Autonomic Drugs

Question 1

These receptors are found on smooth muscles and cause vasoconstriction

Answer 1

A1

Question 2

These receptors are found on nerve terminals, and inhibit release of neurotransmitters.

Answer 2

A2

Question 3

These receptors are found in the heart, and increases heart rate and contractility

Answer 3

B1

Question 4

These receptors are found on respiratory smooth muscles and the uterus. Its actions include bronchodilation and vasodilation.

Answer 4

B2

Question 5

These receptors are found in splanchnic and renal vessels, and are responsible for vasodilation of renal blood vessels.

Answer 5

D1

Question 6

These receptors are found in the nerve terminals of the CNS, and functions to regulate neurotransmitters.

Answer 6

D2

Question 7

These muscarinic Gq-coupled receptors are found in the CNS, and stimulates the IP3, DAG cascade.

Answer 7

M1

Question 8

These muscarinic Gi-coupled receptors are found in the heart, and functions to decrease cAMP and activate K channels.

Answer 8

M2

Question 9

These muscarinic Gq-coupled receptors are found in the smooth muscles of the GI, GU, respiratory tract, and eyes. It triggers the IP3, DAG cascade. It promotes GUT and GIT peristalsis, bladder contraction, bronchoconstriction, and pupillary constriction.

Answer 9

M3

Question 10

These nicotinic receptors are found in the ANS ganglia, and its function include depolarization to evoke action potential.

Answer 10

Nn (or N2) receptors

Question 11

These nicotinic receptors are found in the neuromuscular end plate, and functions to depolarize and evoke action potentials through sodium ion channels.

Answer 11

Nm (or N1) receptors

Question 12

What are the spinal roots of origin of the PANS?

Answer 12

“SS 1973”

Sacral segments of the Spinal cord

CN 10, 9, 7, and 3

Question 13

What is the rate limiting step in the synthesis of acetylcholine

Answer 13

Uptake of choline

Question 14

What inhibits choline transport?

Answer 14

Hemicholinium

Question 15

The active transport of acetylcholine into vesicles for storage by vesicles-associated transporter (VAT) is inhibited by what drug?

Answer 15

Versamicol

Question 16

This toxin alters synaptobrevins to prevent release of acetylcholine

Answer 16

Botulinum

Question 17

These inhibit the degradation of acetylcholine into choline and acetate by acetylcholinesterase.

Answer 17

Indirect-acting cholinomimetics

Examples: Neostigmine, Carbamates, and Organophosphates

Question 18

Used for bowel and bladder atony

Answer 18

Bethanicol

Question 19

Used for Sjogren syndrome (xerostomia, xerophthalmia, and rheumatoid arthritis)

Answer 19

Pilocarpine

Question 20

Used for the diagnosis of myasthenia gravis, and to differentiate myesthenic and cholinergic crisis.

Answer 20

Edrophonium (Tensilon Test)

Question 21

Treatment of myesthenia gravis

Answer 21

Neostigmine (indirect-acting cholinomimetic)

Pyridostigmine (longer duration)

Question 22

Reversal of nondepolarizing neuromuscular block

Answer 22

Neostigmine

Question 23

Treatment of glaucoma

Answer 23

Physostigmine

Question 24

Diagnosis of bronchial hyperreactivity

Answer 24

Methacholine

Question 25

Treatment of Alzheimer's disease

Answer 25

Rivastigmine, galantamine, donepezil, tacrine

Question 26

Autoimmune destruction of nicotinic acetylcholine receptors at motor end plate characterized by fluctuating muscle weakness

Answer 26

Myesthenia gravis

Question 27

Myesthenic crisis or cholinergic crisis? Acute worsening of symptoms due to infection, stress, or undermedication

Answer 27

Myesthenic crisis

Question 28

Myesthenic crisis or cholinergic crisis? Excessive activation of cholinoreceptors (skeletal muscle weakness and parasympathetic signs) due to over medication

Answer 28

Cholinergic crisis

Question 29

How does edrophonium differentiate myesthenic crisis from cholinergic crisis?

Answer 29

Increased muscle strength in myesthenic crisis. Worsens muscle strength in cholinergic crisis.

Question 30

Small cell cancer may present with a myesthenia-like paraneoplastic syndrome called ________________.

Answer 30

Lambert Eaton myesthenic syndrome

Question 31

Signs and symptoms of organophosphate poisoning or cholinergic overdose.

Answer 31

"DUMBBEELSS" ``` Diarrhea Urination Miosis Bronchospasm Bradycardia Excitation (skeletal muscle and CNS) Emesis Lacrimation Salivation Sweating ```

Question 32

Induction of mydriasis and cycloplegia

Answer 32

Tropicamide, Homatropine, Scopolamine, Cyclopentolate

Question 33

Indicated for sinus bradycardia (EXCEPT in infants, and in patients with BPH or acute angle closure glaucoma)

Answer 33

Atropine

Question 34

Treatment for Parkinson's disease

Answer 34

" TRI to park your BENZ, BIP here." Trihexyphenidyl Benztropine Biperiden

Question 35

Used for chronic obstructive pulmonary disease

Answer 35

Ipratropium

Question 36

Used for motion sickness or sea sickness

Answer 36

Scopolamine

Question 37

Used to treat gastrointestinal spasms by competitively blocking M3 receptors.

Answer 37

Dicylomine, Hyoscamine, Glycopyrrolate

Question 38

Treatment for organophosphate poisoning/nerve gas poisoning

Answer 38

Atropine + Pralidoxime (cholinesterase regenerator; useful before 6-8 hours have elapsed from exposure)

Question 39

Why is Ipratropium the preferred bronchodilator in patients with comorbids COPD and heart disease?

Answer 39

Less likely to cause tachycardia and cardiac arrthymias

Question 40

What are the signs of atropine (anticholinergic) toxicity?

Answer 40

``` Hot as a hare Dry as a bone Red as a beet Blind as a bat Mad as a hatter ```

Question 41

DOC for anaphylactic shock. Used as an adjunct to local anesthesia. Used in cardiac arrest, and croup.

Answer 41

Epinephrine

Question 42

Used in acute CHF, cardiac stress testing, B1 receptor agonist

Answer 42

Dobutamine

Question 43

Used in acute CHF, cardiogenic and septic shock.

Answer 43

Dopamine

Question 44

Drug of last resort for shock

Answer 44

Norepinephrine

Question 45

Used for nasal congestion, mydriasis without cycloplegia

Answer 45

Phenylephrine

Question 46

Its side effect include rebound hypertension upon discontinuation

Answer 46

Clonidine

Question 47

SE: hemolytic anemia (positive Coombs test)

Answer 47

Methyldopa

Question 48

Used for bronchial asthma

Answer 48

Salbutamol

Question 49

Used for tocolysis

Answer 49

Terbutaline, Ritodrine

Question 50

Used for the preoperative treatment of pheochromocytoma

Answer 50

Phenoxybenzamine

Question 51

Used for treatment of rebound hypertension

Answer 51

Phentolamine

Question 52

Used for benign prostatic hyperplasia. | SE: first dose orthostatic hypotension

Answer 52

Prazosin

Question 53

Used for angina prophylaxis, hyperthyroidism, masks hypoglycemia in diabetics

Answer 53

Propranolol

Question 54

SE: Bronchospasm, erectile dysfuction

Answer 54

Propanolol

Question 55

Intrinsic sympathomimetic activity

Answer 55

Pindolol, Acebutolol

Question 56

Displays beta-1 selectivity

Answer 56

Atenolol

Question 57

Used for treatment of glaucoma

Answer 57

Timolol

Question 58

Combined alpha and beta blockade

Answer 58

Carvedilol, Labetalol

Question 59

Used for BP control in pheochromocytoma

Answer 59

Phenoxybenzamine, Phentolamine, Labetalol

Question 60

What is the advantage of alpha-1 selectivity?

Answer 60

Less severe and less common reflex tachycardia

Question 61

Beta blocker with the shortest half-life

Answer 61

Esmolol

Question 62

Beta blocker with the longest half-life

Answer 62

Nadolol

Question 63

Used for smoking cessation

Answer 63

Varenicline (Direct-acting, nicotinic cholinomimetic)

Question 64

Competitively blocks all muscarinic receptors.

Answer 64

Atropine

Question 65

Antidote for organophosphate poisoning and nerve gas poisoning.

Answer 65

Pralidoxime

Question 66

Competitively blocks Nn nicotinic Ach receptors Used in hypertension (obsolete) and hypertensive emergencies SE: Postural hypotension, dry mouth, blurred vision, constipation, sexual dysfunction

Answer 66

Hexamethonium, Trimethaphan (Cholinergic nicotinic antagonist)

Question 67

Rate limiting step of norepinephrine synthesis

Answer 67

Hydroxylation of tyrosine to DOPA by tyrosine hydroxylase

Question 68

Hydroxylation of tyrosine to DOPA is inhibited by __________.

Answer 68

Metyrosine

Question 69

Vesicular transport of dopamine is inhibited by _________.

Answer 69

Reserpine

Question 70

Entry of calcium to trigger interaction among SNARE proteins is inhibited by ____________.

Answer 70

Guanethidine

Question 71

Entry of calcium to trigger interaction among SNARE proteins is promoted by ____________.

Answer 71

Amphetamines and Tyramine

Question 72

Diffusion and reuptake via NET and DAT in synaptic clefts are inhibited by ___________.

Answer 72

Cocaine and TCAs

Question 73

Transport of NE and dopamine into vesicles is inactivated by _____________ in the cytoplasm.

Answer 73

Monoamine oxidase and COMT

Question 74

Dopamine dose to cause: - Vasodilation in splanchnic and renal vasculature via D1 receptors - Increased renal blood flow and urine output

Answer 74

Low dose (1-5 mcg/kg/min)

Question 75

Dopamine dose to cause: | - Increased renal blood flow, heart rate, cardiac contractility, and cardiac output via B1 receptors

Answer 75

Medium dose (5-15 mcg/kg/min)

Question 76

Dopamine dose to cause: | - Vasoconstriction and increased blood pressure via alpha receptors

Answer 76

High dose (>15 mcg/kg/min)

Question 77

Treatment of glaucoma | Causes ciliary muscle contraction, opening of trabecular mesh work, and increases outflow

Answer 77

Pilocarpine, physostigmine

Question 78

Treatment of glaucoma | Increased outflow through canal of Schlemm

Answer 78

Latanoprost (Prostaglandin)

Question 79

Treatment of glaucoma | Increased outflow via uveoscleral veins

Answer 79

Epinephrine (Nonselective alpha-agonist)

Question 80

Treatment of glaucoma | Decreased aqueous humor secretion from the ciliary epithelium

Answer 80

Timolol (beta blocker), Mannitol (osmotic agent), Apraclonidine (A2 agonists), Acetazolamide and Dorzolamide (carbonic anhydrase inhibitor)