Question 1

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

Accepted Answer

In males with benign prostatic hyperplasia, the preferred drugs to increase urinary flow are alpha-blockers such as tamsulosin (Flomax) or alfuzosin (Uroxatral); these drugs were discussed in Chapter 6.

Question 2

Myasthenia gravis is diagnosed by intravenous injection of:

Accepted Answer

Myasthenia gravis is diagnosed by intravenous injection of a low dose of edrophonium.

Question 3

This type of cholinergic receptor is not associated with the autonomic nervous system:

Accepted Answer

The nerves and receptors associated with skeletal muscle are not part of the autonomic nervous system.

Question 4

What are two muscle types that are activated via cholinergic activity at muscarinic receptors?

Accepted Answer

Drugs that stimulate muscarinic receptors located on smooth and cardiac muscle and produce effects similar to those of acetylcholine are more commonly referred to as cholinergic.

Question 5

Pyridostigmine is useful in treating patients with myasthenia gravis because:

Accepted Answer

The longer-acting reversible anticholinesterase drugs, pyridostigmine and ambenonium, are preferred and used orally to increase acetylcholine levels and increase skeletal muscle tone and strength.

Question 6

Acetylcholinesterase activity takes place primarily in what location?

Accepted Answer

In the area of the cholinergic receptors is an enzyme, acetylcholinesterase. Acetylcholinesterase inactivates acetylcholine only when it is outside a nerve ending and not on the receptor.

Question 7

Farmer Brown developed cholinergic crisis after spraying his fields with insecticide.Why wouldn't pyridostigmine be an efficient treatment?

Accepted Answer

Pralidoxime is a drug that can reactivate the acetylcholinesterase enzyme after it has been inhibited by an irreversible inhibitor.

Question 8

Which type of cholinergic receptor would need to be stimulated for activation of the gastrointestinal system after surgery?

Accepted Answer

Certain drugs (general anesthetics) and conditions, especially in the elderly, cause urinary retention and intestinal stasis (ileus). Bethanechol may be administered several times a day to stimulate urination and GI activity.

Question 9

What triggers the release of acetylcholine from a neuron?

Accepted Answer

When a nerve is stimulated, acetylcholine is released from its storage vesicles, travels across the synapse to the smooth or cardiac muscle membrane, and binds to the cholinergic receptors.

Question 10

What is a desirable property that would need to be enhanced in developing a new direct-acting cholinergic drug?

Accepted Answer

Acetylcholine is not useful as a drug because of its extremely short duration of action.

Question 11

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

Accepted Answer

By inhibiting the metabolism of acetylcholine, they increase acetylcholine levels in the eye to produce miosis, improved drainage of intraocular fluid, and lower intraocular pressure.

Question 12

The injection of botulinin toxin will affect which type of cholinergic receptor?

Accepted Answer

Some of these toxins can inhibit the release of acetylcholine from the cholinergic nerve ending to produce a flaccid type of skeletal muscle paralysis.

Question 13

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

Accepted Answer

The previously mentioned drugs are all quaternary amines (charged compounds) that do not cross the blood-brain barrier and produce effects only at peripheral receptor sites.

Question 14

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

Accepted Answer

Bethanechol is the exception; this drug is administered orally to stimulate the urinary and intestinal tracts.

Question 15

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

Accepted Answer

Urinary retention (also referred to as atony of the bladder) and intestinal stasis or paralysis (also referred to as paralytic ileus) are usually treated with neostigmine. The increased levels of acetylcholine stimulate bladder contraction and intestinal peristalsis.

Question 16

A middle-stage Alzheimer's patient susceptible to side effects would benefit best from which medication?

Accepted Answer

A newer drug, memantine (Namenda) blocks excitatory glutamate receptors in the brain and appears to offer some protection against excessive excitation and nerve damage. Memantine is claimed to be better tolerated than the anticholinesterase inhibitors.

Question 17

Which medication is preferred for treating all stages of Alzheimer's disease?

Accepted Answer

Galantamine (Reminyl) and rivastigmine (Exelon) are currently indicated for mild to moderate disease, while donepezil (Aricept) is indicated for all stages of Alzheimer's disease.

Question 18

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

Accepted Answer

Direct-acting cholinergic drugs bind to the cholinergic (muscarinic) receptors.

Question 19

Botulinin toxin can be used to reduce wrinkles and lines on the face by inducing what type of paralysis?

Accepted Answer