CBRN Pharmacology & Medication Management 1 — Questions and Answers
Question 1: Which topical antimicrobial agent is most commonly used for burn wound care due to its broad-spectrum coverage and ability to penetrate eschar?
- Bacitracin
- Silver sulfadiazine (Silvadene) (Correct answer)
- Mupirocin
- Neomycin
Correct answer: Silver sulfadiazine (Silvadene)
Silver sulfadiazine is the most widely used topical agent in burn care due to its broad-spectrum antimicrobial properties and ability to penetrate burn eschar.
Question 2: A patient with a major burn is receiving morphine for pain control. Which side effect is MOST concerning in a patient with a concurrent inhalation injury?
- Constipation
- Nausea and vomiting
- Respiratory depression (Correct answer)
- Pruritus
Correct answer: Respiratory depression
Respiratory depression is the most dangerous opioid side effect in burn patients with inhalation injuries, as their respiratory function is already compromised.
Question 3: Mafenide acetate (Sulfamylon) is preferred over silver sulfadiazine in which clinical situation?
- Superficial partial-thickness burns on the torso
- Burns with suspected deep infection requiring eschar penetration (Correct answer)
- Facial burns near the eyes
- Burns in neonates under 2 months
Correct answer: Burns with suspected deep infection requiring eschar penetration
Mafenide acetate penetrates eschar more effectively than silver sulfadiazine, making it the preferred agent when deep infection is suspected or confirmed.
Question 4: Which medication is used to attenuate the hypermetabolic response in burn patients by blocking catecholamine effects?
- Propranolol (Correct answer)
- Dopamine
- Epinephrine
- Atropine
Correct answer: Propranolol
Propranolol, a non-selective beta-blocker, attenuates the hypermetabolic response in burn patients by blocking the effects of excess catecholamines released after major burns.
Question 5: High-dose intravenous Vitamin C (ascorbic acid) is administered early in major burn resuscitation primarily to:
- Prevent scurvy related to nutritional deficits
- Reduce lipid peroxidation and decrease resuscitation fluid requirements (Correct answer)
- Enhance wound healing through collagen synthesis
- Prevent infection by boosting immune function
Correct answer: Reduce lipid peroxidation and decrease resuscitation fluid requirements
High-dose Vitamin C (66 mg/kg/hr for 24 hours) acts as an antioxidant, reducing free radical-mediated lipid peroxidation and capillary leak, thereby decreasing fluid resuscitation requirements.
Question 6: Which opioid analgesic is most appropriate for procedural pain (e.g., dressing changes) in burn patients due to its rapid onset and short duration of action?
- Methadone
- Hydromorphone
- Fentanyl (Correct answer)
- Codeine
Correct answer: Fentanyl
Fentanyl is ideal for procedural pain in burn patients due to its rapid IV onset (1-2 minutes), short duration of action, and high potency, making it effective for painful dressing changes.
Question 7: Silver nitrate solution used in burn wound care can cause which electrolyte imbalance requiring close monitoring?
- Hypernatremia and hyperkalemia
- Hyperkalemia and hypercalcemia
- Hyponatremia and hypochloremia (Correct answer)
- Hypercalcemia and hyperphosphatemia
Correct answer: Hyponatremia and hypochloremia
Silver nitrate solution is hypotonic and leaches sodium and chloride from wound tissues, leading to hyponatremia and hypochloremia requiring frequent electrolyte monitoring and replacement.
