Reference no: EM132613175

Cholenergic Agonist And Cholenergic Ransmission

1. Classes of anticholinesterase drugs:
a. reversible, short-acting
b. intermediate, carbamylating
c. long-acting, phosphorylate agents
d. A & B
e. A, B & C

2. anticholinesterase agent; quaternary ammonium compound; intermediate-duration, carbamylating agent:
a. physostigmine (Antilirium)
b. neostigmine (Prostigmin)
c. edrophonium (Tensilon)
d. tacrine (Cognex)
e. atropine

3. Renal clearance -- acetylcholinesterase inhibitors--
a. actively secreted into renal tubule lumen
b. renal clearance: 50% for neostigmine (Prostigmin)
c. renal clearance: 75% for edrophonium (Tensilon) and pyridostigmine (Mestinon)
d. all of the above

4. More lipophilic:
a. neostigmine (Prostigmin)
b. most organophosphate acetylcholinesterase inhibitors
c. atropine
d. pilocarpine (Pilocar)

5. In organophosphate poisoning, this agent may be capable of re-activating inhibited acetylcholinesterase:
a. atropine
b. pilocarpine (Pilocar)
c. mecamylamine (Inversine)
d. 2-PAM
e. all of the above

6. Consequences of acetylcholinesterase inhibitor application to the conjunctiva
a. relaxation of the pupillary sphincter muscle
b. relaxation of the ciliary muscle
c. both
d. neither

7. Types of glaucoma:
a. primary
b. secondary
c. congenital
d. all the above

8. Which type of glaucoma response to anticholinesterase treatment?
a. primary
b. secondary
c. congenital

9. Anticholinesterases: used in treating glaucoma--
a. echothiophate (Phospholine)
b. demecarium (Humorsol)
c. atropine (generic)
d. A & B
e. A, B, & C

10. Probable cause of myasthenia gravis:
a. excessive synthesis of cholinergic receptors
b. inadequate synthesis of acetylcholine
c. failure of acetylcholine reuptake system
d. binding of anti--muscarinic receptor antibodies to the muscarinic cholinergic receptor
e. binding of anti-nicotinic receptor antibodies to the nicotinic cholinergic receptor

11. Rationale for prescribing anticholinesterase drugs to patients with myasthenia gravis:
a. increase acetylcholine turnover
b. increase receptor number
c. increase amount of acetylcholine available of neuromuscular junctions
d. reduce choline reuptake
e. all of the above

12. Associated disorders in myasthenic patients --
a. thymic abnormalities
b. hyperthyroidism
c. other autoimmune disorders
d. ventilatory dysfunction
e. all the above

13. General clinical uses: anticholinesterases
a. antagonist-assisted reversal of neuromuscular blockade produced by nondepolarizing neuromuscular-blocking drugs
b. myasthenia gravis management
c. glaucoma treatment
d. treatment of paralytic ileus and urinary bladder atony
e. all of the above

14. Drugs used for antagonist-assisted neuromuscular-blockade reversal
a. acetylcholine
b. physostigmine (Antilirium)
c. DFP
d. edrophonium (Tensilon)
e. all of the above

15. Determination of the recovery rates from neuromuscular-blockade when antagonist-assisted reversal is used:
a. spontaneous recovery rate from the blocking drug
b. activity of the pharmacologic antagonist (anticholinesterase drug)
c. both (sum of A plus B)
d. difference (A- B)

16. When our anticholinesterase agents usually administered to enhance neuromuscular blockade reversal?
a. before the neuromuscular-blocking drug is given
b. while the neuromuscular-blocking drug is being infused
c. during the spontaneous neuromuscular-blockade recovery, following cessation of neuromuscular-blocking administration

17. Pharmacologic antagonism (anticholinesterase drugs) would likely be more effective for which type of neuromuscular blocking drug?
a. short-or intermediate-acting neuromuscular-blocking drugs
b. long-acting nondepolarizing neuromuscular-blockade
c. equally effective

18. Rationale for using muscarinic antagonists in pharmacologic (anticholinesterase-mediated) reversal of neuromuscular-blockade:
a. increases acetylcholine concentration that neuromuscular junctions
b. inhibits acetylcholinesterase
c. minimizes muscarinic receptor-mediated effects of anticholinesterase drugs

19. 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. edrophonium (Tensilon)
b. high-dose atropine (10-15 ug/kg)
c. neostigmine (Prostigmin)

20. More effective in reversing deep neuromuscular-blockade produced by continuous atracurium (Tracrium), vecuronium (Norcuron), or pancuronium (Pavulon) infusions
a. edrophonium (Tensilon)
b. neostigmine (Prostigmin)
c. both are equally effective

21. Factor(s) that may prevent or inhibit anticholinesterase-mediated antagonism of neuromuscular-blockade:
a. hyperthermia
b. respiratory alkalosis
c. hyperkalemia
d. certain antibiotics
e. all of the above

22. Reversal of phase II block (following prolonged repeated succinylcholine (Anectine)) in patients with normal plasma cholinesterase:
a. edrophonium (Tensilon)
b. neostigmine (Prostigmin)
c. both
d. neither

23. 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)

24. Intrathecal neostigmine (Prostigmin) produces postoperative analgesia without respiratory depression:
a. true
b. false

25. Cholinergic-receptor-mediated vasodilation -- changes in intracellular concentration of this ion is principally responsible:
a. sodium
b. potassium
c. chloride
d. calcium
e. magnesium

26. Cholinergic-mediated vasodilation involves liberation of this substance, a gas, from endothelial cells:
a. prostaglandins
b. leukotrienes
c. nitric oxide
d. calcium

27. Mechanism(s) of vasodilation mediated by the cholinergic system:
a. cholinergic activation promotes nitric oxide release from endothelial cells
b. acetylcholine inhibits norepinephrine release from postganglionic sympathetic fibers
c. both
d. neither

28. Parasympathetic system: negative chronotropic effect --
a. mediated by M2 muscarinic receptors
b. associated with increased diastolic depolarization (increased phase 4 depolarization)
c. both
d. neither

29. Major mechanism responsible for decreased AV nodal conduction following increased vagal tone:
a. decreased calcium currents in the AV node
b. secondary affected to reduced norepinephrine release
c. decreased sodium currents in the AV node
d. increased potassium conductance in the AV nodal fibers
e. all of the above

30. Associated with excessive vagal tone:
a. partial heart block
b. total heart block
c. other bradyarrhythmias
d. all the above

31. Concerning negative inotropism associated with increased vagal tone:
a. more prominent in atrial compared to ventricular muscle
b. due to a decrease in inward calcium currents
c. both
d. neither

32. Dominating autonomic tone in the ventricle:
a. sympathetic
b. parasympathetic

33. Mechanisms by which muscarinic stimulation reduces ventricular contractility:
a. reduces ventricular responds to norepinephrine
b. reduces norepinephrine release from adrenergic terminals
c. both
d. neither

34. Effects of muscarinic receptor activation and cardiac ionic currents:
a. decreases potassium currents in atrial muscle and in SA nodal MAb nodal tissue
b. increases in slow, inward calcium currents
c. decreased in diastolic depolarization (decrease in phase 4 depolarization)
d. A & C
e. B & C

35. Effect(s) of muscarinic agonists on the gastrointestinal and urinary tracts:
a. increased intestinal peristalsis
b. increased tone
c. increased contraction amplitude
d. increase ureteral peristalsis
e. all the above

36. Substances that increase nitric oxide production:
a. substance P
b. bradykinin
c. acetylcholine
d. A & B
e. A, B & C

37. Clinical uses of bethanecol:
a. management of postoperative abdominal distention
b. management of esophageal reflux
c. postoperative urinary bladder stimulant
d. treatment of reduced salivation secondary to radiation therapy
e. all the above

38. Opthalmological uses of cholinomimetics:
a. acetylcholine may be used as a miotic
b. treatment of glaucoma
c. used along with mydriatic agent in breaking iris-lens adhesions
d. A & B
e. A, B &C

39. Major contraindications -- muscarinic agonists
a. asthma
b. hyperthyroidism
c. peptic ulcer
d. coronary vascular disease
e. all the above

40. Current primary therapeutic rationale for using anticholinergic preoperative medication:
a. sedation
b. antisialagogue effects
c. both
d. neither

41. Usual anticholinergic drug doses for preoperative medication does not affect either gastric volume or pH
a. true
b. 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. scopolamine
b. atropine
c. glycopyrrolate (Robinul)

43. Preferred anticholinergic drug when sedation is the principal objective, preoperatively:
a. atropine
b. glycopyrrolate (Robinul)
c. scopolamine

44. Atropine: most likely to increase heart rate in this patient population:
a. young adult
b. infants
c. elderly

45. Anticholinergic drug most likely to be used clinically to promote bronchodilation:
a. IV atropine
b. aerosolized atropine
c. aerosolized ipratropium bromide (ipratropium (Atrovent))
d. scopolamine
e. all of the above

46. More effective in producing bronchodilation in patients with chronic bronchitis or emphysema:
a. albuterol (Ventolin,Proventil) (beta-adrenergic agonist)
b. ipratropium (Atrovent) (antimuscarinic agent)
c. equally effective

47. Mydriasis without loss of accommodation
a. parasympatholytic
b. sympathomimetic

48. Management of severe bradycardia and A-V block associated with acute myocardial infarction:
a. atropine
b. neostigmine (Prostigmin)

49. Atropine is effective in blocking reflex cardiac slowing secondary to:
a. carotid sinus stimulation
b. pressure on the eyeballs
c. peritoneal stimulation which may occur or during surgery
d. A & B
e. A, B & C

50. Which of the following drugs could theroretically improve asthma symptoms?
Which of the following drugs could theroreticall Which of the following drugs could theroretically
a) Bethanecol
b) Pilocarpine
c) Pyridostigmine
d) Atropine