AccessMed Exam 2
The first animal has received no pretreatment (control) -> INC HR, the second has received an effective dose of a long-acting ganglion blocker -> DEC HR, and the third has received an effective dose of a long-acting muscarinic antagonist -> NC. Drug Y is probably a drug similar to Acetylcholine Edrophonium Hexamethonium Nicotine Pralidoxime
Acetylcholine
Which one of the following is the primary neurotransmitter agent normally released in the sinoatrial node of the heart in response to a blood pressure increase? Acetylcholine Dopamine Epinephrine Glutamate Norepinephrine
Acetylcholine
Four new synthetic drugs (designated W, X, Y, and Z) are to be studied for their cardiovascular effects. They are given to 4 anesthetized animals while the heart rate is recorded. The first animal has received no pretreatment (control); the second has received an effective dose of hexamethonium; the third has received an effective dose of atropine; and the fourth has received an effective dose of phenoxybenzamine. The net changes induced by W, X, Y, and Z in the animals are described in the following questions. The results of the test of drug Z are shown in the graph. Drug Z is probably a drug similar to Acetylcholine Edrophonium Isoproterenol Norepinephrine Pralidoxime
Acetylcholine (Drug Z causes tachycardia that is converted to bradycardia by hexamethonium and blocked completely by atropine. This indicates that the tachycardia is a reflex evoked by muscarinic vasodilation. Drug Z causes bradycardia when the ganglia are blocked, indicating that it also has a direct muscarinic action on the heart. This is confirmed by the ability of atropine to block both the tachycardia and the bradycardia)
Clinical studies have shown that adrenoceptor blockers have many useful effects in patients. However, a number of drug toxicities have been documented. Adverse effects that limit the use of adrenoceptor blockers include which one of the following? Bronchoconstriction (from α-blocking agents) Acute heart failure exacerbation (from β blockers) Impaired blood sugar response (with α blockers) Increased intraocular pressure (with β blockers) Sleep disturbances (from α-blocking drugs)
Acute heart failure exacerbation (from β blockers)
If the effector cell in the diagram is a pupillary dilator smooth muscle cell, which of the following receptor types is affected? Alpha 1 adrenoceptor Beta 1 adrenoceptor Beta 2 adrenoceptor M3 cholinoceptor
Alpha 1 adrenoceptor (nerves innervating the pupillary dilator muscle are postganglionic sympathetic adrenergic nerves. The pupillary constrictor muscle contains M3 cholinoceptors)
Which one of the following drugs causes vasodilation that can be blocked by atropine? Bethanechol Edrophonium Neostigmine Pralidoxime
Bethanechol
When given to a patient, phentolamine blocks which one of the following? Bradycardia induced by phenylephrine Bronchodilation induced by epinephrine Increased cardiac contractile force induced by norepinephrine Miosis induced by acetylcholine Vasodilation induced by isoproterenol
Bradycardia induced by phenylephrine
While playing in the garden, a 7-year-old boy is stung by 3 bees. Because he has a previous history of bee sting allergy, he is brought to the emergency department by his mother who is very concerned about a possible anaphylactic reaction. Which of the following are probable signs of an anaphylactic reaction to bee stings? Bronchodilation, tachycardia, hypertension, vomiting, diarrhea Bronchospasm, tachycardia, hypotension, laryngeal edema Diarrhea, bradycardia, vomiting Laryngeal edema, bradycardia, hypotension, diarrhea Miosis, tachycardia, vomiting, diarrhea
Bronchospasm, tachycardia, hypotension, laryngeal edema
Which of the following is an accepted therapeutic indication for the use of antimuscarinic drugs? Atrial fibrillation Botulinum poisoning Chronic obstructive pulmonary disease (COPD) Glaucoma Postoperative urinary retention
Chronic obstructive pulmonary disease (COPD)
A group of volunteers are involved in a phase 1 clinical trial of a new autonomic drug. When administered by intravenous bolus, the blood pressure increases. When given orally for 1 week, the blood pressure decreases. Which of the following standard agents does the new drug most resemble? Atropine Clonidine Phentolamine (an α blocker) Phenylephrine Propranolol (a β blocker)
Clonidine
Which of the following blocks the plasma transporter/ carrier? Amphetamine Botulinum toxin Cocaine Hemicholinium Reserpine
Cocaine
Which of the following is an expected effect of a therapeutic dose of an antimuscarinic drug? Decreased cAMP (cyclic adenosine monophosphate) in cardiac muscle Decreased DAG (diacylglycerol) in salivary gland tissue Increased IP3 (inositol trisphosphate) in intestinal smooth muscle Increased potassium efflux from smooth muscle Increased sodium influx into the skeletal muscle end plate
Decreased DAG (diacylglycerol) in salivary gland tissue (Muscarinic M1 and M3 receptors mediate increases in IP3 and DAG in intestine, salivary glands. M2 receptors, heart, mediate a decrease in cAMP and an increase in potassium permeability. Antimuscarinic agents block these effects)
Mr Green has just been diagnosed with dysautonomia (chronic idiopathic autonomic insufficiency). You are considering different therapies for his disease. Pyridostigmine and neostigmine may cause which one of the following in this patient? Bronchodilation Cycloplegia Diarrhea Irreversible inhibition of acetylcholinesterase Reduced gastric acid secretion
Diarrhea
Ms Brown, a 28-year-old accountant, has been treated for myasthenia gravis for several years. She reports to the emergency department complaining of recent onset of weakness of her hands, diplopia, and difficulty swallowing. She may be suffering from a change in response to her myasthenia therapy, that is, a cholinergic or a myasthenic crisis. Which of the following is the best drug for distinguishing between myasthenic crisis (insufficient therapy) and cholinergic crisis (excessive therapy)? Atropine Edrophonium Physostigmine Pralidoxime Pyridostigmine
Edrophonium
A new drug was given by subcutaneous injection to 25 normal subjects in a phase 1 clinical trial. The cardiovascular effects are summarized in the table below. Systolic BP INC, Diastolic BP INC, Cardiac output INC, Heart rate INC. Which of the following drugs does the new experimental agent most resemble? Atropine Epinephrine Isoproterenol Phenylephrine Physostigmine
Epinephrine
While playing in the garden, a 7-year-old boy is stung by 3 bees. Because he has a previous history of bee sting allergy, he is brought to the emergency department by his mother who is very concerned about a possible anaphylactic reaction. If this child has signs of anaphylaxis, what is the treatment of choice? Diphenhydramine (an antihistamine) Ephedrine Epinephrine Isoproterenol Methylprednisolone (a corticosteroid)
Epinephrine
Which of the following is the most dangerous effect of belladonna alkaloids in infants and toddlers? Dehydration Hallucinations Hypertension Hyperthermia Intraventricular heart block
Hyperthermia
Your 75-year-old patient with multiple comorbidities is to receive a β-blocking drug. For which of the following conditions are β-blocking drugs NOT indicated? Acute arrhythmias during surgery Atherosclerotic angina pectoris (angina of effort) Chronic heart failure Hypertension Hypoglycemia in diabetes
Hypoglycemia in diabetes
Which of the following is the primary second-messenger process in the contraction of the ciliary muscle when focusing on near objects? cAMP (cyclic adenosine monophosphate) DAG (diacylglycerol) Depolarizing influx of sodium ions via a channel IP3 (inositol 1,4,5-trisphosphate) NO (nitric oxide)
IP3 (inositol 1,4,5-trisphosphate)
JR, a 35-year-old farm worker, is admitted to the emergency department suffering from insecticide poisoning. Parathion has which one of the following characteristics? It is inactivated by conversion to paraoxon It is less toxic to humans than malathion It is more persistent in the environment than DDT It is poorly absorbed through skin and lungs If treated early, its toxicity may be partly reversed by pralidoxime
If treated early, its toxicity may be partly reversed by pralidoxime
Parasympathetic nerve stimulation and a slow infusion of bethanechol will each Cause ganglion cell depolarization Cause skeletal muscle end plate depolarization Cause vasodilation Increase bronchial smooth muscle tone Increase heart rate
Increase bronchial smooth muscle tone (Efferent fibers in the vagus may cause bronchoconstriction)
A 27-year-old compulsive drug user injected a drug he thought was methamphetamine, but he has not developed any signs of methamphetamine action. He has been admitted to the emergency department and antimuscarinic drug overdose is suspected. Probable signs of atropine overdose include which one of the following? Gastrointestinal smooth muscle cramping Increased heart rate Increased gastric secretion Pupillary constriction Urinary frequency
Increased heart rate
Full activation of the parasympathetic nerves is likely to produce which of the following effects? Bronchodilation Decreased intestinal motility Increased thermoregulatory sweating Increased pupillary constrictor tone (miosis) Increased heart rate (tachycardia)
Increased pupillary constrictor tone (miosis)
Several new drugs with autonomic actions were studied in preclinical tests in animals. Autonomic drugs X and Y were given in moderate doses as intravenous boluses. The systolic and diastolic blood pressures changed as shown in the diagram below. Which of the following drugs most resembles drug X (NC- systolic, decrease- distolic)? Bethanechol Epinephrine Isoproterenol Methacholine Phenylephrine
Isoproterenol (decrease in diastolic pressure suggests that the drug decreased vascular resistance, that is, it probably has significant muscarinic or β-agonist effects)
Four new synthetic drugs (designated W, X, Y, and Z) are to be studied for their cardiovascular effects. They are given to 4 anesthetized animals while the heart rate is recorded. The first animal has received no pretreatment (control); the second has received an effective dose of hexamethonium -> INC HR; the third has received an effective dose of atropine -> INC HR; and the fourth has received an effective dose of phenoxybenzamine -> INC HR. The net changes induced by W, X, Y, and Z in the animals are described in the following questions. Acetylcholine Edrophonium Isoproterenol Norepinephrine Prazosin
Isoproterenol (drug Y must have a direct β-agonist effect on the heart)
Actions and appropriate clinical uses of muscarinic cholinoceptor agonists include which one of the following? Bronchodilation (treatment of asthma) Miosis (treatment of narrow angle glaucoma) Decreased gastrointestinal motility (treatment of diarrhea) Decreased neuromuscular transmission and relaxation of skeletal muscle (during surgical anesthesia) Increased sweating (treatment of fever)
Miosis (treatment of narrow angle glaucoma)
A patient presents at the emergency department with threatened anaphylaxis. Respiratory obstruction appears likely if she is not treated immediately. Her past medical history includes hypertension, for which she is receiving an adrenoceptor blocker. The emergency physician plans to use epinephrine to treat her anaphylactic reaction. Which of the following effects of epinephrine would be blocked by prazosin but not by metoprolol? Cardiac stimulation Increase of cAMP (cyclic adenosine monophosphate) in fat cells Mydriasis Relaxation of bronchial smooth muscle Relaxation of the uterus
Mydriasis (Mydriasis caused by contraction of the pupillary dilator radial smooth muscle is mediated by α receptors. All the other effects listed are mediated by β receptors)
A 3-year-old child is admitted to the emergency department after taking a drug from her parents' medicine cabinet and swallowing multiple tablets. The signs suggest that the drug is a cholinomimetic with little or no vascular effect, little or no CNS effect, and a duration of action of about 2-4 h. Which of the following is the most likely cause of these effects? Acetylcholine Bethanechol Neostigmine Physostigmine Pilocarpine
Neostigmine
Four new synthetic drugs (designated W, X, Y, and Z) are to be studied for their cardiovascular effects. They are given to 4 anesthetized animals while the heart rate is recorded. The first animal has received no pretreatment (control); the second has received an effective dose of hexamethonium; the third has received an effective dose of atropine; and the fourth has received an effective dose of phenoxybenzamine. The net changes induced by W, X, Y, and Z in the animals are described in the following questions. Drug W increased heart rate in the control animal, the atropine-pretreated animal, and the phenoxybenzamine-pretreated animal. However, drug W had no effect on heart rate in the hexamethonium-pretreated animal. Drug W is probably a drug similar to Acetylcholine Edrophonium Isoproterenol Nicotine Norepinephrine
Nicotine
A 60-year-old woman was told she had hypertension and should be taking antihypertensive medication. She decides to take an herbal medication from an online "holistic pharmacy." One week after starting the medication, she is found unconscious in her apartment. In the emergency department, her blood pressure is 50/0 mm Hg and heart rate is 40 bpm. Respirations are 20/min; pupils are slightly constricted. Bowel sounds are present. Which of the following would be the most effective cardiovascular stimulant? Amphetamine Clonidine Isoproterenol Norepinephrine Tyramine
Norepinephrine
Four new synthetic drugs (designated W, X, Y, and Z) are to be studied for their cardiovascular effects. They are given to 4 anesthetized animals while the heart rate is recorded. The first animal has received no pretreatment (control); the second has received an effective dose of hexamethonium; the third has received an effective dose of atropine; and the fourth has received an effective dose of phenoxybenzamine. The net changes induced by W, X, Y, and Z in the animals are described in the following questions. No pretreatment ↓HR, Hexamethonium ↑HR, Atropine ↑HR, Phenoxybenzamine ↑HR. Drug X is probably a drug similar to Acetylcholine Albuterol Edrophonium Isoproterenol Norepinephrine
Norepinephrine
A 65-year-old woman with impaired renal function and a necrotic ulcer in the sole of her right foot is admitted to the ward from the emergency department. She has long-standing type 2 diabetes mellitus and you wish to examine her retinas for possible vascular changes. Which of the following drugs is a good choice when pupillary dilation—but not cycloplegia—is desired? Isoproterenol Norepinephrine Phenylephrine Pilocarpine
Phenylephrine
Mr Green, a 54-year-old banker, had a cardiac transplant 6 months ago. His current blood pressure is 120/70 mm Hg and heart rate is 100 bpm. Which of the following drugs would have the least effect on Mr Green's heart rate? Albuterol Epinephrine Isoproterenol Norepinephrine Phenylephrine
Phenylephrine
Mr Green, a 54-year-old banker, had a cardiac transplant 6 months ago. His current blood pressure is 120/70 mm Hg and heart rate is 100 bpm. Which of the following drugs would have the least effect on Mr Green's heart rate? Albuterol Epinephrine Phenylephrine Isoproterenol Norepinephrine
Phenylephrine
Several new drugs with autonomic actions were studied in preclinical tests in animals. Autonomic drugs X and Y were given in moderate doses as intravenous boluses. The systolic and diastolic blood pressures changed as shown in the diagram below. Which of the following drugs most resembles drug Y (INC- systolic, INC- distolic)? Bethanechol Epinephrine Isoproterenol Methacholine Phenylephrine
Phenylephrine
A 30-year-old man has been treated with several autonomic drugs for 4 weeks. He is now admitted to the emergency department showing signs of drug toxicity. Which of the following signs would distinguish between an overdose of a ganglion blocker versus a muscarinic blocker? Cycloplegia Dry skin in a warm environment Miosis Postural hypotension Tachycardia
Postural hypotension
Which one of the following drugs has a very high affinity for the phosphorus atom in parathion and is often used to treat life-threatening insecticide toxicity? Atropine Benztropine Bethanechol Neostigmine Pralidoxime
Pralidoxime
A 56-year-old man has hypertension and an enlarged prostate, which biopsy shows to be benign prostatic hyperplasia. He complains of urinary retention. Which of the following drugs would be the most appropriate initial therapy? Albuterol Atenolol Metoprolol Prazosin Timolol
Prazosin
A 3-year-old child has been admitted to the emergency department having swallowed the contents of 2 bottles of a nasal decongestant. The active ingredient of the medication is phenylephrine, a potent, selective α-adrenoceptor agonist drug. Which of the following is a sign of α-receptor activation that may occur in this child? Bronchodilation Cardiac acceleration (tachycardia) Pupillary dilation (mydriasis) Renin release from the kidneys Vasodilation and hypotension
Pupillary dilation (mydriasis)
Which of the following inhibits vesicle formation? Cocaine Dopamine Reserpine
Reserpine
A crop duster pilot has been accidentally exposed to a high concentration of a highly toxic agricultural organophosphate insecticide. If untreated, the cause of death from such exposure would probably be Cardiac arrhythmia Gastrointestinal bleeding Heart failure Hypotension Respiratory failure
Respiratory failure
Your 30-year-old patient has moderately severe new onset asthma, and you prescribe a highly selective β2 agonist inhaler to be used when needed. In considering the possible drug effects in this patient, you would note that β2 stimulants frequently cause Direct stimulation of renin release Hypoglycemia Itching due to increased cGMP (cyclic guanine monophosphate) in mast cells Skeletal muscle tremor Flushing due to vasodilation in the skin
Skeletal muscle tremor
Which one of the following can be blocked by atropine? Decreased blood pressure caused by hexamethonium Increased blood pressure caused by nicotine Increased skeletal muscle strength caused by neostigmine Tachycardia caused by exercise Sweating caused by exercise
Sweating caused by exercise
A 40-year-old man with a history of major depression is admitted to the emergency department following a suicide attempt with a drug overdose. Which of the following signs or symptoms would be consistent with an overdose of a ganglion-blocking drug? Increased blood pressure Increased bowel sounds Increased sweating Miosis Tachycardia
Tachycardia
Mr Blue is a 30-year-old man who uses amylnitrite to enhance penile erection. Amylnitrite is a powerful vasodilator that does not act on autonomic receptors. Which of the following effects will be observed if a very large dose is used? Tachycardia and increased cardiac contractility Tachycardia and decreased cardiac output Decreased mean arterial pressure and decreased cardiac contractility Decreased mean arterial pressure and increased salt and water excretion by the kidney Bradycardia and decreased cardiac contractility
Tachycardia and increased cardiac contractility
Which of the following is a direct-acting cholinomimetic that is lipid-soluble and is used to facilitate smoking cessation? Acetylcholine Bethanechol Neostigmine Physostigmine Varenicline
Varenicline
A 30-year-old woman undergoes abdominal surgery. In spite of minimal tissue damage, complete ileus (absence of bowel motility) follows, and she complains of severe bloating. She also finds it difficult to urinate. Mild cholinomimetic stimulation with bethanechol or neostigmine is often effective in relieving these complications of surgery. Neostigmine and bethanechol in moderate doses have significantly different effects on which one of the following? Gastric secretory cells Vascular endothelium Salivary glands Sweat glands Ureteral tone
Vascular endothelium
