PCOL Exam 1 Fall

Which of the following can be precipitated by muscarinic agonist

a. glaucoma

b. tears in eyes

c. cycloplegia

d. urinary retention

e. mucus plug

f. asthma attack

g. skeletal muscle relaxation

tears in eyes

asthma attack

your friend is bitten by a poisonous snake while on a hiking trip with you. You call for help but while waiting your friend starts to sweat profusely, starts vomiting, urinate and defecates his pants and apparently cannot seem to stop crying. you have several plant extracts containing the following drugs. Which one could you administer to help your friend until help arrives

a. muscarinic

b. atropine

c. physostigmine

d. nicotine

e. tubocurarine- competitive non depolarizing nicotinic antagonist

atropine, he is having increased secretions so we want to administer a muscarinic antagonist

your friend is bitten by a poisonous snake while on a hiking trip with you. You call for help but while waiting your friend starts to sweat profusely, starts vomiting, urinate and defecates his pants and apparently cannot seem to stop crying. you have several plant extracts containing the following drugs. If in the previous case you also see skeletal muscle twitching and your friend is having difficulty breathing then the snake vemon must have a toxin with a similar MOA

a. muscarinic

b. atropine

c. physostigmine

d. nicotine

e. tubocurarine

physostigmine acetylcholinesterase inhibitor increases levels of ACh acting on muscarinic and nicotinic

an alzheimers disease patient on rivastigmine needs therapy for OAB. Which drug should not be used in this case

a. solifenacin

b. darifenacin

c. tolterodine

d. fesoterodine

e. oxybutynin

f. trospium

fesoterodine. rivastigmine inhibits esterase enzyme, fesoterodine is a prodrug that needs esterase so if you give both of them it wont get activated and wont have any effect on OAB

ER patient has a racing heart rate, fever, headache, blurry vision, difficulty speaking. shows a plant extract that he took in a large quantity to treat severe diarrhea. which of the following could you administer to confirm your inital diagnosis

a. tubocurarine

b. atropine

c. pilocarpine

d. SuCH

pilocarpine then atropine if no effects from pilocarpine

mechanistically speaking, which of the following can relax both skeletal and smooth muscles

a. pilocarpine

b. SuCH

c. spider venom

d. tubocurarine

e. atropine

f. botox

g. physostigmine

botox

on a dare a friend of yours administers tubocurarine and starts having difficulty breathing. What would you administer to help him

a. neostigmine and atropine

b. SuCH and neostigmine

c. rocuronium and SuCH

d. methacholine and atropine

e. SuCH and atropine

neostigmine and atropine

which of the following drugs is ingested orally will be fatal

a. SuCH

b. tubocurarine

c. pilocarpine

d. tiotropium

e. all of the above

pilocarpine because it is not charged and will be absorbed well and affects the BBB

a 32 year old woman is noted to have MG which drug would help treat this disorder

physostimine an AChEI

a female model puts some eyedrops in her eye following the advice from someone running a modeling show, tells her this will make her look more appealing. she does this and becomes distressed and very sensitive to the floodlights on the stage. after she goes to a restaurant and realizes she can not read anything on the menu. What did the eye drops contain

atropine because of the muscarinic antagonists

A patient is brought to the ER at UMASS. the friend that brings him in says that the patient ate some plant material before he started feeling sick. which of the following side effects would indicate poisoning from a muscarinic agonist

miosis and bradycardia

a 21 year old man tells his doctor he has difficulty breathing after climbing a set of stairs, and is unable to complete his sentences. he often has to force himself to breathe. the doctor diagnoses COPD and prescribes ipratropium which relaxes the airways and makes it easier for him to breathe. what signaling pathway does this drug affect in bronchial smooth muscle

prevents Gi stimulation and increases cAMP

prevents Gq stimulation and decreases calcium levels

a 23 year old patient is diagnosed with COPD cannot tolerate CNS effects of a bronchodilator drug prescribed to him which of the following drugs could you use instead

tiotropium

a 5 year old boy is brought to the ER. his parents say hes been acting funny the past 24 hours, confused and imagining things, thirsty even though he has been drinking a lot. physical exam shows fever, elevated heart rate, dilated pupils, blurry vision, and flush. it is revealed that he saw berries at a park and ate them. the active ingredient in these are most likely what. and what should be carried out for drug therapy

atropine, physostigmine

38 year old man brought to the ER by his wife. pt is sweating profusely, drooling, and has tears running down his cheeks. the wife states he was spraying insecticides on his fruit trees when the symptoms started. the insecticide is a carbamate. what drug would you administer to treat this patient

atropine

42 year old woman is given botox to treat her migraines as she was unresponsive to multiple things. what is the MOA of botox

blocks the release of ACh

glaucoma can be treated by

direct acting agonists and indirect agonists because they stimulate muscarinic receptors

a marine combat unit is headed to an area where there is a high likelihood of exposure to sarin gas. what can you administer to protect them from the side effects of sarin

pyridostimine

65 year old retired woman comes to ER after becoming suddenly ill following dinner, exhibits marked perspiration, excessive tear formation, nausea, drooling, pinpoint pupils, and bradycardia, along with peeing a lot. her respiratory rate is normal she says these symptoms started after she ate salad containing lettuc, tomatoes, wild mushrooms and other leaves she though were edible. What is most likely responsible for her symptoms

muscarine

53 year old man undergoes radiotherapy to treat a tumor in his neck starts complaining of dry mouth this is determined to be from hypofunction of the salivary gland. a drug that could be used to provide relief would be

pilocarpine

which of the following tests would a good eye doctor perform prior to administering an agent to dilate the patients pupil

intraocular pressure

43 year old undergoes abdomen surgery and no develops urinary retention. what drug could you use in this situation

betanechol or muscarinic agonist

woman with PMH of smoking complains of SOB and chronic coughing indicating COPD. her physician wants to prescribe a drug that would have minimal effects on the heart what drug would you give

tiotropium

50 year old man prescribed a new muscarinic agonist to reduce BP. which of the following is responsible for this effect

reduction of heart rate by M2 receptor activation

a woman is started on a new drug to control her overactive bladder what side effects would you expect

dry mouth and eyes

50 year old man starts a drug to manage post operative urinary retention. which drug class is this

muscarinic agonist

how would you best classify drugs used to treat MG

indirect acting agonist

muscarine structure

pilocarpine structure

cevimeline

tolterodine structure

nicotine structure

Solifenacin Structure

oxybutynin structure

pirenzepine structure

darifenacin structure

atropine structure

Choline is able to cross the cell membrane by itself

True

False

false

What is the source of acetyl coa?

Mitochondria

Which of the following processes is a symport?

Neuronal transport of choline 2 things moving in the same direction both coming into the cell

Vesicular transport of ACh- antiport

Na K ATPase- antiport

Vesicular ATPase- uniport

Neuronal transport of choline 2 things moving in the same direction both coming into the cell

Does the transport of choline require energy?

No, secondary active transport do not require energy

Symports do not require energy

How many molecules of ACh are needed to activate nACh receptors?

2, binds to alpha all nicotinic receptors must have 2 subunits in order to open a channel

AChEI are best described as:

Direct acting agonist

Direct acting antagonist

Indirect acting agonist

Indirect acting antagonist

Indirect acting agonist

What happens when nACh receptors are activated?

Influx of sodium: sodium is in high conc outside so when the channel opens sodium will come in

Influx of chloride

Activation of G proteins

Influx of sodium: sodium is in high conc outside so when the channel opens sodium will come in

What is responsible in CNS

Nn only present on skeletal muscles

Nm

Nm

If a drug blocks the receptor of endogenous agonist is best classified as

Direct acting agonist

Direct acting antagonist

Indirect acting agonist

Indirect acting antagonist

Direct acting antagonist

Drug that inhibits presynaptic autoreceptors is best classified as

Direct acting agonist

Direct acting antagonist

Indirect acting agonist

Indirect acting antagonist

Indirect acting agonist

Drug that inhibits enzyme degrades endogenous agonist is called

Direct acting agonist

Direct acting antagonist

Indirect acting agonist

Indirect acting antagonist

Indirect acting agonist

When activated by calcium, ENOS creates NO, which does

cGMP, increases relaxation

Endothelial cell layer is damaged vascular smooth muscle is exposed ACh produces

Vasoconstriction leading to M3 being activated, ca activated, muscle contraction

Which of the following inhibits micturition? We want to control overactive bladder

Muscarinic agonist- would relax internal sphincter and make you urinate which we don't want

Muscarinic antagonist: allows for bladder volume to increase and store

Alpha 1 agonist: alpha present will contract and close internal sphincter but we do not use bc cardiac problems

Alpha 1 antagonist- allows for relaxation of sphincter and pass through

Beta 3 agonists: activated muscles promote storing and it relaxes

Beta 3 agonists: activated muscles promote storing and it relaxes

Muscarinic antagonist: allows for bladder volume to increase and store

Alpha 1 agonist: alpha present will contract and close internal sphincter but we do not use bc cardiac problems

Why is drainage of aqueous humor so important?

If does not drain glaucoma builds pressure in the eye, you need a muscarinic agonist to allow for greater drainage

What is the most significant characteristic of NaK2Cl symport inhibitors

Short elimination half life

Profoundly increases Na, Cl excretion in TAL loop of henle

Increases renal blood flow

Loss of TAL electrostatic driving force

Profoundly increases Na, Cl excretion in TAL loop of henle

What is an example of a direct renin inhibitor

aliskiren

What are 3 characteristics of ACh?

achiral

quat

ester

If patient is moved from oral oxybutynin to TD we should

Increase the dose

Decrease the dose

Keep the same dose

Decrease the dose

Tolterodine dose should be reduced in a patient that is on

Esterase inhibitor

CYP2D6 inhibitor

CYP3A4 inhibitor

CYP3A4 inhibitor