Deck 6: Autonomic Pharmacology

Question 1

Parasympathetic stimulation would result in which one of the following sets of responses?

A) Increased gastric juice secretion, slowed heart rate, goose pimples and pupil dilation.
B) Sweating, urination, salivation and pupil dilation.
C) Increased gastrointestinal motility, pupil constriction, defecation and erection of genitalia.
D) Slowed heart rate, increased blood pressure, pupil constriction and pallor.

Answer 1

Increased gastrointestinal motility, pupil constriction, defecation and erection of genitalia.

Question 2

A drug group that produces pupil dilation, increased blood pressure, urinary retention and constipation is likely to be the:

A) β₁-blockers.
B) α₂ antagonists.
C) β₂ agonists.
D) α₁ agonists.

Answer 2

α₁ agonists.

Question 3

The 'fight or flight' responses are initiated by which system?

A) Somatic nervous system.
B) Parasympathetic nervous system.
C) Central nervous system.
D) Sympathetic nervous system.

Answer 3

Sympathetic nervous system.

Question 4

In regards to neurotransmitters in the sympathetic (SNS) and parasympathetic nervous systems, it is true that:

A) both systems release noradrenaline and acetylcholine.
B) both systems release acetylcholine and the SNS also releases noradrenaline.
C) both systems release noradrenaline and the SNS also releases acetylcholine.
D) the SNS releases acetylcholine and noradrenaline, and the parasympathetic nervous system releases dopamine.

Question 5

Which one of the following chemical transmitters is not formed from the amino acid tyrosine?

A) Noradrenaline.
B) Acetylcholine.
C) Dopamine.
D) Adrenaline.

Question 6

The component of the autonomic nervous system pathway that contains the cell bodies of nerve fibres that communicate with the body tissue is called the:

A) autonomic ganglion.
B) preganglionic fibre.
C) postganglionic fibre.
D) effector.

Question 7

Which one of the following statements best describes the actions of the ephedrines?

A) These drugs directly activate adrenergic receptor populations.
B) These drugs are pro-drugs of adrenaline.
C) These drugs trigger the release of presynaptic stores of noradrenaline.
D) These drugs work by a mixed action of releasing noradrenaline and direct agonist activity.

Question 8

Receptors that respond to noradrenaline are called:

A) adrenergic.
B) cholinergic.
C) dopaminergic.
D) noradrenergic.

Question 9

Receptors that respond to acetylcholine (ACh) are called:

A) adrenergic.
B) cholinergic.
C) dopaminergic.
D) acetylergic.

Question 10

Which presynaptic adrenergic receptors acts to enhance the release of noradrenaline?

A) β₁ receptors.
B) β₂ receptors.
C) α₁ receptors.
D) α₂ receptors.

Question 11

The second messenger system associated with α₁ adrenergic receptor stimulation involves the:

A) activation of inositol triphosphate production.
B) inhibition of cyclic AMP production.
C) inhibition of inositol triphosphate production.
D) activation of cyclic AMP production.

Question 12

A common characteristic associated with both the parasympathetic and sympathetic divisions of the autonomic nervous system is the:

A) transmitter released from most of the postganglionic fibres.
B) origin in the central nervous system of the preganglionic fibres.
C) relative lengths of pre- and postganglionic fibres.
D) release of the same chemical transmitter from the preganglionic fibres.

Question 13

The involuntary subconscious motor component of the peripheral nervous system is called the:

A) autonomic nervous system.
B) somatic nervous system.
C) afferent nervous system.
D) brain.

Question 14

A clinical use for β antagonists is in the treatment of:

A) bronchial asthma.
B) hypotension.
C) hypertension.
D) nasal decongestion.

Question 15

A neuromodulator that promotes vasodilation in the kidneys is:

A) dopamine.
B) vasoactive intestinal peptide.
C) neuropeptide Y.
D) nitric oxide.

Question 16

α agonists can be used in the management of:

A) hypertension.
B) angina pectoris.
C) nasal congestion.
D) constipation.

Question 17

Generally, 'first messengers' are the chemicals to make contact with a cell's receptor first. Which of the following are first messengers?

A) Hormones.
B) Neurotransmitters.
C) A and B.
D) Neither A or B.

Question 18

Receptor selectivity in adrenergic agonists is desirable as:

A) potentially unwanted effects caused by stimulation of additional receptors are minimised.
B) these medications always have fewer side effects on patients.
C) there is a broader range of medications for prescribers to choose from.
D) patients like to choose their own prescriptions.

Question 19

Common adverse effects of β₁ agonists include:

A) a decrease in cardiac workload and blood pressure, as well as increased gastrointestinal peristalsis.
B) increased vasoconstriction and blood pressure, constipation and pupil dilation.
C) increased blood pressure, tachycardia and constipation.
D) bronchodilation, fine muscle tremor and tachycardia.

Question 20

Which one of the following drug effects would not be associated with central adrenergic receptor activation?

A) Talkativeness.
B) Anxiety.
C) Insomnia.
D) Depression.

Question 21

Which of the following non-depolarising competitive neuromuscular agents causes tachycardia and is therefore not useful to administer during heart surgery?

A) Atracurium.
B) Mivacurium.
C) Vecuronium.
D) Rocuronium.

Question 22

A drug group that produces decreases in heart rate and blood pressure, as well as increases in gastrointestinal motility, is likely to be the:

A) α₁ agonists.
B) β₂ agonists.
C) α₁ antagonists.
D) β₁-blockers.

Question 23

A major advantage of the non-depolarising neuromuscular blockers over the depolarising neuromuscular blockers is that the effect is reversible. The reason for this is that the:

A) non-depolarising blockers are competitive antagonists at nicotinic receptors.
B) depolarising blockers act rapidly and usually have a prolonged action.
C) non-depolarising blockers act via histamine release.
D) action of depolarising blockers must be terminated by acetylcholinesterase.

Question 24

An expected central nervous system response associated with cholinergic agonists would be:

A) sedation.
B) mental confusion.
C) tremor.
D) facial flushing.

Question 25

Muscarinic agonists can be used in the management of:

A) tobacco dependence.
B) glaucoma.
C) bradycardia.
D) peptic ulcer.

Question 26

Following the administration of muscarinic agonist eyedrops, the client should be instructed to:

A) lie down.
B) rinse the eye with saline solution.
C) perform eye muscle exercises.
D) avoid driving and working with dangerous tools.

Question 27

What type of medication should be administered concurrently with a non-depolarising competitive neuromuscular agent?

A) A positive inotrope.
B) An anaesthetic.
C) An antibiotic.
D) An antihypertensive.

Question 28

Medications for myasthenia gravis are best taken:

A) in the morning.
B) at lunchtime.
C) in the late afternoon.
D) at bedtime.

Question 29

When administering an acetylcholinesterase inhibitor in the ward setting, which of the following drugs should be kept on hand to reverse the effects of any decrease in pulse?

A) Cholinergic receptor stimulation.
B) Suxamethonium.
C) Tubocurarine.
D) Atropine.

Question 30

Which one of the following is not an acceptable route of nicotine administration in the management of tobacco dependence?

A) Transdermal patch.
B) Subcutaneous injection.
C) Nasal spray.
D) Oral formulation.

Question 31

If a reversal drug such as neostigmine (anticholinesterase inhibitor) is required to interrupt the neuromuscular blockade, what other drug should also be administered?

A) Tubocurarine.
B) Suxamethonium.
C) Atropine.
D) Atracurium.

Question 32

Dopamine should be administered:

A) in a strongly alkaline solution and through a peripheral vein.
B) in a strongly alkaline solution and through a large central vein.
C) in a non-alkaline solution and through a peripheral vein.
D) in a non-alkaline solution and through a large central vein.

Question 33

Which set of drug responses best matches the action of an acetylcholinesterase inhibitor?

A) Feelings of relaxation, increased skeletal muscle tone, increased autonomic tone and the release of catecholamines.
B) Bronchoconstriction, increased gastrointestinal motility, pupil constriction, increased skeletal muscle tension and bradycardia.
C) Tachycardia, facial flushing, decreased gastrointestinal motility, dry mouth and urinary retention.
D) Tachycardia, histamine-induced hypotension, muscle relaxation and decreased gastrointestinal motility.

Question 34

If a muscarinic antagonist is given as part of preoperative medication:

A) the blood pressure should be monitored every 5 minutes until the start of surgery.
B) the client should remain in bed with the side rails up.
C) the pulse should be monitored every 5 minutes until the start of surgery.
D) a specimen for full blood examination should be taken.

Question 35

How many subtypes of muscarinic receptors have been identified?

A) Two.
B) Three.
C) Four.
D) Five.

Question 36

When administering an acetylcholinesterase inhibitor, the nurse should be aware of the possibility of a cholinergic crisis (overdose). The symptoms include which of the following:

A) muscle twitching, diarrhoea and dry mouth.
B) convulsions, dry mouth and constipation.
C) muscle twitching, cardiac dysrhythmias, constipation and dry mouth.
D) muscle weakness, increased salivation and diarrhoea.

Question 37

The way to determine the effect of a sympatholytic agent on postural hypotension is to measure:

A) lying blood pressure only.
B) lying and standing blood pressures.
C) sitting blood pressure only.
D) standing blood pressure only.

Question 38

Clients on an α receptor blocking agent should be advised not to stop taking the medication abruptly if they experience problems, because this may lead to all of the following except:

A) rebound hypertension.
B) angina attacks.
C) rebound tachycardia.
D) severe depression.

Question 39

A drug group that produces increases in heart rate, decreases in gastrointestinal motility, bronchodilation, urinary retention and blurred vision is likely to be the:

A) muscarinic antagonists.
B) α₁ antagonists.
C) acetylcholinesterase inhibitors.
D) nicotinic agonists.

Question 40

A ________ should be used when administering a sympathomimetic intravenously.

A) large central vein
B) small central vein
C) large peripheral vein
D) small peripheral vein

Question 41

The parasympathetic fibres originate from the thoracolumbar regions of the spinal cord, and the ganglia are located close to the CNS (alongside vertebral column).

Question 42

Which subtype of cholinergic receptors affects gastric acid secretion?

A) M₁ receptors.
B) Nicotinic receptors.
C) M₂ receptors.
D) Acetylcholinesterase inhibitors.

Question 43

At moderate doses, dopamine receptor agonists can lead to:

A) α₁ receptor activation.
B) α₂ receptor activation.
C) β₁ receptor activation.
D) β₂ receptor activation.

Question 44

Common adverse reactions of muscarinic antagonists include drowsiness, tachycardia, constipation, blurred vision, dry mouth and facial flushing.

Question 45

Which of the following receptors, when stimulated, inhibit further release of noradrenaline?

A) Postsynaptic α₁.
B) Presynaptic α₂.
C) Postsynaptic β₁.
D) Presynaptic β₂.

Question 46

Which of the following drugs would be recommended to relieve acute symptoms of asthma?

A) Muscarinic agonist, carbachol because it constricts bronchioles and increases mucus secretion.
B) Nicotinic antagonist, atracurium because it relaxes skeletal muscles.
C) Selective β₂ agonist, salbutamol because it dilates bronchioles.
D) β antagonist, sotalol because it constricts bronchioles.

Question 47

Muscarinic antagonists are useful in the management of:

A) myasthenia gravis.
B) glaucoma.
C) tachycardia.
D) urinary incontinence.

Question 48

Clonidine, a selective α₂ agonist, is used in the treatment of hypertension because it acts by inhibiting further release of noradrenaline.

Question 49

The enzyme associated with uptake-2 in adrenergic nerves is:

A) catechol-O-methyltransferase.
B) monoamine oxidase.
C) acetylcholinesterase.
D) tyrosine kinase.

Question 50

In response to stressful ('fight or flight') situations, sympathetic nervous stimulation causes dilation of bronchioles (to allow rapid air movement) and of coronary blood vessels, and increases heart rate and contractile force.