Cholinergic/Adrenergic drugs — MCQs

A high-throughput screen to identify new sympathomimetic compounds was developed such that a transgenic line of cells was created that contained the alpha-1 (red), alpha-2 (yellow), beta-1 (green) and beta-2 (blue) receptors. When each of the receptors was activated a different fluorescent protein was expressed and new compounds with different properties could be identified by the fluorescence that they induced. Compound 7583 selectively induced the expression of the blue fluorescent protein. Which of the following known sympathomimetic medications if administered would similarly result in expression of only the blue fluorescent protein?

A 53-year-old man is brought by his daughter to the clinic. She lives a town away but visits often. She reports that on recent visits, his mood has been volatile, ranging from aggressive at some moments to depressed at others. She has noticed some new jerky movements which she has never seen before and has been quite forgetful. She is concerned that he might be abusing alcohol and drugs. What changes would you expect in the brain of this patient?

A 61-year-old man with Alzheimer disease is brought to the emergency department 20 minutes after ingesting an unknown amount of his medications in a suicide attempt. He reports abdominal cramps, diarrhea, diaphoresis, and muscular weakness and spasms in his extremities. His temperature is 38.4°C (101.1°F), pulse is 51/min, respirations are 12/min and labored, and blood pressure is 88/56 mm Hg. Physical examination shows excessive salivation and tearing, and small pupils bilaterally. Treatment with atropine is initiated. Shortly after, most of his symptoms have resolved, but he continues to have muscular spasms. Administration of which of the following is the most appropriate next step in management of this patient?

A 32-year-old man comes to the physician with involuntary lip smacking and hand and leg movements for the past two weeks. The movements are causing him difficulty walking and functioning at work. He has bipolar disorder treated with fluphenazine. Three months ago, he was hospitalized because of a manic episode, and his dosage was adjusted. Since then, he has not experienced a depressed mood, increased energy, irritability, or a change in his eating or sleeping patterns. He does not have suicidal or homicidal ideation. His temperature is 37.2°C (99°F), pulse is 75/min, and blood pressure is 126/78 mmHg. Examination shows repetitive lip smacking and dance-like hand and leg movements. His speech is not pressured, and his affect is appropriate. He is switched from fluphenazine to risperidone and his symptoms improve. Which of the following mechanisms explains this patient's improvement?

A 28-year-old man is brought to the emergency department after his girlfriend found him twitching and jerking in the yard while gardening. Shortly after he became obtunded, emergency medical services reported 1 episode of emesis during transport. His blood pressure is 85/50 mmHg, pulse is 55/min, and respirations are irregular. Physical examination demonstrates marks on his left forearm, pinpoint pupils, diaphoresis, and fasciculations of his left calf. Following initial stabilization and respiratory support, what is the best next step?

A 72-year-old man comes to the physician with his son for a follow-up examination. The son reports that his father's mental status has declined since the previous visit when he was diagnosed with Alzheimer dementia. The patient often begins tasks and forgets what he was doing. He has increased trouble remembering events that occurred the day before and sometimes forgets names of common household objects. He has hypertension and hyperlipidemia. His current medications include lisinopril, hydrochlorothiazide, atorvastatin, and donepezil. He is confused and oriented only to person. He is unable to count serial sevens backward from 100. He is able to register 3 items but unable to recall them 5 minutes later. Which of the following is the most appropriate pharmacotherapy?

A 45-year-old woman comes to the physician for the evaluation of persistent headaches for the last 2 months. The symptoms started insidiously. Menses had previously occurred at regular 28-day intervals with moderate flow. Her last menstrual period was 12 weeks ago. She is sexually active with her husband but reports decreased interest in sexual intercourse over the past few months. The patient does not smoke or drink alcohol. She is 168 cm (5 ft 6 in) tall and weighs 68 kg (150 lb); BMI is 24 kg/m2. She appears uncomfortable. Vital signs are within normal limits. A urine pregnancy test is negative. A pelvic ultrasound shows atrophic endometrium. A cranial MRI with contrast shows a 2-cm intrasellar mass. A hormone assay is performed and is positive. Which of the following is the most appropriate next step in the management?

A 27-year-old woman comes to the physician for the evaluation of infertility. She has been unable to conceive for the past 2 years. Menses occur at 45 to 80-day intervals. She is 168 cm (5 ft 6 in) tall and weighs 77 kg (170 lb); BMI is 27.4 kg/m2. Physical examination shows facial acne and pigmented hair on the upper lip. Serum studies show elevated levels of testosterone and an LH:FSH ratio of 4:1. Treatment with the appropriate drug for this patient's infertility is begun. Which of the following is the primary mechanism of action of this drug?

A 64-year-old man is brought to the emergency department by his wife with a 2-hour history of diarrhea and vomiting. He says that he felt fine in the morning, but noticed that he was salivating, sweating, and feeling nauseated on the way home from his work as a landscaper. The diarrhea and vomiting then started about 10 minutes after he got home. His past medical history is significant for depression and drug abuse. His wife says that he has also been more confused lately and is afraid he may have ingested something unusual. Physical exam reveals miosis, rhinorrhea, wheezing, and tongue fasciculations. Which of the following treatments would most likely be effective for this patient?

A 65-year-old male who is being treated for depression visits your emergency room complaining of being unable to urinate. In addition, the patient complains of tachycardia and dry mouth. He has no history of benign prostatic hyperplasia and reports of only being on one psychiatric medication. What type of psychiatric medication would cause such a side effect profile?