ventilation-limited) to the slower rise phase (uptake-limited by tissues). For insoluble agents (Desflurane), the curve rises rapidly because less agent is removed from the alveoli by blood. For soluble agents (Isoflurane), the curve rises slowly because the blood acts as a large reservoir, removing agent from the alveoli. Exam Tip: NBCRNA often asks which agent reaches equilibrium fastest; it's always the least soluble (Desflurane > Sevoflurane > Isoflurane).
A patient with chronic catecholamine depletion (end-stage heart failure) is induced with ketamine. Instead of the expected tachycardia, the patient becomes profoundly hypotensive. What is the pharmacological rationale for this paradoxical response?
Show answer →Ketamine is an indirect sympathomimetic that inhibits the reuptake of norepinephrine into postganglionic sympathetic nerve endings. However, it also possesses a direct, but usually masked, negative inotropic (myocardial depressant) effect. In patients with depleted catecholamine stores (e.g., chronic shock, severe HF), the indirect stimulatory effect is lost, unmasking the direct myocardial depression, leading to hypotension. **Exam Tip:** NBCRNA frequently tests the unmasking of direct depressant effects in hemodynamically compromised patients. Distractors often include allergic reaction or NMDA-mediated vasodilation.
A patient exhibits prolonged paralysis after 1 mg/kg of succinylcholine. A Dibucaine test is ordered. What does a Dibucaine number of 20 indicate regarding the enzyme's function and the expected clinical duration of the block?
Show answer →A Dibucaine number of 20 indicates a homozygous atypical pseudocholinesterase (butyrylcholinesterase) variant. Dibucaine inhibits normal enzyme by 80%, but atypical enzyme by only 20%. This results in a significantly prolonged neuromuscular block, typically lasting 4 to 8 hours. Exam Strategy: NBCRNA often tests the difference between quantity and quality. Dibucaine measures the QUALITY (ability to inhibit) of the enzyme, not the amount of enzyme present. Management involves continued mechanical ventilation and sedation until muscle function returns spontaneously. Avoid reversing with anticholinesterases as they further inhibit the already deficient pseudocholinesterase.
Identify the structural component responsible for the metabolic pathway of local anesthetics like lidocaine and bupivacaine.
Show answer →Amide local anesthetics contain an amide link between the aromatic ring and the hydrocarbon chain. They are metabolized by hepatic CYP450 enzymes. Esters (procaine, tetracaine) have an ester link and are metabolized by pseudocholinesterase. Exam Tip: Amides have two is in their name (Lidocaine, Bupivacaine), whereas Esters have only one (Procaine, Cocaine). Clinical Pearl: Liver failure significantly prolongs the half-life of amides but has minimal effect on ester metabolism.
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Try 30 free CRNA cards firstThe full CRNA deck contains 1050 flashcards, and 150 of them focus on pharmacology. This page shows 5 free samples.
Our CRNA deck dedicates 150 of 1050 cards (14%) to pharmacology — always cross-check the official NBCRNA exam outline for the current blueprint weighting.
Yes — the samples on this page are free, and the CRNA preview page has 30 more free cards. Full access to all 1050 cards is a one-time $7.
Assessment
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Diagnostics
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Management
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Pathology
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