Deck 7: Drugs Affecting the Parasympathetic Nervous System

Question 1

Which pair of muscles is activated via cholinergic activity at the muscarinic receptors?

A) Smooth and cardiac muscle
B) Smooth and skeletal muscle
C) Skeletal and cardiac muscle
D) Branchiomeric and smooth muscle

Answer 1

Smooth and cardiac muscle

Question 2

Identify a difference between direct-acting and indirect-acting cholinergic drugs.

A) Indirect-acting drugs bind to muscarinic receptors, whereas direct-acting drugs do not bind to any receptors.
B) Direct-acting drugs inhibit the activity of the enzyme acetylcholinesterase, whereas indirect-acting drugs enhance the activity of acetylcholinesterase.
C) Indirect-acting drugs increase cholinergic activity at all muscarinic and nicotinic receptors sites, whereas direct-acting drugs only increase cholinergic activity at the muscarinic receptor sites.
D) Direct-acting drugs lead to an increase in the concentration of acetylcholine in the synaptic cleft of all cholinergic nerve endings, whereas indirect-acting drugs do not affect the concentration of acetylcholine in the synaptic cleft of cholinergic nerve endings.

Answer 2

Indirect-acting drugs increase cholinergic activity at all muscarinic and nicotinic receptors sites, whereas direct-acting drugs only increase cholinergic activity at the muscarinic receptor sites.

Question 3

Which of the following statements is true of the drug nicotine?

A) It is an alkaloid derived from a particular type of mushroom.
B) It produces the same effects as the neurotransmitter epinephrine.
C) It stimulates the autonomic ganglia of both the sympathetic and parasympathetic divisions of the nervous system in low doses.
D) It behaves like a ganglionic blocker at low doses.

Answer 3

It stimulates the autonomic ganglia of both the sympathetic and parasympathetic divisions of the nervous system in low doses.

Question 4

Myasthenia gravis is diagnosed by the intravenous injection of:

A) edrophonium.
B) neostigmine.
C) pyridostigmine.
D) ambenonium.

Question 5

Which type of cholinergic receptor will an injection of Botox most likely affect?

A) Ganglionic receptor
B) Muscarinic receptor
C) Nicotinic-muscle receptor
D) Nicotinic-neural receptor

Question 6

Acetylcholinesterase activity primarily takes place:

A) in the neuronal synapse.
B) within presynaptic vesicles.
C) inside the presynaptic axon terminal.
D) on the membrane of the postsynaptic neuron.

Question 7

David is suffering from myasthenia gravis,a disease characterized by skeletal muscle paralysis.His doctor,Pablo,prescribes him with a certain drug that inhibits the enzyme acetylcholinesterase,thereby increasing the concentration of acetylcholine at the nicotinic muscle receptors.This will,in turn,increase the strength of skeletal muscular contraction and improve David's condition.Which of the following drugs has Pablo most likely prescribed?

A) A reversible indirect-acting cholinergic drug
B) An adrenergic drug
C) A direct-acting cholinergic drug
D) An anticholinergic drug

Question 8

Since quaternary amines do not cross the blood-brain barrier,one would expect these indirect-acting cholinergic drugs to have:

A) no therapeutic effects.
B) potentiated effects.
C) increased side effects.
D) decreased side effects.

Question 9

The neurotransmitter of the parasympathetic system is _____.

A) dopamine
B) acetylcholine
C) epinephrine
D) adrenaline

Question 10

Dr.Stein suspects that his patient,Alex,is suffering from myasthenia gravis.To confirm his suspicions,Dr.Stein gives Alex a low dose of a certain drug through an intravenous injection and then monitors his condition.Within the first few minutes,Dr.Stein observes an immediate increase in muscle strength.The effects of the drug last for about 30 minutes and then subside.The results confirm that Alex is suffering from myasthenia gravis.Based on the information provided in this scenario,which of the following drugs has Dr.Stein used to diagnose Alex's condition?

A) Edrophonium
B) Echothiophate
C) Atropine
D) Pralidoxime

Question 11

An intravenous injection of acetylcholine may not be successful in facilitating cholinergic activity in the presence of:

A) phosphodiesterase.
B) pseudocholinesterase.
C) serum albumin.
D) hemoglobin.

Question 12

Which of the following statements is true of direct-acting cholinergic drugs?

A) They bind to muscarinic receptors and produce effects similar to those of acetylcholine.
B) They primarily work to inhibit the enzyme acetylcholinesterase.
C) They increase the activity of acetylcholine at all muscarinic and nicotinic receptor sites.
D) They significantly increase the concentration of acetylcholine in the synaptic cleft of all cholinergic nerve endings.

Question 13

Which of the following statements is true of cholinergic drugs?

A) Cholinergic drugs block cholinergic receptors.
B) Cholinergic drugs stimulate the muscarinic receptors located on smooth and cardiac muscle.
C) Cholinergic drugs prevent epinephrine from acting upon its receptors.
D) Cholinergic drugs stimulate the alpha and beta receptors located on the surfaces of organs.

Question 14

What triggers the release of acetylcholine from a neuron?

A) Hormonal inhibition
B) Enzyme activity
C) Nerve stimulation
D) Regulator proteins

Question 15

Which of the following types of cholinergic receptors is not associated with the autonomic nervous system?

A) Muscarinic receptor
B) Ganglionic receptor
C) Nicotinic-neural receptor
D) Nicotinic-muscle receptor

Question 16

Which of the following types of cholinergic receptors would need to be stimulated for the activation of the gastrointestinal system after surgery?

A) Ganglionic receptors
B) Nicotinic-muscle receptors
C) Nicotinic-neural receptors
D) Muscarinic receptors

Question 17

Cholinergic drugs that exert their effect at the receptor belong to which class of medications?

A) Reversible indirect-acting cholinergic drugs
B) Irreversible indirect-acting cholinergic drugs
C) Ganglionic stimulants
D) Direct-acting cholinergic drugs

Question 18

Identify a difference between muscarinic receptors and nicotinic-muscle (Nm)receptors.

A) Muscarinic receptors interact and bind with acetylcholine, whereas Nm receptors interact and bind with dopamine.
B) Muscarinic receptors are located at parasympathetic postganglionic nerve endings, whereas Nm receptors are located at the neuromuscular junction of skeletal muscles.
C) Muscarinic receptors are cholinergic receptors, whereas Nm receptors are adrenergic receptors.
D) Muscarinic receptors are blocked by the same class of drugs that block nicotinic-neural receptors, whereas Nm receptors are blocked by the same class of drugs that block alpha and beta receptors.

Question 19

Identify a direct-acting cholinergic drug that is used systemically.

A) Pilocarpine
B) Demecarium
C) Bethanechol
D) Edrophonium

Question 20

Which of the following is a desirable property that would need to be enhanced while developing a new direct-acting cholinergic drug?

A) Longer duration of action
B) Shorter duration of action
C) Slower absorption
D) Slower elimination

Question 21

Ben,a farmer,developed cholinergic crisis after spraying his fields with insecticide.Which of the following drugs should be administered to reverse the effects of excessive acetylcholine and improve Ben's condition?

A) Phospholine
B) Physostigmine
C) Bethanechol
D) Atropine

Question 22

Pyridostigmine is useful in treating patients with myasthenia gravis because:

A) it increases the secretion of acetylcholine from cholinergic nerve endings.
B) it binds to nicotinic-muscle receptors and produces the same effects as those of acetylcholine.
C) it causes the irreversible inhibition of acetylcholinesterase, thereby increasing the levels of acetylcholine at the parasympathetic postganglionic nerve endings.
D) it causes the reversible inhibition of acetylcholinesterase, thereby increasing the levels of acetylcholine at the skeletal neuromuscular junction.

Question 23

Which class of drugs is preferred for increasing urinary flow in patients with benign prostatic hyperplasia?

A) Beta-blockers
B) Alpha-blockers
C) Muscarinic blockers
D) Nicotinic blockers

Question 24

Indirect-acting anticholinesterase drugs are effective at treating glaucoma because they produce:

A) mydriasis.
B) miosis.
C) cycloplegia.
D) diplopia.

Question 25

Which of the following statements is true of the effects of anticholinergic drugs on the body?

A) They cause miosis.
B) They lead to an increase in heart rate.
C) They decrease urinary retention.
D) They promote urinary peristalsis.

Question 26

Which of the following statements is true of reversible anticholinesterase drugs?

A) These drugs are derivatives of organophosphate compounds widely used as chemical warfare agents.
B) These drugs form irreversible bonds with the enzyme acetylcholinesterase.
C) These drugs stimulate the sympathetic nervous system.
D) These drugs are more widely used than the direct-acting cholinergic drugs.

Question 27

Which of the following statements is true of anticholinergic drugs?

A) They bind to muscarinic receptors.
B) They increase the activity of the vagus nerve in the heart.
C) They lead to a decrease in the heart rate.
D) They are used to stimulate urinary peristalsis.

Question 28

Pyridostigmine is useful in treating patients with myasthenia gravis because:

A) it increases the secretion of acetylcholine from cholinergic nerve endings.
B) it binds to nicotinic-muscle receptors and produces the same effects as those of acetylcholine.
C) it causes the irreversible inhibition of acetylcholinesterase, thereby increasing the levels of acetylcholine at the parasympathetic postganglionic nerve endings.
D) it causes the reversible inhibition of acetylcholinesterase, thereby increasing the levels of acetylcholine at the skeletal neuromuscular junction.

Question 29

Identify an accurate statement about anticholinergic drugs.

A) They prevent acetylcholine from binding to cholinergic receptors and producing an effect.
B) They are used to enhance the effects of acetylcholine.
C) They can be used to decrease heart rate and atrioventricular conduction.
D) They are useful in the treatment of Alzheimer's disease.

Question 30

Why do clinicians favor the drug donepezil over the drug tacrine in the treatment of Alzheimer's disease?

A) Because tacrine is associated with more side effects than donepezil
B) Because tacrine is only used to treat very mild forms of the disease
C) Because tacrine produces less intense drugs effects than donepezil
D) Because tacrine is an irreversible anticholinesterase inhibitor

Question 31

Neostigmine is an indirect-acting anticholinesterase drug that is used to treat urinary retention by:

A) stimulating bladder contractions.
B) inhibiting the release of the antidiuretic hormone.
C) stimulating the hypothalamic thirst centers.
D) increasing the release of the antidiuretic hormone.

Question 32

Dr.Patrick diagnoses 65-year-old Alex with glaucoma.He advises Alex to start using eyedrops containing a certain type of drug that will stimulate Alex's pupils to constrict,thereby facilitating the better drainage of intraocular fluid from Alex's eyes.Which of the following types of drugs has Patrick most likely advised Alex to take?

A) A reversible anticholinesterase drug
B) A direct-acting drug
C) An adrenergic drug
D) An anticholinergic drug

Question 33

What is the mechanism of action of the drug botulinum?

A) It inhibits the release of acetylcholine from cholinergic nerve endings.
B) It enhances the activity of the enzyme acetylcholinesterase.
C) It displaces acetylcholine from muscarinic receptor sites and prevents it from producing its effects.
D) It permanently inactivates acetylcholinesterase by forming an irreversible bond with the enzyme.

Question 34

Which medication would most likely benefit a middle-stage Alzheimer's patient susceptible to side effects?

A) Tacrine
B) Memantine
C) Galantamine
D) Rivastigmine

Question 35

Which of the following medications is preferred for treating all the stages of Alzheimer's disease?

A) Galantamine
B) Donepezil
C) Rivastigmine
D) Tacrine