Cholinergic/Adrenergic drugs Practice Questions

Question 1

In patients with chronic obstructive pulmonary disease, stimulation of muscarinic acetylcholine receptors results in an increase in mucus secretion, smooth muscle contraction and bronchoconstriction. The end result is an increase in airway resistance. Which of the following pharmacologic agents interferes directly with this pathway?

Accepted Answer

Ipratropium

Answer

Epinephrine

Answer

Albuterol

Answer

Theophylline

Answer

Metoprolol

Question 2

A 32-year-old farmer is brought to the emergency department by his wife. The patient was reportedly anxious, sweaty, and complaining of a headache and chest tightness before losing consciousness on route to the hospital. Which of the following is mechanistically responsible for this patient's symptoms?

Accepted Answer

Irreversible inhibition of acetylcholinesterase

Answer

Reversible inhibition of acetylcholinesterase

Answer

Competitive inhibition of acetylcholine at post-junctional effector sites

Answer

Binding of acetylcholine agonists to post-junctional receptors

Answer

Inhibition of presynaptic exocytosis of acetylcholine vesicles

Question 3

A 43-year-old man is brought to the emergency department by his wife because of a 1-hour history of confusion and strange behavior. She reports that he started behaving in an agitated manner shortly after eating some wild berries that they had picked during their camping trip. His temperature is 38.7°C (101.7°F). Physical examination shows warm, dry skin and dry mucous membranes. His pupils are dilated and minimally reactive to light. His bowel sounds are decreased. The patient is admitted and pharmacotherapy is initiated with a drug that eventually results in complete resolution of all of his symptoms. This patient was most likely administered which of the following drugs?

Accepted Answer

Physostigmine

Answer

Rivastigmine

Answer

Atropine

Answer

Scopolamine

Answer

Neostigmine

Question 4

A 34-year-old female presents to the emergency room with headache and palpitations. She is sweating profusely and appears tremulous on exam. Vital signs are as follows: HR 120, BP 190/110, RR 18, O2 99% on room air, and Temp 37C. Urinary metanephrines and catechols are positive. Which of the following medical regimens is contraindicated as a first-line therapy in this patient?

Accepted Answer

Propranolol

Answer

Labetalol

Answer

Nitroprusside

Answer

Lisinopril

Answer

Phenoxybenzamine

Question 5

A 55-year-old woman comes to the physician because of involuntary hand movements that improve with alcohol consumption. Physical examination shows bilateral hand tremors that worsen when the patient is asked to extend her arms out in front of her. The physician prescribes a medication that is associated with an increased risk of bronchospasms. This drug has which of the following immediate effects on the cardiovascular system?

Stroke volume | Heart rate | Peripheral vascular resistance

Accepted Answer

↓ ↓ ↑

Answer

↓ ↓ ↓

Answer

↓ ↑ ↑

Answer

↑ ↑ ↑

Answer

↑ ↑ ↓

Question 6

A 44-year-old male is brought to the emergency department by fire and rescue after he was the unrestrained driver in a motor vehicle accident. His wife notes that the patient’s only past medical history is recent development of severe episodes of headache accompanied by sweating and palpitations. She says that these episodes were diagnosed as atypical panic attacks by the patient’s primary care provider, and the patient was started on sertraline and alprazolam. In the trauma bay, the patient’s temperature is 97.6°F (36.4°C), blood pressure is 81/56 mmHg, pulse is 127/min, and respirations are 14/min. He has a Glascow Coma Score (GCS) of 10. He is extremely tender to palpation in the abdomen with rebound and guarding. His skin is cool and clammy, and he has thready peripheral pulses. The patient's Focused Assessment with Sonography for Trauma (FAST) exam reveals bleeding in the perisplenic space, and he is taken for emergency laparotomy. He is found to have a ruptured spleen, and his spleen is removed. During manipulation of the bowel, the patient’s temperature is 97.8°F (36.6°C), blood pressure is 246/124 mmHg, and pulse is 104/min. The patient is administered intravenous labetalol, but his blood pressure continues to worsen. The patient dies during the surgery.

Which of the following medications would most likely have prevented this outcome?

Accepted Answer

Phenoxybenzamine

Answer

Lorazepam

Answer

Propylthiouracil

Answer

Dantrolene

Answer

Phentolamine

Question 7

A researcher is studying receptors that respond to epinephrine in the body and discovers a particular subset that is expressed in presynaptic adrenergic nerve terminals. She discovers that upon activation, these receptors will lead to decreased sympathetic nervous system activity. She then studies the intracellular second messenger changes that occur when this receptor is activated. She records these changes and begins searching for analogous receptor pathways. Which of the following receptors would cause the most similar set of intracellular second messenger changes?

Accepted Answer

Dopamine receptors in the brain

Answer

Muscarinic cholinoreceptors in the gastrointestinal tract

Answer

Growth hormone receptors in the musculoskeletal system

Answer

Vasopressin receptors in the kidney

Answer

Aldosterone receptors in the kidney

Question 8

A 50-year-old woman presents with altered taste and a gritty sensation in her eyes for the last month. She mentions that she needs to drink water frequently and often feels that her mouth and throat are dry. On physical examination, she has bilateral enlargement of the parotid glands and dry conjunctivae. Her physical examination and laboratory findings suggest a diagnosis of sicca syndrome. In addition to non-pharmacological measures, a drug is prescribed to improve symptoms related to dryness of mouth by increasing salivation. Which of the following is the mechanism of action of the drug that most likely is being prescribed to this patient?

Accepted Answer

Selective M3 muscarinic receptor agonist

Answer

Selective M2 muscarinic receptor agonist

Answer

Selective M2 muscarinic receptor antagonist

Answer

Selective M3 muscarinic receptor antagonist

Answer

Selective M1 muscarinic receptor antagonist

Question 9

A 3-year-old girl swallowed a handful of pills after her grandmother dropped the bottle on the ground this afternoon. She presents to the ER in a very drowsy but agitated state. She is clutching her abdomen, as if in pain, her skin is dry and flushed, and she does not know her name or where she is. Her pupils are dilated. Her grandmother reports that she has not urinated in several hours. The grandmother's medical history is significant for allergic rhinitis and osteoarthritis, both of which are treated with over the counter medications. What is the appropriate treatment for this child?

Accepted Answer

Physostigmine

Answer

N-acetylcysteine

Answer

Naloxone

Answer

Deferoxamine

Answer

Atropine

Question 10

A 50-year-old man comes to the physician because of gradually worsening rhythmic movements of his right hand for the past 5 months. His symptoms worsen when he is in a meeting and he is concerned that people are noticing it more frequently. There is no personal or family history of serious illness, but the patient recalls that his father developed bobbing of the head in older age. He takes no medications. Neurological examination shows a tremor of the right hand when the limbs are relaxed. When the patient is asked to move his arm the tremor decreases. He has reduced arm swing while walking. Which of the following is the most appropriate pharmacotherapy?

Accepted Answer

Levodopa/carbidopa

Answer

Trihexyphenidyl

Answer

Propranolol

Answer

Clonazepam

Answer

Donepezil

Cholinergic/Adrenergic drugs

Study Resources

Lessons

Questions

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Lessons

Acetylcholine receptors and function

Cholinergic agonists (direct and indirect)

Muscarinic antagonists

Nicotinic antagonists

Neuromuscular blocking agents

Adrenergic receptor subtypes

Alpha-adrenergic agonists

Beta-adrenergic agonists

Alpha-adrenergic antagonists

Beta-adrenergic antagonists

Sympathomimetics

Autonomic drug interactions

Clinical applications in autonomic disorders

Practice Questions

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About Cholinergic/Adrenergic drugs for USMLE

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