Pharmacological targeting of signaling pathways US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Pharmacological targeting of signaling pathways. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Pharmacological targeting of signaling pathways US Medical PG Question 1: Which receptor type mediates the slow phase of synaptic transmission in autonomic ganglia?
- A. Muscarinic (M3)
- B. Muscarinic (M2)
- C. Muscarinic (M1) (Correct Answer)
- D. Nicotinic (N2)
Pharmacological targeting of signaling pathways Explanation: ***Muscarinic (M1)***
- **M1 receptors** are **Gq-protein coupled receptors** that activate phospholipase C, leading to increased intracellular calcium and diacylglycerol, which mediates the slow excitatory postsynaptic potential in autonomic ganglia.
- This activation results in a **slow depolarization** that prolongs the excitability of ganglionic neurons after the initial fast synaptic transmission.
*Muscarinic (M3)*
- **M3 receptors** are primarily found on **smooth muscle**, glands, and endothelium, mediating contraction, secretion, and vasodilation, respectively.
- While also **Gq-protein coupled**, their role in autonomic ganglia is not the main mediator of the slow phase of synaptic transmission.
*Muscarinic (M2)*
- **M2 receptors** are **Gi-protein coupled receptors** mainly found in the heart, mediating decreased heart rate and contractility.
- In autonomic ganglia, M2 receptors could have a modulatory role, but they are not responsible for the slow excitatory phase of synaptic transmission.
*Nicotinic (N2)*
- **Nicotinic N2 receptors** (also known as **NN or neuronal nicotinic receptors**) mediate the **fast excitatory postsynaptic potential** (EPSP) in autonomic ganglia by opening ion channels.
- This leads to rapid depolarization and action potential generation, which is distinct from the **slower, prolonged phase** of transmission.
Pharmacological targeting of signaling pathways US Medical PG Question 2: A 23-year-old woman presents to the emergency department with acute onset of shortness of breath, wheezing, and chest tightness. This is her 4th visit for these symptoms in the last 5 years. She tells you she recently ran out of her normal "controller" medication. Concerned for an asthma exacerbation, you begin therapy with a short-acting beta2-agonist. What is the expected cellular response to your therapy?
- A. Gs protein coupled receptor activates adenylyl cyclase and increases intracellular cAMP (Correct Answer)
- B. Gq protein coupled receptor activates phospholipase C and increases intracellular calcium
- C. Gq protein coupled receptor activates adenylyl cyclase and increases intracellular cAMP
- D. Gs protein coupled receptor activates phospholipase C and increases intracellular calcium
- E. Gi protein coupled receptor inhibits adenylyl cyclase and decreases cAMP
Pharmacological targeting of signaling pathways Explanation: ***Gs protein coupled receptor activates adenylyl cyclase and increases intracellular cAMP***
- **Short-acting beta2-agonists (SABAs)** like **albuterol** bind to **beta2-adrenergic receptors** on airway smooth muscle cells, which are **Gs protein-coupled receptors**.
- Activation of **Gs protein** stimulates **adenylyl cyclase**, leading to an increase in intracellular **cyclic AMP (cAMP)**, which triggers downstream relaxation of bronchial smooth muscle.
*Gq protein coupled receptor activates phospholipase C and increases intracellular calcium*
- **Gq protein-coupled receptors** are typically associated with **alpha1-adrenergic receptors** or **muscarinic M1/M3 receptors**, which, when activated, cause **bronchoconstriction** not bronchodilation.
- Activation of **Gq protein** leads to activation of **phospholipase C**, which generates **IP3** and **DAG**, ultimately increasing intracellular **calcium** and promoting contraction.
*Gq protein coupled receptor activates adenylyl cyclase and increases intracellular cAMP*
- This option incorrectly pairs **Gq protein** with the activation of **adenylyl cyclase** and an increase in **cAMP**.
- **Gq protein** signaling primarily involves the **phospholipase C pathway** and **calcium** mobilization, not direct adenylyl cyclase activation.
*Gs protein coupled receptor activates phospholipase C and increases intracellular calcium*
- This option incorrectly pairs **Gs protein** with the activation of **phospholipase C** and an increase in intracellular **calcium**.
- **Gs protein** is specifically coupled to the **adenylyl cyclase/cAMP pathway**, while **phospholipase C** and **calcium** are associated with **Gq protein** signaling.
*Gi protein coupled receptor inhibits adenylyl cyclase and decreases cAMP*
- **Gi protein-coupled receptors** inhibit **adenylyl cyclase** and decrease intracellular **cAMP**, which would lead to **bronchoconstriction**, not bronchodilation.
- This mechanism is associated with **M2 muscarinic receptors** on presynaptic terminals, which regulate acetylcholine release, or alpha2-adrenergic receptors, which are not the primary target for bronchodilation in asthma exacerbations.
Pharmacological targeting of signaling pathways US Medical PG Question 3: An investigator is studying a drug that acts on a G protein-coupled receptor in the pituitary gland. Binding of the drug to this receptor leads to increased production of inositol triphosphate (IP3) in the basophilic cells of the anterior pituitary. Administration of this drug every 90 minutes is most likely to be beneficial in the treatment of which of the following conditions?
- A. Prostate cancer
- B. Variceal bleeding
- C. Central diabetes insipidus
- D. Anovulatory infertility (Correct Answer)
- E. Hyperkalemia
Pharmacological targeting of signaling pathways Explanation: ***Anovulatory infertility***
- The drug's action on a G protein-coupled receptor leading to increased **IP3 production** in pituitary basophils suggests activation of the **gonadotropin-releasing hormone (GnRH) receptor**.
- **Pulsatile administration** (e.g., every 90 minutes) of GnRH or its agonists is crucial for stimulating the release of **FSH and LH**, which can induce ovulation in women with anovulatory infertility due to hypothalamic-pituitary dysfunction.
*Prostate cancer*
- While GnRH agonists are used in prostate cancer, they are typically administered **continuously or in depot forms** to desensitize the GnRH receptor, thereby suppressing testosterone production.
- **Pulsatile administration** would rather stimulate testosterone release, which is detrimental in prostate cancer.
*Variceal bleeding*
- **Variceal bleeding** is primarily managed with vasoconstrictors like **octreotide** (a somatostatin analog) or **vasopressin**, which are unrelated to GnRH receptor activation.
- The mechanism of action described (increased IP3 in pituitary basophils) does not align with treatments for variceal bleeding.
*Central diabetes insipidus*
- **Central diabetes insipidus** is caused by a deficiency in **vasopressin (ADH)**, which regulates water balance in the kidneys.
- Treatment involves synthetic ADH (**desmopressin**), not drugs acting on GnRH receptors and affecting pituitary basophils.
*Hyperkalemia*
- **Hyperkalemia** is an electrolyte imbalance characterized by high potassium levels and is managed with medications that shift potassium intracellularly (e.g., insulin, beta-agonists) or promote its excretion (e.g., diuretics, potassium binders).
- The described drug action on pituitary GnRH receptors is unrelated to potassium homeostasis.
Pharmacological targeting of signaling pathways US Medical PG Question 4: An investigator is developing a drug for muscle spasms. The drug inactivates muscular contraction by blocking the site where calcium ions bind to regulate actin-myosin interaction. Which of the following is the most likely site of action of this drug?
- A. Troponin C (Correct Answer)
- B. Myosin-binding site
- C. Acetylcholine receptor
- D. Ryanodine receptor
- E. Myosin head
Pharmacological targeting of signaling pathways Explanation: ***Troponin C***
- **Calcium ions** bind to **Troponin C**, initiating a conformational change in the troponin-tropomyosin complex, which exposes the **myosin-binding sites on actin**.
- Blocking this site directly prevents the **calcium-mediated regulation** of muscle contraction, thus inactivating it.
*Myosin-binding site*
- The **myosin-binding site** is located on the **actin filament** and is where the **myosin head** attaches to form cross-bridges.
- While essential for contraction, this site doesn't directly bind calcium ions to initiate the process.
*Acetylcholine receptor*
- The **acetylcholine receptor** is located on the **neuromuscular junction** and mediates the transmission of a nerve impulse to the muscle fiber.
- Blocking this receptor would prevent muscle depolarization, but it's not the direct site where calcium ions regulate actin-myosin interaction.
*Ryanodine receptor*
- The **ryanodine receptor** is located on the **sarcoplasmic reticulum** and controls the release of calcium ions into the sarcoplasm.
- While it's involved in calcium signaling, it doesn't represent the site where calcium binds to *regulate* the actin-myosin interaction itself.
*Myosin head*
- The **myosin head** contains the **ATPase activity** and binds to actin to form cross-bridges, enabling muscle contraction.
- It does not directly bind **calcium ions** to regulate the initiation of contraction; instead, its binding to actin is regulated by the troponin-tropomyosin complex.
Pharmacological targeting of signaling pathways US Medical PG Question 5: A 60-year-old man presents to the office for a scheduled follow-up visit. He has had hypertension for the past 30 years and his current anti-hypertensive medications include lisinopril (40 mg/day) and hydrochlorothiazide (50 mg/day). He follows most of the lifestyle modifications recommended by his physician, but is concerned about his occasional occipital headaches in the morning. His blood pressure is 160/98 mm Hg. The physician adds another drug to his regimen that acts centrally as an α2-adrenergic agonist. Which of the following second messengers is involved in the mechanism of action of this new drug?
- A. Calcium ions
- B. Inositol triphosphate
- C. Cyclic guanosine monophosphate
- D. Cyclic adenosine monophosphate (Correct Answer)
- E. Diacylglycerol
Pharmacological targeting of signaling pathways Explanation: ***Cyclic adenosine monophosphate***
- The physician likely added **clonidine or methyldopa**, both of which are **central α2-adrenergic agonists** used to treat hypertension.
- Activation of **α2-adrenergic receptors** leads to the **inhibition of adenylyl cyclase** and a decrease in **intracellular cyclic AMP (cAMP) levels**, which is the second messenger.
*Calcium ions*
- While calcium ions are crucial second messengers in many cellular processes, they are primarily involved in the mechanism of action of **α1-adrenergic receptors** and **voltage-gated calcium channels**, not directly inhibited by α2-agonists.
- **α2-adrenergic agonism** primarily acts to *reduce* neuronal excitability, which can indirectly affect calcium flux but does not directly involve calcium as the primary second messenger.
*Inositol triphosphate*
- **Inositol triphosphate (IP3)** is a second messenger primarily associated with the activation of **Gq protein-coupled receptors**, leading to the release of intracellular calcium.
- This pathway is characteristic of **α1-adrenergic receptors**, which cause vasoconstriction, and is antagonistic to the α2-agonist mechanism.
*Cyclic guanosine monophosphate*
- **Cyclic GMP (cGMP)** is a key second messenger in processes such as **vasodilation mediated by nitric oxide** and the action of ANP/BNP.
- **α2-adrenergic agonists** do not directly modulate cGMP levels as their primary mechanism of action.
*Diacylglycerol*
- **Diacylglycerol (DAG)** is a second messenger, along with IP3, produced from the hydrolysis of **PIP2** by phospholipase C, following activation of **Gq protein-coupled receptors**.
- This pathway is associated with **α1-adrenergic receptor activation**, not the inhibitory pathway initiated by central α2-adrenergic agonists.
Pharmacological targeting of signaling pathways US Medical PG Question 6: A 46-year-old premenopausal woman undergoes lumpectomy after a diagnosis of invasive ductal carcinoma of the breast is made. Pathologic examination of the surgical specimen shows that the breast cancer cells stain positive for estrogen receptor and progesterone receptor, and negative for human epidermal growth factor receptor 2. Which of the following characteristics applies to the most appropriate pharmacotherapy for this patient's condition?
- A. Monoclonal antibody against tyrosine kinase receptor
- B. Monoclonal antibody against vascular endothelial growth factor
- C. Selective agonist at progesterone receptors in mammary tissue
- D. Selective agonist at estrogen receptors in bone tissue
- E. Selective antagonist at estrogen receptors in mammary tissue (Correct Answer)
Pharmacological targeting of signaling pathways Explanation: ***Selective antagonist at estrogen receptors in mammary tissue***
- The patient's tumor is **estrogen receptor (ER) positive** and **progesterone receptor (PR) positive**. This indicates a **hormone-sensitive cancer**, making endocrine therapy the most appropriate pharmacotherapy.
- A **selective antagonist at estrogen receptors** in mammary tissue, such as **tamoxifen** (a selective estrogen receptor modulator, SERM), is effective in blocking estrogen-mediated tumor growth in premenopausal patients.
*Monoclonal antibody against tyrosine kinase receptor*
- This therapy, typically targeting **HER2 (human epidermal growth factor receptor 2)**, would be appropriate if the tumor was **HER2-positive**.
- The patient's tumor is **HER2-negative**, meaning this type of targeted therapy would not be beneficial.
*Monoclonal antibody against vascular endothelial growth factor*
- This class of drugs, like **bevacizumab**, targets **angiogenesis** by inhibiting VEGF, which is crucial for tumor blood supply.
- While used in some cancers, it is not the primary or most appropriate pharmacotherapy based on the specific receptor status of this patient's breast cancer.
*Selective agonist at progesterone receptors in mammary tissue*
- An **agonist** at progesterone receptors would **promote growth** if the tumor is progesterone receptor-positive, which would be counterproductive for cancer treatment.
- The goal of endocrine therapy for PR-positive tumors is to inhibit the effects of progesterone.
*Selective agonist at estrogen receptors in bone tissue*
- An agonist at estrogen receptors in bone tissue would **mimic estrogen's effects**, which is undesirable given the estrogen-sensitive nature of the breast cancer.
- While some SERMs (like tamoxifen) can have agonist effects in bone (which can be beneficial for bone density), the primary therapeutic action for breast cancer is antagonism in mammary tissue.
Pharmacological targeting of signaling pathways US Medical PG Question 7: A 25-year-old man is brought to the emergency department by paramedics with a seizure lasting over 30 minutes. The patient's neighbors found him outside his apartment with all four limbs flailing and not responding to his name. No significant past medical history. On physical examination, the patient continues to be unresponsive and slightly cyanotic with irregular breathing. His teeth are clenched tightly. Intravenous glucose and an anticonvulsant medication are administered. Which of the following is the mechanism of action of the drug that was most likely administered to stop this patient’s seizure?
- A. Blockage of voltage-gated calcium channels
- B. Blockage of T-type calcium
- C. Increase in frequency of chloride channel opening (Correct Answer)
- D. Prolongation of chloride channel opening
- E. Inactivation of sodium channels
Pharmacological targeting of signaling pathways Explanation: ***Increase in frequency of chloride channel opening***
- The patient is experiencing **status epilepticus** (seizure lasting >5 minutes or recurrent seizures without full recovery of consciousness), which requires rapid intervention, typically with a **benzodiazepine**.
- **Benzodiazepines** (e.g., lorazepam, diazepam) act by binding to the **GABA-A receptor** and increasing the **frequency of chloride channel opening**, leading to neuronal hyperpolarization and reduced excitability.
*Blockage of voltage-gated calcium channels*
- This mechanism is characteristic of **gabapentin** and **pregabalin**, which are used for **neuropathic pain** and adjunctive seizure therapy, but not typically as first-line for status epilepticus.
- Blocking voltage-gated calcium channels primarily reduces **neurotransmitter release**, which is a slower mechanism of action compared to GABAergic potentiation for acute seizure cessation.
*Blockage of T-type calcium*
- This is the primary mechanism of action for **ethosuximide**, which is used specifically for **absence seizures**.
- Absence seizures are brief, generalized non-convulsive seizures, distinct from the generalized tonic-clonic seizure described in the patient.
*Prolongation of chloride channel opening*
- This mechanism is associated with **barbiturates** (e.g., phenobarbital), which also act on the GABA-A receptor but cause a **prolonged opening** of the chloride channel at high concentrations.
- While barbiturates can be used for refractory status epilepticus, **benzodiazepines** are generally preferred as first-line due to a better safety profile and fewer side effects compared to barbiturates.
*Inactivation of sodium channels*
- This mechanism is characteristic of several anticonvulsant drugs, including **phenytoin, carbamazepine, and lamotrigine**.
- These drugs are typically used for **long-term seizure control** and prevention, not as first-line agents for aborting an ongoing status epilepticus, due to their slower onset of action.
Pharmacological targeting of signaling pathways US Medical PG Question 8: A 59-year-old man comes to the physician because of a 1-year history of increased urinary frequency, weak urinary stream, and occasional straining to void urine. Rectal examination shows a large, nontender prostate without asymmetry or nodularity. His serum creatinine, prostate-specific antigen, and urinalysis are all within the reference range. A diagnosis of benign prostatic hyperplasia is made, and treatment with tamsulosin is begun. Which of the following changes in intracellular messaging is most likely to occur in response to this drug?
- A. Decreased activity of phospholipase C (Correct Answer)
- B. Increased activity of protein kinase C
- C. Increased production of diacylglycerol
- D. Decreased activity of protein kinase A
- E. Increased activity of adenylyl cyclase
Pharmacological targeting of signaling pathways Explanation: ***Decreased activity of phospholipase C***
- **Tamsulosin** is an **alpha-1 adrenergic receptor antagonist** that works by blocking alpha-1 receptors on the smooth muscle of the prostate and bladder neck, causing relaxation.
- Alpha-1 receptor activation normally utilizes the **Gq protein pathway**, which leads to the activation of phospholipase C, thus blocking these receptors decreases phospholipase C activity.
*Increased activity of protein kinase C*
- **Protein kinase C** is activated by **diacylglycerol (DAG)** and intracellular calcium, both of which are products of the phospholipase C pathway.
- Since tamsulosin decreases phospholipase C activity, it would subsequently lead to a *decrease*, not an increase, in protein kinase C activity.
*Increased production of diacylglycerol*
- **Diacylglycerol (DAG)** is a secondary messenger produced by the action of **phospholipase C** on **phosphatidylinositol bisphosphate (PIP2)**.
- As tamsulosin inhibits the alpha-1 receptor and thus phospholipase C activity, it would *decrease* the production of DAG.
*Decreased activity of protein kinase A*
- **Protein kinase A (PKA)** is typically activated by **cyclic AMP (cAMP)**, which is produced by **adenylyl cyclase**.
- The alpha-1 receptor pathway (affected by tamsulosin) primarily involves phospholipase C, not adenylyl cyclase or protein kinase A.
*Increased activity of adenylyl cyclase*
- **Adenylyl cyclase** is responsible for converting **ATP to cAMP**, which is part of the Gs protein signaling pathway (beta-adrenergic receptors) or Gi protein pathway (alpha-2 adrenergic receptors).
- Tamsulosin specifically targets **alpha-1 adrenergic receptors** which are coupled to **Gq proteins**, not Gs or Gi proteins; therefore, it does not directly affect adenylyl cyclase activity.
Pharmacological targeting of signaling pathways US Medical PG Question 9: A 78-year-old man receives chemotherapy for advanced hepatocellular carcinoma. Despite appropriate therapy, he dies 4 months later. Histopathological examination of the cancer cells shows the presence of a transmembrane efflux pump protein that is known to cause decreased intracellular concentrations of chemotherapeutic drugs. Which of the following best describes this membrane protein?
- A. G protein
- B. Cadherin
- C. P-glycoprotein (Correct Answer)
- D. Tyrosine receptor
- E. Channel protein
Pharmacological targeting of signaling pathways Explanation: **P-glycoprotein**
- **P-glycoprotein** (also known as **MDR1**) is a well-known **efflux pump** that actively transports many chemotherapy drugs out of cancer cells, leading to **multidrug resistance**.
- Its presence explains the **decreased intracellular concentrations** of chemotherapy drugs and the poor response to treatment in this patient.
*G protein*
- **G proteins** are intracellular signaling molecules that mediate responses to various extracellular stimuli, not primarily involved in drug efflux.
- They are typically associated with **G protein-coupled receptors** and downstream signaling pathways, not direct drug transport.
*Cadherin*
- **Cadherins** are cell adhesion molecules that play a crucial role in cell-cell binding and maintaining tissue structure.
- They are not involved in the active transport of drugs across the cell membrane.
*Tyrosine receptor*
- **Tyrosine kinase receptors** are transmembrane proteins that bind to growth factors and initiate intracellular signaling cascades, promoting cell growth and differentiation.
- They are involved in signaling, not in the active transport of chemotherapy drugs out of the cell.
*Channel protein*
- **Channel proteins** facilitate the passive diffusion of ions or small molecules across the cell membrane, typically down their electrochemical gradient.
- While they are transmembrane proteins, they do not actively pump drugs out against a concentration gradient, which is characteristic of multidrug resistance.
Pharmacological targeting of signaling pathways US Medical PG Question 10: A 66-year-old man comes to the physician because of a 3-month history of constipation and streaks of blood in his stool. He has had a 10-kg (22-lb) weight loss during this period. Colonoscopy shows an exophytic tumor in the sigmoid colon. A CT scan of the abdomen shows liver metastases and enlarged mesenteric and para-aortic lymph nodes. A diagnosis of stage IV colorectal cancer is made, and palliative chemotherapy is initiated. The chemotherapy regimen includes a monoclonal antibody that inhibits tumor growth by preventing ligand binding to a protein directly responsible for epithelial cell proliferation and organogenesis. Which of the following proteins is most likely inhibited by this drug?
- A. VEGF
- B. TNF-α
- C. EGFR (Correct Answer)
- D. ALK
- E. CD52
Pharmacological targeting of signaling pathways Explanation: ***EGFR***
- The description of a monoclonal antibody preventing ligand binding to a protein responsible for **epithelial cell proliferation** and organogenesis strongly points to the **epidermal growth factor receptor (EGFR)**.
- EGFR is highly expressed in many colorectal cancers and its activation by ligands like EGF promotes cell growth, survival, and metastasis. Inhibiting it reduces tumor progression.
*VEGF*
- **Vascular endothelial growth factor (VEGF)** is primarily involved in **angiogenesis**, the formation of new blood vessels.
- While anti-VEGF therapies (e.g., bevacizumab) are used in colorectal cancer, their mechanism is inhibiting blood supply to the tumor, not directly blocking a receptor responsible for epithelial cell proliferation as described.
*TNF-α*
- **Tumor necrosis factor-alpha (TNF-α)** is a **cytokine** primarily involved in inflammation and immune responses.
- Antibodies against TNF-α (e.g., infliximab) are used in inflammatory conditions like Crohn's disease, not typically as targeted therapy for colorectal cancer directly inhibiting epithelial proliferation.
*ALK*
- **Anaplastic lymphoma kinase (ALK)** is a **receptor tyrosine kinase** often implicated in lung cancer and lymphomas.
- ALK rearrangements lead to oncogenic fusion proteins, but it is not a primary target for widespread epithelial cell proliferation in colorectal cancer.
*CD52*
- **CD52** is a glycoprotein found on the surface of various immune cells, including lymphocytes.
- Antibodies targeting CD52 (e.g., alemtuzumab) are used in certain leukemias and lymphomas to deplete these cells, not for inhibiting epithelial cell proliferation in solid tumors.
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