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Pharm Exam 3 > Expanded ANS powerpoint > Flashcards

Expanded ANS powerpoint Flashcards

1
Q

Which of the following statements concerning neuro- transmission in the autonomic nervous system is TRUE?

A. Norepinephrine and epinephrine are the major neurotransmitters in the ANS.

B. Sympathetic nervous system is essential for life.

C. Heart rate is under predominant control of the sympathetic nervous system.

D. Most organs are innervated by both branches.

A

D. Most organs are innervated by both branches.

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2
Q

Public health officials reported that suspected contaminated heroin putting users at risk in L.A. “… the illness includes symptoms including drooping eyelids, blurred vision, and trouble breathing.” These symptoms are most consistent with contamination from:

Fentanyl
Methamphetamine
Belladonna alkaloids
Clostridium botulinum
Clostridium tetani
A

Clostridium botulinum

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3
Q

A neurophysiology expert is teaching his students the physiology of the neuromuscular junction. While describing the sequence of events that takes place at the neuromuscular junction, he mentions that as the action potential travels down the motor neuron and causes depolarization of the presynaptic membrane. This results in the opening of voltage-gated calcium channels, which leads to an influx of calcium into the synapse of the motor neuron. Consequently, the cytosolic concentration of Ca2+ ions increases. Which of the following occurs at the NMJ as a result of this increase in cytosolic Ca2+?

A. Release of Ca2+ ions into the synaptic cleft

B. Increased Na+ and K+ conductance of the motor end plate

C. Exocytosis of acetylcholine from the synaptic vesicles

D. Generation of an end plate potential

A

C. Exocytosis of acetylcholine from the synaptic vesicles

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4
Q

The most common mechanism of action for indirect-acting cholinergic agonists is:

A. Inhibition of acetylcholine metabolism in the presynaptic neuron

B. Inhibition of acetylcholine reuptake from the synapse into the presynaptic neuron

C. Inhibition of acetylcholine metabolism in the synapse

D.Enhancement of acetylcholine release from presynaptic neurons

A

C. Inhibition of acetylcholine metabolism in the synapse

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5
Q

Activation of which of the following peripheral nervous system receptor subtypes is most commonly associated with smooth muscle contraction?

alpha-1
beta-1
M2
NM

A

alpha-1

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6
Q

A 48-year-old man is unable to pass urine after undergoing open abdominal surgery. His physical examination and imaging findings suggest that the cause of his urinary retention is non-obstructive and is most probably due to urinary bladder atony. He is prescribed a muscarinic (M3) receptor agonist, which improves his symptoms. Which of the following is most likely involved in the mechanism of action of this new drug?

A. Inhibition of adenylyl cyclase

B. Inhibition of guanylyl cyclase

C. Increased transmembrane K+ conductance

D.Activation of phospholipase C

A

D. Activation of phospholipase C

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7
Q

Select the TRUE statement concerning neurotransmission in the peripheral nervous system:

A. NE activation of α2 adrenergic receptors on cholinergic neurons in the GI tract will increase ACh release.

B. NE activation of α2 adrenergic receptors on adrenergic neurons in cardiac tissue will increase NE release.

C. ACh activation of NN receptors on the adrenal gland causes release of epinephrine.

D. Prolonged stimulation of M receptors can lead to a depolarization blockade.

A

C. ACh activation of NN receptors on the adrenal gland causes release of epinephrine.

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8
Q

Which of the following organs or organ systems has M receptors present, but lacks cholinergic innervation?

Blood vessels (resistance)
Eye
Urinary bladder muscle
Lungs

A

Blood vessels (resistance)

notes: when you stimulate the PNS you wont cause skeletal muscle effects (it’s only on SMOOTH muscle)

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9
Q

Parasympathetic nerve stimulation and a slow infusion of bethanechol will both:

A. Cause ganglion cell depolarization

B. Cause skeletal muscle end plate depolarization

C. Cause vasodilation in resistance vessels

D. Increase bladder muscle tone

A

D. Increase bladder muscle tone

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10
Q

Which of the following drugs causes vasodilation that can be blocked by atropine?

Doxazosin
Labetalol
Nitroglycerin
Bethanechol

A

Bethanechol

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11
Q

A 30-year-old man had been treated with several ANS drugs for 4 weeks. He is now admitted to the ED showing signs of drug toxicity. Which of the following signs would distinguish between an overdose of a ganglionic blocker versus a muscarinic blocker?

Dry mouth
Hypotension
Mydriasis
Tachycardia

A

hypotension

Notes: Ganglionic blockers are NO LONGER made . Ganglionic block both SNs and PNS

SNS –is vessel constriction– can cause hypotension

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12
Q

Bethanechol (Urecholine):

A. Is an indirect-acting cholinergic agonist

B. Is an alkaloid with significant effects in the CNS

C. Has greater affinity for muscarinic receptors than nicotinic receptors

D. All of the above

A

C. Has greater affinity for muscarinic receptors than nicotinic receptors

(Bethanechol- is a muscarinc agonist )

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13
Q

Direct-acting parasympathetic agonists are used in thetreatment of:

Asthma
Glaucoma
Diarrhea
Bradycardia

A

Glaucoma

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14
Q

Select the optimal drug action to increase GI motility in patients with paralytic ileus

Alpha-1 adrenergic antagonist
Muscarinic agonist
Beta-2 adrenergic agonist
Muscarinic antagonist

A

Muscarinic agonist

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15
Q

A cholinesterase inhibitor such as physostigmine would be expected to exert its actions at all the following sites EXCEPT:

A. Postganglionic PNS synapses in the heart

B. Postganglionic SNS synapses in the vasculature

C. Nicotinic receptors in the CNS

D. Nicotinic receptors at sympathetic ganglia

A

B. . Postganglionic SNS synapses in the vasculature

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16
Q

The doctors did their best to save the children but there was so much poison in their food that the doctors couldn’t save them all,” Sinha told NDTV news channel. June 2013

“The children came back crying from school and complained of stomach ache after having dhal, rice and vegetables. We went to the school to find out and saw many children lying sick,” he told Indian TV.

As soon as my son returned from school, we rushed to the hospital with him. His condition was not good. He was vomiting and said his stomach was hurting,” one parent told the Indian broadcaster CBN-IBN.

Early tests showed that the food at the school may have been contaminated with pesticides used on rice and wheat crops in the area. Staff stopped serving the meal after children began vomiting.

These symptoms are most likely mediated by which receptor action?

Nicotinic neuronal agonist
Nicotinic neuronal antagonist
Muscarinic antagonist
Muscarinic agonist
Muscarinic antagonist
A

Muscarinic agonist

17
Q

Lethal Exposures - AChEIs
Initial signs –> muscarinic excess and double vision (via NMJ block)

“BB-SLUDGE” for muscarinic receptor signs:

A

B - Bradycardia
B - Bronchospasm

S - Salivation		
L - Lacrimation	
U - Urination		
D - Defecation 
G - GI cramping
E - Emesis, Eye (miosis)

With toxic exposures muscarinic signs of bradycardia and hypotension predominate—>require emergent treatment

18
Q

Anticholinergic Side Effects

A
  • no spit
  • no shit –constipation
  • no see
  • no pee (urinary retention)
19
Q

Select the optimal drug action for relief of overactive bladder:

A. Alpha-1 adrenergic antagonist

B. Beta-3 adrenergic agonist (Mirabegron-Myrbetriq®)

C. Muscarinic antagonist

D.Muscarinic agonist

A

C. Muscarinic antagonist

20
Q

Physiology of Urination;

  • GO=
  • STOP=
A

GO: Stimulate M – block α1

STOP: Block M or stimulate α1 - β2-3

21
Q

Therapeutic uses of muscarinic receptor antagonists include all of the following EXCEPT:

A. Treatment of Parkinson’s disease

B. Prevention of motion sickness

C. Treatment of asthma and COPD

D.Treatment of narrow angle glaucoma

A

D.Treatment of narrow angle glaucoma

22
Q

All of the following side effects are associated with drugs that block muscarinic receptors EXCEPT:

Delirium
Increased stomach acidity
Dry Mouth
Urinary retention

A

increased stomach acidity

23
Q

Select the optimal receptor action for producing mydriasis and cycloplegia for eye exams

Alpha-1 adrenergic agonist
Beta-2 adrenergic agonist
Muscarinic antagonist
Muscarinic agonist

A

Muscarinic antagonist

24
Q

Select the optimal receptor action for producing mydriasis without cycloplegia for eye exams

Alpha-1 adrenergic agonist
Beta-2 adrenergic agonist
Muscarinic antagonist
Muscarinic agonist

A

Alpha-1 adrenergic agonist

25
Q

Block of Muscarinic Receptor Tone:

  • at the lungs?
  • eye?
  • GU tract?
  • GI tract?
A

Lungs: Relaxation of bronchiolar smooth muscle –>bronchodilation

Eye: Mydriasis and paralysis of accommodation (cycloplegia) –> blurred vision, increased IOP

Genitourinary tract: Relaxation of ureters and bladder wall muscle –> urinary retention

Gastrointestinal tract: Reduced gastrointestinal motility–> constipation

Pharm Exam 3 (2 decks)

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