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WBHRB OT Technologist CBT exam pharmacology syllabus topics 2024 2025

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I have excellent content from Katzung and Miller's Anesthesia. I now have enough pharmacology knowledge to generate 50 high-quality MCQs for an OT Technologist. Let me write them now based on the textbook content and my clinical pharmacology knowledge.Here are 50 Pharmacology MCQs for WBHRB OT Technologist CBT Exam, covering anesthesia drugs, muscle relaxants, analgesics, emergency drugs, premedication, and basic pharmacology:

WBHRB OT Technologist CBT - Pharmacology MCQs (50 Questions)

SECTION A: General Anesthesia & Induction Agents (Q1-Q10)

Q1. Which intravenous agent is most commonly used for induction of general anesthesia?
  • A) Ketamine
  • B) Propofol
  • C) Etomidate
  • D) Thiopentone
Answer: B) Propofol Propofol is the most widely used IV induction agent due to its rapid onset, smooth induction, and fast recovery with antiemetic properties.
Q2. Which inhalational anesthetic has the LOWEST blood-gas partition coefficient, resulting in the fastest induction and recovery?
  • A) Halothane
  • B) Isoflurane
  • C) Desflurane
  • D) Sevoflurane
Answer: C) Desflurane Desflurane has the lowest blood-gas partition coefficient (0.42) among inhalational agents, giving the fastest onset and recovery. However, sevoflurane is preferred for mask induction.
Q3. Ketamine produces a state called:
  • A) Conscious sedation
  • B) Neuroleptanalgesia
  • C) Dissociative anesthesia
  • D) Balanced anesthesia
Answer: C) Dissociative anesthesia Ketamine blocks NMDA receptors and produces dissociative anesthesia - a trance-like state with profound analgesia, amnesia, and catalepsy while maintaining airway reflexes.
Q4. Which anesthetic agent is CONTRAINDICATED in patients with a history of malignant hyperthermia?
  • A) Propofol
  • B) Ketamine
  • C) Succinylcholine
  • D) Midazolam
Answer: C) Succinylcholine Succinylcholine (along with volatile halogenated agents) is a known trigger of malignant hyperthermia. It must be avoided in susceptible patients.
Q5. The MAC (Minimum Alveolar Concentration) of an inhalational anesthetic is used to measure:
  • A) Speed of induction
  • B) Potency
  • C) Duration of action
  • D) Hepatotoxicity risk
Answer: B) Potency MAC is the alveolar concentration that prevents movement in 50% of patients to a surgical skin incision - it is the standard measure of inhalational anesthetic potency. Lower MAC = higher potency.
Q6. Which IV induction agent provides the BEST cardiovascular stability, making it preferred in hemodynamically compromised patients?
  • A) Propofol
  • B) Thiopentone
  • C) Etomidate
  • D) Ketamine
Answer: C) Etomidate Etomidate has minimal effect on heart rate and blood pressure, making it the agent of choice for patients with cardiovascular compromise. Its main drawback is adrenocortical suppression.
Q7. Thiopentone sodium belongs to which drug class?
  • A) Benzodiazepine
  • B) Barbiturate
  • C) Imidazole derivative
  • D) Phenol derivative
Answer: B) Barbiturate Thiopentone is an ultra-short-acting barbiturate that acts by potentiating GABA-A receptor activity, causing CNS depression.
Q8. Propofol is formulated in which vehicle?
  • A) Normal saline
  • B) Intralipid (soybean oil emulsion)
  • C) 5% Dextrose
  • D) Polyethylene glycol
Answer: B) Intralipid (soybean oil emulsion) Propofol is formulated in a 10% soybean oil, 2.25% glycerol, and 1.2% egg lecithin emulsion (Intralipid). Patients with egg or soy allergy need careful evaluation.
Q9. Which inhalational agent is preferred for inhalational induction in pediatric patients?
  • A) Desflurane
  • B) Halothane
  • C) Sevoflurane
  • D) Isoflurane
Answer: C) Sevoflurane Sevoflurane has a pleasant, non-pungent smell and low airway irritability, making it the preferred agent for mask induction, especially in children.
Q10. Nitrous oxide (N2O) is associated with which of the following risks on prolonged exposure?
  • A) Hepatotoxicity
  • B) Nephrotoxicity
  • C) Megaloblastic anemia (Vitamin B12 inactivation)
  • D) Malignant hyperthermia
Answer: C) Megaloblastic anemia (Vitamin B12 inactivation) N2O irreversibly oxidizes the cobalt center of Vitamin B12, inactivating methionine synthase, and causing megaloblastic changes. Prolonged use is avoided for this reason.

SECTION B: Muscle Relaxants (Q11-Q20)

Q11. Succinylcholine (suxamethonium) is classified as which type of neuromuscular blocking agent?
  • A) Non-depolarizing
  • B) Depolarizing
  • C) Competitive antagonist
  • D) Centrally acting relaxant
Answer: B) Depolarizing Succinylcholine mimics acetylcholine, causing persistent depolarization of the motor end plate (Phase I block), resulting in initial fasciculations followed by flaccid paralysis.
Q12. The antidote for non-depolarizing neuromuscular blockade (reversal agent) is:
  • A) Naloxone
  • B) Flumazenil
  • C) Neostigmine
  • D) Atropine
Answer: C) Neostigmine Neostigmine is an anticholinesterase that inhibits acetylcholinesterase, increasing acetylcholine at the NMJ and reversing non-depolarizing blockade. It is given with atropine to prevent bradycardia.
Q13. Rocuronium is an example of which class of muscle relaxant?
  • A) Depolarizing
  • B) Non-depolarizing aminosteroid
  • C) Benzylisoquinolinium
  • D) Centrally acting
Answer: B) Non-depolarizing aminosteroid Rocuronium belongs to the aminosteroid class of non-depolarizing NMBDs. Its high-dose (1.2 mg/kg) can be used for rapid sequence intubation as an alternative to succinylcholine.
Q14. Which drug is the specific reversal agent for rocuronium and vecuronium?
  • A) Neostigmine
  • B) Protamine
  • C) Sugammadex
  • D) Physostigmine
Answer: C) Sugammadex Sugammadex is a modified gamma-cyclodextrin that encapsulates and inactivates rocuronium and vecuronium, providing rapid and complete reversal at any depth of blockade.
Q15. The phenomenon of "train-of-four fade" is characteristic of which type of neuromuscular block?
  • A) Depolarizing (Phase I)
  • B) Non-depolarizing
  • C) Phase II depolarizing
  • D) Central muscle relaxation
Answer: B) Non-depolarizing Non-depolarizing agents block nicotinic receptors competitively, causing a progressive decline (fade) in the train-of-four response. Phase I depolarizing block shows no fade.
Q16. Atracurium undergoes which unique elimination process?
  • A) Hepatic metabolism
  • B) Renal excretion
  • C) Hofmann degradation
  • D) Pseudocholinesterase hydrolysis
Answer: C) Hofmann degradation Atracurium undergoes spontaneous non-enzymatic degradation at physiological pH and temperature (Hofmann elimination), making it safe in hepatic and renal failure patients.
Q17. A patient with pseudocholinesterase deficiency would have prolonged paralysis after which drug?
  • A) Vecuronium
  • B) Rocuronium
  • C) Atracurium
  • D) Succinylcholine
Answer: D) Succinylcholine Succinylcholine is normally hydrolyzed rapidly by plasma pseudocholinesterase. Deficiency of this enzyme leads to prolonged neuromuscular blockade ("scoline apnea").
Q18. Which muscle relaxant is associated with histamine release, causing bronchospasm and hypotension?
  • A) Vecuronium
  • B) Rocuronium
  • C) Atracurium
  • D) Pancuronium
Answer: C) Atracurium Atracurium (and mivacurium) can cause histamine release, especially at higher doses or rapid injection, leading to flushing, bronchospasm, and hypotension. Cisatracurium (a stereoisomer) has less histamine release.
Q19. Pancuronium is known for which cardiovascular side effect?
  • A) Bradycardia
  • B) Hypotension
  • C) Tachycardia and hypertension
  • D) Heart block
Answer: C) Tachycardia and hypertension Pancuronium blocks muscarinic receptors and causes sympathomimetic effects, leading to tachycardia and increased blood pressure. It is avoided in patients with coronary artery disease.
Q20. The normal duration of succinylcholine action is approximately:
  • A) 2-3 minutes
  • B) 10-15 minutes
  • C) 30-45 minutes
  • D) 60-90 minutes
Answer: A) 2-3 minutes Succinylcholine has a very short duration (10-15 minutes with normal pseudocholinesterase activity; onset about 60 seconds). Its ultrashort action makes it ideal for rapid sequence intubation.

SECTION C: Opioid Analgesics (Q21-Q28)

Q21. Which opioid is most commonly used intraoperatively as an analgesic adjunct due to its rapid onset and short duration?
  • A) Morphine
  • B) Meperidine (Pethidine)
  • C) Fentanyl
  • D) Codeine
Answer: C) Fentanyl Fentanyl is 100 times more potent than morphine, highly lipid-soluble with rapid onset (2-3 min IV), and short duration (30-60 min), making it ideal for intraoperative use.
Q22. The specific reversal agent for opioid-induced respiratory depression is:
  • A) Flumazenil
  • B) Naloxone
  • C) Neostigmine
  • D) Sugammadex
Answer: B) Naloxone Naloxone is a competitive opioid receptor antagonist that reverses all effects of opioids including respiratory depression, sedation, and analgesia. Its short half-life may necessitate repeated doses.
Q23. Morphine causes all of the following EXCEPT:
  • A) Miosis
  • B) Constipation
  • C) Mydriasis
  • D) Respiratory depression
Answer: C) Mydriasis Morphine (and other opioids) cause miosis (pinpoint pupils) by stimulating the Edinger-Westphal nucleus. Mydriasis does NOT occur; in fact, miosis is a hallmark of opioid toxicity.
Q24. Which opioid analgesic is contraindicated with MAO inhibitors due to risk of serotonin syndrome?
  • A) Fentanyl
  • B) Morphine
  • C) Meperidine (Pethidine)
  • D) Oxycodone
Answer: C) Meperidine (Pethidine) Pethidine inhibits serotonin reuptake. Combined with MAOIs, it can cause a life-threatening serotonin syndrome (hyperthermia, rigidity, seizures, agitation).
Q25. Tramadol acts by which mechanism?
  • A) Pure mu-opioid agonism
  • B) NMDA receptor antagonism
  • C) Weak opioid agonism + serotonin/norepinephrine reuptake inhibition
  • D) COX inhibition
Answer: C) Weak opioid agonism + serotonin/norepinephrine reuptake inhibition Tramadol is a weak mu-opioid agonist that also inhibits reuptake of serotonin and norepinephrine. This dual mechanism provides analgesia with lower abuse potential.
Q26. Patient-controlled analgesia (PCA) most commonly uses which opioid?
  • A) Codeine
  • B) Morphine
  • C) Buprenorphine
  • D) Pentazocine
Answer: B) Morphine Morphine is the standard opioid for IV PCA in postoperative pain management. Its pharmacokinetics allow titratable, effective analgesia.
Q27. Which of the following is a partial opioid agonist used in opioid dependence treatment?
  • A) Naloxone
  • B) Naltrexone
  • C) Buprenorphine
  • D) Fentanyl
Answer: C) Buprenorphine Buprenorphine is a partial mu-opioid agonist with high receptor affinity and long duration, used in opioid dependence treatment (often combined with naloxone as Suboxone).
Q28. Remifentanil is unique among opioids because:
  • A) It is orally active
  • B) It is metabolized by plasma esterases, giving ultrashort action
  • C) It does not cause respiratory depression
  • D) It is a kappa-agonist
Answer: B) It is metabolized by plasma esterases, giving ultrashort action Remifentanil is hydrolyzed by nonspecific plasma and tissue esterases, resulting in context-insensitive half-life of about 3-4 minutes regardless of infusion duration.

SECTION D: Local Anesthetics (Q29-Q35)

Q29. Local anesthetics primarily work by:
  • A) Blocking potassium channels
  • B) Blocking voltage-gated sodium channels
  • C) Stimulating GABA receptors
  • D) Blocking calcium channels
Answer: B) Blocking voltage-gated sodium channels Local anesthetics block voltage-gated Na+ channels in the inactivated state, preventing action potential generation and conduction, thus blocking nerve impulse transmission.
Q30. Which local anesthetic is MOST cardiotoxic?
  • A) Lidocaine
  • B) Procaine
  • C) Bupivacaine
  • D) Prilocaine
Answer: C) Bupivacaine Bupivacaine binds avidly to cardiac sodium channels and can cause severe, refractory ventricular arrhythmias and cardiac arrest. It has a narrow therapeutic index compared to other local anesthetics.
Q31. Epinephrine is added to local anesthetic solutions to:
  • A) Increase systemic absorption
  • B) Prolong duration of action by causing vasoconstriction
  • C) Prevent infection
  • D) Reduce the dose needed
Answer: B) Prolong duration of action by causing vasoconstriction Epinephrine causes local vasoconstriction, reducing the absorption of the local anesthetic into the bloodstream, thereby prolonging its local action and reducing systemic toxicity.
Q32. Which local anesthetic is an ESTER type?
  • A) Lidocaine
  • B) Bupivacaine
  • C) Procaine
  • D) Ropivacaine
Answer: C) Procaine Local anesthetics are classified as esters (procaine, cocaine, benzocaine, tetracaine) or amides (lidocaine, bupivacaine, ropivacaine, prilocaine). Esters are hydrolyzed by plasma pseudocholinesterase.
Q33. The maximum safe dose of lidocaine WITHOUT epinephrine is approximately:
  • A) 1 mg/kg
  • B) 3 mg/kg
  • C) 7 mg/kg
  • D) 10 mg/kg
Answer: B) 3 mg/kg The maximum safe dose of lidocaine without epinephrine is 3 mg/kg (300 mg in a 70 kg adult). With epinephrine it increases to 7 mg/kg due to reduced absorption.
Q34. Prilocaine-induced methemoglobinemia is treated with:
  • A) Naloxone
  • B) Methylene blue
  • C) Atropine
  • D) Oxygen alone
Answer: B) Methylene blue Prilocaine's metabolite orthotoluidine oxidizes hemoglobin to methemoglobin. Treatment is methylene blue (1-2 mg/kg IV), which acts as a cofactor for NADPH methemoglobin reductase.
Q35. Which local anesthetic is preferred for spinal (intrathecal) anesthesia?
  • A) Lidocaine
  • B) Bupivacaine (heavy)
  • C) Prilocaine
  • D) Ropivacaine
Answer: B) Bupivacaine (heavy) Hyperbaric (heavy) bupivacaine 0.5% is the most commonly used agent for spinal anesthesia due to its predictable spread, appropriate duration (2-3 hours), and reliable sensory/motor block.

SECTION E: Premedication & Sedation (Q36-Q42)

Q36. The standard premedication for reducing gastric acidity before emergency surgery is:
  • A) Metoclopramide
  • B) Sodium citrate (Antacid)
  • C) Ranitidine
  • D) All of the above (rapid sequence protocol)
Answer: D) All of the above (rapid sequence protocol) For emergency/full stomach patients, the combination of a non-particulate antacid (sodium citrate), H2-blocker (ranitidine/famotidine), and prokinetic (metoclopramide) is used to reduce aspiration risk.
Q37. Midazolam used for premedication provides all of the following EXCEPT:
  • A) Anxiolysis
  • B) Anterograde amnesia
  • C) Analgesia
  • D) Sedation
Answer: C) Analgesia Midazolam, a short-acting benzodiazepine, provides anxiolysis, amnesia (anterograde), sedation, and anticonvulsant activity - but it has NO analgesic properties.
Q38. Atropine is used as a premedicant primarily to:
  • A) Reduce anxiety
  • B) Reduce secretions (antisialagogue effect)
  • C) Provide analgesia
  • D) Prevent nausea
Answer: B) Reduce secretions (antisialagogue effect) Atropine is an anticholinergic that reduces salivary, bronchial, and gastric secretions. It also prevents vagally mediated bradycardia during laryngoscopy and intubation.
Q39. Which benzodiazepine antagonist is used to reverse midazolam sedation?
  • A) Naloxone
  • B) Neostigmine
  • C) Flumazenil
  • D) Physostigmine
Answer: C) Flumazenil Flumazenil is a competitive benzodiazepine antagonist at GABA-A receptors. It reverses sedation, respiratory depression, and amnesia caused by benzodiazepines.
Q40. Dexmedetomidine provides sedation via which mechanism?
  • A) GABA-A receptor potentiation
  • B) NMDA receptor blockade
  • C) Alpha-2 adrenergic receptor agonism
  • D) Opioid receptor stimulation
Answer: C) Alpha-2 adrenergic receptor agonism Dexmedetomidine is a highly selective alpha-2 adrenergic agonist providing "cooperative sedation" - patients are sedated but easily arousable, without significant respiratory depression.
Q41. Which drug combination is used for neuroleptanalgesia?
  • A) Propofol + Fentanyl
  • B) Droperidol + Fentanyl
  • C) Midazolam + Ketamine
  • D) Haloperidol + Morphine
Answer: B) Droperidol + Fentanyl Neuroleptanalgesia is produced by combining a butyrophenone neuroleptic (droperidol) with a potent opioid (fentanyl). This combination (Innovar) produces a state of indifference and analgesia.
Q42. Ondansetron is used in the perioperative setting for:
  • A) Induction of anesthesia
  • B) Prevention and treatment of PONV (Postoperative Nausea and Vomiting)
  • C) Muscle relaxation
  • D) Postoperative analgesia
Answer: B) Prevention and treatment of PONV Ondansetron is a 5-HT3 receptor antagonist used for prophylaxis and treatment of postoperative nausea and vomiting (PONV), which is one of the most common postoperative complaints.

SECTION F: Emergency & Cardiovascular Drugs in OT (Q43-Q50)

Q43. The drug of choice for anaphylaxis in the operating room is:
  • A) Hydrocortisone
  • B) Diphenhydramine
  • C) Epinephrine (Adrenaline)
  • D) Dopamine
Answer: C) Epinephrine (Adrenaline) Epinephrine is the FIRST-LINE treatment for anaphylaxis. It acts on alpha-1 receptors (vasoconstriction), beta-1 (cardiac stimulation), and beta-2 (bronchodilation), reversing all features of anaphylaxis.
Q44. Which drug is used for the treatment of malignant hyperthermia?
  • A) Propranolol
  • B) Dantrolene sodium
  • C) Verapamil
  • D) Sodium bicarbonate
Answer: B) Dantrolene sodium Dantrolene is the specific treatment for malignant hyperthermia. It blocks ryanodine receptors (RYR1) in skeletal muscle sarcoplasmic reticulum, preventing massive calcium release.
Q45. During intraoperative bradycardia, which drug is given first?
  • A) Epinephrine
  • B) Atropine
  • C) Isoproterenol
  • D) Dopamine
Answer: B) Atropine Atropine (0.5-1 mg IV) is the first-line drug for symptomatic bradycardia. It blocks muscarinic receptors, increasing heart rate. If atropine fails, epinephrine or isoproterenol is used.
Q46. Phenylephrine infusion is used intraoperatively to treat:
  • A) Bronchospasm
  • B) Tachycardia
  • C) Hypotension due to spinal anesthesia
  • D) Pulmonary hypertension
Answer: C) Hypotension due to spinal anesthesia Phenylephrine is a pure alpha-1 agonist that causes vasoconstriction, used to treat hypotension from spinal/epidural anesthesia, particularly in obstetric patients.
Q47. Sodium nitroprusside (SNP) is used intraoperatively for:
  • A) Inducing controlled hypotension
  • B) Treating bronchospasm
  • C) Reversing neuromuscular blockade
  • D) Treating anaphylaxis
Answer: A) Inducing controlled hypotension SNP releases nitric oxide, causing both arterial and venous dilation, producing a rapid fall in blood pressure. It is used for controlled hypotension to reduce surgical bleeding, especially in neurosurgery.
Q48. Protamine sulfate is used to reverse the effects of:
  • A) Warfarin
  • B) Aspirin
  • C) Heparin
  • D) Clopidogrel
Answer: C) Heparin Protamine sulfate is a positively charged protein that binds and neutralizes negatively charged heparin, reversing anticoagulation. It is routinely used after cardiopulmonary bypass surgery.
Q49. Which drug is used to reduce intraoperative bleeding by inhibiting fibrinolysis?
  • A) Heparin
  • B) Tranexamic acid
  • C) Streptokinase
  • D) Warfarin
Answer: B) Tranexamic acid Tranexamic acid is an antifibrinolytic that blocks lysine binding sites on plasminogen, preventing fibrin clot dissolution. It significantly reduces perioperative blood loss and transfusion requirements.
Q50. Neostigmine is always given with atropine during reversal of neuromuscular blockade because:
  • A) Atropine enhances neostigmine's action
  • B) Atropine prevents bradycardia and excessive secretions caused by neostigmine
  • C) Atropine reverses the neuromuscular block
  • D) Atropine prevents nausea caused by neostigmine
Answer: B) Atropine prevents bradycardia and excessive secretions caused by neostigmine Neostigmine inhibits acetylcholinesterase, increasing acetylcholine everywhere - including muscarinic receptors, causing bradycardia, increased secretions, and bronchospasm. Atropine blocks these unwanted muscarinic effects.

Quick Reference - Answer Key

QAnsQAnsQAnsQAnsQAns
1B11B21C31B41B
2C12C22B32C42B
3C13B23C33B43C
4C14C24C34B44B
5B15B25C35B45B
6C16C26B36D46C
7B17D27C37C47A
8B18C28B38B48C
9C19C29B39C49B
10C20A30C40C50B

Topics Covered

SectionTopicQuestions
AGeneral Anesthesia & Induction AgentsQ1-Q10
BNeuromuscular Blocking AgentsQ11-Q20
COpioid AnalgesicsQ21-Q28
DLocal AnestheticsQ29-Q35
EPremedication & SedationQ36-Q42
FEmergency & Cardiovascular DrugsQ43-Q50
Key Points to Remember for Exam:
  • Propofol = most common IV induction agent; Thiopentone = barbiturate
  • Succinylcholine = only depolarizing NMBD; reversed by Sugammadex (NO - wait it out); Rocuronium reversed by Sugammadex
  • Neostigmine reverses non-depolarizing NMBDs but MUST be given with Atropine
  • Fentanyl = intraoperative opioid; Naloxone = reversal agent
  • Dantrolene = treatment of malignant hyperthermia
  • Bupivacaine = most cardiotoxic local anesthetic
  • Epinephrine = drug of choice in anaphylaxis
Sources: Katzung's Basic & Clinical Pharmacology 16th Ed, Miller's Anesthesia 10th Ed, Goodman & Gilman's Pharmacological Basis of Therapeutics
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