CSFA Pharmacology Practice Questions (60 Flashcards)

Thrombin must NEVER be injected intravascularly. If it enters the systemic circulation, it causes immediate, widespread thrombosis and potential death. The NBSTSA emphasizes that Thrombin should be kept in a distinct container (often a spray kit or specialized basin) and clearly labeled Topical Use Only to prevent accidental syringe uptake by the anesthesia provider or surgeon for IV use. Clinical Pearl: Recombinant Thrombin (Recothrom) is preferred in 2026 to reduce the risk of bovine-derived antibodies that can lead to Factor V deficiency.

Sugammadex (Bridion) is used for the rapid reversal of steroidal neuromuscular blocking agents (Rocuronium, Vecuronium). Unlike Neostigmine, which is an acetylcholinesterase inhibitor that increases ACh at the NMJ, Sugammadex is a selective relaxant binding agent. It encapsulates the aminosteroid molecule in the plasma, creating a concentration gradient that pulls the drug away from the receptors. Clinical Pearl: Sugammadex works regardless of the depth of block, whereas Neostigmine requires at least 2/4 twitches on a Train-of-Four (TOF) monitor.

0.5% Lidocaine (without epinephrine) is the standard agent. Bupivacaine is strictly contraindicated due to the risk of cardiotoxicity upon cuff deflation. The tourniquet must remain inflated for a minimum of 20 minutes to allow for tissue fixation of the drug; premature deflation can cause a massive systemic bolus of lidocaine, leading to LAST.

NMS and MH are distinct. NMS is caused by dopamine depletion in the CNS (due to antipsychotics), whereas MH is a skeletal muscle calcium regulation defect. While both can be treated with Dantrolene to reduce muscle rigidity, NMS also requires dopamine agonists (e.g., Bromocriptine). Crucially, a history of NMS does NOT predispose a patient to MH. For the CSFA exam, remember: MH is triggered by volatile gases/succinylcholine; NMS is triggered by neuroleptics. The anesthetic plan for an NMS patient does not strictly require the avoidance of MH triggers unless a separate MH risk is identified.

If the needle is accidentally placed intravascularly, the Epinephrine will cause an immediate (within 30-60 seconds) transient increase in heart rate (tachycardia >10 bpm) and systolic blood pressure (>15 mmHg). Clinical Application: This allows the provider to stop the injection before a toxic load of the anesthetic is delivered. Note: This marker may be masked in patients taking beta-blockers or in elderly patients with blunted autonomic responses.