ANS

Question 1

Direct Parasympathomimetic (Receptor binding)

Answer 1

Pilocarpine

Question 2

Indirect Parasympathomimetic (Reversible ACh esterase inhibitors)

Answer 2

Neostigmine
Pyridostigmine
Physostigmine
Edrophonium

Question 3

Indirect Parasympathomimetic (Irreversible ACh esterase inhibitors)

Answer 3

Organophosphates
Parathion
Malathion
Soman, Sarin

Question 4

Toxic Parasympathomimetic

Answer 4

Organophosphates
Parathion
Malathion

Question 5

Cholinergic Toxidrome (8)

Answer 5

Sweating, Vomiting
Crying, diarrhea
Runny nose, urination
Frothing at mouth, bradycardia

Question 6

Antidote for Cholinergic Toxidrome

Answer 6

Atropine

Pralidoxime

Question 7

Adverse effects of Cholinergic agonists

Answer 7

Salivation
Diaphoresis (Sweating)
Nausea
Miosis
Urinary urgency

Question 8

Pilocarpine Indication and route administration

Answer 8

Glaucoma

Topical administration

Question 9

Neostigmine
MOA:
Indication:
S/E:
Administration:

Answer 9

MOA: Reversible ACh-esterase inhibitor
Indications: Myasthenia gravis mx, Reverse NMS blockers
S/E: Diarrhea, salivation+sweating, bradycardia, bronchospasm
Administration: IM, SC, IV, DoA 2-4hrs

Question 10

Pyridostigmine
MOA
Indications
S/E
Administration

Answer 10

MOA: Reversible ACh-esterase inhibitor
Indications: Chronic myasthenia gravis
S/E: Diarrhea, salivation+sweating, bradycardia, bronchospasm
Administration: Oral, DoA 3-6hrs

Question 11

Edrophonium
MOA:
Indications:
S/E:
Administration:

Answer 11

MOA: Short acting reversible ACh-esterase inhibitor
Indications: Myasthenia gravis diagnosis
S/E: Diarrhea, sweating+salivation
Administration: Injection

Question 12

Tacrine, Donepezil, Rivastigmine, Galantamine
MOA:
Indications:
S/E:

Answer 12

MOA: Reversible ACh-esterase inhibitor
Indications: Alzheimer’s disease
S/E: hepatotoxicity, GI distress

Question 13

It is safe to use Neostigmine and Pyridostigmine with intestinal or urinary obstruction.

Answer 13

NO, is contraindicated in urinary and intestinal obstruction.

Question 14

Activating Muscarinic receptors results in?

Answer 14

Miosis (pupil constriction)
Decreased heart rate
Bronchial constriction
GI motility
Relaxation of sphincters
Increased secretions

Question 15

Tensilon test is used for?

Answer 15

Diagnosis of Myasthenia gravis

Question 16

Parasympatholytic drugs (Anticholinergics)

Answer 16

Atropine
Ipratropium
Scopolamine
Cyclopentolate

Question 17

Antimuscarinics effects

Answer 17

Mydriasis (dilation of pupils)
Reduced sweating
Reduced GI motility and secretions
Increased heart rate
Bronchodilation
Urinary retention
Drowsiness

Question 18

Indications for antimuscarinics

Answer 18

Parkinsons
Motion sickness
COPD
Urinary disorder
Cholinergic disorders

Question 19

Atropine
MOA:
Indications:
S/E:
Administration:

Answer 19

MOA:
Indications: Refractive errors in eyes, Antispasmodic in GI, Anti secretory, bradycardia, Antidote for organophosphate poisoning
S/E: Dry mouth, blurred vision, tachycardia, constipation, urinary retention
Administration: Oral DoA 4hrs

Question 20

Adverse effects of antimuscarinics

Answer 20

Blurry vison, urinary retention, constipation, tachycardia, drowsiness

Question 21

Scopolamine
S/E:
Indications:
Administration:

Answer 21

Indications: Motion sickness prevention, post op vomiting and nausea
Administration: Motion sickness - patch, Post op - IM
S/E: Sedation, delirium

Question 22

GIT - Hyoscine/butylbromide
Indications
S/E
Administration

Answer 22

Indications: IBS, antispasmodic
S/E: Tachycardia, confusion, urinary retention
Administration: oral, IV, IM, SC

Question 23

Secretory - Glycopyrrolate
Indications
Administration

Answer 23

Indications: Drooling, Pre-op - decrease secretions
Administration: IV, Inhaler

Question 24

Respiratory - Ipratropium bromide, Tiotropium, Glycopyrrolate
Indications
S/E
Administration

Answer 24

Indications: Asthma, COPD
S/E: Cough
Administration: inhaler

Question 25

Ophthalmology - Atropine (see notes), Tropicamide, Cyclopentolate Indications S/E Administration

Answer 25

Indications: Retinal exam, Produce pupil dilation S/E: Increased intraocular pressure Administration: Eye drops

Question 26

Trihexyphenidyl biperiden Indications S/E Administration

Answer 26

Indications: Parkinsons Administration: Oral, IV, IM

Question 27

Urinary incontinence - Oxybutinin, Darifenacin Indications S/E Administration

Answer 27

Indications: Enuresis S/E: dry mouth, palpitations, constipation, confusion Administration: Oral

Question 28

Adrenergic receptor types (Norepinephrine)

Answer 28

a1 b1 a2 b2 a3 b3

Question 29

Sweat glands are stimulated by NE

Answer 29

False, sweat glands are innervated in the SNS by ACh

Question 30

Catechol-o-methyl transferase (COMT) and monoamine oxidase (MOA) metabolizes which neurotransmitters?

Answer 30

Norepinephrine and Epinephrine

Question 31

Indirect acting adrenergic agonists directly bind to the receptors (True or false)

Answer 31

False direct acting adrenergic agonists bind directly receptors and indirect acting adrenergic agonists inhibits enzymes or inhibits uptake or causes release of neurotransmitters.

Question 32

a1 receptors are located in cardiac tissue

Answer 32

False, a1 receptors are found in vascular smooth muscle and the eye. B1 receptors can be found in cardiac tissue.

Question 33

a2 receptors when binding to a agonist causes NE release

Answer 33

False, inhibits NE release

Question 34

B2 have a increased affinity for Epinephrine compared to NE

Answer 34

True

Question 35

B2 receptors are located in the....

Answer 35

Respiratory tract Uterus Vsm Liver

Question 36

Function of ... when agonist binds a1 b1 b2

Answer 36

a1 - agonist causes smooth muscle contraction b2 - agonist binding increases heart rate b2 - agonists bind to receptor in respiratory and uterine smooth muscle causing relaxation. Also causes vasodilation.

Question 37

Location of a1 receptors

Answer 37

Vascular smooth muscle Pupillary dilation muscles Prostate Heart

Question 38

Location of a2 receptors

Answer 38

Post synaptic CNS receptors Some vascular smooth muscle Fat cells

Question 39

Location of B1 receptors

Answer 39

Heart | Juxtaglomerular

Question 40

Location of B2 receptors

Answer 40

Respiratory tract Uterine wall vascular smooth muscle

Question 41

Location of B3 receptors

Answer 41

Fat cells

Question 42

``` Epinephrine: Target receptors and affinity Indications Contraindications Administration A/E ```

Answer 42

Target receptors and affinity: a + B Indications: Anaphylaxis, cardiac arrest Contraindications: Tachyarrhythmias, Pheochromocytoma Administration: IM, IV, SC A/E: Angina, hypertension, ventricular arrythmias, peripheral vasoconstriction

Question 43

``` Phenylephrine Target receptors and affinity Indications Contraindications Administration A/E ```

Answer 43

Target receptors and affinity: a1 (increases BP + vasoconstriction) Indications: Nasal decongestant, Hypotension, Mydriatic eye exams Contraindications: Administration: IV, Oral, Topical

Question 44

``` Oxymetazoline, Xylometazoline Target receptors and affinity Indications Contraindications Administration A/E ```

Answer 44

``` Target receptors and affinity: a1 Indications: Nasal decongestant Contraindications: Administration: Topical A/E: Hypertension ```

Question 45

Clonidine Target receptor Indications

Answer 45

Target receptors: a2 | Indications: Migraine prophylaxis

Question 46

a-methyldopa Target receptor Indications

Answer 46

Target receptor: a2 | Indications: Hypertension in pregnancy

Question 47

Dopamine MOA Indications

Answer 47

MOA: Dose dependent, High dose - B1, Large dose - a1 Indications: Cardiogenic or septic shock, acute hypotension, heart failure

Question 48

Dobutamine Target receptor Indications

Answer 48

Target receptors: B1 | Indications: Acute myocardial infarct

Question 49

Direct B2 agonists (7)

Answer 49

``` Salbutamol (S) Fenoterol (S) Terbutaline (S) Salmetarol (L) Formoterol (L) Indicatarole (UL) Vilanterol (UL) ```

Question 50

Direct B2 agonists MOA Indications Administration

Answer 50

MOA: B2 receptor agonist Indications: Asthma, COPD Administration: Inhaler