Pharm: Cumulative Book Questions Ch. 6

A 12-year-old boy with a peanut allergy is brought to the emergency room after accidental consumption of peanuts. He is in anaphylactic shock. Which of the following drugs is most appropriate to treat this patient? A. Norepinephrine B. Phenylephrine C. Dobutamine D. Epinephrine

A 12-year-old boy with a peanut allergy is brought to the emergency room after accidental consumption of peanuts. He is in anaphylactic shock. Which of the following drugs is most appropriate to treat this patient? A. Norepinephrine B. Phenylephrine C. Dobutamine D. Epinephrine Norepinephrine has more alpha agonistic effects and activates mainly alpha 1, alpha 2, and beta 1 receptors. Epinephrine has more beta agonistic effects and activates mainly alpha 1, alpha 2, beta 1 and beta 2 receptors. Phenylephrine has predominantly alpha effects and activates mainly alpha 1 receptors. Dobutamine mainly activates beta 1 receptors and has no significant effects on beta 2 receptors. Thus, epinephrine is the drug of choice in anaphylactic shock that can both stimulate the heart (beta 1 activation) and dilate bronchioles (beta 2 activation).

A 22-year-old male is brought to the emergency room with suspected cocaine overdose. Which of the following symptoms is most likely in this patient? A. Hypertension B. Bronchoconstriction C. Bradycardia d. Miosis (constriction of pupil)

A 22-year-old male is brought to the emergency room with suspected cocaine overdose. Which of the following symptoms is most likely in this patient? A. Hypertension B. Bronchoconstriction C. Bradycardia d. Miosis (constriction of pupil) Cocaine is an indirect adrenergic agonist that prevents the reuptake of norepinephrine into the nerve terminals, thus increasing the levels of NE in the synaptic cleft. The increase in NE leads to an increase in blood pressure (hypertension), tachycardia (not bradycardia), mydriasis (not miosis), and other symptoms of sympathetic overactivity.

A patient who has hypertension and mild asthma attacks bought a herbal remedy for asthma online. He does not take any prescription medications for asthma, but takes a beta 1-selective blocker for hypertension. The herbal remedy relieves the asthma attacks, but his blood pressure seems to increase despite the beta-blocker therapy. Which of the following drugs is most likely present in the herbal remedy? A. Phenylephrine B. Norepinephrine C. Ephedrine D. Salmeterol

A. Phenylephrine B. Norepinephrine C. Ephedrine D. Salmeterol Both ephedrine and salmeterol can relieve asthma symptoms, as they activate beta 2 receptors in the bronchioles and cause bronchodilation. However, salmeterol is a selective beta 2 agonist and should not increase blood pressure. By contrast, ephedrine stimulates the release of norepinephrine and acts as a direct agonist at alpha and beta adrenergic receptors, thus causing an increase in blood pressure. Phenylephrine (a nonselective alpha agonist) does not cause bronchodilation, so it would not relieve asthma symptoms. Norepinephrine is a nonselective adrenergic agonist that does not have any stimulatory effects on beta 2 receptors. In addition, norepinephrine is not active when given orally.

An asthma patient was given a nonselective Beta agonist to relieve bronchoconstriction. Which adverse effect would you expect in this patient? A. Bradycardia B. Tachycardia C. Hypotension (reduction in blood pressure) D. Worsening bronchoconstriction

An asthma patient was given a nonselective Beta agonist to relieve bronchoconstriction. Which adverse effect would you expect in this patient? A. Bradycardia B. Tachycardia C. Hypotension (reduction in blood pressure) D. Worsening bronchoconstriction A nonselective beta agonist activates both beta 1 and beta 2 receptors. Beta 1 activation causes an increase in heart rate (tachycardia), contractility, and subsequent increase in blood pressure. It relieves bronchoconstriction because of the beta 2 receptor activation.

An elderly patient is brought to the emergency room with a blood pressure of 76/60 mmHg, tachycardia, and low cardiac output. He is diagnosed with acute heart failure. Which of the following drugs is most appropriate to improve his cardiac function? A. Epinephrine B. Fenoldopam C. Dobutamine D. Isoproterenol

An elderly patient is brought to the emergency room with a blood pressure of 76/60 mmHg, tachycardia, and low cardiac output. He is diagnosed with acute heart failure. Which of the following drugs is most appropriate to improve his cardiac function? A. Epinephrine B. Fenoldopam C. Dobutamine D. Isoproterenol Among the choices, the ideal drug to increase contractility in acute heart failure is dobutamine, since it is a selective beta 1-adrenergic agonist. Fenoldopam is a dopamine agonist used to treat severe hypertension. The other drugs are nonselective adrenergic agonists that could cause unwanted side effects.

Which of the follow adrenergic drugs is used in the treatment of overactive bladder? A. Epinephrine B. Dobutamine C. Phenylephrine D. Mirabegron

Which of the follow adrenergic drugs is used in the treatment of overactive bladder? A. Epinephrine B. Dobutamine C. Phenylephrine D. Mirabegron Detrusor muscles in the urinary bladder wall have B3 receptors. Stimulation of these receptors relaxes the urinary bladder wall and relieves overactive bladder. Mirabegron is a B3 agonist and therefore used in treating overactive bladder. None of the other drugs listed have B3 agonist activity.

Which of the following adrenergic agonists is commonly present in nasal sprays available over-the-counter (OTC) to treat nasal congestion? A. Clonidine B. Albuterol C. Oxymetazoline D. Formoterol

Which of the following adrenergic agonists is commonly present in nasal sprays available over-the-counter (OTC) to treat nasal congestion? A. Clonidine B. Albuterol C. Oxymetazoline D. Formoterol

Which of the following classes of adrenergic agents has utility in the management of hypertension? A. Alpha 1 agonist B. Alpha 2 agonist C. Beta 1 agonist D. Beta 3 agonist

Which of the following classes of adrenergic agents has utility in the management of hypertension? A. Alpha 1 agonist B. Alpha 2 agonist C. Beta 1 agonist D. Beta 3 agonist Alpha 2 agonist activate alpha 2 receptors located in the presynaptic terminal of sympathetic neurons and cause a reduction in the release of norepinephrine from sympathetic nerve terminals. This leads to a reduction in blood pressure. Alpha 2 agonists such as clonidine and methyldopa are therefore used as antihypertensive agents. Alpha 1 agonists cause vasoconstriction, and Beta 1 agonists cause increased cardiac output and renin release, so these agents may increase blood pressure. Beta 3 agonists are not used in the management of hypertension.

Which of the following is correct regarding adrenergic neurotransmission? A. Norepinephrine is the major neurotransmitter released from sympathetic nerve terminals. B. Norepinephrine is mainly released from the adrenal glands. C. Tricyclic antidepressants and cocaine prevent the release of norepinephrine from the nerve terminals. D. Monoamine oxidase (MAO) converts dopamine to norepinephrine in the nerve terminal.

Which of the following is correct regarding adrenergic neurotransmission? A. Norepinephrine is the major neurotransmitter released from sympathetic nerve terminals. B. Norepinephrine is mainly released from the adrenal glands. C. Tricyclic antidepressants and cocaine prevent the release of norepinephrine from the nerve terminals. D. Monoamine oxidase (MAO) converts dopamine to norepinephrine in the nerve terminal. Norepinephrine (NE) is the major neurotransmitter released from sympathetic nerve terminals. Epinephrine, not norepinephrine, is mainly released from the adrenal glands. Tricyclic antidepressants (TCAs) and cocaine inhibit the reuptake of norepinephrine into the sympathetic nerve terminals, but they do not prevent the release of NE. Dopamine is converted to norepinephrine by dopamine B-hydroxylase, not by MAO.

Which of the following is correct regarding responses mediated by adrenergic receptors? A. Stimulation of alpha 1 receptors increases blood pressure B. Stimulation of sympathetic presynaptic alpha 2 receptors increases norepinephrine release C. Stimulation of beta 2 receptors increases heart rate (tachycardia) D. Stimulation of beta 2 receptors causes bronchoconstriction

Which of the following is correct regarding responses mediated by adrenergic receptors? A. Stimulation of alpha 1 receptors increases blood pressure B. Stimulation of sympathetic presynaptic alpha 2 receptors increases norepinephrine release C. Stimulation of beta 2 receptors increases heart rate (tachycardia) D. Stimulation of beta 2 receptors causes bronchoconstriction Stimulation of alpha 1 receptors, mostly found in the blood vessels, causes vasoconstriction and an increase in blood pressure. Stimulation of alpha 2 receptors on the sympathetic presynaptic terminal reduces the release of norepinephrine. Beta 2 receptors are not found in the heart, so activation of beta 2 receptors does not affect heart rate. Stimulation of beta 2 receptors found in the bronchial tissues causes bronchodilation, not bronchoconstriction.