Autonomic Pharmacology

Question 0

Spinal roots of origin for SANS

Answer 0

Thoracolumbar - thoracic ( T1-T12) and lumbar (L1-L5) segments of the spinal cord

Question 1

Part of ANS consist of myenteric plexus and submucous plexus

Answer 1

Enteric nervous system (ENS)
Myenteric plexus - Auerbach plexus
Submucous plexus - Meissner plexus

Question 2

Spinal roots of origin for PANS

Answer 2

Crariosacral - CN III, VII, IX and X and sacral segment of spinal cord (S3 and S4)

Question 3

Ganglia for SANs are located at?

Answer 3

Paravertebral chains lie along the spinal cord

Question 4

Location of ganglia for PANS

Answer 4

Located in the organ innervated

Question 5

Has shorter preganglionic fiber and a longer postganglionic fiber

Answer 5

SANS - Sympathetic ANS

Question 6

Shorter postganglionic fiber and longer preganglionic fiber

Answer 6

Parasympathetic ANS

Question 7

Receptor causes Mydriasis? And miosis?

Answer 7

Mydriasis - a1 receptor of Sympathetic ANS

Miosis - M3 receptor of Parasympathetic ANS

Question 8

Primary transmitter in all autonomic ganglia and parasympathetic postganglionic neurons synapses

Answer 8

Acethylcholine

Question 9

Enzyme that synthesized ACh from acetyl-CoA and choline

Answer 9

Choline acetyltransferase (CHAT)

Question 10

Choline transport is inhibited by what?

Answer 10

Hemicholinium

Question 11

Vesamicol inhibit what enzyme that actively transport ACh into vesicles

Answer 11

Vesicle-associated transporter (VAT)

Question 12

Calcium triggers interaction among SNARE proteins thus releasing ACh is prevented by what toxin?

Answer 12

Botulinum toxin

Question 13

Indirect-acting Cholinomimetics inhibits what enzyme thus preventing degradation of ACh into choline and acetate

Answer 13

Acetylcholinesterase

Question 14

Direct-acting, muscarinic drug used for post-surgery or spinal cord injury bladder/bowel atony

Answer 14

Betanechol-M3 receptor activator

Question 15

Direct-acting, muscarinic, for glaucoma, Sjogren syndrome and Sicca syndrome

Answer 15

Pilocarpine - M3 receptor increasing aqueous humor outflow

Question 16

Sjogren syndrome triad?

Answer 16

A. Xerostomia
B. Xerophthalmia
C. Rheumatoid arthritis

Question 17

Varenicline is used for smoking cessation belongs to what type of drug classification?

Answer 17

Nicotine - direct-acting cholinomimetics, nicotinics

Question 18

Cyclospasm, miosis, bronchoconstriction are present in what drug toxicity?

Answer 18

Muscarinic toxicity

Question 19

Toxicity results to blockade of neuromuscular end plate depolarization leading to fasciculations and paralysis

Answer 19

Nicotinic toxicity

Question 20

Group of drugs that bind to cholinesterase and amplify acetylcholine effects wherever ACh is released

Answer 20

Indirect-Acting Cholinomimetics

Question 21

Drug used for differentiation between cholinergic and myasthenic crisis in Myasthenia gravis

Answer 21

Edrophonium - short-acting upon IV administration

Diagnosis for MG: Tensilon test

Question 22

Used for MG, Ogilvie syndrome and reversal of nondepolarizing neuromuscular blockade

Answer 22

Neostigmine

Question 23

Myasthenia gravis is an autoimmune destruction of what receptors? Resulting to fluctuating muscle, weakness, ocular symptoms and proximal muscle weakness

Answer 23

Nicotinic ACh receptors

Question 24

Aside from infection and stress, Myasthenic crisis results from?

Answer 24

Undermedication - symptoms improved with Edrophonium

Question 25

Cholinergic crisis results from excessive activation of cholinoreceptors due to?

Answer 25

Overmedication- Edrophonium weakens muscle strength

Question 26

Indirect-acting cholinomimetic drug used for Alzheimer's disease

Answer 26

Rivastigmine - SIMD: Donepezil, Tacrine

Question 27

Signs and symptoms of organophosphate poisoning

Answer 27

DUMBBELSS-diarrhea, urination, miosis, bronchospasm, bradycardia, excitation, lacrimation, sweating and salivation

Question 28

First choice antidote for organophosphate poisoning

Answer 28

Atropine - completely blocks all muscarinic receptors

Question 29

Chemical antagonist, antidote for organophosphate poisoning and nerve gas poisoning, must be administered 6-8hrs before bond with cholinesterase

Answer 29

Pralidoxime

Question 30

Prototype nonselective muscarinic blocker, a tertiary amine that crosses membrane barriers; SIMD: Homatropine, Cyclopentolate and Tropicamide

Answer 30

Atropine - also for mydriatic, cycloplegic

Question 31

Non-selective muscarinic blocker used for Parkinson's disease

Answer 31

Benztropine, Biperiden, and Trihexyphenidyl - reduces tremors more than bradykinesia

Question 32

Cholinergic-muscarinic antagonist used for Asthma and COPD

Answer 32

Ipratropium - prevents vagal-stimulated bronchoconstriction, less likely cause tachycardia and cardiac arrhythmias

Question 33

Cholinergic-muscarinic antagonist used for motion sickness, antagonizes histamine and serotonin

Answer 33

Scopolamine - applied as transdermal patch

Question 34

What drug toxicity results to fever, flush, tachycardia, arrhythmias, CNS toxicity

Answer 34

Atropine toxicity

Question 35

First successful agents for hypertension but were abandoned due to its severe adverse effect on ganglion blockade

Answer 35

Ganglionic blockers

Question 36

Cholinergic-nicotinic antagonist used for hypertension and hypertensive emergencies

Answer 36

Hexamethonium - se: postural hypotension

Question 37

Primary transmitter at the sympathetic postganglionic neuron-effector cell synapse in most tissues except for eccrine sweat glands and vasodilator sympathetic fibers in skeletal muscles

Answer 37

Norepinephrine

Question 38

Hydroxylation of tyrosine to DOPA is inhibited by?

Answer 38

Metyrosine -inhibits tyrosine hydroxylase enzyme

Question 39

Vesicular transport of NE and DOpamine to vesicles is inhibited by?

Answer 39

Reserpine (stage 2: storage)

Question 40

Guanethidine inhibits release of NE during step 3 but promoted by _____ and _____

Answer 40

Amphetamine and Tyramine

Question 41

Reuptake of NE via NET and DAT in synaptic cleft is inhibited by?

Answer 41

Cocaine and TCAs

Question 42

Norepinephrine is metabolized by MAO and COMT into?

Answer 42

Metanephrines and VMA

Question 43

Symphatomimetic, direct-acting, non-selective used for cardiac arrest, anaphylaxis,

Answer 43

Epinephrine - actions on a1, B1, and B2 receptors

Question 44

Norepinephrine - sympathomimetic, direct-acting, non-selective is used as last resort for what type of shock?

Answer 44

Cardiogenic shock - also for neurogenic shock

Question 45

Sympathomimetic, non-selective, direct-acting drug that activates alpha, beta and D1 receptors

Answer 45

Dopamine - used for shock, and heart failure

Question 46

1-5mcg/kg/min dose of Dopamine causes vasodilation in the splanchnic and renal vascular beds via what receptors?

Answer 46

D1 receptors - increased renal blood flow and urine output

Question 47

At what dose of Dopamine causes vasoconstriction and increased blood pressure via alpha receptors?

Answer 47

High dose (>15mcg/kg/min)

Question 48

At what dose of Dopamine that activates the B1 receptors resulting to increase renal blood flow, heart rate, cardiac contractility and cardiac output?

Answer 48

Medium dose at 5-15 mcg/kg/min

Question 49

Sympathomimetic, beta-nonselective drug used for asthma

Answer 49

Isoproterenol

Question 50

Sympathomimetic, a1 selective drug, used for decongestant with a side effect of having rebound nasal congestion

Answer 50

Phenylephrine - causes mydriasis without cycloplegia

Question 51

Drug that decreases central sympathetic outflow used for hypertension, cancer pain and opioid withdrawal

Answer 51

Clonidine - sympathomimetic, a2 selective

Question 52

Drug used for rebound hypertension

Answer 52

Phentolamine

Question 53

Sympathomimetic drug, a2-selective, used for pre-eclampsia

Answer 53

Methlydopa. - SE: hemolytic anemia

Question 54

Apraclonidine, a2-selective drug used for glaucoma by what mechanism?

Answer 54

Activates a2-receptor : decreasing secretions of aqueous humor

Question 55

Sympathomimetic, B1-selective drug for acute heart failure and cardiogenic shock. Also used in cardiac stress testing

Answer 55

Dobutamine

Question 56

Drug of choice for acute asthma attacks, used also as tocolysis for preterm labor (terbutaline/ritodrine)

Answer 56

Albuterol/Salbutamol - may precipitate arrhythmias in patient with concurrent COPD and heart disease

Question 57

If B1and D1 agonists is for acute heart failure/septic shock then ____ is for hemostasis, decongestion and spinal shock

Answer 57

a1 agonist

Question 58

B2 agonist is for bronchospasm/premature labor then _____ is for hypertension and glaucoma

Answer 58

a2 agonist

Question 59

Alpha-nonselective antagonist used for Pheochromocytoma (pre-surgical). Effects last for several days

Answer 59

Phenoxybenzamine - SE: orthostatic hypotension

Question 60

Alpha-nonselective used as antidote to a1 agonist overdose, rebound hypertension, and pre-surgical pheochromocytoma

Answer 60

Phentolamine

Question 61

a1 selective antagonist for benign prostatic hyperplasia, hypertension

Answer 61

Prazosin - Tamsulosin (most selective for prostatic smooth muscle)

Question 62

Beta-nonselective antagonist for angina prophylaxis, hypertension, migraine and hyperthyroidism

Answer 62

Propranolol

Question 63

Nonselective beta blocker that has combined a and B blockade maybe used for pheochromocytoma

Answer 63

Carvedilol and Labetalol

Question 64

Nonselective beta blocker that has Intrinsic Sympathomimetic Activity

Answer 64

Acebutolol and Pindolol - ISA = advantage in treating patient with asthma because it less likely cause bronchospasm

Question 65

Beta blockers that are useful for glaucoma since it has less effect on protective reflexes and less risk for corneal ulceration

Answer 65

Timolol and Betaxolol

Question 66

Beta-blocker that has A. Longest half-life B. Shortest half-life

Answer 66

A. Nadolol - NasaDOLO = longest half life | B. Esmolol - ESMOL (small) = shortest half life

Question 67

Autonomic drugs used for Glaucoma except: | Mannitol, Timolol, Apraclonidine, Epinephrine

Answer 67

Mannitol used for Glaucoma but it is not an autonomic drug, it is an osmotic agent