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1.

Sympathetic nervous system anatomy and properties:

A.
B.
C.
D.

2.

somatic nerves, like autonomic nerves contain ganglia.


Most of the fibers in the vagus nerve ar sensory
denervated smooth muscle show spontaneous activity
motor nerves are typically unmyelinated.

?
?
?
?

cerebellum
sensory cortex
hypothalamus
spinal cord--dorsal horn

Division of the autonomic nervous system associated with diffuse autonomic responses.

A.
B.
C.
D.

5.

?
?
?
?

Major anatomical site for integration of autonomic information:

A.
B.
C.
D.

4.

gangionic neurotransmitter: acetylcholine


generalized response upond sympathetic stimulation
thoraco-lumbar origin for preganglionic cell bodies
all of the above

Comparing autonomic and somatic nerves:

A.
B.
C.
D.

3.

?
?
?
?

?
?
?
?

sympathetic
parasympathetic
both
neither

Activation of the sympathetic nervous system will caus which change in the skeletal muscle
versus cutaneous vascular beds.

A.
B.
C.
D.

?
?
?
?

vasoconstriction, vasoconstriction
vasodilatation, vasodilatation
vasodilatation, vasoconstriction
vasoconstriction, vasodilation

renergic receptor type(s) mediating pupillary dilation


A.

beta-2

B.
C.
D.

?
?
?

alpha-1
muscarinic
serotonergic

E. Cholinergic receptor type that mediates vasodilation following low-dose i.v. acetylcholine
administration:

A.
B.
C.
D.

F.

?
?
?
?

nicotinic
muscarinic
nitric oxide receptor
substance P receptor

"True" acetylcholinesterase is found in:

A.
B.
C.
D.

?
?
?
?

glia
liver
erythrocytes
plasma

G. Catalyzes rate-limiting step in catecholamine biosynthesis:

A.
B.
C.
D.

?
?
?
?

DOPA decarboxylase
phenylethanolamine N-methyl transferase
tyrosine hydroxylase
dopamine-beta-hydroxylase

nhibited by drugs such as phenelzine or tranylcypromine;


A.

COMT (catechol-O-methyl transferase)

B.
C.
D.

?
?
?

MAO (monoamine oxidase)


choline acetyltransferase
reuptake-I inhibitor

E. Concentation increased by epinephrine:

A.
B.
C.
D.

F.

?
?
?
?

blood free fatty acids


blood glucose
skeletal muscle glycogen
A&B

Due to receptor specificity, catecholamine LEAST likely to produce bronchiolar smooth


muscle relaxation:

A.
B.
C.
D.

?
?
?
?

epinephrine
terbutaline (Brethine)
phenylephrine
phentolamine (Regitine)

G. Alpha adrenergic receptor blocker

A.
B.

?
?

phentolamine (Regitine)
phenoxybenzamine (Dibenzyline)

C.
D.

?
?

terbutaline (Brethine)
A&B

H. Covalent inhibitor of acetylcholinesterse:

A.
B.
C.
D.

I.

edrophonium (Tensilon)
diisopropylphosphate (DFP)
atropine
muscarine

Alpha-adenergic receptor agonist:

A.
B.
C.
D.

J.

?
?
?
?

?
?
?
?

terbutaline (Brethine)
atropine
methoxamine (Vasoxyl)
isoproterenol (Isuprel)

Parasympathetic direct cardiac effects:

A.
B.
C.
D.

?
?
?
?

decrease heart rate; increase contractility


increase heart rate; decrease contractility
decrease heart rate; decrease contractility
increase AV nodal conduction velocity

K. Choline ester substrate for acetylcholinesterase:

A.
B.
C.
D.

?
?
?
?

carbachol
methacholine (Provocholine)
both
neither

L. Alkaloid agonist acting at muscarinic, cholinergic receptors:

A.
B.
C.
D.

?
?
?
?

DFP
pilocarpine (Pilocar)
physostigmine (Antilirium)
ipratropium (Atrovent)

M. Effective in treating both organophosphate and muscarine intoxication:

A.
B.
C.
D.

?
?
?
?

nicotine
echothiophate (Phospholine)
atropine
pilocarpine (Pilocar)

N. Cholinergic activity on stomach acid secretion

A.
B.
C.
D.

?
?
?
?

increased
decreased
no changed
one of the others is right

O. Most likely to reduce blood pressure by directly decreasing heart rate:

A.
B.
C.
D.

P.

?
?
?
?

phentolamine (Regitine)
propranolol (Inderal)
nitroprusside sodium (Nipride)
phenylephrine (Neo-Synephrine)

From the point of view of Starling's law which antihypertensive would be most likely to
reduce contractility.

A.
B.
C.
D.

?
?
?
?

methoxamine (Vasoxyl)
nitroprusside sodium (Nipride)
propranolol (Inderal)
metoprolol (Lopressor)

Q. Negative inotropism

A.
B.
C.
D.

?
?
?
?

isoproterenol (Isuprel)
epinephrine
diltiazem (Cardiazem)
norepinephrine

R. Increases pulmonary congestion in congestive heart failure (CHF)

A.
B.
C.
D.

?
?
?
?

dopamine (Intropin)
metoprolol (Lopressor)
nitroprusside sodium (Nipride)
digoxin (Lanoxin, Lanoxicaps)

S. Major neurotransmitter released at end organ effectors of the thoracolumbar division of the
autonomic nervous system:

A.
B.
C.
D.

?
?
?
?

dopamine (Intropin)
epinephrine
norepinephrine
acetylcholine

T. Neurotransmitter of preganglionic fibers:

A.
B.
C.
D.

?
?
?
?

norepinephrine
substance P
epinephrine
acetylcholine

U. "Fight or flight" activation of the ANS:

A.
B.
C.
D.

?
?
?
?

pupillary constriction
blood flow shifted from cutaneous beds to skeletal muscle
blood glucose falls
bronchiolar constriction

V. Methoxamine (Vasoxyl)-induced bradycardia would be prevented by:

A.
B.
C.
D.

?
?
?
?

phentolamine (Regitine)
mecamylamine (Inversine)
atropine
all of the above

W. Dopamine beta hydroxylase catalyzes:

A.
B.
C.
D.

?
?
?
?

tyrosine to DOPA
DOPA to dopamine
dopamine to norepinephrine
norepinephrine to epinephrine

X. Primary mechaism for termination of norepinephrine and epinephrine action:

A.
B.
C.
D.

?
?
?
?

metabolic transformation catalyzed by MAO


metabolic transformation catalyzed by COMT
diffusion away from the synaptic cleft and uptake at extraneuronal sites
reuptake into nerve terminals

Y. Most potent at beta adrenergic receptors

A.
B.
C.
D.

?
?
?
?

epinephrine
isoproterenol (Isuprel)
norepinephrine
dopamine

Z. Interferes with norepinephrine release:

A.

? alpha-methyltyrosine by preventing synthesis of a protein that promotes fusion


of the vesicle and the presynaptic membrane
B. ? bretylium (Bretylol) following a transient stimulation of release by displacement
C. ? reserpine

AA. alpha-2 receptor agonist; peripheral sympathomimetic

A.
B.
C.
D.

?
?
?
?

yohimbine (Yocon)
dobutamine (Dobutrex)
clonidine (Catapres)
phenylephrine

BB. Primary antihypertensive effect due to nitric oxide mediation of smooth muscle relaxation.

A.
B.
C.
D.

?
?
?
?

atropine
nitroprusside sodium (Nipride)
mecamylamine (Inversine)
captopril (Capoten)

CC. Inhibits neurotransmitter enzymic degradation:

A.
B.
C.
D.

?
?
?
?

tubocurarine
phenoxybenzamine (Dibenzyline)
physostigmine (Antilirium)
bretylium (Bretylol)

DD. Cardiac effects not like to be directly affected by the presence of an anticholinesterase:

A.
B.
C.
D.

?
?
?
?

acetylcholine
methacholine (Provocholine)
vagal stimulation
carbamylcholine (carbachol)

EE. Pilocarpine (Pilocar):

A.
B.
C.
D.

?
?
?
?

dry mouth
pupillary dilation
increased gastrointestinal tone
bronchiolar relaxation

RETURN
1.

Atropine effects:

A.
B.
C.
D.
2.

physostigmine (Antilirium)
DFP
edrophonium (Tensilon)
soman

? scopolamine
? dopamine (Intropin)
? mecamylamine (Inversine)

?
?
?
?

veins:parasympathetic
heart:sympathetic
ciliary muscle: sympathetic
salivary glands: parasympathetic

Powerful agonist at both alpha and beta adrenergic receptors

A.
B.
C.
D.
7.

?
?
?
?

Predominant autonomic tone:

A.
B.
C.
D.
6.

atropine
scopolamine
ipratropium (Atrovent)
DFP

Ganglionic blocker:

A.
B.
C.
5.

?
?
?
?

Reversible, noncovalent inhibitor of acetylcholinesterase

A.
B.
C.
D.
4.

increased heart rate


pupillary dilation
dry mouth
all of the above

Cholinergic agent least likely to enter the brain:

A.
B.
C.
D.
3.

?
?
?
?

?
?
?
?

isoproterenol (Isuprel)
dopamine (Intropin)
clonidine (Catapres)
epinephrine

Positive inotropic drug that at low doses specifically promotes an increase in renal blood flow:

A.
B.
C.
D.
8.

dobutamine (Dobutrex)
dopamine (Intropin)
terbutaline (Brethine)
lodoxamine (Alomide)

Beta-2 receptor activation

A.
B.
C.
D.
9.

?
?
?
?

?
?
?
?

terbutaline (Brethine)
metaproterenol (Alupent)
ritodrine (Yutopar)
all of the above

Antihypertensive effect due to activation of CNS alpha-2 receptors

A.
B.
C.
D.

?
?
?
?

guanfacine (Tenex)
captopril (Capoten)
esmolol (Brevibloc)
phenoxybenzamine (Dibenzyline)

10. CNS stimulant used in management of narcolepsy or attention-deficit disorder

A.
B.
C.
D.

?
?
?
?

scopolamine
methylphenidate (Ritalin)
mecamylamine (Inversine)
clonidine (Catapres)

11. Antihypertensive agent that acts by direct arteriolar dilation:

A.
B.
C.
D.

?
?
?
?

labetalol (Trandate, Normodyne)


hydralazine (Apresoline)
methoxamine (Vasoxyl)
reserpine

12. Inhibitor of angiotensin converting enzyme

A.
B.
C.
D.

?
?
?
?

nicardipine (Cardene)
captopril (Capoten)
phentolamine (Regitine)
esmolol (Brevibloc)

13. Vasodilator used to manage hypertensive emergencies:

A.
B.
C.
D.

?
?
?
?

captopril (Capoten)
nitroprusside sodium (Nipride)
phenoxybenzamine (Dibenzyline)
minoxidil (Loniten)

14. Angiotensin II receptor antagonist:

A.
B.
C.
D.

?
?
?
?

captopril (Capoten)
losartin (Cozaar)
methyldopa (Aldomet)
phenoxybenzamine (Dibenzyline)

15. Most common side effect of oral beta-2 receptor agonists

A.
B.
C.
D.

?
?
?
?

brochodilation
tremor
vasodilation
tachycardia

16. Probably the neurotransmitter in sensory afferents

A.
B.
C.
D.
E.

?
?
?
?
?

acetylcholine
bradykinin
substance P
glycine
norepinephrine

17. Autonomic: Sympathetic

A.
B.

? craniosacral
? thoracolumbar

18. Preganglionic fibers terminating on adrenal medullary chromaffin cells release:

A.
B.
C.
D.

?
?
?
?

norepinephrine
epinephrine
acetylcholine
dopamine

E.

? substance P

19. Primary receptor type at autonomic ganglia:

A.
B.
C.
D.
E.

?
?
?
?
?

adrenergic: beta 1
adrenergic: beta 2
cholinergic: muscarinic
cholinergic: nicotinic
dopaminergic: D. 1

20. Vesicular protein important in docking with the presynaptic membrane:

A.
B.
C.
D.

?
?
?
?

neurexin
syntaxin
saxitonin
synaptobrevin

21. Rate-limiting step in acetylcholine synthesis:

A.
B.
C.
D.
E.

?
?
?
?
?

choline acetyltransferase activity


vesicular protein synthesis
choline uptake
acetylcholinesterase activity
availability of acetate

22. Inhibits choline transport into cholinergic vesicles

A.
B.
C.
D.

?
?
?
?

bretylium
vesamicol
reserpine
atropine

23. Influx of this ion promotes fusion between axoplasmic membrane and nearby vesicles.

A.
B.
C.
D.

?
?
?
?

sodium
potassium
calcium
chloride

24. Clostridium toxins:

A.
B.
C.
D.

?
?
?
?

inhibit acetylcholinesterase
prevent reuptake of choline
inhibit vesicular acetylcholine release
prevent calcium influx

25. Denervation supersensitivity in skeletal muscle is mainly due to:

A.
B.
C.
D.
E.

?
?
?
?
?

increase in receptor affinity


no increase in the receptor number
proliferation of receptors
increase in G.-protein coupling efficiency
increase in acetylcholine release

26. Enzyme responsible for acetylcholine synthesis:

A.
B.

? acetylcholinesterase
? choline acetyltransferase

27. Cholinergic receptor type that mediates the decrease in heart rate by activating potassium
channels:

A.
B.
C.
D.

?
?
?
?

M1-- muscarinic
M2-muscarinic
M3-muscarinic
nicotinic

28. Effect of atropine on the heart:

A.
B.

? increased rate
? decreased rate

29. Essential cofactor for the enzyme dopamine beta-hydroxylase:

A.
B.
C.
D.

?
?
?
?

pyridoxyl phosphate
ascorbate
tetrahydrobiopterin
glycine

30. Phosphorylation of this enzyme is most likely to have an effect on catecholamine


biosynthesis:

A.
B.
C.

? phenylethanolamine N-methyltransferase
? dopamine beta-hydroxylase
? tyrosine hydroxylase

31. ? dopa decarboxylaserugs activating this receptor are used in treating asthma:
A.
B.
C.
D.

?
?
?
?

beta1 adrenergic
muscarinic cholinergic
beta2 adrenergic
nicotinic cholinergic

32. Epinephrine effects on the heart

A.
B.
C.
D.

?
?
?
?

increased rate
decreased contractility
coronary vasodilation
A& C

33. Receptor activation mainly responsible for positive inotropism:

A.
B.
C.
D.

?
?
?
?

alpha1
beta1
dopamine D1
muscarinic cholinergic

34. Epinephrine effects on respiration:

A.
B.

? stimulation
? inhibition

35. Activates alpha receptors

A.
B.
C.
D.

?
?
?
?

isoproterenol (Isuprel)
propranolol (Inderal)
phenylephrine (Neo-Synephrine)
terbutaline (Brethine)

36. Blocks cardiac isoproterenol effects

A.
B.
C.
D.

?
?
?
?

terbutaline (Brethine)
esmolol (Brevibloc)
atropine
mecamylamine (Inversine)

37. Alpha agonist: vasoconstriction and elevates blood pressure:

A.
B.
C.
D.

?
?
?
?

metoprolol (Lopressor)
methoxamine (Vasoxyl)
terbutaline (Brethine)
ipratropium (Atrovent)

38. Nerve terminal reuptake inhibitor

A.
B.
C.
D.

?
?
?
?

methoxamine (Vasoxyl)
cocaine
reserpine
timolol (Blocadren)

39. Alpha adrenoceptor COVALENT blocker:

A.
B.
C.
D.

?
?
?
?

propranolol (Inderal)
phenoxybenzamine (Dibenzyline)
phentolamine (Regitine)
pilocarpine (Pilocar)

40. Orthostatic (postural) hypotension

A.
B.
C.
D.

?
?
?
?

beta receptor activation


alpha receptor activation
alpha receptor blocker
dopamine receptor blockade

41. Norepinephrine pressor response blocked by:

A.
B.
C.
D.

?
?
?
?

mecamylamine (Inversine)
prazosin (Minipress)
atropine
propranolol (Inderal)

42. Bronchodilation

A.
B.
C.
D.

?
?
?
?

ipratropium (Atrovent)
timolol (Blocadren)
albuterol (Ventolin,Proventil)
A& C

43. Positive chronotropic effects of epinephrine:

A.
B.
C.
D.

?
?
?
?

increased SA nodal potassium current


beta1 receptor activation
mediated by G protein
B&C

44. Maximal -adrenergic receptor desensitization depends on:

A.
B.
C.
D.

?
?
?
?

receptor occupancy by agonists


an arrestin protein
receptor phosphorylation
A, B & C

45. Phase of the cardiac action potential that principally determine heart rate

A.
B.
C.
D.

?
?
?
?

phase 0
phase 4
phase 2
phase 3

46. Most likely to increase myocardial afterload

A.

? angiotensin converting enzyme inhibitor (decreases angiotensin II


concentration)
B. ? propranolol (Inderal)
C. ? phenylephrine (Neo-Synephrine)
D. ? low-dose epinephrine
47. Pressor effects of epinephrine are blocked by this drug ("epinephrine reversal")

A.
B.

? propranolol (Inderal)
? phentolamine (Regitine)

C.
D.

? phenylephrine (Neo-Synephrine)
? metoprolol (Lopressor)

48. Decreases blood pressure

A.
B.
C.
D.

?
?
?
?

propranolol (Inderal)
mecamylamine (Inversine)
phentolamine (Regitine)
all of the above

49. Specific alpha2 receptor agonist

A.
B.
C.
D.

?
?
?
?

phenoxybenzamine (Dibenzyline)
propranolol (Inderal)
guanfacine (Tenex)
methoxamine (Vasoxyl)

50. Centrally-acting antihypertensive drug

A.
B.
C.
D.
E.

?
?
?
?

nitroprusside sodium (Nipride)


clonidine (Catapres)
methoxamine (Vasoxyl)
captopril (Capoten)

51. Therapeutic use of esmolol (Brevibloc):

A.
B.
C.
D.
E.

?
?
?
?
?

renal vasodilator
bronchial asthma
antiarrhythmic drug
positive inotrope in CHF
antihypertensive

52. Drug causes pupillar dilation with no effect on accommodation:

A.
B.
C.
D.
E.

?
?
?
?
?

atropine
pilocarpine (Pilocar)
neostigmine (Prostigmin)
phentolamine (Regitine)
phenoxybenzamine (Dibenzyline)

53. Increases both magnitude of the blood pressure increase due to phenylephrine and the heart
rate decrease due to methacholine:

A.
B.
C.
D.
E.

?
?
?
?
?

mecamylamine (Inversine)
timolol (Blocadren)
nitroprusside sodium (Nipride)
clonidine (Catapres)
atropine

54. The magnitude of the cardiovascular response to norepinephrine is increased by cocaine


because:

A.
B.
C.
D.
E.

?
?
?
?
?

cocaine decreases cholinergic receptor number


cocaine decreases N.E. metabolism by MAO
cocaine increases N.E. receptor number
cocaine inhibits norepinephrine reuptake
cocaine increases conversion of norepinephrine to phenylephrine

55. Immediate biosynthetic precursor of epinephrine:

A.
B.
C.
D.
E.

?
?
?
?
?

metaraminol
norepinephrine
doapmine
isoproterenol
L-DOPA

56. Isoproterenol (Isuprel): cardiopulmonary effects:

A.
B.
C.
D.
E.

?
?
?
?
?

A& C
positive inotropism
positive chronotropism
B&C
increases peripheral resistance

57. Beta-2 selective agonist:

A.
B.
C.
D.
E.

?
?
?
?
?

epinephrine
metaproterenol (Alupent)
phentolamine (Regitine)
phenylephrine (Neo-Synephrine)
labetalol (Trandate, Normodyne)

58. Physiological effects associated with isoproterenol (Isuprel):

A.
B.
C.
D.
E.

?
?
?
?
?

bronchoconstriction
increased GI motility
increased blood glucose
increased peripheral resistance
decreased heart rate

59. Prevents blood pressure reduction seen with isoproterenol (Isuprel):

A.
B.
C.
D.
E.

?
?
?
?
?

phentolamine (Regitine)
propranolol (Inderal)
esmolol (Brevibloc)
atropine
phenylephrine (Neo-Synephrine)

60. Albuterol (Ventolin,Proventil):

A.
B.
C.
D.
E.

?
?
?
?
?

significant heart rate increase


bronchodilation
decreases myocardial contractility
alpha adrenoceptor antagonist
by I.V. injection only

1.

Epinephrine:

A.
B.
C.

? limited effect on alpha receptors


? increases heart rate, contributing to increase blood pressure
? epinephrine often reduces peripheral vascular resistance, especially at high
concentration
D. ? epinephrine tends to exhibit negative inotropic effects
E. ? all of the above

2.

Vasoconstrictive effects of epinephrine:

A.

? alpha-1 adrenergic receptor-mediated affecting precapillary resistance vessels of


the skin, kidney, and mucosa
B. ? veins
C. ? both
D. ? neither

3.

Rapid administration of epinephrine, with resulting significant systolic pressure elevation will
cause this effect on heart rate:

A.
B.

4.

?
?

increase, due to direct beta1 receptor activation


decrease in heart rate

A decrease in diastolic pressures associated with epinephrine administration would most likely
occur in which dosage?

A.
B.

?
?

relatively high doses


relatively low doses

5.

Renal effects relatively low epinephrine dose.

A.
B.
C.
D.

6.

? limited effect
? beta1 adrenergic receptor activation decreases renin release
? significant reduction in renal blood flow
? significant increase in renal blood flow; mechanism similar to that exhibited by
low-dose dopamine

Most probable BP effect of epinephrine, if epinephrine is administered after an alpha-receptor


antagonist:

A.

? previous administration of the alpha-receptor antagonist will not influence the


blood-pressure response to epinephrine
B. ? increased blood-pressure response to epinephrine
C. ? decreased blood-pressure response to epinephrine

7.

Prominent cardiac beta-adrenergic receptor type:

A.
B.
C.

8.

beta-1
beta-2
beta-3

Cardiac effects associated with epinephrine:

A.
B.
C.
D.
E.

9.

?
?
?

?
?
?
?
?

positive chronotropic
positive inotropic
increased cardiac output
increased oxygen consumption
all of the above

Significant respiratory tract effects of epinephrine:

A.
B.
C.
D.

?
?
?
?

beta-2 receptor mediated bronchoconstriction


alpha-1 receptor-mediated bronchodilation
beta-1 receptor-mediated bronchodilation
beta-2 receptor-mediated bronchodilation

10. Examples of epinephrine metabolic effects

A.
B.
C.
D.
E.

?
?
?
?
?

insulin secretion reduced by beta2 adrenergic receptor activation


glucagon secretion: diminished by beta adrenergic receptor activation
free fatty acids: increased
minimal calorigenic effect
glycolysis inhibition

11. Toxicities/adverse reactions associated with sympathomimetics

A.
B.
C.
D.
E.

?
?
?
?
?

angina
hypertension; cerebral hemorrhage
cardiac arrhythmias
anxiety reactions
all the above

12. Drugs antagonize epinephrine pressor effects:

A.
B.
C.
D.
E.

?
?
?
?
?

phentolamine (Regitine)
terbutaline (Brethine)
dopamine (Intropin)
dobutamine (Dobutrex)
atropine

13. Epinephrine effects on AV nodall conduction:

A.
B.
C.

?
?
?

increased conduction velocity


decreased conduction velocity
promotes AV block

14. Ventricular effects associated with epinephrine administration:

A.
B.
C.
D.
E.

1.

? constriction
? dilation

beta-2 adrenergic receptor mediated effects on skeletal muscle arteriole vasculature

A.
B.
3.

increased automaticity
increased ectopic pacemaker activity
increased conduction philosophy
increased contractility
all the above

Major adrenergic effects on skin/mucosa arteriole vascular beds:

A.
B.
2.

?
?
?
?
?

? constriction
? dilation

Alpha-adrenergic effects on pulmonary arterioles:

A.
B.
4.

Beta-adrenergic effects on pulmonary arterioles:

A.
B.
5.

? relaxation
? constriction

Major alpha-adrenergic receptor effect on renin secretion

A.
B.
9.

? constriction
? dilation

Major adrenergic effects on tracheal and bronchial smooth muscle:

A.
B.
8.

? constriction
? dilation

beta-2 adrenergic receptor effects on systemic veins:

A.
B.
7.

? constriction
? dilation

Alpha-adrenergic effects on renal arterioles:

A.
B.
6.

? constriction
? dilation

? decrease
? increase

Enhanced antidiuretic hormone secretion (ADH secretion):

A.
B.
C.

? beta-1 adrenergic receptor effect


? alpha adrenergic receptor effect
? cholinergic muscarinic receptor effect

10. Decreases bronchial gland secretion

A.
B.

? alpha-1 adrenergic
? beta-2 adrenergic

C.

1.

Primary neurotransmitter released by postganglionic neurons of the autonomic sympathetic


system:

A.
B.
C.
D.
E.

2.

? cholinergic muscarinic

?
?
?
?
?

epinephrine
dopamine
dobutamine
norepinephrine
phenylephrine

Decreased heart rate following norepinephrine infusion is most likely due to:

A.
B.

? direct norepinephrine activation of muscarinic receptors at the SA node


? heart rate cannot decrease following norepinephrine infusion because
norepinephrine activates beta-1 adrenergic receptors
C. ? activation of the baroreceptor system causing a reflex-mediated decrease in heart
rate
D. ? peripheral vasodilation
E. ? none of the above

3.

Vascular effects of norepinephrine (Levophed):

A.
B.
C.
D.

4.

significantly decreases glomerularl filtration rates


effective in treating variant (Prinzmetal's) angina
norepinephrine pressor effects blocked by prazosin (Minipress)
increased blood flow to liver, kidney, and skeletal muscle

Immediate synthetic precursor of norepinephrine:

A.
B.
C.
D.
E.

5.

?
?
?
?

?
?
?
?
?

epinephrine
tyrosine
tyrosine hydroxylase
dopamine
dopa

CNS neurotransmitter associated with the basal ganglia and motor control:

A.
B.
C.
D.

?
?
?
?

dopamine
acetylcholine
both
neither

6.

Low doses, this precursor of norepinephrine causes renovascular dilation:

A.
B.
C.
D.
E.

7.

?
?
?
?
?

positive inotropism
promotes myocardial norepinephrine release
increases glomerular filtration rates (low-dose)
vasoconstriction by alpha-1 receptor activation (high-dose)
all the above

Significant therapeutic use for dopamine:

A.
B.
C.
D.

9.

epinephrine
dopa
dopamine (Intropin)
dobutamine (Dobutrex)
nitroprusside sodium (Nipride)

Pharmacological action(s) of dopamine (Intropin):

A.
B.
C.
D.
E.

8.

?
?
?
?
?

?
?
?
?

management of sleep cycles


treatment of Raynaud's phenomenon
treatment of cardiogenic/hypovolemic shock
management of tachyarrhythmias

Has limited action at alpha-adrenergic receptors

A.
B.
C.
D.
E.

?
?
?
?
?

phenylephrine (Neo-Synephrine)
methoxamine (Vasoxyl)
norepinephrine (Levophed)
isoproterenol (Isuprel)
prazosin (Minipress)

10. Effect of IV isoproterenol (Isuprel) infusions on blood pressure:

A.
B.
C.
D.

?
?
?
?

significant vasopressor effect


significant hypotensive effect
slight decrease in mean pressure with a significant decrease in diastolic pressure
significant increase in systolic pressure with minimal effect on diastolic pressure

11. Adverse effects associated with isoproterenol (Isuprel) administration:

A.
B.
C.
D.
E.

?
?
?
?
?

palpitations
tachycardia
arrhythmias
A&C
A,B & C

12. Cardiovascular characteristics of patients who might benefit from IV dopamine (Intropin)
administration:

A.
B.
C.

?
?
?

low systemic blood pressure


decreased atrial filling pressures
high urinary output

13. Simultaneous increases in myocardial contractility, glomerular filtration rate, sodium


excretion, urine output, and renal blood flow are associated most likely with:

A.
B.
C.
D.
E.

?
?
?
?
?

epinephrine
isoproterenol (Isuprel)
phenylephrine (Neo-Synephrine)
dopamine (Intropin)
norepinephrine (Levophed)

14. IV dopamine (Intropin) properties:

A.
B.
C.
D.
E.

?
?
?
?
?

promotes renal tubule or solid reabsorption


reduces sodium excretion
causes reduced ventilatory response to arterial hypoxemia
decreases myocardial contractility
increases atrial filling pressures

15. Therapeutic uses for isoproterenol (Isuprel):

A.
B.
C.
D.
E.

?
?
?
?
?

management of heart block


management of severe bradycardia
management Torsades de pointes (a ventricular arrhythmia)
all of the above
none of the above; no therapeutic uses for isoproterenol (Isuprel)

16. Properties of dobutamine (Dobutrex):

A.
B.
C.
D.
E.

? positive inotropic agent; causes significant increase in heart rate


? promotes catecholamine release
? mainly acts through dopamine receptors
? positive inotropic effect is mediated through beta-adrenergic receptor activation
? appropriate for long-term management of myocardial pump-failure following
surgery

17. Examples of beta-2 selective adrenergic agonists

A.
B.

?
?

metaproterenol (Alupent)
terbutaline (Brethine)

C.
D.
E.

?
?
?

albuterol (Ventolin,Proventil)
A&B
A, B & C

18. Adverse effects associated with beta2 adrenergic receptor agonists:

A.
B.
C.

? excessive cardiovascular stimulation


? skeletal muscle tremor
? over usage of these drugs may predisposed to morbidity immortality in
asthmatics
D. ? A & C
E. ? A, B & C

19. Alpha-1-selective adrenergic agonists: properties of

A.
B.
C.
D.
E.

? phenylephrine (Neo-Synephrine) is an example of the indirect-acting


vasoconstrictor
? metaraminol (Aramine) acts by direct and indirect mechanisms
? methoxamine (Vasoxyl) is an indirect acting vasoconstrictor
? alpha1-receptor activation decreases calcium influx
? all of the above

20. Clinical use(s) of alpha-1-receptor agonists:

A.
B.
C.
D.
E.

?
?
?
?
?

management hypotensive states


termination of paroxysmal atrial tachycardia
nasal decongestant
A&B
A,B & C

21. Primary use for alpha-2-selective adrenergic agonists:

A.
B.
C.
D.
E.

1.

?
?
?
?
?

to manage hypotensive states


to increase myocardial contractility
to reduce blood pressure
A&B
A,B & C

ajor mechanism of antihypertensive effects associated with alpha-2-selective adrenergic


agonists:

A.
B.

? competitive inhibition of vascular alpha receptors


? reduced sympathetic outflow

2.

Alpha-2-selective adrenergic agonists: examples

A.
B.
C.
D.
E.
3.

?
?
?
?
?

hypovolemic shock caused by dehydration or blood loss


cardiogenic shock (pump failure)
cardiac output obstruction
loss of peripheral vascular tone
all of the above

?
?
?
?
?

increase myocardial contractility


decreased peripheral resistance
promote better renal perfusion
ensure adequate CNS perfusion
improve coronary perfusion

Most likely to reduce myocardial performance in a damaged heart by increasing afterload:

A.
B.
C.
D.
7.

dry mouth
sedation
sexual dysfunction
all of the above

Primary objective sympathomimetic drug use for management of shock:

A.
B.
C.
D.
E.
6.

?
?
?
?

Clinical uses for sympathomimetic drugs:

A.
B.
C.
D.
E.
5.

isoproterenol (Isuprel)
metaraminol (Aramine)
dopamine (Intropin)
dobutamine (Dobutrex)
guanabenz (Wytensin)

Adverse effects associated with clonidine (Catapres):

A.
B.
C.
D.
4.

?
?
?
?
?

?
?
?
?

isoproterenol (Isuprel)
phenylephrine (Neo-Synephrine)
low-dose dopamine (Intropin)
low-dose epinephrine

Receptor system most likely responsible for improved myocardial contractility when
dopamine is administered at low concentrations:

A.
B.
C.
D.
E.
8.

muscarinic cholinergic receptors


alpha adrenergic receptors
beta adrenergic receptors
dopamine receptors (D1)
leukotriene receptors

Reasonable intervention(s) to reverse cardiogenic shock caused by acute myocardial infarction

A.
B.
C.
D.
E.
9.

?
?
?
?
?

?
?
?
?
?

supplemental oxygen
IV nitroglycerin
intra-aortic balloon pump
revascularization
all of the above

Phosphodiesterase inhibitor(s) which have positive inotropic actions; might be used in


management of cardiogenic shock

A.
B.
C.
D.
E.

?
?
?
?
?

phentolamine (Regitine)
nitroglycerin
amrinone (Inocor)
clonidine (Catapres)
caffeine

10. Mechanism by a which methoxamine might terminate paroxysmal supraventricular


tachycardia:

A.
B.
C.
D.

? direct action at the AV node


? increases SA nodal rates -- overdrives the ectopic focus
? blocks beta-1-receptors
? causes increased vagal tone through reflex activation -- secondary
to increase blood pressure
E. ? directly inhibit sodium channel conductance

1.

Clinical applications of beta-adrenergic antagonists:

A.
B.
C.
D.

2.

?
?
?
?

management of coronary vascular disease


treatment of arrhythmias
treatment of hypertension
all the above

A non-selective beta-adrenergic receptor blocker:

A.
B.
C.
D.

3.

true
false

?
?
?
?

metoprolol (Lopressor)
propranolol (Inderal)l
esmolol (Brevibloc)
atenolol (Tenormin)

?
?
?
?

decreased hepatic blood flow


inhibition of hepatic metabolism of local anesthetic
both
neither

Effect of propranolol (chronic administration) on pulmonary first-pass fentanyl (Sublimaze)


uptake

A.
B.

8.

?
?

Mechanism(s) for propranolol-decreased amide local anesthetic clearance:

A.
B.
C.
D.

7.

increase heart rate


increased AV nodal refractory period
increased contractility
increased myocardial oxygen demand
increased phase 4 depolarization

Most likely to cause dangerous bronchiolar constriction in asthmatic patients or patients with
COPD

A.
B.
C.
D.

6.

?
?
?
?
?

Beta-adrenergic receptor blockers are usually effective in reducing blood pressure in both "
high-renin" and "low-renin" patients:

A.
B.

5.

metoprolol (Lopressor)
atenolol (Tenormin)
timolol (Blocadren)
esmolol (Brevibloc)

Beta-adrenergic receptor blockers: effects on the heart --

A.
B.
C.
D.
E.

4.

?
?
?
?

?
?

significant reduction
significant enhancement

The major exception to the rule that additive myocardial depression between anesthetics and
beta-adrenergic antagonists is not excessive:

A.

metoprolol (Lopressor)

B.
C.
D.
E.

9.

?
?
?
?

propranolol (Inderal)
esmolol (Brevibloc)
timolol (Blocadren)
nadolol (Corgard)

Bradycardia hypotension, refractory to atropine, may occur during anesthesia in pediatric and
adult patients receiving this beta adrenergic receptor antagonist:

A.
B.
C.
D.

?
?
?
?

nadolol (Corgard)
propranolol (Inderal)
esmolol (Brevibloc)
timolol (Blocadren)

10. Greatest additive cardiovascular effects with inhaled anesthetics in the presence of betaadrenergic receptor blockade:

A.
B.
C.

?
?
?

enflurane (Ethrane)
halothane (Fluothane)
isoflurane (Forane)

11. Preferred beta-blocking agent to prevent systolic blood pressure increases associated with
direct laryngoscopy in tracheal intubation:

A.
B.
C.
D.
E.

?
?
?
?
?

IV propranolol (Inderal)
IV labetalol (Trandate, Normodyne)
IV esmolol (Brevibloc)
IV timolol (Blocadren)
IV nadolol (Corgard)

12. Beta-blocker having special benefits for patients undergoing noncardiac surgery but having
significant underlying coronary artery disease-- given IV perioperatively and orally during
remainder of hospital stay.

A.
B.
C.
D.

?
?
?
?

esmolol (Brevibloc)
atenolol (Tenormin)
propranolol (Inderal)
nadolol

A 35 yr. old, overweight female purchased a weight-reduction product which contained

ephedrine.
She is using the product in accordance with directions on the label for one-month, then

stopped using it during a vacation week, and then started again upon her return to work. Two
days after restarting, she was awakened by anterior chest pain, which radiated to her left
shoulder and arm.
She experienced numbness in the left arm,shortness of breath, and sweating (diaphoresis).

At the emergency department, she was treated with morphine and nitroglycerin.
o Cardiac catherization revealed 60% narrowing of the left anterior descending

o
o

coronary vessel and a


50 percent narrowing of the circumflex coronary artery.
There was no evidence of completely occluded coronary vessels.
ECG tracings indicated T-wave changes indicative of an acute myocardial

infarction, later confirmed by elevated cardiac enzymes.


Recovery was uneventful; the patient was discharged with instructions to avoid using the
weight loss product or
similar weight loss products in the future.

(adapted from a case used in Medical Pharmacology, UCSF ,courtesy of Dr. Susan Masters, Dept. of
Pharmacology, University of California San Francisco, used with permission.)
1.

Primary mechanism of ephedrine (orally administered) cardiovascular action:

A.
B.
C.
D.
E.

2.

orally active
catecholamine
weak base
A&C
A, B & C

?
?
?
?

ephedrine may increase myocardial oxygen requirements


promotes coronary vasospasm
both
neither

In this patient, if it were concluded that coronary vasospasm was responsible for acute
myocardial infarction, what drugs might reduce the likelihood of a recurrence.

A.
B.
C.
D.
E.

5.

?
?
?
?
?

Possible explanations why ephedrine might cause myocardial infarction:

A.
B.
C.
D.

4.

direct alpha receptor agonist


direct beta-1 receptor agonist
release of stored catecholamines (indirect action)
ephedrine not active following oral administration
release of stored histamine (indirect action)

Properties of ephedrine:

A.
B.
C.
D.
E.

3.

?
?
?
?
?

?
?
?
?
?

propranolol
metoprolol
diltiazem
ergonovine
all the above

For what reason(s) was/were morphine used in the management of this patient?

A.
B.
C.

6.

decrease myocardial oxygen demand


increase blood pressure
must be administered following morphine

?
?
?
?

low systolic arterial pressure (< 100 mm Hg)


clinical suspicion of right ventricular infarction
both
neither

In this patient, if acute myocardial infarction was caused by ephedrine-induced increased


myocardial oxygen demand and if nitroglycerin were unable to reverse this effect, what
alternative drug(s) might be effective?

A.
B.
C.
D.

?
?
?

What physiological factors might contraindicate the use of nitroglycerin in a patient with acute
myocardial infarction?

A.
B.
C.
D.

8.

pain relief
bradycardic effects
increases cardiac output

What is the major rationale for administration of nitroglycerin to this patient?

A.
B.
C.

7.

?
?
?

?
?
?
?

alpha adrenergic blocker


beta-adrenergic blocker
both
neither

A ten-year old boy was referred to the asthma clinic for workup.
History: consistent with asthma; on pulmonary function testing, a marked reduction of FEV1
was noted.

(adapted from a case used in Medical Pharmacology,


UCSF, 1998 ,courtesy of Dr. Susan Masters, Dept. of Pharmacology,
University of California San Francisco, used with permission.)

1.

Autonomic drug: beneficial in treating asthma:

A.
B.
C.
D.
E.

?
?
?
?
?

bethanechol (Urecholine)
acetylcholine
ipratropium (Atrovent)
scopolamine
mecamylamine (Inversine)

2.

Drug category most likely to be effective in treating asthma:

A.
B.
C.
D.
E.

1.

case author: Hugh S. Mathewson,


M.D., Professor Emeritus, School of Allied
Health, Department of Nurse Anesthesia,
University of Kansas Medical Center

case editor: Michael Gordon, Ph.D. Associate


Professor, University of Kansas Medical Center

What are the principal risks associated wtih ECT?

?
?
?
?

General anesthesia with neuromuscular blockade


Consequences of sympathetic stimulation.
both
neither

What is/are the most hazardous response to sympathetic stimulation?

A.
B.
C.
D.
E.

3.

beta-1 antagonists
nonselective beta antagonists
beta-2 agonists
muscarinic agonists
none of the above

A 48-year old woman with post-menopausal depression was admitted


to the
hospital after a suicide attempt.
She had been previously treated at various times with SSRIs
(serotonin-specific reuptake inhibitors) antidepressants, tricyclic
antidepressants, and lithium--all with marginal results.
Electoconvulsive therapy (ECT) was recommended.

A.
B.
C.
D.

2.

?
?
?
?
?

?
?
?
?
?

tachycardia
arrhythmias
hypertension
A&C
A, B & C

How can sympathetic overstimulation be to a substantial degree prevented?

A.

? An anesthetic induction agent such as thiopental will substantially reduce the


risk of hypertension.
B. ? Administer hydralazine to the patient
C. ? use a long-acting alpha-receptor blocker

D.
E.

4.

use a long-acting beta-receptor blocker


none of the above

In this case, how is tachycardia best controlled?

A.
B.
C.
D.

5.

?
?

?
?
?
?

administer atropine before the procedure


administer hexamethonium before the procedure
use a selective beta1 adrenergic blocking agent prior to seizure production
infuse acetylcholine

By what route of administration should esmolol (Brevibloc) begin to this patient?

A.
B.
C.
D.
E.

?
?
?
?
?

intramuscular
oral
subcutaneous
intravenous
by transdermal patch

Return

A 58 year-old man has been in progressive coronary insufficiency for


at least five years, with angina of effort and recent early signs of left
ventricular failure.
Cardiac catherization revealed atherosclerotic obstruction of both the
left anterior descending and circumflex arteries.
Coronary artery bypass graft (CABG) operation schedule, since
cardiac failure appeared imminent.
The patient was on a daily regimen of nicardipine at the time of
surgery.

case author: Hugh S. Mathewson,


M.D., Professor Emeritus, School of Allied
Health, Department of Nurse Anesthesia,
University of Kansas Medical Center

case editor: Michael Gordon, Ph.D. Associate


Professor of Pharmacology and Surgery, School of
Medicine, Department of Pharmacology, University
of Kansas Medical Center

1.

Drug classification: nicardipine --

A.
B.
C.
D.
E.

2.

?
?
?
?
?

beta-blocker
alpha-adrenergic agonist
calcium channel blockers
beta-adrenergic agonist
prostaglandin analog

What is the most likely effect of cardiopulmonary bypass on myocardial perfusion in this
patient?

A.
B.
C.
D.
E.

?
?
?
?
?

significantly improved
somewhat improved
no change
somewhat diminished
significantly worsened

A 47 year-old man with terminal diabetic nephropathy was scheduled for


renal transplant.
4. He received hemodialysis preceding surgery and electrolyte correction was
subsequently performed before induction of anesthesia.
3.

1.

Note the case:What electrolyte is most likely to be abnormal in this patient?

A.
B.
C.
D.
E.

?
?
?
?
?

sodium
chloride
potassium
calcium
magnesium

2.
3.

A 22 year-old man suffers 4 broken ribs in a motor vehicle accident.


Although displacement of the ribs at fracture sites was minimal, the patient
complained of severe pain, and required large doses of fentanyl for relief.

4.

What would be another reasonable way to provide analgesia for this patient?

A.
B.
C.
D.

5.

?
?
?
?

thiopental (Pentothal)
phenobarbital (Luminal), orally
intercostal nerve block with 2% lidocaine
general anesthesia, "balanced"

Since the duration of lidocaine action is relatively short, why not use bupivacaine, a longeracting local anesthetic?

A.

too expensive

B.
C.

? increased toxicity
? bupivacaine (Marcaine) tends to have many drug-drug interactions, since it is a
powerful inducer of drug metabolizing enzyme.
D. ? all of the above

6.

Is there a way that the duration of action of 2% lidocaine (Xylocaine) can be significantly
increased?

A.

? No, but one could use a signficantly higher initial concentration to achieve
longer action.
B. ? add a vasoconstrictor to the lidocaine solution
C. ? both
D. ? neither

A 29 year-old woman with a history of asthma since childhood was admitted


for arthroscopic repair of an injured knee.
8. For years she had been on maintenance doses of cromolyn sodium and
theophylline, was well-controlled, not having had any exacerbation of her
asthma during the past three years.
9. The preoperative workup did not reveal any evidence of bronchospasm.
7.

10. Consider the case: Should an aerosolized bronchodilator be administered prior to surgery?

A.
B.

?
?

yes
no

A 32 year-old woman was scheduled for a repeat cesarean section.


12. She was about 20 kg overweight, and was chosen to receive a spinal block.
13. About 14 mg of tetracaine were estimated to produce analgesia to a sensory
level of T4.
14. The baby was of unusually large size, and episodes of fetal bradycardia
occurred.
How can maternal hypotensioypotension should be anticipated, both from the hazards
of maternal circulatory depression and fetal ischemia. A large intravenous needle
should be inserted an infusion of 5% dextrose in lactated Ringer's solution begun.n be
avoided after spinal block
11.

?How could hypotension be avoided by titration of vasoconstrictor drug


Phenylephrine is nearly an exclusively alpha-adrenergic agent. Adding 10 mg of
phenylephrine to 500 ml of 5% dextrose in water can be a sensitive method of
preventing hypotension from occurring during the onset of spinal block
1.

Very potent beta adrenergic receptor agonists with minimal effects on alpha adrenergic
receptors:

A.

? propranolol (Inderal) propranolol (Inderal)

B.
C.
D.
E.
2.

?
?
?
?
?

cocaine
ephedrine
dobutamine (Dobutrex)
epinephrine
yohimbine (Yocon)

?
?
?
?
?

epinephrine
isoproterenol (Isuprel)
cromolyn sodium (Intal)
beclomethasone (Banceril)
albuterol (Ventolin,Proventil)

Useful in management of hypotensive states:low-dose increases renal blood flow:

A.
B.
C.
D.
E.
6.

low-dose epinephrine
isoproterenol (Isuprel)
mecamylamine (Inversine)
methoxamine (Vasoxyl)
atropine

Beta-2 selective agonist-- typically administered by aerosol for asthma management:

A.
B.
C.
D.
E.
5.

?
?
?
?
?

Sympathomimetic due to inhibition of transmitter uptake at noradrenergic synapses:

A.
B.
C.
D.
E.
4.

isoproterenol (Isuprel)
epinephrine
yohimbine (Yocon)
phentolamine (Regitine)

Most likely to produce a reflex-mediated bradycardia:

A.
B.
C.
D.
E.
3.

?
?
?
?

?
?
?
?
?

dobutamine (Dobutrex)
isoproterenol (Isuprel)
dopamine (Intropin)
phenylephrine (Neo-Synephrine)
norepinephrine (Levophed)

Used to suppress premature labor:

A.
B.

? isoproterenol (Isuprel)
? losartin (Cozaar)

C.
D.
E.
7.

Produces epinephrine reversal, converting a pressor response to a deep pressor response:

A.
B.
C.
D.
E.
8.

? ritodrine (Yutopar)
? phenylephrine (Neo-Synephrine)
? clonidine (Catapres)

?
?
?
?
?

losartin (Cozaar)
propranolol (Inderal)
metoprolol (Lopressor)
phentolamine (Regitine)
clonidine (Catapres)

Choose the incorrect statement concerning metabolic effects of sympathomimetic agents

A.
B.
C.

? Activation of beta receptors in fat cells increase lipolysis.


? Alpha -- 2 adrenergic receptors inhibit lipolysis
? Hepatic catecholamine effects our mediated mainly by beta
adrenergic receptor activation
D. ? At high concentrations, catecholamines may induce a metabolic
acidosis
E. ? Sympathomimetic drugs increase extracellular potassium
9.

Effects of sympathomimetic agents on the gastrointestinal tract:

A.
B.
C.
D.
E.

? alpha -adrenergic receptor activation relaxes gastrointestinal


smooth muscle
? beta-adrenergic receptor activation relaxes gastrointestinal smooth
muscle
? alpha-2 agonists act indirectly by reducing acetylcholine release
(presynaptic effect)
? A& B
? A,B & C

10. Catecholamine effects: choose the incorrect match(es):

A.
B.
C.

?
?
?
C
D. ?
E. ?

Gs -- stimulatory G. protein of adenylyl cyclase


Gi -- inhibitory G protein of adenylyl cyclase
Gq -- protein coupling between beta-receptors and phospholipase
A& B
A, B & C

11. Catecholamine desensitization

A.
B.
C.
D.
E.

?
?
?
?
?

receptor sequestration
receptor down regulation
receptor phosphorylation
A & B only
A, B & C

12. Correct receptor type: tissues -- actions

A.
B.
C.
D.
E.

?
?
?
?
?

alpha 1: heart: positive inotropic


alpha 1: pupillary dilator muscle: miosis (pupillary contraction)
alpha 2:cholinergic nerve terminals: facilitate transmitter release
beta 1: heart: decrease forests of contraction
beta 2:human liver: inhibits glycogenolysis

13. Correct receptor type: tissues: actions

A.
B.
C.
D.
E.

?
?
?
?
?

alpha 1:most innervated vascular smooth muscle: contraction


alpha 2:platelets: aggregation
beta 2:uterine smooth muscle: smooth muscle relaxation
A& C
A, B & C

14. Effectively blocks reflex bradycardia following phenylephrine administration:

A.
B.
C.
D.
E.

?
?
?
?
?

prazosin (Minipress)
propranolol (Inderal)
mecamylamine (Inversine)
A& C
A, B & C

15. Rate-determining enzyme reaction in catecholamine biosynthesis

A.
B.
C.
D.
E.

?
?
?
?
?

phenylethanolamine N-methyltransferase
dopa decarboxylase
tyrosine hydroxylase
dopamine beta-hydroxylase
catechol-O-methyltransferase

estion # 1 (Multiple Choice) This catecholamine simultaneously can


increase myocardial contractility, glomerular filtration rates, sodium
excretion, urinary output, and renal blood flow:
A) phenylephrine
B) isoproterenol
C) dobutamine
D) dopamine
E) epinephrine
Question # 2 (Multiple Answer) Clinical uses of for propranolol:
A) treatment of essential hypertension
B) management of angina
C) management of certain arrhythmias
D) prophylactic against asthma attacks
Question # 3 (Multiple Choice) Most cardioselective beta1 adrenergic
receptor antagonist
A) esmolol
B) metoprolol
C) atenolol
D) propranolol
E) timolol
Question # 4 (Multiple Choice) Mechanisms by which epinephrine
increases blood pressure:
A) positive chronotropism
B) positive inotropism
C) vasoconstriction
D) all of the above
Question # 5 (Multiple Choice) Primary therapeutic use for alpha2
selective adrenergic agonists:

A) management of arrhythmias
B) management of renal insufficiency
C) management of intraoperative hypotensive states
D) management of hypertension
E) management of Raynaud's phenomenon
Question # 6 (Multiple Answer) Examples of metabolic effects (often
adverse effects) associated with beta adrenergic receptor antagonists:
A) speeds recovery from insulin-induced hypoglycemia
B) decreases awareness of hypoglycemic symptom onset
C) increases blood lipid levels
Question # 7 (Multiple Choice) Receptors that mediate most of
epinephrine's cardiac effects:
A) beta1 adrenergic
B) beta2 adrenergic
C) dopaminergic
D) alpha-adrenergic
Question # 8 (Multiple Choice) Methoxamine-induced bradycardia
could be blocked by administration of:
A) pilocarpine
B) labetalol
C) esmolol
D) atropine
E) edrophonium
Question # 9 (Multiple Choice) Substantial bradycardia observed in the
presence of inhaled anesthetics with this beta adrenergic receptor
antagonist
A) propranolol
B) esmolol
C) labetalol

D) timolol
E) metoprolol
Question # 10 (Multiple Choice) Dangerous bronchiolar constriction
would be most prominent with this beta adrenergic receptor blocker:
A) metoprolol
B) esmolol
C) atenolol
D) timolol
Question # 11 (Multiple Choice) Primary effect of epinephrine on
respiratory tract smooth muscle:
A) smooth muscle constriction
B) smooth muscle relaxation
Question # 12 (Multiple Choice) Typical heart rate response following
methoxamine administration:
A) increase
B) decrease
Question # 13 (Multiple Answer) Alpha2 selective adrenergic agonists:
A) phentolamine
B) clonidine
C) guanabenz
D) phenoxybenzamine
E) methyldopa
Question # 14 (Multiple Choice) Propranolo loften decreases amide
local anesthetic clearance by
A) decreasing hepatic blood flow
B) inhibiting hepatic metabolism of local anesthetic
C) both
D) neither

Question # 15 (Multiple Choice) Additive cardiovascular effects with


inhaled anesthetics and bayonet adrenergic receptor blockers greatest
with:
A) halothane
B) sevoflurane
C) desflurane
D) isoflurane
E) enflurane
Question # 16 (Multiple Choice) Propranolol (after chronic
administration) would reduce significant first pass uptake of fentanyl at
this anatomical site:
A) liver
B) kidney
C) lung
D) spleen
E) gastrointestinal tract
Question # 17 (Multiple Choice) Concerning low-dose dopamine:
interaction with this receptor causes renal, mesenteric, and coronary
vasodilation:
A) beta1 adrenergic receptors
B) beta2 adrenergic receptors
C) dopamine D1 receptors
D) alpha-adrenergic
E) prostaglandin receptors
Question # 18 (Multiple Answer) beta1 selective adrenergic receptor
antagonist
A) propranolol
B) timolol
C) nadolol
D) metoprolol
E) atenolol

Question # 19 (Multiple Answer) Direct cardiac responses to


epinephrine:
A) increase contractility
B) increased rate of isometric muscle tension development
C) increased slope of phase 4 depolarization
D) decreased automaticity
Question # 20 (Multiple Answer) Examples of beta2 adrenergic selective
agonists:
A) epinephrine
B) isoproterenol
C) terbutaline
D) albuterol
E) metaproterenol
Question # 21 (Multiple Choice) Beta-receptor antagonist primarily
used for the treatment of glaucoma:
A) esmolol
B) propranolol
C) nadolol
D) timolol
E) pilocarpine
Question # 22 (Multiple Choice) Beta adrenergic receptor
blockers:effects on the heart
A) increase heart rate
B) decrease AV node refractory period
C) reduce contractility
D) increase phase 4 depolarization
Question # 23 (Multiple Answer) Direct acting vasoconstrictors:
A) phenylephrine
B) metaraminol

C) mephentermine
D) methoxamine
Question # 24 (Multiple Answer) Epinephrine: therapeutic uses
A) rapid relief of respiratory distress due to bronchospasm
B) topical hemostasis
C) cardiopulmonary resuscitation
D) reversal of hypersensitivity reactions
Question # 25 (Multiple Answer) Primary mechanism by which
norepinephrine acutely increases BP:
A) increases intravascular volume
B) increases heart rate
C) vasoconstriction at precapillary resistance muscles and
veins
D) increases angiotensin II plasma levels
Question # 26 (Multiple Answer) Principal receptors activated by
norepinephrine:
A) alpha-adrenergic
B) beta1 adrenergic
C) beta2 adrenergic
Question # 27 (Multiple Answer) beta-2 adrenergic receptor-selective
agonist(s):may be used in management of both chronic and acute
asthma
A) ritodrine
B) terbutaline
C) albuterol
D) propranolol
E) timolol
Question # 28 (Multiple Answer) Vascular effects of norepinephrine:

A) increases total peripheral resistance; often inducing reflex


bradycardia
B) blood flow reduction to the kidney
C) maintenance of glomerular filtration rates
D) may increase coronary blood flow (secondary to increase
blood pressure and reflex activity)
Question # 29 (Multiple Choice) Perioperative use of this selective beta
adrenergic receptor antagonist in patients with significant underlying
coronary heart disease may reduce the incidence of cardiovascular
complications
A) atenolol
B) propranolol
C) metoprolol
D) esmolol
E) timolol
Question # 30 (Multiple Choice) beta adrenergic receptor antagonist
that also blocks alpha receptors
A) timolol
B) esmolol
C) labetalol
D) propranolol
E) nadolol
Correct Answers
1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ,
21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30
Question # 1 (Multiple Choice) This catecholamine simultaneously can
increase myocardial contractility, glomerular filtration rates, sodium
excretion, urinary output, and renal blood flow:
Answer: (D) dopamine
BACK

Question # 2 (Multiple Answer) Clinical uses of for propranolol:


(A) treatment of essential hypertension
(B) management of angina
(C) management of certain arrhythmias
BACK

Question # 3 (Multiple Choice) Most cardioselective beta1 adrenergic


receptor antagonist
Answer: (C) atenolol
BACKQuestion # 4 (Multiple Choice) Mechanisms by which epinephrine
increases blood pressure:
Answer: (D) all of the above
BACK

Question # 5 (Multiple Choice) Primary therapeutic use for alpha2 selective


adrenergic agonists:
Answer: (D) management of hypertension
BACK

Question # 6 (Multiple Answer) Examples of metabolic effects (often


adverse effects) associated with beta adrenergic receptor antagonists:
(B) decreases awareness of hypoglycemic symptom onset
(C) increases blood lipid levels
BACK
Question # 7 (Multiple Choice) Receptors that mediate most of
epinephrine's cardiac effects:
Answer: (A) beta1 adrenergic
BACK

Question # 8 (Multiple Choice) Methoxamine-induced bradycardia could be


blocked by administration of:
Answer: (D) atropine
BACKQuestion # 9 (Multiple Choice) Substantial bradycardia observed in
the presence of inhaled anesthetics with this beta adrenergic receptor
antagonist
Answer: (D) timolol
BACK
Question # 10 (Multiple Choice) Dangerous bronchiolar constriction would
be most prominent with this beta adrenergic receptor blocker:
Answer: (D) timolol
BACK

Question # 11 (Multiple Choice) Primary effect of epinephrine on


respiratory tract smooth muscle:
Answer: (B) smooth muscle relaxation
BACK

Question # 12 (Multiple Choice) Typical heart rate response following


methoxamine administration:
Answer: (B) decrease
BACK

Question # 13 (Multiple Answer) Alpha2 selective adrenergic agonists:


(B) clonidine
(C) guanabenz
(E) methyldopa
BACK

Question # 14 (Multiple Choice) Propranolo loften decreases amide local


anesthetic clearance by
Answer: (C) both
BACK

Question # 15 (Multiple Choice) Additive cardiovascular effects with


inhaled anesthetics and bayonet adrenergic receptor blockers greatest with:
Answer: (E) enflurane
BACK

Question # 16 (Multiple Choice) Propranolol (after chronic administration)


would reduce significant first pass uptake of fentanyl at this anatomical site:
Answer: (C) lung
BACKQuestion # 17 (Multiple Choice) Concerning low-dose dopamine:
interaction with this receptor causes renal, mesenteric, and coronary
vasodilation:
Answer: (C) dopamine D1 receptors
BACKQuestion # 18 (Multiple Answer) beta1 selective adrenergic receptor
antagonist
(D) metoprolol
(E) atenolol
BACKQuestion # 19 (Multiple Answer) Direct cardiac responses to
epinephrine:
(A) increase contractility
(B) increased rate of isometric muscle tension development
(C) increased slope of phase 4 depolarization
BACK
Question # 20 (Multiple Answer) Examples of beta2 adrenergic selective
agonists:
(C) terbutaline
(D) albuterol
(E) metaproterenol
BACK
Question # 21 (Multiple Choice) Beta-receptor antagonist primarily used for
the treatment of glaucoma:
Answer: (D) timolo
BACKQuestion # 22 (Multiple Choice) Beta adrenergic receptor
blockers:effects on the heart

Answer: (C) reduce contractility


BACKQuestion # 23 (Multiple Answer) Direct acting vasoconstrictors:
(A) phenylephrine
(D) methoxamine
BACK
Question # 24 (Multiple Answer) Epinephrine: therapeutic uses
(A) rapid relief of respiratory distress due to bronchospasm
(B) topical hemostasis
(C) cardiopulmonary resuscitation
(D) reversal of hypersensitivity reBACK

Question # 25 (Multiple Answer) Primary mechanism by which


norepinephrine acutely increases BP:
(C) vasoconstriction at precapillary resistance muscles and veins
BACK
Question # 26 (Multiple Answer) Principal receptors activated by
norepinephrine:
(A) alpha-adrenergic
(B) beta1 adrenerg
BACK

Question # 27 (Multiple Answer) beta-2 adrenergic receptor-selective


agonist(s):may be used in management of both chronic and acute asthma
(B) terbutaline

(CBACKQuestion #
28 (Multiple Answer) Vascular effects of norepinephrine:
(A) increases total peripheral resistance; often inducing reflex bradycardia
(B) blood flow reduction to the kidney
(C) maintenance of glomerular filtration rates
(D) may increase coronary blood flow (secondary to increase blood BACK
Question # 29 (Multiple Choice) Perioperative use of this selective beta
adrenergic receptor antagonist in patients wit
# 1 (Multiple Choice) Nonselective alpha-adrenergic receptor
antagonist(s)
A) phentolamine
B) prazosin
C) yohimbine
Question # 2 (Multiple Choice) "Epinephrine reversal" could occur if
epinephrine is administered in the presence of:
A) cocaine
B) imipramine
C) propranolol
D) phentolamine
E) dopamine
Question # 3 (Multiple Choice) Catecholamine desensitization:
regulation of catecholamine responsiveness occurs at:
A) receptors
B) G protein
C) adenylyl cyclase
D) cyclic nucleotide phosphodiesterase
E) all the above
Question # 4 (Multiple Choice) Drugs used to manage allergic reactions:

A) glucocorticoids
B) antihistamines
C) subcutaneous epinephrine
D) all the above
Question # 5 (Multiple Answer) Drugs which may be used to terminate
paroxysmal supraventricular tachycardia:
A) adenosine
B) calcium channel blockers
C) esmolol
D) methoxamine
Question # 6 (Multiple Answer) Clinical conditions that may result in
shock:
A) dehydration or blood loss
B) cardiac failure
C) cardiac output obstruction
D) loss of peripheral vascular tone
Question # 7 (Multiple Choice) Correct order of adrenergic beta-agonist
potency (greatest to least)
A) isoproterenol, norepinephrine, epinephrine
B) norepinephrine, epinephrine, isoproterenol
C) epinephrine, isoproterenol, norepinephrine
D) isoproterenol, epinephrine, norepinephrine
Question # 8 (Multiple Choice) Alpha receptor class activated by drugs
such as clonidine:
A) alpha1
B) alpha2
Question # 9 (Multiple Answer) Enzyme(s) that degrade
catecholamines:

A) MAO (monoamine oxidase)


B) dopamine beta-hydroxylase
C) tyrosine hydroxylase
D) dopa decarboxylase
E) COMT (catechol-O-methyltransferase)
Question # 10 (Multiple Choice) Beta adrenergic receptor class found
mainly in smooth muscle and most other noncardiac sites:
A) beta1
B) beta2
C) beta3
Question # 11 (Multiple Choice) Enzyme catalyzing the conversion of
norepinephrine to epinephrine:
A) dopamine beta-hydroxylase
B) phenylethanolamine N-methyltransferase
C) tyrosine hydroxylase
D) dopa decarboxylase
Question # 12 (Multiple Answer) Drugs that block translocation of
norepinephrine from extraneuronal sites into the cytoplasm: (Uptake I
inhibitors) -A) imipramine
B) amitriptyline
C) desipramine
D) protriptyline
E) cocaine
Question # 13 (Multiple Choice) Termination of norepinephrine effect is
mainly due to:
A) metabolism
B) diffusion of norepinephrine away from receptors
C) reuptake into presynaptic nerve terminals
D) water-catalyzed hydrolysis

Question # 14 (Multiple Choice) Competitive antagonist in both alpha1


and alpha2 receptor sites; also block serotonin receptors
A) esmolol
B) labetalol
C) phentolamine
D) yohimbine
E) prazosin
Question # 15 (Multiple Choice) Alpha adrenergic antagonist more
potent at alpha2 compared alpha1 adrenergic receptors:
A) phentolamine
B) prazosin
C) yohimbine
Question # 16 (Multiple Choice) Beta adrenergic receptor class found
mainly in myocardial tissue:
A) beta1
B) beta2
Question # 17 (Multiple Choice) Most abundant catecholamine in the
adrenal medulla:
A) isoproterenol
B) dopamine
C) amphetamine
D) norepinephrine
E) epinephrine
Question # 18 (Multiple Choice) Phosphorylation of tyrosine
hydroxylase has its effect on tyrosine hydroxylase activity:
A) increase
B) decrease
C) no effect

Question # 19 (Multiple Answer) Physiological consequences alpha-2


receptor activation:
A) contraction of arterial smooth muscle
B) increased vagal tone
C) decreased sympathetic outflow
D) decreased insulin release
E) contraction of venular smooth muscle
Question # 20 (Multiple Answer) Drugs used in cardiogenic shock
treatment:
A) adrenergic agonists
B) nitrates
C) amrinone
Question # 21 (Multiple Choice) Primary objective in pharmacological
management of shock:
A) maintain adequate renal perfusion
B) maintain adequate CNS perfusion
C) maintain adequate hepatic perfusion
Question # 22 (Multiple Choice) Order of alpha-adrenergic agonist
potency (greatest to least):
A) norepinephrine, isoproterenol, epinephrine
B) isoproterenol, norepinephrine, epinephrine
C) epinephrine, norepinephrine, isoproterenol
D) isoproterenol, epinephrine, norepinephrine
E) norepinephrine, epinephrine, isoproterenol
Question # 23 (Multiple Choice) Rate-limiting step been catecholamine
biosynthesis is catalyzed by this enzyme:
A) dopa decarboxylase
B) phenylethanolamine N-methyltransferase

C) tyrosine hydroxylase
D) dopamine beta-hydroxylase
Question # 24 (Multiple Choice) Alpha-adrenergic receptors found
primarily postsynaptically:
A) alpha1
B) alpha2
Question # 25 (Multiple Choice) Consequence of beta-adrenergic
receptor phosphorylation:
A) enhanced receptor responsiveness
B) decreased receptor responsiveness
Correct Answers
1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ,
21 , 22 , 23 , 24 , 25

Question # 1 (Multiple Choice) Nonselective alpha-adrenergic receptor


antagonist(s)
Answer: (A) phentolamine
BACK
Question # 2 (Multiple Choice) "Epinephrine reversal" could occur if
epinephrine is administered in the presence of:
Answer: (D) phentolaminBACKQuestion # 3 (Multiple Choice)
Catecholamine desensitization: regulation of catecholamine responsiveness
occurs at:
Answer: (E) all the above
BACKQuestion # 4 (Multiple Choice) Drugs used to manage allergic
reactions:

Answer: (D) all the aboveBACKQuestion # 5 (Multiple Answer) Drugs


which may be used to terminate paroxysmal supraventricular tachycardia:
(A) adenosine
(B) calcium channel blockers
(C) esmolol
(D) methoxamineBACKQuestion # 6 (Multiple Answer) Clinical conditions
that may result in shock:
(A) dehydration or blood loss
(B) cardiac failure
(C) cardiac output obstruction
(D) loss of peripheral vascular tone
BACKQuestion # 7 (Multiple Choice) Correct order of adrenergic betaagonist potency (greatest to least)
Answer: (D) isoproterenol, epinephrine, norepinephrine
BACK

Question # 8 (Multiple Choice) Alpha receptor class activated by drugs such


as clonidine:
Answer: (B) alpha2
BACK

Question # 9 (Multiple Answer) Enzyme(s) that degrade catecholamines:


(A) MAO (monoamine oxidase)
(E) COMT (catechol-O-methyltransferase)

BACK

Question # 10 (Multiple Choice) Beta adrenergic receptor class found


mainly in smooth muscle and most other noncardiac sites:
Answer: (B) beta2
BACK

Question # 11 (Multiple Choice) Enzyme catalyzing the conversion of


norepinephrine to epinephrine:
Answer: (B) phenylethanolamine N-methyltransferase
BACK
Question # 12 (Multiple Answer) Drugs that block translocation of
norepinephrine from extraneuronal sites into the cytoplasm: (Uptake I
inhibitors) -(A) imipramine
(B) amitriptyline
(C) desipramine
(D) protriptyline
(E) cocaine
BACK
Question # 13 (Multiple Choice) Termination of norepinephrine effect is
mainly due to:
Answer: (C) reuptake into presynaptic nerve terminals
BACK
Question # 14 (Multiple Choice) Competitive antagonist in both alpha1 and
alpha2 receptor sites; also block serotonin receptors

Answer: (C) phentolaminBACKQuestion # 15 (Multiple Choice) Alpha


adrenergic antagonist more potent at alpha2 compared alpha1 adrenergic
receptors:
Answer: (C) yohimbine
BACK
Question # 16 (Multiple Choice) Beta adrenergic receptor class found
mainly in myocardial tissue:
Answer: (A) beta1
BACKQuestion # 17 (Multiple Choice) Most abundant catecholamine in the
adrenal medulla:
Answer: (E) epinephrine
BACK
Question # 18 (Multiple Choice) Phosphorylation of tyrosine hydroxylase
has its effect on tyrosine hydroxylase activity:
Answer: (A) increase
BACKQuestion # 19 (Multiple Answer) Physiological consequences alpha-2
receptor activation:
(B) increased vagal tone
(C) decreased sympathetic outflow
(D) decreased insulin release
BACKQuestion # 20 (Multiple Answer) Drugs used in cardiogenic shock
treatment:
(B) nitrates
(C) amrinone
BACK

Question # 21 (Multiple Choice) Primary objective in pharmacological


management of shock:

Answer: (B) maintain adequate CNS perfusion


BACK
Question # 22 (Multiple Choice) Order of alpha-adrenergic agonist potency
(greatest to least):
Answer: (C) epinephrine, norepinephrine, isoproterenol
BACK
Question # 23 (Multiple Choice) Rate-limiting step been catecholamine
biosynthesis is catalyzed by this enzyme:
Answer: (C) tyrosi
BACKQuestion # 24 (Multiple Choice) Alphaadrenergic receptors found primarily postsynaptically:
Answer: (A) alpha1
BACKQuestion # 25 (Multiple Choice) Consequence of beta-adrenergic
receptor phosphorylation:
Answer: (B) decreased receptor responsiveness
BACK

1.

Sympathetic Nervous System

A.
B.
C.
D.

2.

Ganglionic neurotransmitter: acetylcholine


generalized response upon sympathetic activation
thoraco-lumbar origin for preganglionic cell bodies
A, B and C

Choline ester most susceptible to hydrolysis by acetylcholinesterase:

A.
B.
C.
D.

3.

?
?
?
?

?
?
?
?

carbachol
acetylcholine
methacholine (Provocholine)
pilocarpine (Pilocar)

Resistant to hydrolysis by acetylcholinesterase

A.
B.
C.
D.

4.

increase heart rate


decreased GI motility
decrease cardiac contractility
urinary retention

?
?
?
?

metoprolol (Lopressor)
atropine
albuterol (Ventolin,Proventil)
ipratropium (Atrovent)

?
?
?
?

pilocarpine (Pilocar)
atropine
both
neither

Antimuscarinic drug with highest CNS activity

A.
B.
C.
D.

9.

?
?
?
?

Miosis

A.
B.
C.
D.

8.

acetylcholine
atropine
methacholine (Provocholine)
carbachol

Bronchoconstriction in an asthmatic:

A.
B.
C.
D.

7.

?
?
?
?

Associated with parasympathetic activation (direct effects):

A.
B.
C.
D.

6.

carbachol (carbamylcholine)
methacholine (Provocholine)
both
neither

Highest nicotinic receptor activity among choline esters:

A.
B.
C.
D.

5.

?
?
?
?

?
?
?
?

atropine
scopolamine
homatropine
muscarine

Muscarinic agent: enhances transmission through the A-V node:

A.
B.

?
?

isoproterenol (Isuprel)
atropine

C.
D.

?
?

propranolol (Inderal)
methacholine (Provocholine)

10. Least likely to be used as a mydriatic because of long-duration of action:

A.
B.
C.
D.

?
?
?
?

homatropine (Isopto Homatropine)


atropine
cyclopentolate (Cyclogyl)
benztropine (Cogentin)

11. Clinically-used to treat sinus bradycardia secondary to acute myocardial infarction:

A.
B.
C.
D.

?
?
?
?

homatropine (Isopto Homatropine)


atropine
benztropine (Cogentin)
tropicamide (Mydriacyl)

12. Reflex bradycardia secondary to an abrupt increase in blood pressure may be blocked by:

A.
B.
C.
D.

?
?
?
?

atropine
mecamylamine (Inversine)
both
neither

13. Symptoms following DFP exposure (diisopropylfluorophosphate, an organophosphate


poison):

A.
B.
C.
D.

?
?
?
?

constipation
salivation
decreased gastric acid secretion
none of the above

14. Location(s) of cholinergic synaptic sites:

A.
B.

? neuromuscular junction
? autonomic effector sites innervated by post-ganglionic
sympathetic fibers
C. ? some CNS synapses
D. ? A & C
E. ? B & C
15. Factors that limit CNS effects of systemic acetylcholine: administration:

A.
B.
C.
D.

?
?
?
?

poor CNS penetration


inactivation by plasma butrylcholinesterase
both
neither

16. Localization of muscarinic cholinergic receptors:

A.
B.
C.
D.
E.

?
?
?
?
?

postganglionic parasympathetic effector sites


autonomic ganglia cells
adrenal medulla
A& C
A, B & C

17. Cholinergic receptor type primarily localized at skeletal muscle neuromuscular junctions:

A.
B.

? muscarinic
? nicotinic

18. Highly sensitive to the action of acetylcholinesterase:

A.
B.
C.
D.
E.

?
?
?
?
?

carbachol
bethanechol (Urecholine)
acetylcholine
A& C
A,B, & C

19. Muscarinic receptor subtype primarily associated with the heart:

A.
B.
C.
D.

?
?
?
?

M1
M2
M3
M4

20. Effective antagonist at neuromuscular junction receptors;

A.
B.

? atropine
? tubocurarine

21. Most likely to be effective in blocking all ganglionic neurotransmission:

A.
B.
C.
D.

?
?
?
?

tubocurarine
mecamylamine (Inversine)
atropine
all of the above

22. Cardiac muscarinic Type M2-receptor mediated action(s):

A.
B.
C.
D.

?
?
?
?

increased phase 4 depolarization rate


increased AV nodal conduction velocity
Decreased atrial and ventricular contractility
all the above

23. Ligand-gated ion channels:

A.
B.
C.
D.

?
?
?
?

nicotinic
muscarinic
both
neither

24. Tends to cause fast responses:

A.
B.

? nicotinic
? muscarinic

25. Agonist effects blocked by tubocurarine:

A.
B.

? muscarinic receptors
? nicotinic receptors

26. Indirect-acting cholinomimetic:

A.
B.
C.
D.
E.

?
?
?
?
?

atropine
edrophonium (Tensilon)
carbachol
acetylcholine
ephedrine
Return

1.

Cholinergic-receptor-mediated vasodilation -- changes in intracellular concentration of this ion


is principally responsible:

A.
B.
C.
D.
E.

2.

sodium
potassium
chloride
calcium
magnesium

Cholinergic-mediated vasodilation involves liberation of this substance, a gas, from


endothelial cells:

A.
B.
C.
D.

3.

?
?
?
?
?

?
?
?
?

prostaglandins
leukotrienes
nitric oxide
calcium

Mechanism(s) of vasodilation mediated by the cholinergic system:

A.
B.

? cholinergic activation promotes nitric oxide release from endothelial cells


? acetylcholine inhibits norepinephrine release from postganglionic sympathetic
fibers
C. ? both
D. ? neither

4.

Parasympathetic system: negative chronotropic effect --

A.
B.

? mediated by M2 muscarinic receptors


? associated with increased diastolic depolarization (increased phase 4
depolarization)
C. ? both
D. ? neither

5.

Major mechanism responsible for decreased AV nodal conduction following increased vagal
tone:

A.
B.
C.
D.
E.

6.

?
?
?
?
?

decreased calcium currents in the AV node


secondary affected to reduced norepinephrine release
decreased sodium currents in the AV node
increased potassium conductance in the AV nodal fibers
all of the above

Associated with excessive vagal tone:

A.

partial heart block

B.
C.
D.

7.

?
?
?
?

more prominent in atrial compared to ventricular muscle


due to a decrease in inward calcium currents
both
neither

Dominating autonomic tone in the ventricle:

A.
B.

9.

total heart block


other bradyarrhythmias
all the above

Concerning negative inotropism associated with increased vagal tone:

A.
B.
C.
D.

8.

?
?
?

?
?

sympathetic
parasympathetic

Mechanisms by which muscarinic stimulation reduces ventricular contractility:

A.
B.
C.
D.

?
?
?
?

reduces ventricular responds to norepinephrine


reduces norepinephrine release from adrenergic terminals
both
neither

10. Effects of muscarinic receptor activation and cardiac ionic currents:

A.
B.
C.
D.
E.

?
?
?
?
?

decreases potassium currents in atrial muscle and in SA nodal MAb nodal tissue
increases in slow, inward calcium currents
decreased in diastolic depolarization (decrease in phase 4 depolarization)
A&C
B&C

11. Effect(s) of muscarinic agonists on the gastrointestinal and urinary tracts:

A.
B.
C.
D.
E.

?
?
?
?
?

increased intestinal peristalsis


increased tone
increased contraction amplitude
increase ureteral peristalsis
all the above

12. Substances that increase nitric oxide production:

A.
B.
C.

?
?
?

substance P
bradykinin
acetylcholine

D.
E.

?
?

A&B
A, B & C

13. Clinical uses of bethanecol:

A.
B.
C.
D.
E.

?
?
?
?
?

management of postoperative abdominal distention


management of esophageal reflux
postoperative urinary bladder stimulant
treatment of reduced salivation secondary to radiation therapy
all the above

14. Opthalmological uses of cholinomimetics:

A.
B.
C.
D.
E.

?
?
?
?
?

acetylcholine may be used as a miotic


treatment of glaucoma
used along with mydriatic agent in breaking iris-lens adhesions
A&B
A, B &C

15. Major contraindications -- muscarinic agonists

A.
B.
C.
D.

16.

?
?
?
?

asthma
hyperthyroidism
peptic ulcer
coronary vascular disease

all the aboveClasses of anticholinesterase drugs:

A.
B.
C.
D.
E.

?
?
?
?
?

reversible, short-acting
intermediate, carbamylating
long-acting, phosphorylate agents
A&B
A, B & C

17. anticholinesterase agent; quaternary ammonium compound; intermediate-duration,


carbamylating agent:

A.
B.
C.
D.
E.

?
?
?
?
?

physostigmine (Antilirium)
neostigmine (Prostigmin)
edrophonium (Tensilon)
tacrine (Cognex)
atropine

18. Renal clearance -- acetylcholinesterase inhibitors--

A.
B.
C.

? actively secreted into renal tubule lumen


? renal clearance: 50% for neostigmine (Prostigmin)
? renal clearance: 75% for edrophonium (Tensilon) and pyridostigmine
(Mestinon)
D. ? all of the above

19. More lipophilic:

A.
B.

?
?

neostigmine (Prostigmin)
most organophosphate acetylcholinesterase inhibitors

20. In organophosphate poisoning, this agent may be capable of re-activating inhibited


acetylcholinesterase:

A.
B.
C.
D.
E.

?
?
?
?
?

atropine
pilocarpine (Pilocar)
mecamylamine (Inversine)
2-PAM
all of the above

21. Consequences of acetylcholinesterase inhibitor application to the conjunctiva

A.
B.
C.
D.

?
?
?
?

relaxation of the pupillary sphincter muscle


relaxation of the ciliary muscle
both
neither

22. Types of glaucoma:

A.
B.
C.
D.

?
?
?
?

primary
secondary
congenital
all the above

23. Which type of glaucoma response to anticholinesterase treatment?

A.
B.
C.

?
?
?

primary
secondary
congenital

24. Anticholinesterases: used in treating glaucoma--

A.
B.

?
?

echothiophate (Phospholine)
demecarium (Humorsol)

C.
D.
E.

?
?
?

atropine (generic)
A&B
A, B, & C

25. Probable cause of myasthenia gravis:

A.
B.
C.
D.

? excessive synthesis of cholinergic receptors


? inadequate synthesis of acetylcholine
? failure of acetylcholine reuptake system
? binding of anti--muscarinic receptor antibodies to the muscarinic cholinergic
receptor
E. ? binding of anti-nicotinic receptor antibodies to the nicotinic cholinergic receptor

26. Rationale for prescribing anticholinesterase drugs to patients with myasthenia gravis:

A.
B.
C.
D.
E.

?
?
?
?
?

increase acetylcholine turnover


increase receptor number
increase amount of acetylcholine available of neuromuscular junctions
reduce choline reuptake
all of the above

27. Associated disorders in myasthenic patients --

A.
B.
C.
D.
E.
F.

?
?
?
?
?

thymic abnormalities
hyperthyroidism
other autoimmune disorders
ventilatory dysfunction
all the above

28. General clinical uses: anticholinesterases

A.
B.
C.
D.
E.

? antagonist-assisted reversal of neuromuscular blockade produced by


nondepolarizing neuromuscular-blocking drugs
? myasthenia gravis management
? glaucoma treatment
? treatment of paralytic ileus and urinary bladder atony
? all of the above

29. Drugs used for antagonist-assisted neuromuscular-blockade reversal

A.
B.
C.
D.
E.

?
?
?
?
?

acetylcholine
physostigmine (Antilirium)
DFP
edrophonium (Tensilon)
all of the above

30. Determination of the recovery rates from neuromuscular-blockade when antagonist-assisted


reversal is used:

A.
B.
C.
D.

?
?
?
?

spontaneous recovery rate from the blocking drug


activity of the pharmacologic antagonist (anticholinesterase drug)
both (sum of A plus B)
difference (A- B)

31. When our anticholinesterase agents usually administered to enhance neuromuscular blockade
reversal?

A.
B.
C.

? before the neuromuscular-blocking drug is given


? while the neuromuscular-blocking drug is being infused
? during the spontaneous neuromuscular-blockade recovery, following cessation
of neuromuscular-blocking administration

32. Pharmacologic antagonism (anticholinesterase drugs) would likely be more effective for
which type of neuromuscular blocking drug?

A.
B.
C.

?
?
?

short-or intermediate-acting neuromuscular-blocking drugs


long-acting nondepolarizing neuromuscular-blockade
equally effective

33. Rationale for using muscarinic antagonists in pharmacologic (anticholinesterase-mediated)


reversal of neuromuscular-blockade:

A.
B.
C.

?
?
?

increases acetylcholine concentration that neuromuscular junctions


inhibits acetylcholinesterase
minimizes muscarinic receptor-mediated effects of anticholinesterase drugs

34. which antimuscarinic agent might be used in combination with an anticholinesterase when
desiring reversal of neuromuscular-blockade and opioid-based maintenance anesthesia has
been used:

A.
B.
C.

?
?
?

edrophonium (Tensilon)
high-dose atropine (10-15 ug/kg)
neostigmine (Prostigmin)

35. More effective in reversing deep neuromuscular-blockade produced by continuous atracurium


(Tracrium), vecuronium (Norcuron), or pancuronium (Pavulon) infusions

A.
B.
C.

?
?
?

edrophonium (Tensilon)
neostigmine (Prostigmin)
both are equally effective

36. Factor(s) that may prevent or inhibit anticholinesterase-mediated antagonism of


neuromuscular-blockade:

A.
B.
C.
D.
E.

?
?
?
?
?

hyperthermia
respiratory alkalosis
hyperkalemia
certain antibiotics
all of the above

37. Reversal of phase II block (following prolonged repeated succinylcholine (Anectine)) in


patients with normal plasma cholinesterase:

A.
B.
C.
D.

?
?
?
?

edrophonium (Tensilon)
neostigmine (Prostigmin)
both
neither

38. Reversal of phase II block (following prolonged or repeated succinylcholine (Anectine)


administration) in patients with atypical plasma cholinesterase:

A.

? reliable, assisted neuromuscular blockade reversal using edrophonium


(Tensilon) or neostigmine (Prostigmin)
B. ? unreliable, assisted neuromuscular blockade reversal using edrophonium
(Tensilon) or neostigmine (Prostigmin)

39. Intrathecal neostigmine (Prostigmin) produces postoperative analgesia without respiratory


depression:

A.
B.

?
?

true
false

40. Current primary therapeutic rationale for using anticholinergic preoperative medication:

A.
B.
C.
D.

?
?
?
?

sedation
antisialagogue effects
both
neither

41. Usual anticholinergic drug doses for preoperative medication does not affect either gastric
volume or pH

A.
B.

? true
? false

42. In using anticholinergic drugs as preoperative medication in a patient with glaucoma: drug
least likely to have an effect on pupil size

A.
B.
C.

? scopolamine
? atropine
? glycopyrrolate (Robinul)

43. Preferred anticholinergic drug when sedation is the principal objective, preoperatively:

A.
B.
C.

? atropine
? glycopyrrolate (Robinul)
? scopolamine

44. Atropine: most likely to increase heart rate in this patient population:

A.
B.
C.

? young adult
? infants
? elderly

45. Anticholinergic drug most likely to be used clinically to promote bronchodilation:

A.
B.
C.
D.
E.

?
?
?
?
?

IV atropine
aerosolized atropine
aerosolized ipratropium bromide (ipratropium (Atrovent))
scopolamine
all of the above

46. More effective in producing bronchodilation in patients with chronic bronchitis or


emphysema:

A.
B.
C.

? albuterol (Ventolin,Proventil) (beta-adrenergic agonist)


? ipratropium (Atrovent) (antimuscarinic agent)
? equally effective

47. Mydriasis without loss of accommodation

A.
B.

? parasympatholytic
? sympathomimetic

48. Management of severe bradycardia and A-V block associated with acute myocardial
infarction:

A.
B.

? atropine
? neostigmine (Prostigmin)

49. Atropine is effective in blocking reflex cardiac slowing secondary to:

A.
B.
C.
D.
E.

?
?
?
?
?

carotid sinus stimulation


pressure on the eyeballs
peritoneal stimulation which may occur or during surgery
A& B
A, B & C
Return

uestion # 1 (Multiple Answer) Anticholinesterases used to treat myasthenia


gravis:
A) neostigmine (Prostigmin)
B) pyridostigmine (Mestinon)
C) ambenonium
Question # 2 (Multiple Choice) Nicotinic receptor:
A) ionic channel coupling
B) G protein coupling
Question # 3 (Multiple Choice) Glaucoma category responding to
anticholinesterase treatment
A) primary (narrow angle -- acute, congestive)
B) secondary (aphakic --no lens; following cataract surgery)
C) congenital
Question # 4 (Multiple Answer) Major contraindications to the use of muscarinic
agonists
A) postoperative abdominal distention
B) asthma
C) treatment of diminished salvation, secondary to radiation

D) peptic ulcer
E) hyperthyroidism
Question # 5 (Multiple Choice) Cardiac muscarinic Type M2 receptor effects:
A) decreased phase 4 depolarization
B) decreased atrial contractility
C) decreased conduction velocity through the AV node
D) decreased ventricular contractility
E) all the above
Question # 6 (Multiple Answer) Anticholinesterase agents used in antagonistassisted neuromuscular-blockade reversal:
A) edrophonium (Tensilon)
B) neostigmine (Prostigmin)
C) physostigmine (Antilirium)
D) pyridostigmine (Mestinon)
Question # 7 (Multiple Answer) Drug:correct clinical application
A) bethanechol (Urecholine)l: treatment of paralytic ileus
B) bethanechol (Urecholine): treatment of postpartum urinary
retention
C) methacholine (Provocholine): testing for bronchial hyperreactivity
D) bethanechol (Urecholine): treatment of esophageal reflux
Question # 8 (Multiple Choice) Major of route of elimination for
anticholinesterase drugs:
A) pulmonary
B) hepatic
C) renal
Question # 9 (Multiple Choice) Determines recovery rate following
neuromuscular blockade:
A) A, spontaneous recovery rate from the blocking drug
B) B. activity the pharmacologic antagonist

C) A plus B
D) A minus B
Question # 10 (Multiple Choice) Probable cause of myasthenia gravis:
A) defect in acetylcholine synthesis
B) decreased receptor turnover
C) binding of anti-nicotinic receptor antibodies to the nicotinic
receptor
Question # 11 (Multiple Choice) Probably most important ion for transmission to
the AV node -A) sodium
B) potassium
C) chloride
D) calcium
E) magnesium
Question # 12 (Multiple Choice) In clinical anesthesia (anesthetized patients):
longer duration of action -A) edrophonium (Tensilon)
B) neostigmine (Prostigmin)
C) both about the same
Question # 13 (Multiple Choice) Rationale of combining atropine and
anticholinesterases in reversal of nondepolarizing neuromuscular-blockade
A) the antimuscarinic increases the rate of recovery
B) the antimuscarinic reduces muscarinic-receptor-mediated side
effects
C) both
D) neither
Question # 14 (Multiple Choice) Renal clearance of anticholinesterase drugs:
A) glomerular filtration
B) active secretion into renal tubule lumen
Question # 15 (Multiple Choice) Dominant autonomic tone in the ventricle:

A) adrenergic
B) cholinergic
Question # 16 (Multiple Choice) Quaternary ammonium compound;
anticholinesterase -- permanently positively charged:
A) neostigmine (Prostigmin)
B) physostigmine (Antilirium)
Question # 17 (Multiple Answer) Cardiovascular effects of cholinomimetics:
A) negative chronotropic
B) vasoconstriction
C) decreased AV nodal conduction velocity
D) negative inotropism
Question # 18 (Multiple Choice) Reactivation of acetylcholinesterase following
inhibition by organophosphates:
A) atropine
B) pilocarpine (Pilocar)
C) 2-PAM-- pralidoxime (Protopam)
D) scopolamine
E) mecamylamine (Inversine)
Question # 19 (Multiple Choice) Longest duration of acetylcholinesterase
inhibition:
A) DFP
B) neostigmine (Prostigmin)
C) physostigmine (Antilirium)
D) edrophonium (Tensilon)
E) tacrine (Cognex)
Question # 20 (Multiple Answer) Muscarinic receptor activation: effects on
cardiac currents
A) increase potassium conductance in atrial muscle, S.A., AV nodal
tissue
B) decreased inward calcium current

C) increase in phase 4 depolarization (increased diastolic


depolarization)
Question # 21 (Multiple Answer) Increased nitric oxide production:
A) bradykinin
B) substance P
C) acetylcholine
Question # 22 (Multiple Choice) Effects of muscarinic agonists on the
gastrointestinal tract
A) reduced intestinal peristalsis
B) reduced smooth muscle tone
C) reduced contraction amplitude
D) all of the above
E) none of the above
Question # 23 (Multiple Answer) Example of short-acting reversible,
anticholinesterases:
A) physostigmine (Antilirium)
B) neostigmine (Prostigmin)
C) edrophonium (Tensilon)
D) DFP
E) tacrine (Cognex)
Correct Answers
1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ,
23

Question # 1 (Multiple Answer) Anticholinesterases used to treat myasthenia gravis:


(A) neostigmine (Prostigmin)
(B) pyridostigmine (Mestinon)
(C) ambenonium
BACK
Question # 2 (Multiple Choice) Nicotinic receptor:
Answer: (A) ionic channel coupling
BACKQuestion # 3 (Multiple Choice) Glaucoma category responding to
anticholinesterase treatment
Answer: (A) primary (narrow angle -- acute, congestive)
BACK
Question # 4 (Multiple Answer) Major contraindications to the use of muscarinic
agonists
(B) asthma
(D) peptic ulcer
(E) hyperthyroidism
BACK

Question # 5 (Multiple Choice) Cardiac muscarinic Type M2 receptor effects:


Answer: (E) all the above
BACK

Question # 6 (Multiple Answer) Anticholinesterase agents used in antagonist-assisted


neuromuscular-blockade reversal:
(A) edrophonium (Tensilon)
(B) neostigmine (Prostigmin)
(D) pyridostigmine (Mestinon)
physostigmine: would require too large a dosage BACKQuestion # 7 (Multiple
Answer) Drug:correct clinical application
(A) bethanechol (Urecholine)l: treatment of paralytic ileus
(B) bethanechol (Urecholine): treatment of postpartum urinary retention
(C) methacholine (Provocholine): testing for bronchial hyperreactivity
(D) bethanechol (Urecholine): treatment of esophageal reflux
other drugs are better than bethanecol for esophageal reflux, e.g. cisapride (serotonin
agonists),metoclopramide (dopamine antagonistBACKQuestion # 8 (Multiple
Choice) Major of route of elimination for anticholinesterase drugs:
Answer: (C) renalBACKQuestion # 9 (Multiple Choice) Determines recovery rate
following neuromuscular blockade:
Answer: (C) A plBACKQuestion # 10 (Multiple Choice) Probable cause of
myasthenia gravis:
Answer: (C) binding of anti-nicotinic receptor antibodies to the nicotinic receptor
BACK

Question # 11 (Multiple Choice) Probably most important ion for transmission to the
AV node -Answer: (D) calciumBACKQuestion # 12 (Multiple Choice) In clinical anesthesia
(anesthetized patients): longer duration of action -Answer: (C) both about the same
BACKQuestion # 13 (Multiple Choice) Rationale of combining atropine and
anticholinesterases in reversal of nondepolarizing neuromuscular-blockade

Answer: (C) both


BACK

Answer: (B) active secretion into renal tubule lumen


BACKQuestion # 15 (Multiple Choice) Dominant autonomic tone in the ventricle:
Answer: (A) adrenergic
BACKQuestion # 16 (Multiple Choice) Quaternary ammonium compound;
anticholinesterase -- permanently positively charged:
Answer: (A) neostigmine (Prostigmin)
quaternary ammonium compounds are poorly absorbed due to their permanent
charge BACK

Question # 17 (Multiple Answer) Cardiovascular effects of cholinomimetics:


(A) negative chronotropic
(C) decreased AV nodal conduction velocity
(D) negative inotropism
BACKQuestion # 18 (Multiple Choice) Reactivation of acetylcholinesterase
following inhibition by organophosphates:
Answer: (C) 2-PAM-- pralidoxime (Protopam)
BACKQuestion # 19 (Multiple Choice) Longest duration of acetylcholinesterase
inhibition:
Answer: (A) DFP
BACK

Question # 20 (Multiple Answer) Muscarinic receptor activation: effects on cardiac


currents
(A) increase potassium conductance in atrial muscle, S.A., AV nodal tissue

(B) decreased inward calcium current


BACK
Question # 21 (Multiple Answer) Increased nitric oxide production:
(A) bradykinin
(B) substance P
(C) acetylcholine
BACK
Question # 22 (Multiple Choice) Effects of muscarinic agonists on the gastrointestinal
tract
Answer: (E) none of the above
increased intestinal peristalsis, tone, contraction amplitude BACKQuestion # 23
(Multiple Answer) Example of short-acting reversible, anticholinesterases:
(C) edrophonium (Tensilon)
(E) tacrine (Cognex)
non-covalent; other agents form covalent bonds --some very stable BACK

1 (Multiple Answer) Factors influencing the speed and extent of


neuromuscular-blockade reversal by anticholinesterases
A) intensity of neuromuscular-blockade when reversal is
initiated
B) which nondepolarizing neuromuscular-blocking drug is
being reversed
C) hypothermia
D) hypokalemia
E) respiratory acidosis
Question # 2 (Multiple Choice) Preferred anticholinergic drug when the
objective (in preoperative medication) is sedation:

A) atropine
B) glycopyrrolate (Robinul)
C) scopolamine
D) ipratropium (Atrovent)
E) neostigmine (Prostigmin)
Question # 3 (Multiple Choice) Preoperative medication: atropine -A) sedation
B) antisialagogue
C) both
D) neither
Question # 4 (Multiple Answer) Atropine should be effective in blocking
which of the following cardiac responses?
A) positive inotropism in response to significant increases in
circulating epinephrine
B) reflex slowing of the heart due to peritoneal stimulation
occurring during surgery
C) reflex slowing of the heart due to pressure on the eyeballs
D) A-V blockade associatet with acute myocardial infarction
E) all of the above
Question # 5 (True/False) Intrathecal neostigmine injection -- produces
postoperative analgesia without respiratory depression seen with
neuraxial opioids:
A) true
B) false
Question # 6 (Multiple Choice) Anticholinesterase better for reversing
atracurium blockade:
A) neostigmine (Prostigmin)
B) edrophonium (Tensilon)
C) equally effective

Question # 7 (True/False) Atropine has limited effects on circulation


because most vascular beds lack significant cholinergic innervation
A) true
B) false
Question # 8 (Multiple Choice) Probably better for reversing
vecuronium (Norcuron) blockade:
A) edrophonium (Tensilon)
B) neostigmine (Prostigmin)
C) about equal
Question # 9 (Multiple Answer) Effect of ganglionic blockade at these
anatomical sites:
A) veins: dilatation, blood pooling, decreased venous return,
decreased cardiac output
B) arterioles: vasoconstriction, decreased peripheral blood
flow, hypertension
C) heart: bradycardia
D) gastrointestinal tract: reduced tone and motility;
constipation; decreased secretions
Question # 10 (Multiple Choice) More effective in reversing deep
neuromuscular-blockade produced by continuous vecuronium infusion:
A) neostigmine (Prostigmin)
B) edrophonium (Tensilon)
Question # 11 (Multiple Choice) Least effect on pupil size of all
anticholinergic drugs used in preoperative medication:
A) glycopyrrolate (Robinul)
B) atropine
C) scopolamine
Question # 12 (Multiple Answer) Concerning use of antimuscarinic
agents a long with anticholinesterases in reversal of neuromuscularblockade:

A) antimuscarinic agents are beneficial because they


minimize muscarinic receptor-mediated effects of
anticholinesterase agents
B) antimuscarinic drug should have a slower onset then the
anticholinesterase drugs
C) higher does atropine has been recommended if opioidbased maintenance anesthesia has been used
Question # 13 (Multiple Answer) Predominant autonomic tone:
A) arterioles -- sympathetic: adrenergic
B) heart -- sympathetic: adrenergic
C) gastrointestinal tract -- parasympathetic: cholinergic
D) veins -- sympathetic: adrenergic
Question # 14 (Multiple Answer) Factors which may prevent or inhibit
anticholinesterase-mediated reversal of neuromuscular blockade:
A) hyperthermia
B) hyperkalemia
C) respiratory acidosis
D) certain antibiotics
E) all of the above
Question # 15 (Multiple Choice) Effect of antimuscarinic agents on
bronchiolar smooth muscle:
A) tends to promote bronchorelaxation
B) tends to promote bronchial constriction
Question # 16 (Multiple Choice) Highest CNS activity
A) atropine
B) glycopyrrolate (Robinul)
C) scopolamine
Question # 17 (Multiple Choice) Drug not appropriate for antagonistassisted neuromuscular-blockade reversal, because the dosage
requirement is excessive:

A) edrophonium (Tensilon)
B) physostigmine (Antilirium)
C) neostigmine (Prostigmin)
D) pyridostigmine (Mestinon)
E) vecuronium (Norcuron)
Question # 18 (Multiple Answer) Effects of ganglionic blockade on these
anatomical sites:
A) veins: dilation, decreased venous return, decreased
cardiac output
B) arterioles: vasoconstriction, decreaset peripheral blood
flow, hypertension
C) heart: bradycardia
Question # 19 (Multiple Choice) Drug category of choice in
management of intraoperative bradycardia -- especially if bradycardia
results from increased vagal tone:
A) anticholinesterase
B) nicotinic receptor agonist
C) muscarinic receptor agonist
D) nicotinic receptor antagonist
E) muscarinic receptor antagonist
Question # 20 (Multiple Answer) Comparing ipratropium (Atrovent)
and atropine in management of asthma:
A) ipratropium (Atrovent) does not inhibit mucociliary
clearance --atropine does
B) ipratropium (Atrovent) has no significant CNS effects
C) ipratropium (Atrovent) is limited or no systemic effects
D) ipratropium (Atrovent) generally it is advantageous
compared atropine in management of asthma
Question # 21 (Multiple Choice) Anesthetic that probably increases
central venous tone:

A) enflurane (Ethrane)
B) halothane (Fluothane)
C) both
D) neither
r) Factors influencing the speed and extent of neuromuscular-blockade reversal by
anticholinesterases
(A) intensity of neuromuscular-blockade when reversal is initiated
(B) which nondepolarizing neuromuscular-blocking drug is being reversed
(C) hypothermia
(D) hypokalemia
(E) respiratory acidosis
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Question # 2 (Multiple Choice) Preferred anticholinergic drug when the objective (in
preoperative medication) is sedation:
Answer: (C) scopolamine
BACK

Question # 3 (Multiple Choice) Preoperative medication: atropine -Answer: (C) both


BACK
Question # 4 (Multiple Answer) Atropine should be effective in blocking which of the
following cardiac responses?
(B) reflex slowing of the heart due to peritoneal stimulation occurring during surgery
(C) reflex slowing of the heart due to pressure on the eyeballs
(D) A-V blockade associatet with acute myocardial infarction
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Question # 5 (True/False) Intrathecal neostigmine injection -- produces postoperative


analgesia without respiratory depression seen with neuraxial opioids:
Answer: True
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Question # 6 (Multiple Choice) Anticholinesterase better for reversing atracurium
blockade:
Answer: (A) neostigmine (Prostigmin)
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Question # 7 (True/False) Atropine has limited effects on circulation because most
vascular beds lack significant cholinergic innervation
Answer: True
BAQuestion # 8 (Multiple Choice) Probably better for reversing vecuronium
(Norcuron) blockade:
Answer: (B) neostigmine (Prostigmin)

BACKQuestion # 9 (Multiple Answer) Effect of ganglionic blockade at these


anatomical sites:
(A) veins: dilatation, blood pooling, decreased venous return, decreased cardiac
output
(D) gastrointestinal tract: reduced tone and motility; constipation; decreased
secretions
arterioles: vasodilatation, increased peripheral blood flow, hypotension, heart -tachycardia BACK
Question # 10 (Multiple Choice) More effective in reversing deep neuromuscularblockade produced by continuous vecuronium infusion:
Answer: (B) edrophonium (Tensilon)
BACKQuestion # 11 (Multiple Choice) Least effect on pupil size of all
anticholinergic drugs used in preoperative medication:
Answer: (A) glycopyrrolate (Robinul)
BACKQuestion # 12 (Multiple Answer) Concerning use of antimuscarinic agents a
long with anticholinesterases in reversal of neuromuscular-blockade:
(A) antimuscarinic agents are beneficial because they minimize muscarinic receptormediated effects of anticholinesterase agents
(C) higher does atropine has been recommended if opioid-based maintenance
anesthesia has been used
BACKQuestion # 13 (Multiple Answer) Predominant autonomic tone:
(A) arterioles -- sympathetic: adrenergic
(C) gastrointestinal tract -- parasympathetic: cholinergic
(D) veins -- sympathetic: adrenergic
heart is parasympathetic: cholinergic; BACK

Question # 14 (Multiple Answer) Factors which may prevent or inhibit


anticholinesterase-mediated reversal of neuromuscular blockade:
(D) certain antibiotics
hypokalemia, respiratory acidosis, hypokalemia/metabolic acidosis BACK

Question # 15 (Multiple Choice) Effect of antimuscarinic agents on bronchiolar


smooth muscle:
Answer: (A) tends to promote bronchorelaxation
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Question # 16 (Multiple Choice) Highest CNS activity


Answer: (C) scopolamine
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Question # 17 (Multiple Choice) Drug not appropriate for antagonist-assisted
neuromuscular-blockade reversal, because the dosage requirement is excessive:
Answer: (B) physostigmine (Antilirium)
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Question # 18 (Multiple Answer) Effects of ganglionic blockade on these anatomical
sites:
(A) veins: dilation, decreased venous return, decreased cardiac output
arterioles: vasodilation, increased peripheral blood flow, hypotension BACK
Question # 19 (Multiple Choice) Drug category of choice in management of
intraoperative bradycardia -- especially if bradycardia results from increased vagal
tone:
Answer: (E) muscarinic receptor antagonist
BACKQuestion # 20 (Multiple Answer) Comparing ipratropium (Atrovent) and
atropine in management of asthma:
(A) ipratropium (Atrovent) does not inhibit mucociliary clearance --atropine does
(B) ipratropium (Atrovent) has no significant CNS effects
(C) ipratropium (Atrovent) is limited or no systemic effects
(D) ipratropium (Atrovent) generally it is advantageous compared atropine in
management of asthma
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Question # 21 (Multiple Choice) Anesthetic that probably increases central venous


tone:
Answer: (B) halothane (Fluothane)
BACK