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ANS questions


									1) A 47 year old male patient undergoes radiotherapy to treat a tumor in the neck region. A side effect of this therapy was the development of salivary gland hypofunction, with associated dry mouth. An agent that could be used to treat this patients condition is: a. Atropine b. Ipratropium c. Nicotine d. Pilocarpine e. Scopolamine 2) MJ is a 5 yr old male child that was admitted with an initial complaint (by his parents) of a 24 hr history of confusion with delusions and inappropriate laughter. On examination the patient was febrile, tachycardic, his skin had an unusual “flush” color, and his pupils were dilated. His parents also indicated that the patient had been consuming an extraordinary amount of fluids (water and Kool Aid) over the past 24 hours. Upon further questioning, it was determined that the patient had recently consumed some berries growing on a wild shrub close to the patients home. The most likely active ingredient in these berries is: a. Atropine b. Pilocarpine c. Reserpine d. Tyramine 3) Ms. CM, a 42 yr old ex-hippy reports to the Tulane Emergency Department after becoming suddenly ill following her evening meal. Her presenting symptoms include marked perspiration, salivation, excessive tear formation, nausea and upon examination, miosis and bradycardia. When asked about her recent meal, she claims that all she had was a salad comtaining lettuce, fresh tomatores, “organic” dressing, and some mushrooms her neighbor picked for her. The next day her son brings in a sample of the mushrooms to a Tulane botanist, who identifies it as “Clitocybe dealbata”. The symptoms of this poisoning resemble the effects of which agent? a. Atropine b. Cocaine c. Muscurine- her symptoms resemble “SLUDE”. The organism in this case is called “sweating muschroom” and contains high concentrations of muscurine. d. Reserpine e. Trimethaphan

4) Before your opthamologist dilates your eyes with an antimuscurinic they will typically check your: a. BP b. Credit history c. IOP d. Temperature 5) When exposed to Sarin, the most likely cause of death. Other than seizures is likely to be related to: a. Cardiac arrest b. Hypertensive crisis c. Respiratory compromise- the muscurinic induced accumulation of bronchial secretions and bronchoconstriction, combined with nicotinic induced compromise of the diaphragm (fasciculation), and possible CNS effects on the respiratory center make this the most likely answer 6) Effective treatment following exposure to nerve gas Sarin typically involves the administration of which two agents? a. Atropine + pralidoxime- atropine can reverse the excessive levels of muscurinic stimulation and pralidoxime can reverse the binding of Sarin to AChE at both muscurinic and nicotinic synapses. However, it has to be given prior to its “aging” when Sarin’s effect becomes irreversible (t1/2= 5 hrs). b. Atropine + trimethaphan c. Pyridostigmine + pralidoxime d. Tubocurarine + trimethaphan 7) A long acting organophosphate inhibitor of cholinesterase that is used in topical eye drops to cause contraction of the ciliary body, which facilitates the outflow of aqueous humor, and reduces glaucoma: a. Edrophonium b. Echothiophate c. Physostimine d. Pyridostigmine 8) Your 43 yr old patient is recovering from abdominal surgery and develops a postoperative urinary retention. A drug that you could give orally to treat this condition is: a. Atropine b. Bethanechol

c. Scopolamine d. Succinylcholine e. Tubocurarine 9) As an officer in a US Marine combat unit, you are given orders to lead your troops into an area where there is a high probability of exposure to the nerve gas Soman. To protect you and your troops you order them to take an oral medication approximately 8 hours before departure. This medication is: a. Atropine b. Echothiophate c. Pralidoime d. Pyridostigmine-animal studies indicate that pyridostigmine pretreatment can increase the LD50 of SOman by ~5 times, giving you better protection if you are exposed to a level that is less than 5x the normal LD50. The mechanism by which it is believed to work is “competitive” prevention of SOman causing irreversible inactivation of the AChE. It is not clear whether pralidoxime would be effective, since Soman ages so quickly. Atropine has too short of a half life to be useful as prophylaxis. Echothiphate is an organophosphate that would covalently inactivate the AChE, and would be a “bad idea” for prophylaxis. 10) Your patient with myasthenia gravis requires chronic treatment for relief of muscle weakness. A drug that would be a good choice for maintenance therapy, and which would not cross the blood brain barrier is: a. Echothiophate b. Edrophonium c. Neostigmine d. Physostimine e. Pralidoxime 11) Your 40 yr old patient who has a family history of myasthenia gravis develops muscle weakness around the eyes and muscle fatigue that increases upon physical exertion, but improves after periods of rest. In addition to blood tests for elevated antibodies, you administer a drug to help confirm the diagnosis that the symptoms are due to myasthenia gravis. If the diagnosis is correct, it will produce a transient reversal of the patients symptoms. The drug you administer is: a. Echothiophate b. Edrophonium c. Pilocarpine

d. Succinylcholine e. Tubocurarine 12) The enzyme found in presynaptic vesicles that convert dopamine to norepinephrine is: a. COMT b. Dopamine beta-hydroxylase c. Phenylethanolamine methyltransferase d. Tyrosine hydroxylase e. MAD 13) In vascular smooth muscle there is an inverse relationship between intracellular calcium and: a. Activated protein kinase C b. cAMP or cGMP- in vascular smooth muscle, drugs or neurotransmitters that elevate either cAMP or cGMP result in a fall in cytoplasmic Ca levels, and vasodilation. The other mediators are involved with the vasoconstriction pathway, e.g. that is activated by alpha 1 receptors. c. diacylglycerol d. IP3 14) A 26 yr old woman who is 23 weeks into her pregnancy in experiencing a preterm labour with regular uterine contractions and a cervix of 15mm. To save the life of the fetus, you admit her, have her transferred her to a level 3 care unit, and begin treatment with: a. Atropine b. Epinephrine c. Norepinephrine d. Phenylephrine e. Terbutaline- it is a tocolytic. Tocolytics are given when delivery would result in a premature birth. The glucocorticoid betamethasone is also typically given to accelerate fetal lung maturity. 15) An indirectly acting drug that is indicated for the treatment of narcolepsy and attention deficit disorder: a. Amphetamine b. Ephedrine- used to cause vasoconstriction for some hypotensive states c. Cocaine- for nasal surgery d. Tyramine- not given as a drug

16) Your 54 yr old patient undergoes intra-abdominal surgery for an appendicitis. During his post-operative recovery he develops constipation and abdominal discomfort due to paralytic ileus (paralysis of the bowel) that can result from surgical manipulation of the intestines. Which of the following could be given to best treat his condition? a. Ipratropium- antimuscurinic b. Neostigmine- cholinesternase inhibiting actions increase parasympathetic tone to the GI tract and increase paristalsis. Also used to treat myasthenia gravis. It is preferred over physostigmine for these indixations because it is a quaternary drug that does not cross the BBB and produce unwanted CNS effects. c. Physostigime d. Scopolamine- antimuscurinic e. Tubocurarine 17) Which of the following is a cholinesterase inhibiting drug that would be insensitive to the effects of pralidoxime? a. b. c. d. bethanachol echothiophate neostigmine sarin

18) A drug used both as a nasal decongestant, and as a pressor agent to correct surgically induced hypotension without the risk of epinephrine-induced arrhythmias: a. bretylium b. isoproternol c. phentolamine d. phenylephrine* alpha-1 selective agonist e. phenelzine

A catecholamine that when given IV in moderate doses will produce the relatively largest increase in heart rate and cardiac output: a. epinephrine b. isoproterenol*It produces both direct stimulation of cardiac beta-1 receptors, and a reflexmediated sympathetic stimulation of cardiac beta-1 receptors as a result of its effect to lower the mean arterial blood pressure in response to stimulating beta-2 receptors in skeletal muscle

c. norepinephrine d. dopamine

A selective beta-1 agonist that is used to produce short term positive inotropic support is: a. bretylium b. dobutamine* the only drug listed with beta-1 selectivity c. dopamine d. epinephrine e. norepinephrine

A 27-year old woman with a history of hypertension comes to your office to discuss her drug therapy for hypertension. She is currently well controlled (BP< 130/85) on the combination of an ACE inhibitor (enalapril) and a thiazide diuretic (hydrochlorothiazide). The reason for her visit is that she is planning to become pregnant in the immediate near future. You discuss her options and recommend that for the a. albuterol b. alpha-methyldopa* alpa-methyldopa is relatively safe and can be used to help reduce blood pressure towards normotensive levels in pregnant patients. c. alpha-methyltyrosine d. terbutaline

In the presence of a drug with alpha blocking activity, injection of epinephrine will produce a change in arterial blood pressure resembling that produced by: a. dobutamine b. norepinephrine c. isoproterenol* Since epinephrine is an agonist for alpha-1 and alpha-2 receptors, blocking alpha receptors will make epinephrine’s effects resemble that of isoproterenol. d. propranolol e. phenylephrine

In contrast to patients with essential hypertension, patients with secondary hypertension due to a pheochromocytoma will have elevated urinary levels of: a. alpha methylnorepinephrine b. 3-methyl-4-hydroxymandelic acid (VMA)* VMA is a metabolite that shows up in the urine in elevated concentrations in patients with catecholamine secreting tumors. Its elevated presence is diagnostic. c. octopamine d. tyramine

Patients with atypical depression are commonly treated with drugs that can produce potentially dangerous interactions with tyramine-rich foods. An example of this type of drug is: a. clonididine b. labetolol c. phenelzine* one of the more common monoamine oxidase inhibitor’s (MAOIs) used to treat atypical depression (where patients are depressed, but eat too much and sleep too much) d. terbutaline e. yohimbine In contrast, patients with “typical” depression can be treated with a different drug class that will block the neuronal uptake of tyramine (similar to cocaine). These patients don’t have to be concerned about their consumption of tyramine-rich foods. An example of this other type of antidepressant is: a. b. c. d. e. amphetamine bretylium guanethidine imipramine yohimbine

Repeated administration of this drug over a short period of time can cause tachyphylaxis or acute tolerance to its actions: a. ephedrine* ephedrine and tyramine can both lose their effect if given repeatedly over a short period of time. The other drugs are direct agonists and do not develop an acute tolerance. b. epinephrine

c. norepinephrine d. phenylephrine A 40-year old male cropduster is accidentally exposed to a high level of organophosphate insecticide. Which of the following describes the symptoms he is likely to suffer prior to medical treatment? a. big pupils, far sighted b. blind as a bat, dry as bone c. red as a beet, mad as a hatter d. salivation, urination, vomiting

Your 54-year old patient undergoes intra-abdominal surgery for appendicitis. During his postoperative recovery he develops constipation and abdominal discomfort due to a paralytic ileus (paralysis of the bowel) that can result from surgical manipulation of the intestines. Which of the following could be given to best treat his condition? a. ipratropium b. neostigmine* its cholinesterase inhibiting actions will increase parasympathetic tone to the GIT and increase peristalsis. It is also used in the treatment of myasthenia gravis. It is preferred over physostigmine for these indications because it is a quaternary drug that does not cross the blood-brain barrier and produce unwanted CNS effects. c. physostigmine d. scopolamine e. tubocurarine Trimethaphan administered IV will produce: a. b. c. d. e. bradycardia increased GI motility vasoconstriction and hypertension vasodilation and hypotension vomiting

A pre-surgical drug that produces skeletal muscle relaxation by blocking the subtype of nicotinic receptors expressed at the skeletal muscle NMJ:

a. atropine b. ipratropium c. pralidoxime d. scopolamine e. tubocurarine

When given, this drug produces a dilated pupil that is unresponsive to light, and difficulty with reading restaurant menus: a. atropine b. ephedrine c. imipramine d. phenelzine e. tyramine 18)

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