Kruse CIS

Question 1

alpha 1 do what?

beta 2 do what?

muscarinic receptors do what?

Answer 1

stimulate contraction of all smooth muscle. vasoconstriction / secretion

relax smooth muscle - vasodilation

contract smooth muscle

Question 2

adult diapers and bladder training. symptoms are consistent with what division of the nervous system?

Answer 2

parasympathetic

Question 3

knowing someone is having trouble with urination, what is going to be administered to alleviate symptoms?

beta 2 receptor agonist
direct-acting cholinergic agonist
indirect-acting cholinergic agonist
muscarinic AchR antagonist
Nicotinic AChR

Answer 3

it has to be something sympathetic, so it’ll probably be inhibiting muscarinic AChR.

Muscarinic AChR antagonist.. they are causing contraction of smooth muscle. if we block that surrounding the bladder, it’ll increase volume of the bladder and decrease the frequency

Beta 2 relaxes smooth muscle.. IT’LL INCREASE BLADDER CAPACITY but it won’t work because it doesn’t inhibit bladder contraction

direct/indirect acting cholinergic agonists –> used for paralysis of the bladder during surgery.

nicotinic AChR antagonist –> no effect because not part of the parasympathetics.

Question 4

what works on the sphincters usually?

Answer 4

alpha 1

Question 5

How does activation of mAChRs cause trigone and sphincter relaxation?

what do they do though??

Answer 5

if we have acetylcholine and give it to the endothelial cells there is going to be vasodilation due to NO!

activating muscarinic in endothelial cells results in production of NO.

relaxation of the sphincter through muscarinic is due to NO.

contract smooth muscle!

Question 6

Oxybutinin – nonselective muscarinic antagonist..

what adverse effect could you have?

constipation
lacrimation
miosis
salivation
vomiting

Answer 6

blocking muscarinic which is responsible for parasympathetic.

parasympathetics are moving stuff through the GI so constipation is the answer.

Lacrimation = tears is PNS
Miosis = constriction of the pupil... PNS
salivation = PNS
vomiting = PNS??

Question 7

other than constipation, what else would you see happen from a muscarinic antagonist (nonselective)

Answer 7

dry mouth/eyes, dizziness, blurred vision

Question 8

feelings of impending doom and tremors.. this often happens after exercise or drinking coffee..

super high blood pressure

positive free metanephrine test!

what is it?

Answer 8

pheochromocytoma

Question 9

what is a pheochromocytoma?

what are the common symptoms

Answer 9

adrenaline secreting tumor.

Epi/NE secreting tumor sitting on the adrenal medulla.

spills out catecholamines from exercise or coffee..

common symptoms are headache, perspiration, palpitations!

Question 10

what is a metanephrine test?

Answer 10

they’re searching for catecholamine breakdown and this is what they find

Question 11

someone has a pheochromatoma.. which of the following is going to immediately reduce a pheochromocytoma?

alpha 1 antagonist
alpha 2 antagonist
beta 1 antagonist
mAChR M2 agonist
Thiazide diuretic

Answer 11

alpha 1 deals with blood pressure vasoconstriction.. so blocking those would lead to vasodilation.

Alpha 2 doesn’t really make sense because they’re most often found presynaptically in the CNS so that won’t be super fast.

beta 1 antagonist = reduces blood pressure (it’s a beta blocker), but the most immediate effect will be ones that are directly targeting the vasculature.

mAChR M2 agonist also slows it down but it’s not the fastest acting.

thiazide diuretic is a slow acting blood pressure regulatar

Question 12

an antagonist of what receptor is going to reduce heart rate (remember, not blood pressure)

Alpha 1
Beta 1
Beta 2
mAChR M2
mAChR M3

Answer 12

Beta 1! Remember Beta 1 are primarily found on the heart, when they are active they increase strength and force. so blocking that will best lower it.

the only other ones found on the heart are muscurinic but those will have to be agonists, not antagonists

Question 13

person with pheochromocytoma…

if we give a beta-receptor selective agonist (propranolol) is administered, which of the following is most expected?

bronchial smooth muscle relaxation
Diarrhea
increase heart rate
uncontrollable urination
worsening of hypertension

Answer 13

Beta receptor antagonist… if you’re antagonizing that you’re going to lower blood pressure.. but we have spilling of tons of catecholamines and blocking Beta is going to have more available for alpha, which vasoconstriction, worsening hypertension.

we know that Beta are going to increase heart rate.. so blocking that won’t do anything

Beta 2 normally cause smooth muscle relaxation.. so antagonist would block smooth muscle relaxation.. so not that.

Question 14

in a pheochromocytoma, what results if you use a beta blocker?

Answer 14

you’re going to have unopposed alpha stimulation (i.e. vasoconstriction).. worsening hypertension

Question 15

if you use an alpha 2 receptor agonist (clonidine) on a patient with a pheochromoscytoma.. what’s going to happen?

Answer 15

Alpha 2 are present in the CNS.. and they suppress further sympathetic outflow in the CNS so suppresses sympathetics.. but pheochromocytoma is going to keep secreting a bunch of stuff so it’s not going to do anything

Question 16

clonidine function?

Answer 16

activate central pre-synaptic alpha 2 receptors to suppress release of catecholamines form neurons.

they block the further release of catecholamines from the nerve terminal in the adrenergic nerve!!

Question 17

smoker has wheezing but no chest pain.. what would you give them to help him?

Answer 17

Remember that alpha receptors are for blood pressure

we need something that will relax smooth muscle. the only thing that does is B2 agonists or mAChR antagonist

beta 2 = relaxation
alpha 1 = vasculature
alpha 2 = CNS only really

Question 18

you give someone a mAChR antagonist.. what adverse symptoms are you going to see of the following?

excess perspiration
excess salivation
Delierium
Diarrhea
Decreased Mucus Production

Answer 18

blocking parasympathetic

it would be decreased mucus production in the bronchial glands because the muscarinic stimulates secretions… but inhibiting that would decrease because mucus production in the bronachial glands.

so not salivation
not diarrhea

excess perspiration –> activation of muscarinic receptors causes this, so block will be less perspiration.

Question 19

excess perspiration is coming from what?

what happens if you inhibit them?

Answer 19

muscarinic receptors.. so if you inhibit muscarinic you will have less perspiration!

Question 20

Inhibiting mucus production may lead to what?

Answer 20

increased infection

Question 21

someone has super dry eyes or mouth, what are you going to do to increase this?

AChE inhibitor
AChE regenerator
Charged mAChR antagonist
mAChR agonist
Uncharged mAChR antagonist

Answer 21

mAChR agonist

you want to increase tear production and secretions and that’s done by mAChR

AChE inhibitor = inhibits AChE and that will lead to more in the presynaptic cleft, but not necessarily work faster

Question 22

Cevimeline (mAChR Agonist) is prescribed to someone with dry eyes and mouth. what is the adverse effect that could happen?

nausea
increased BP
dry eyes
diaphoresis
decreased urinary frequency

Answer 22

you would have increased frequency of urine, so not that

no sweating would probably be the answer

increasing BP (maybe)

dry eyes. no that’s not it

nausea (not necessarily)

diaphoresis is directly acted upon by muscarinic receptors

Question 23

diaphoresis is acted on by what?

Answer 23

directly by Ach and muscarinic.. so having an agonist will have a ton more sweat than normal

Question 24

which concomitant condition would be exacerbated by cevimeline if prescribed?

remember, it’s an mAChR agonist

Answer 24

smooth muscle contraction is what mAChR is doing… so agonists to that will increase asthma.

Question 25

muscarinic agonist and…

heart failure
myasthenia gravis?
xerostomia?

Answer 25

xerostomia is dry mouth, so no.

myasthenia graves is caused by antibodies attacking nicotinic receptors on skeletal muscle… so muscarinic has nothing to do with it.

heart failure –> muscarinic line M2 receptors on the heart and could slow down the heart… but there is baroreceptor reflex that overtakes that to fix it

Question 26

someone found that peed themself, muscle fasciculations, oral foaming.

receptor is most likely involved?

Answer 26

Cholinergic (muscle fasciculations leads to nicotinic… the rest is muscarinic)

Question 27

someone found that peed themself, muscle fasciculations, oral foaming.

an agent from which drug class was most likely ingested?

Answer 27

AChE inhibitor…

this is because if they’re doing both muscle fasciculations and peeing themselves, there has got to be more ACh in the system

Question 28

symptoms of acetylcholineesterase inhibitors?

Answer 28

SLUDGE

salivation, lacrimation, urination, defecation, gastrointestinal pain, gas, emesis

DUMBELS - defecation, urination, mitosis, bronchorrhea/bronchospasm/bradycardai, emesis, lacrimation, salivation

Question 29

when you take an AChE inhibitor, which symptoms occur first?

if you drink it

Answer 29

GI symptoms occur first if you drink it

if it’s a crop duster, you’d have sweating and muscle fasciculations because of the percutaneous absorption

Question 30

Antidote for AChE inhibitor toxicity? what does it do?

Answer 30

atropine

muscarinic antagonist. so it’s not going to inhibit the muscle fasciculations