Question 1

Patients who need to remain alert are taught to avoid which drug due to its antimuscarinic effects?

Accepted Answer

Diphenhydramine has antimuscarinic effects, which can cause drowsiness and impair alertness, making it unsuitable for patients who need to remain alert.

Question 2

John has been prescribed clonidine, a centrally acting adrenergic blocker, for his hypertension. He should:

Accepted Answer

Clonidine, a centrally acting adrenergic blocker, can cause rebound hypertension if suddenly stopped or doses are missed, making it crucial for patients to adhere to their prescribed regimen consistently.

Question 3

Beta blockers have favorable effects on survival and disease progression in patients with heart failure. Treatment should be initiated when the:

Accepted Answer

Beta blockers are beneficial in patients with heart failure primarily when left ventricular dysfunction is diagnosed, as they can improve survival and slow disease progression regardless of symptom severity or the presence of hypertension.

Question 4

Anticholinesterase inhibitors are used to treat:

Accepted Answer

Anticholinesterase inhibitors are used to treat Myasthenia gravis by increasing the levels of acetylcholine at the neuromuscular junction, improving muscle contraction. They are not used for peptic ulcer disease.

Question 5

Beta blockers are the drugs of choice for exertional angina because they:

Accepted Answer

Beta blockers are primarily used in the treatment of exertional angina because they decrease myocardial oxygen demand. This is achieved by reducing the heart rate and myocardial contractility, which in turn lowers the workload on the heart and thus its oxygen requirements. They do not directly vasodilate the coronary arteries to improve oxygen supply.

Question 6

Jim is being treated for hypertension. Because he has a history of heart attack, the drug prescribed is atenolol. Beta blockers treat hypertension by:

Accepted Answer

Beta blockers like atenolol treat hypertension primarily by reducing heart rate and contractility, which lowers cardiac output. This indirectly reduces vascular smooth muscle tone, leading to decreased blood pressure. Choices A, C, and D describe mechanisms not directly related to the primary action of beta blockers in treating hypertension.

Question 7

Clonidine has several off-label uses, including:

Accepted Answer

Clonidine is used off-label for both alcohol and nicotine withdrawal, as well as for treating postherpetic neuralgia, making both statements A and B correct.

Question 8

Clinical dosing of Bethanechol:

Accepted Answer

Bethanechol dosing typically starts at a lower dose of 5 to 10 mg taken orally, and it can be repeated every hour until a satisfactory response is achieved. This approach helps to minimize side effects while ensuring effectiveness.

Question 9

Carvedilol is heavily metabolized by CYP2D6 and 2C9, resulting in drug interactions with which of the following drug classes?

Accepted Answer

Carvedilol is metabolized by CYP2D6 and CYP2C9 enzymes. Drugs that inhibit or are metabolized by these enzymes can interact with carvedilol. Histamine 2 blockers, quinolones, and serotonin reuptake inhibitors can all affect the metabolism of drugs that are substrates of CYP2D6 and CYP2C9, leading to potential drug interactions.

Question 10

Charlie is a 65-year-old male who has been diagnosed with hypertension and benign prostatic hyperplasia. Doxazosin has been chosen to treat his hypertension because it:

Accepted Answer

Doxazosin is an alpha-1 adrenergic receptor blocker, which relaxes smooth muscle in the bladder neck (helpful for benign prostatic hyperplasia symptoms) and also dilates blood vessels to lower blood pressure, making it a suitable choice for Charlie's conditions.

Question 11

Alpha-beta blockers are especially effective at treating hypertension in which ethnic group?

Accepted Answer

Alpha-beta blockers are particularly effective in treating hypertension in African American patients. This is due to their ability to address the specific cardiovascular characteristics and the higher prevalence of hypertension in this group, making them a suitable choice for managing high blood pressure.

Question 12

Richard is 70 years old and has a history of cardiac dysrhythmias. He has been prescribed nadolol. You do his annual laboratory work and find a CrCl of 25 mL/min. What action should you take related to his nadolol?

Accepted Answer

Nadolol is excreted by the kidneys, and in patients with reduced renal function, such as a creatinine clearance (CrCl) of 25 mL/min, extending the dosage interval can help prevent drug accumulation and toxicity.

Question 13

Combined alpha-beta antagonists are used to reduce the progression of heart failure because they:

Accepted Answer

Combined alpha-beta antagonists reduce the progression of heart failure primarily through vasodilation of the peripheral vasculature. This action decreases the resistance against which the heart must pump, thereby reducing the workload on the heart and helping to manage heart failure symptoms.

Question 14

Bethanechol:

Accepted Answer

Bethanechol is a muscarinic agonist that specifically targets muscarinic receptors in the bladder, increasing detrusor muscle tone to help empty the bladder. It does not directly affect gastric acid secretion, voluntary muscle tone, or bronchial airway constriction in the context of asthma treatment.

Question 15

To reduce potential adverse effects, patients taking a peripherally acting $\alpha$₁ antagonist should do all of the following EXCEPT:

Accepted Answer

Peripherally acting alpha-1 antagonists can cause orthostatic hypotension, hence the advice to sit up slowly and dangle feet before standing (B) and to take the dose at bedtime to minimize the impact of blood pressure drops during sleep (A). Weighing daily and reporting significant weight gain (D) is important for monitoring fluid retention, another possible side effect. However, monitoring blood pressure and skipping doses based on specific readings (C) is not generally recommended as it could lead to uncontrolled hypertension or other complications. Patients should follow their healthcare provider's instructions for dose adjustments.

Question 16

Which of the following adverse effects are less likely in a $\beta$₁-selective blocker?

Accepted Answer

Beta-1 selective blockers primarily affect the heart and are less likely to impair insulin release, which is more associated with non-selective beta blockers that also block beta-2 receptors.

Question 17

Abrupt withdrawal of beta blockers can be life threatening. Patients at highest risk for serious consequences of rapid withdrawal are those with:

Accepted Answer

Patients with angina and coronary artery disease are at the highest risk for serious consequences of rapid beta blocker withdrawal, as it can lead to acute tachycardia, hypertension, and myocardial ischemia.

Question 18

To prevent life-threatening events resulting from rapid withdrawal of a beta blocker:

Accepted Answer

The answer of To prevent life-threatening events resulting from rapid...

Question 19

Adherence to beta blocker therapy may be affected by their:

Accepted Answer

The answer of Adherence to beta blocker therapy may be...

Question 20

Beta blockers are prescribed with caution for diabetics because they may block the common symptoms of hypoglycemia. Which of the following symptoms of hypoglycemia is not blocked by these drugs and so can be used to warn diabetics of possible decreased blood glucose?

Accepted Answer

Beta blockers can mask the adrenergic symptoms of hypoglycemia such as dizziness, increased heart rate, and nervousness/shakiness, but they do not typically block the symptom of diaphoresis (sweating), which can still serve as a warning sign of hypoglycemia for individuals taking these medications.

Quiz 11: Drugs Affecting the Autonomic Nervous System

Patients who need to remain alert are taught to avoid which drug due to its antimuscarinic effects?

John has been prescribed clonidine, a centrally acting adrenergic blocker, for his hypertension. He should:

Beta blockers have favorable effects on survival and disease progression in patients with heart failure. Treatment should be initiated when the:

Anticholinesterase inhibitors are used to treat:

Beta blockers are the drugs of choice for exertional angina because they:

Jim is being treated for hypertension. Because he has a history of heart attack, the drug prescribed is atenolol. Beta blockers treat hypertension by:

Clonidine has several off-label uses, including:

Clinical dosing of Bethanechol:

Carvedilol is heavily metabolized by CYP2D6 and 2C9, resulting in drug interactions with which of the following drug classes?

Charlie is a 65-year-old male who has been diagnosed with hypertension and benign prostatic hyperplasia. Doxazosin has been chosen to treat his hypertension because it:

Alpha-beta blockers are especially effective at treating hypertension in which ethnic group?

Richard is 70 years old and has a history of cardiac dysrhythmias. He has been prescribed nadolol. You do his annual laboratory work and find a CrCl of 25 mL/min. What action should you take related to his nadolol?

Combined alpha-beta antagonists are used to reduce the progression of heart failure because they:

Bethanechol:

To reduce potential adverse effects, patients taking a peripherally acting $\alpha$ ₁ antagonist should do all of the following EXCEPT:

Which of the following adverse effects are less likely in a $\beta$ ₁-selective blocker?

Abrupt withdrawal of beta blockers can be life threatening. Patients at highest risk for serious consequences of rapid withdrawal are those with:

To prevent life-threatening events resulting from rapid withdrawal of a beta blocker:

Adherence to beta blocker therapy may be affected by their:

Beta blockers are prescribed with caution for diabetics because they may block the common symptoms of hypoglycemia. Which of the following symptoms of hypoglycemia is not blocked by these drugs and so can be used to warn diabetics of possible decreased blood glucose?

Quiz 11: Drugs Affecting the Autonomic Nervous System

Patients who need to remain alert are taught to avoid which drug due to its antimuscarinic effects?

John has been prescribed clonidine, a centrally acting adrenergic blocker, for his hypertension. He should:

Beta blockers have favorable effects on survival and disease progression in patients with heart failure. Treatment should be initiated when the:

Anticholinesterase inhibitors are used to treat:

Beta blockers are the drugs of choice for exertional angina because they:

Jim is being treated for hypertension. Because he has a history of heart attack, the drug prescribed is atenolol. Beta blockers treat hypertension by:

Clonidine has several off-label uses, including:

Clinical dosing of Bethanechol:

Carvedilol is heavily metabolized by CYP2D6 and 2C9, resulting in drug interactions with which of the following drug classes?

Charlie is a 65-year-old male who has been diagnosed with hypertension and benign prostatic hyperplasia. Doxazosin has been chosen to treat his hypertension because it:

Alpha-beta blockers are especially effective at treating hypertension in which ethnic group?

Richard is 70 years old and has a history of cardiac dysrhythmias. He has been prescribed nadolol. You do his annual laboratory work and find a CrCl of 25 mL/min. What action should you take related to his nadolol?

Combined alpha-beta antagonists are used to reduce the progression of heart failure because they:

Bethanechol:

To reduce potential adverse effects, patients taking a peripherally acting α\alphaα 1 antagonist should do all of the following EXCEPT:

Which of the following adverse effects are less likely in a β\betaβ 1-selective blocker?

Abrupt withdrawal of beta blockers can be life threatening. Patients at highest risk for serious consequences of rapid withdrawal are those with:

To prevent life-threatening events resulting from rapid withdrawal of a beta blocker:

Adherence to beta blocker therapy may be affected by their:

Beta blockers are prescribed with caution for diabetics because they may block the common symptoms of hypoglycemia. Which of the following symptoms of hypoglycemia is not blocked by these drugs and so can be used to warn diabetics of possible decreased blood glucose?

To reduce potential adverse effects, patients taking a peripherally acting $\alpha$ ₁ antagonist should do all of the following EXCEPT:

Which of the following adverse effects are less likely in a $\beta$ ₁-selective blocker?