Documentos de Académico
Documentos de Profesional
Documentos de Cultura
A.
B.
C.
D.
2.
?
?
?
?
cerebellum
sensory cortex
hypothalamus
spinal cord--dorsal horn
Division of the autonomic nervous system associated with diffuse autonomic responses.
A.
B.
C.
D.
5.
?
?
?
?
A.
B.
C.
D.
4.
A.
B.
C.
D.
3.
?
?
?
?
?
?
?
?
sympathetic
parasympathetic
both
neither
Activation of the sympathetic nervous system will caus which change in the skeletal muscle
versus cutaneous vascular beds.
A.
B.
C.
D.
?
?
?
?
vasoconstriction, vasoconstriction
vasodilatation, vasodilatation
vasodilatation, vasoconstriction
vasoconstriction, vasodilation
beta-2
B.
C.
D.
?
?
?
alpha-1
muscarinic
serotonergic
E. Cholinergic receptor type that mediates vasodilation following low-dose i.v. acetylcholine
administration:
A.
B.
C.
D.
F.
?
?
?
?
nicotinic
muscarinic
nitric oxide receptor
substance P receptor
A.
B.
C.
D.
?
?
?
?
glia
liver
erythrocytes
plasma
A.
B.
C.
D.
?
?
?
?
DOPA decarboxylase
phenylethanolamine N-methyl transferase
tyrosine hydroxylase
dopamine-beta-hydroxylase
B.
C.
D.
?
?
?
A.
B.
C.
D.
F.
?
?
?
?
A.
B.
C.
D.
?
?
?
?
epinephrine
terbutaline (Brethine)
phenylephrine
phentolamine (Regitine)
A.
B.
?
?
phentolamine (Regitine)
phenoxybenzamine (Dibenzyline)
C.
D.
?
?
terbutaline (Brethine)
A&B
A.
B.
C.
D.
I.
edrophonium (Tensilon)
diisopropylphosphate (DFP)
atropine
muscarine
A.
B.
C.
D.
J.
?
?
?
?
?
?
?
?
terbutaline (Brethine)
atropine
methoxamine (Vasoxyl)
isoproterenol (Isuprel)
A.
B.
C.
D.
?
?
?
?
A.
B.
C.
D.
?
?
?
?
carbachol
methacholine (Provocholine)
both
neither
A.
B.
C.
D.
?
?
?
?
DFP
pilocarpine (Pilocar)
physostigmine (Antilirium)
ipratropium (Atrovent)
A.
B.
C.
D.
?
?
?
?
nicotine
echothiophate (Phospholine)
atropine
pilocarpine (Pilocar)
A.
B.
C.
D.
?
?
?
?
increased
decreased
no changed
one of the others is right
A.
B.
C.
D.
P.
?
?
?
?
phentolamine (Regitine)
propranolol (Inderal)
nitroprusside sodium (Nipride)
phenylephrine (Neo-Synephrine)
From the point of view of Starling's law which antihypertensive would be most likely to
reduce contractility.
A.
B.
C.
D.
?
?
?
?
methoxamine (Vasoxyl)
nitroprusside sodium (Nipride)
propranolol (Inderal)
metoprolol (Lopressor)
Q. Negative inotropism
A.
B.
C.
D.
?
?
?
?
isoproterenol (Isuprel)
epinephrine
diltiazem (Cardiazem)
norepinephrine
A.
B.
C.
D.
?
?
?
?
dopamine (Intropin)
metoprolol (Lopressor)
nitroprusside sodium (Nipride)
digoxin (Lanoxin, Lanoxicaps)
S. Major neurotransmitter released at end organ effectors of the thoracolumbar division of the
autonomic nervous system:
A.
B.
C.
D.
?
?
?
?
dopamine (Intropin)
epinephrine
norepinephrine
acetylcholine
A.
B.
C.
D.
?
?
?
?
norepinephrine
substance P
epinephrine
acetylcholine
A.
B.
C.
D.
?
?
?
?
pupillary constriction
blood flow shifted from cutaneous beds to skeletal muscle
blood glucose falls
bronchiolar constriction
A.
B.
C.
D.
?
?
?
?
phentolamine (Regitine)
mecamylamine (Inversine)
atropine
all of the above
A.
B.
C.
D.
?
?
?
?
tyrosine to DOPA
DOPA to dopamine
dopamine to norepinephrine
norepinephrine to epinephrine
A.
B.
C.
D.
?
?
?
?
A.
B.
C.
D.
?
?
?
?
epinephrine
isoproterenol (Isuprel)
norepinephrine
dopamine
A.
A.
B.
C.
D.
?
?
?
?
yohimbine (Yocon)
dobutamine (Dobutrex)
clonidine (Catapres)
phenylephrine
BB. Primary antihypertensive effect due to nitric oxide mediation of smooth muscle relaxation.
A.
B.
C.
D.
?
?
?
?
atropine
nitroprusside sodium (Nipride)
mecamylamine (Inversine)
captopril (Capoten)
A.
B.
C.
D.
?
?
?
?
tubocurarine
phenoxybenzamine (Dibenzyline)
physostigmine (Antilirium)
bretylium (Bretylol)
DD. Cardiac effects not like to be directly affected by the presence of an anticholinesterase:
A.
B.
C.
D.
?
?
?
?
acetylcholine
methacholine (Provocholine)
vagal stimulation
carbamylcholine (carbachol)
A.
B.
C.
D.
?
?
?
?
dry mouth
pupillary dilation
increased gastrointestinal tone
bronchiolar relaxation
RETURN
1.
Atropine effects:
A.
B.
C.
D.
2.
physostigmine (Antilirium)
DFP
edrophonium (Tensilon)
soman
? scopolamine
? dopamine (Intropin)
? mecamylamine (Inversine)
?
?
?
?
veins:parasympathetic
heart:sympathetic
ciliary muscle: sympathetic
salivary glands: parasympathetic
A.
B.
C.
D.
7.
?
?
?
?
A.
B.
C.
D.
6.
atropine
scopolamine
ipratropium (Atrovent)
DFP
Ganglionic blocker:
A.
B.
C.
5.
?
?
?
?
A.
B.
C.
D.
4.
A.
B.
C.
D.
3.
?
?
?
?
?
?
?
?
isoproterenol (Isuprel)
dopamine (Intropin)
clonidine (Catapres)
epinephrine
Positive inotropic drug that at low doses specifically promotes an increase in renal blood flow:
A.
B.
C.
D.
8.
dobutamine (Dobutrex)
dopamine (Intropin)
terbutaline (Brethine)
lodoxamine (Alomide)
A.
B.
C.
D.
9.
?
?
?
?
?
?
?
?
terbutaline (Brethine)
metaproterenol (Alupent)
ritodrine (Yutopar)
all of the above
A.
B.
C.
D.
?
?
?
?
guanfacine (Tenex)
captopril (Capoten)
esmolol (Brevibloc)
phenoxybenzamine (Dibenzyline)
A.
B.
C.
D.
?
?
?
?
scopolamine
methylphenidate (Ritalin)
mecamylamine (Inversine)
clonidine (Catapres)
A.
B.
C.
D.
?
?
?
?
A.
B.
C.
D.
?
?
?
?
nicardipine (Cardene)
captopril (Capoten)
phentolamine (Regitine)
esmolol (Brevibloc)
A.
B.
C.
D.
?
?
?
?
captopril (Capoten)
nitroprusside sodium (Nipride)
phenoxybenzamine (Dibenzyline)
minoxidil (Loniten)
A.
B.
C.
D.
?
?
?
?
captopril (Capoten)
losartin (Cozaar)
methyldopa (Aldomet)
phenoxybenzamine (Dibenzyline)
A.
B.
C.
D.
?
?
?
?
brochodilation
tremor
vasodilation
tachycardia
A.
B.
C.
D.
E.
?
?
?
?
?
acetylcholine
bradykinin
substance P
glycine
norepinephrine
A.
B.
? craniosacral
? thoracolumbar
A.
B.
C.
D.
?
?
?
?
norepinephrine
epinephrine
acetylcholine
dopamine
E.
? substance P
A.
B.
C.
D.
E.
?
?
?
?
?
adrenergic: beta 1
adrenergic: beta 2
cholinergic: muscarinic
cholinergic: nicotinic
dopaminergic: D. 1
A.
B.
C.
D.
?
?
?
?
neurexin
syntaxin
saxitonin
synaptobrevin
A.
B.
C.
D.
E.
?
?
?
?
?
A.
B.
C.
D.
?
?
?
?
bretylium
vesamicol
reserpine
atropine
23. Influx of this ion promotes fusion between axoplasmic membrane and nearby vesicles.
A.
B.
C.
D.
?
?
?
?
sodium
potassium
calcium
chloride
A.
B.
C.
D.
?
?
?
?
inhibit acetylcholinesterase
prevent reuptake of choline
inhibit vesicular acetylcholine release
prevent calcium influx
A.
B.
C.
D.
E.
?
?
?
?
?
A.
B.
? acetylcholinesterase
? choline acetyltransferase
27. Cholinergic receptor type that mediates the decrease in heart rate by activating potassium
channels:
A.
B.
C.
D.
?
?
?
?
M1-- muscarinic
M2-muscarinic
M3-muscarinic
nicotinic
A.
B.
? increased rate
? decreased rate
A.
B.
C.
D.
?
?
?
?
pyridoxyl phosphate
ascorbate
tetrahydrobiopterin
glycine
A.
B.
C.
? phenylethanolamine N-methyltransferase
? dopamine beta-hydroxylase
? tyrosine hydroxylase
31. ? dopa decarboxylaserugs activating this receptor are used in treating asthma:
A.
B.
C.
D.
?
?
?
?
beta1 adrenergic
muscarinic cholinergic
beta2 adrenergic
nicotinic cholinergic
A.
B.
C.
D.
?
?
?
?
increased rate
decreased contractility
coronary vasodilation
A& C
A.
B.
C.
D.
?
?
?
?
alpha1
beta1
dopamine D1
muscarinic cholinergic
A.
B.
? stimulation
? inhibition
A.
B.
C.
D.
?
?
?
?
isoproterenol (Isuprel)
propranolol (Inderal)
phenylephrine (Neo-Synephrine)
terbutaline (Brethine)
A.
B.
C.
D.
?
?
?
?
terbutaline (Brethine)
esmolol (Brevibloc)
atropine
mecamylamine (Inversine)
A.
B.
C.
D.
?
?
?
?
metoprolol (Lopressor)
methoxamine (Vasoxyl)
terbutaline (Brethine)
ipratropium (Atrovent)
A.
B.
C.
D.
?
?
?
?
methoxamine (Vasoxyl)
cocaine
reserpine
timolol (Blocadren)
A.
B.
C.
D.
?
?
?
?
propranolol (Inderal)
phenoxybenzamine (Dibenzyline)
phentolamine (Regitine)
pilocarpine (Pilocar)
A.
B.
C.
D.
?
?
?
?
A.
B.
C.
D.
?
?
?
?
mecamylamine (Inversine)
prazosin (Minipress)
atropine
propranolol (Inderal)
42. Bronchodilation
A.
B.
C.
D.
?
?
?
?
ipratropium (Atrovent)
timolol (Blocadren)
albuterol (Ventolin,Proventil)
A& C
A.
B.
C.
D.
?
?
?
?
A.
B.
C.
D.
?
?
?
?
45. Phase of the cardiac action potential that principally determine heart rate
A.
B.
C.
D.
?
?
?
?
phase 0
phase 4
phase 2
phase 3
A.
A.
B.
? propranolol (Inderal)
? phentolamine (Regitine)
C.
D.
? phenylephrine (Neo-Synephrine)
? metoprolol (Lopressor)
A.
B.
C.
D.
?
?
?
?
propranolol (Inderal)
mecamylamine (Inversine)
phentolamine (Regitine)
all of the above
A.
B.
C.
D.
?
?
?
?
phenoxybenzamine (Dibenzyline)
propranolol (Inderal)
guanfacine (Tenex)
methoxamine (Vasoxyl)
A.
B.
C.
D.
E.
?
?
?
?
A.
B.
C.
D.
E.
?
?
?
?
?
renal vasodilator
bronchial asthma
antiarrhythmic drug
positive inotrope in CHF
antihypertensive
A.
B.
C.
D.
E.
?
?
?
?
?
atropine
pilocarpine (Pilocar)
neostigmine (Prostigmin)
phentolamine (Regitine)
phenoxybenzamine (Dibenzyline)
53. Increases both magnitude of the blood pressure increase due to phenylephrine and the heart
rate decrease due to methacholine:
A.
B.
C.
D.
E.
?
?
?
?
?
mecamylamine (Inversine)
timolol (Blocadren)
nitroprusside sodium (Nipride)
clonidine (Catapres)
atropine
A.
B.
C.
D.
E.
?
?
?
?
?
A.
B.
C.
D.
E.
?
?
?
?
?
metaraminol
norepinephrine
doapmine
isoproterenol
L-DOPA
A.
B.
C.
D.
E.
?
?
?
?
?
A& C
positive inotropism
positive chronotropism
B&C
increases peripheral resistance
A.
B.
C.
D.
E.
?
?
?
?
?
epinephrine
metaproterenol (Alupent)
phentolamine (Regitine)
phenylephrine (Neo-Synephrine)
labetalol (Trandate, Normodyne)
A.
B.
C.
D.
E.
?
?
?
?
?
bronchoconstriction
increased GI motility
increased blood glucose
increased peripheral resistance
decreased heart rate
A.
B.
C.
D.
E.
?
?
?
?
?
phentolamine (Regitine)
propranolol (Inderal)
esmolol (Brevibloc)
atropine
phenylephrine (Neo-Synephrine)
A.
B.
C.
D.
E.
?
?
?
?
?
1.
Epinephrine:
A.
B.
C.
2.
A.
3.
Rapid administration of epinephrine, with resulting significant systolic pressure elevation will
cause this effect on heart rate:
A.
B.
4.
?
?
A decrease in diastolic pressures associated with epinephrine administration would most likely
occur in which dosage?
A.
B.
?
?
5.
A.
B.
C.
D.
6.
? limited effect
? beta1 adrenergic receptor activation decreases renin release
? significant reduction in renal blood flow
? significant increase in renal blood flow; mechanism similar to that exhibited by
low-dose dopamine
A.
7.
A.
B.
C.
8.
beta-1
beta-2
beta-3
A.
B.
C.
D.
E.
9.
?
?
?
?
?
?
?
?
positive chronotropic
positive inotropic
increased cardiac output
increased oxygen consumption
all of the above
A.
B.
C.
D.
?
?
?
?
A.
B.
C.
D.
E.
?
?
?
?
?
A.
B.
C.
D.
E.
?
?
?
?
?
angina
hypertension; cerebral hemorrhage
cardiac arrhythmias
anxiety reactions
all the above
A.
B.
C.
D.
E.
?
?
?
?
?
phentolamine (Regitine)
terbutaline (Brethine)
dopamine (Intropin)
dobutamine (Dobutrex)
atropine
A.
B.
C.
?
?
?
A.
B.
C.
D.
E.
1.
? constriction
? dilation
A.
B.
3.
increased automaticity
increased ectopic pacemaker activity
increased conduction philosophy
increased contractility
all the above
A.
B.
2.
?
?
?
?
?
? constriction
? dilation
A.
B.
4.
A.
B.
5.
? relaxation
? constriction
A.
B.
9.
? constriction
? dilation
A.
B.
8.
? constriction
? dilation
A.
B.
7.
? constriction
? dilation
A.
B.
6.
? constriction
? dilation
? decrease
? increase
A.
B.
C.
A.
B.
? alpha-1 adrenergic
? beta-2 adrenergic
C.
1.
A.
B.
C.
D.
E.
2.
? cholinergic muscarinic
?
?
?
?
?
epinephrine
dopamine
dobutamine
norepinephrine
phenylephrine
Decreased heart rate following norepinephrine infusion is most likely due to:
A.
B.
3.
A.
B.
C.
D.
4.
A.
B.
C.
D.
E.
5.
?
?
?
?
?
?
?
?
?
epinephrine
tyrosine
tyrosine hydroxylase
dopamine
dopa
CNS neurotransmitter associated with the basal ganglia and motor control:
A.
B.
C.
D.
?
?
?
?
dopamine
acetylcholine
both
neither
6.
A.
B.
C.
D.
E.
7.
?
?
?
?
?
positive inotropism
promotes myocardial norepinephrine release
increases glomerular filtration rates (low-dose)
vasoconstriction by alpha-1 receptor activation (high-dose)
all the above
A.
B.
C.
D.
9.
epinephrine
dopa
dopamine (Intropin)
dobutamine (Dobutrex)
nitroprusside sodium (Nipride)
A.
B.
C.
D.
E.
8.
?
?
?
?
?
?
?
?
?
A.
B.
C.
D.
E.
?
?
?
?
?
phenylephrine (Neo-Synephrine)
methoxamine (Vasoxyl)
norepinephrine (Levophed)
isoproterenol (Isuprel)
prazosin (Minipress)
A.
B.
C.
D.
?
?
?
?
A.
B.
C.
D.
E.
?
?
?
?
?
palpitations
tachycardia
arrhythmias
A&C
A,B & C
12. Cardiovascular characteristics of patients who might benefit from IV dopamine (Intropin)
administration:
A.
B.
C.
?
?
?
A.
B.
C.
D.
E.
?
?
?
?
?
epinephrine
isoproterenol (Isuprel)
phenylephrine (Neo-Synephrine)
dopamine (Intropin)
norepinephrine (Levophed)
A.
B.
C.
D.
E.
?
?
?
?
?
A.
B.
C.
D.
E.
?
?
?
?
?
A.
B.
C.
D.
E.
A.
B.
?
?
metaproterenol (Alupent)
terbutaline (Brethine)
C.
D.
E.
?
?
?
albuterol (Ventolin,Proventil)
A&B
A, B & C
A.
B.
C.
A.
B.
C.
D.
E.
A.
B.
C.
D.
E.
?
?
?
?
?
A.
B.
C.
D.
E.
1.
?
?
?
?
?
A.
B.
2.
A.
B.
C.
D.
E.
3.
?
?
?
?
?
?
?
?
?
?
A.
B.
C.
D.
7.
dry mouth
sedation
sexual dysfunction
all of the above
A.
B.
C.
D.
E.
6.
?
?
?
?
A.
B.
C.
D.
E.
5.
isoproterenol (Isuprel)
metaraminol (Aramine)
dopamine (Intropin)
dobutamine (Dobutrex)
guanabenz (Wytensin)
A.
B.
C.
D.
4.
?
?
?
?
?
?
?
?
?
isoproterenol (Isuprel)
phenylephrine (Neo-Synephrine)
low-dose dopamine (Intropin)
low-dose epinephrine
Receptor system most likely responsible for improved myocardial contractility when
dopamine is administered at low concentrations:
A.
B.
C.
D.
E.
8.
A.
B.
C.
D.
E.
9.
?
?
?
?
?
?
?
?
?
?
supplemental oxygen
IV nitroglycerin
intra-aortic balloon pump
revascularization
all of the above
A.
B.
C.
D.
E.
?
?
?
?
?
phentolamine (Regitine)
nitroglycerin
amrinone (Inocor)
clonidine (Catapres)
caffeine
A.
B.
C.
D.
1.
A.
B.
C.
D.
2.
?
?
?
?
A.
B.
C.
D.
3.
true
false
?
?
?
?
metoprolol (Lopressor)
propranolol (Inderal)l
esmolol (Brevibloc)
atenolol (Tenormin)
?
?
?
?
A.
B.
8.
?
?
A.
B.
C.
D.
7.
Most likely to cause dangerous bronchiolar constriction in asthmatic patients or patients with
COPD
A.
B.
C.
D.
6.
?
?
?
?
?
Beta-adrenergic receptor blockers are usually effective in reducing blood pressure in both "
high-renin" and "low-renin" patients:
A.
B.
5.
metoprolol (Lopressor)
atenolol (Tenormin)
timolol (Blocadren)
esmolol (Brevibloc)
A.
B.
C.
D.
E.
4.
?
?
?
?
?
?
significant reduction
significant enhancement
The major exception to the rule that additive myocardial depression between anesthetics and
beta-adrenergic antagonists is not excessive:
A.
metoprolol (Lopressor)
B.
C.
D.
E.
9.
?
?
?
?
propranolol (Inderal)
esmolol (Brevibloc)
timolol (Blocadren)
nadolol (Corgard)
Bradycardia hypotension, refractory to atropine, may occur during anesthesia in pediatric and
adult patients receiving this beta adrenergic receptor antagonist:
A.
B.
C.
D.
?
?
?
?
nadolol (Corgard)
propranolol (Inderal)
esmolol (Brevibloc)
timolol (Blocadren)
10. Greatest additive cardiovascular effects with inhaled anesthetics in the presence of betaadrenergic receptor blockade:
A.
B.
C.
?
?
?
enflurane (Ethrane)
halothane (Fluothane)
isoflurane (Forane)
11. Preferred beta-blocking agent to prevent systolic blood pressure increases associated with
direct laryngoscopy in tracheal intubation:
A.
B.
C.
D.
E.
?
?
?
?
?
IV propranolol (Inderal)
IV labetalol (Trandate, Normodyne)
IV esmolol (Brevibloc)
IV timolol (Blocadren)
IV nadolol (Corgard)
12. Beta-blocker having special benefits for patients undergoing noncardiac surgery but having
significant underlying coronary artery disease-- given IV perioperatively and orally during
remainder of hospital stay.
A.
B.
C.
D.
?
?
?
?
esmolol (Brevibloc)
atenolol (Tenormin)
propranolol (Inderal)
nadolol
ephedrine.
She is using the product in accordance with directions on the label for one-month, then
stopped using it during a vacation week, and then started again upon her return to work. Two
days after restarting, she was awakened by anterior chest pain, which radiated to her left
shoulder and arm.
She experienced numbness in the left arm,shortness of breath, and sweating (diaphoresis).
At the emergency department, she was treated with morphine and nitroglycerin.
o Cardiac catherization revealed 60% narrowing of the left anterior descending
o
o
(adapted from a case used in Medical Pharmacology, UCSF ,courtesy of Dr. Susan Masters, Dept. of
Pharmacology, University of California San Francisco, used with permission.)
1.
A.
B.
C.
D.
E.
2.
orally active
catecholamine
weak base
A&C
A, B & C
?
?
?
?
In this patient, if it were concluded that coronary vasospasm was responsible for acute
myocardial infarction, what drugs might reduce the likelihood of a recurrence.
A.
B.
C.
D.
E.
5.
?
?
?
?
?
A.
B.
C.
D.
4.
Properties of ephedrine:
A.
B.
C.
D.
E.
3.
?
?
?
?
?
?
?
?
?
?
propranolol
metoprolol
diltiazem
ergonovine
all the above
For what reason(s) was/were morphine used in the management of this patient?
A.
B.
C.
6.
?
?
?
?
A.
B.
C.
D.
?
?
?
What physiological factors might contraindicate the use of nitroglycerin in a patient with acute
myocardial infarction?
A.
B.
C.
D.
8.
pain relief
bradycardic effects
increases cardiac output
A.
B.
C.
7.
?
?
?
?
?
?
?
A ten-year old boy was referred to the asthma clinic for workup.
History: consistent with asthma; on pulmonary function testing, a marked reduction of FEV1
was noted.
1.
A.
B.
C.
D.
E.
?
?
?
?
?
bethanechol (Urecholine)
acetylcholine
ipratropium (Atrovent)
scopolamine
mecamylamine (Inversine)
2.
A.
B.
C.
D.
E.
1.
?
?
?
?
A.
B.
C.
D.
E.
3.
beta-1 antagonists
nonselective beta antagonists
beta-2 agonists
muscarinic agonists
none of the above
A.
B.
C.
D.
2.
?
?
?
?
?
?
?
?
?
?
tachycardia
arrhythmias
hypertension
A&C
A, B & C
A.
D.
E.
4.
A.
B.
C.
D.
5.
?
?
?
?
?
?
A.
B.
C.
D.
E.
?
?
?
?
?
intramuscular
oral
subcutaneous
intravenous
by transdermal patch
Return
1.
A.
B.
C.
D.
E.
2.
?
?
?
?
?
beta-blocker
alpha-adrenergic agonist
calcium channel blockers
beta-adrenergic agonist
prostaglandin analog
What is the most likely effect of cardiopulmonary bypass on myocardial perfusion in this
patient?
A.
B.
C.
D.
E.
?
?
?
?
?
significantly improved
somewhat improved
no change
somewhat diminished
significantly worsened
1.
A.
B.
C.
D.
E.
?
?
?
?
?
sodium
chloride
potassium
calcium
magnesium
2.
3.
4.
What would be another reasonable way to provide analgesia for this patient?
A.
B.
C.
D.
5.
?
?
?
?
thiopental (Pentothal)
phenobarbital (Luminal), orally
intercostal nerve block with 2% lidocaine
general anesthesia, "balanced"
Since the duration of lidocaine action is relatively short, why not use bupivacaine, a longeracting local anesthetic?
A.
too expensive
B.
C.
? increased toxicity
? bupivacaine (Marcaine) tends to have many drug-drug interactions, since it is a
powerful inducer of drug metabolizing enzyme.
D. ? all of the above
6.
Is there a way that the duration of action of 2% lidocaine (Xylocaine) can be significantly
increased?
A.
? No, but one could use a signficantly higher initial concentration to achieve
longer action.
B. ? add a vasoconstrictor to the lidocaine solution
C. ? both
D. ? neither
10. Consider the case: Should an aerosolized bronchodilator be administered prior to surgery?
A.
B.
?
?
yes
no
Very potent beta adrenergic receptor agonists with minimal effects on alpha adrenergic
receptors:
A.
B.
C.
D.
E.
2.
?
?
?
?
?
cocaine
ephedrine
dobutamine (Dobutrex)
epinephrine
yohimbine (Yocon)
?
?
?
?
?
epinephrine
isoproterenol (Isuprel)
cromolyn sodium (Intal)
beclomethasone (Banceril)
albuterol (Ventolin,Proventil)
A.
B.
C.
D.
E.
6.
low-dose epinephrine
isoproterenol (Isuprel)
mecamylamine (Inversine)
methoxamine (Vasoxyl)
atropine
A.
B.
C.
D.
E.
5.
?
?
?
?
?
A.
B.
C.
D.
E.
4.
isoproterenol (Isuprel)
epinephrine
yohimbine (Yocon)
phentolamine (Regitine)
A.
B.
C.
D.
E.
3.
?
?
?
?
?
?
?
?
?
dobutamine (Dobutrex)
isoproterenol (Isuprel)
dopamine (Intropin)
phenylephrine (Neo-Synephrine)
norepinephrine (Levophed)
A.
B.
? isoproterenol (Isuprel)
? losartin (Cozaar)
C.
D.
E.
7.
A.
B.
C.
D.
E.
8.
? ritodrine (Yutopar)
? phenylephrine (Neo-Synephrine)
? clonidine (Catapres)
?
?
?
?
?
losartin (Cozaar)
propranolol (Inderal)
metoprolol (Lopressor)
phentolamine (Regitine)
clonidine (Catapres)
A.
B.
C.
A.
B.
C.
D.
E.
A.
B.
C.
?
?
?
C
D. ?
E. ?
A.
B.
C.
D.
E.
?
?
?
?
?
receptor sequestration
receptor down regulation
receptor phosphorylation
A & B only
A, B & C
A.
B.
C.
D.
E.
?
?
?
?
?
A.
B.
C.
D.
E.
?
?
?
?
?
A.
B.
C.
D.
E.
?
?
?
?
?
prazosin (Minipress)
propranolol (Inderal)
mecamylamine (Inversine)
A& C
A, B & C
A.
B.
C.
D.
E.
?
?
?
?
?
phenylethanolamine N-methyltransferase
dopa decarboxylase
tyrosine hydroxylase
dopamine beta-hydroxylase
catechol-O-methyltransferase
A) management of arrhythmias
B) management of renal insufficiency
C) management of intraoperative hypotensive states
D) management of hypertension
E) management of Raynaud's phenomenon
Question # 6 (Multiple Answer) Examples of metabolic effects (often
adverse effects) associated with beta adrenergic receptor antagonists:
A) speeds recovery from insulin-induced hypoglycemia
B) decreases awareness of hypoglycemic symptom onset
C) increases blood lipid levels
Question # 7 (Multiple Choice) Receptors that mediate most of
epinephrine's cardiac effects:
A) beta1 adrenergic
B) beta2 adrenergic
C) dopaminergic
D) alpha-adrenergic
Question # 8 (Multiple Choice) Methoxamine-induced bradycardia
could be blocked by administration of:
A) pilocarpine
B) labetalol
C) esmolol
D) atropine
E) edrophonium
Question # 9 (Multiple Choice) Substantial bradycardia observed in the
presence of inhaled anesthetics with this beta adrenergic receptor
antagonist
A) propranolol
B) esmolol
C) labetalol
D) timolol
E) metoprolol
Question # 10 (Multiple Choice) Dangerous bronchiolar constriction
would be most prominent with this beta adrenergic receptor blocker:
A) metoprolol
B) esmolol
C) atenolol
D) timolol
Question # 11 (Multiple Choice) Primary effect of epinephrine on
respiratory tract smooth muscle:
A) smooth muscle constriction
B) smooth muscle relaxation
Question # 12 (Multiple Choice) Typical heart rate response following
methoxamine administration:
A) increase
B) decrease
Question # 13 (Multiple Answer) Alpha2 selective adrenergic agonists:
A) phentolamine
B) clonidine
C) guanabenz
D) phenoxybenzamine
E) methyldopa
Question # 14 (Multiple Choice) Propranolo loften decreases amide
local anesthetic clearance by
A) decreasing hepatic blood flow
B) inhibiting hepatic metabolism of local anesthetic
C) both
D) neither
C) mephentermine
D) methoxamine
Question # 24 (Multiple Answer) Epinephrine: therapeutic uses
A) rapid relief of respiratory distress due to bronchospasm
B) topical hemostasis
C) cardiopulmonary resuscitation
D) reversal of hypersensitivity reactions
Question # 25 (Multiple Answer) Primary mechanism by which
norepinephrine acutely increases BP:
A) increases intravascular volume
B) increases heart rate
C) vasoconstriction at precapillary resistance muscles and
veins
D) increases angiotensin II plasma levels
Question # 26 (Multiple Answer) Principal receptors activated by
norepinephrine:
A) alpha-adrenergic
B) beta1 adrenergic
C) beta2 adrenergic
Question # 27 (Multiple Answer) beta-2 adrenergic receptor-selective
agonist(s):may be used in management of both chronic and acute
asthma
A) ritodrine
B) terbutaline
C) albuterol
D) propranolol
E) timolol
Question # 28 (Multiple Answer) Vascular effects of norepinephrine:
(CBACKQuestion #
28 (Multiple Answer) Vascular effects of norepinephrine:
(A) increases total peripheral resistance; often inducing reflex bradycardia
(B) blood flow reduction to the kidney
(C) maintenance of glomerular filtration rates
(D) may increase coronary blood flow (secondary to increase blood BACK
Question # 29 (Multiple Choice) Perioperative use of this selective beta
adrenergic receptor antagonist in patients wit
# 1 (Multiple Choice) Nonselective alpha-adrenergic receptor
antagonist(s)
A) phentolamine
B) prazosin
C) yohimbine
Question # 2 (Multiple Choice) "Epinephrine reversal" could occur if
epinephrine is administered in the presence of:
A) cocaine
B) imipramine
C) propranolol
D) phentolamine
E) dopamine
Question # 3 (Multiple Choice) Catecholamine desensitization:
regulation of catecholamine responsiveness occurs at:
A) receptors
B) G protein
C) adenylyl cyclase
D) cyclic nucleotide phosphodiesterase
E) all the above
Question # 4 (Multiple Choice) Drugs used to manage allergic reactions:
A) glucocorticoids
B) antihistamines
C) subcutaneous epinephrine
D) all the above
Question # 5 (Multiple Answer) Drugs which may be used to terminate
paroxysmal supraventricular tachycardia:
A) adenosine
B) calcium channel blockers
C) esmolol
D) methoxamine
Question # 6 (Multiple Answer) Clinical conditions that may result in
shock:
A) dehydration or blood loss
B) cardiac failure
C) cardiac output obstruction
D) loss of peripheral vascular tone
Question # 7 (Multiple Choice) Correct order of adrenergic beta-agonist
potency (greatest to least)
A) isoproterenol, norepinephrine, epinephrine
B) norepinephrine, epinephrine, isoproterenol
C) epinephrine, isoproterenol, norepinephrine
D) isoproterenol, epinephrine, norepinephrine
Question # 8 (Multiple Choice) Alpha receptor class activated by drugs
such as clonidine:
A) alpha1
B) alpha2
Question # 9 (Multiple Answer) Enzyme(s) that degrade
catecholamines:
C) tyrosine hydroxylase
D) dopamine beta-hydroxylase
Question # 24 (Multiple Choice) Alpha-adrenergic receptors found
primarily postsynaptically:
A) alpha1
B) alpha2
Question # 25 (Multiple Choice) Consequence of beta-adrenergic
receptor phosphorylation:
A) enhanced receptor responsiveness
B) decreased receptor responsiveness
Correct Answers
1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ,
21 , 22 , 23 , 24 , 25
BACK
1.
A.
B.
C.
D.
2.
A.
B.
C.
D.
3.
?
?
?
?
?
?
?
?
carbachol
acetylcholine
methacholine (Provocholine)
pilocarpine (Pilocar)
A.
B.
C.
D.
4.
?
?
?
?
metoprolol (Lopressor)
atropine
albuterol (Ventolin,Proventil)
ipratropium (Atrovent)
?
?
?
?
pilocarpine (Pilocar)
atropine
both
neither
A.
B.
C.
D.
9.
?
?
?
?
Miosis
A.
B.
C.
D.
8.
acetylcholine
atropine
methacholine (Provocholine)
carbachol
Bronchoconstriction in an asthmatic:
A.
B.
C.
D.
7.
?
?
?
?
A.
B.
C.
D.
6.
carbachol (carbamylcholine)
methacholine (Provocholine)
both
neither
A.
B.
C.
D.
5.
?
?
?
?
?
?
?
?
atropine
scopolamine
homatropine
muscarine
A.
B.
?
?
isoproterenol (Isuprel)
atropine
C.
D.
?
?
propranolol (Inderal)
methacholine (Provocholine)
A.
B.
C.
D.
?
?
?
?
A.
B.
C.
D.
?
?
?
?
12. Reflex bradycardia secondary to an abrupt increase in blood pressure may be blocked by:
A.
B.
C.
D.
?
?
?
?
atropine
mecamylamine (Inversine)
both
neither
A.
B.
C.
D.
?
?
?
?
constipation
salivation
decreased gastric acid secretion
none of the above
A.
B.
? neuromuscular junction
? autonomic effector sites innervated by post-ganglionic
sympathetic fibers
C. ? some CNS synapses
D. ? A & C
E. ? B & C
15. Factors that limit CNS effects of systemic acetylcholine: administration:
A.
B.
C.
D.
?
?
?
?
A.
B.
C.
D.
E.
?
?
?
?
?
17. Cholinergic receptor type primarily localized at skeletal muscle neuromuscular junctions:
A.
B.
? muscarinic
? nicotinic
A.
B.
C.
D.
E.
?
?
?
?
?
carbachol
bethanechol (Urecholine)
acetylcholine
A& C
A,B, & C
A.
B.
C.
D.
?
?
?
?
M1
M2
M3
M4
A.
B.
? atropine
? tubocurarine
A.
B.
C.
D.
?
?
?
?
tubocurarine
mecamylamine (Inversine)
atropine
all of the above
A.
B.
C.
D.
?
?
?
?
A.
B.
C.
D.
?
?
?
?
nicotinic
muscarinic
both
neither
A.
B.
? nicotinic
? muscarinic
A.
B.
? muscarinic receptors
? nicotinic receptors
A.
B.
C.
D.
E.
?
?
?
?
?
atropine
edrophonium (Tensilon)
carbachol
acetylcholine
ephedrine
Return
1.
A.
B.
C.
D.
E.
2.
sodium
potassium
chloride
calcium
magnesium
A.
B.
C.
D.
3.
?
?
?
?
?
?
?
?
?
prostaglandins
leukotrienes
nitric oxide
calcium
A.
B.
4.
A.
B.
5.
Major mechanism responsible for decreased AV nodal conduction following increased vagal
tone:
A.
B.
C.
D.
E.
6.
?
?
?
?
?
A.
B.
C.
D.
7.
?
?
?
?
A.
B.
9.
A.
B.
C.
D.
8.
?
?
?
?
?
sympathetic
parasympathetic
A.
B.
C.
D.
?
?
?
?
A.
B.
C.
D.
E.
?
?
?
?
?
decreases potassium currents in atrial muscle and in SA nodal MAb nodal tissue
increases in slow, inward calcium currents
decreased in diastolic depolarization (decrease in phase 4 depolarization)
A&C
B&C
A.
B.
C.
D.
E.
?
?
?
?
?
A.
B.
C.
?
?
?
substance P
bradykinin
acetylcholine
D.
E.
?
?
A&B
A, B & C
A.
B.
C.
D.
E.
?
?
?
?
?
A.
B.
C.
D.
E.
?
?
?
?
?
A.
B.
C.
D.
16.
?
?
?
?
asthma
hyperthyroidism
peptic ulcer
coronary vascular disease
A.
B.
C.
D.
E.
?
?
?
?
?
reversible, short-acting
intermediate, carbamylating
long-acting, phosphorylate agents
A&B
A, B & C
A.
B.
C.
D.
E.
?
?
?
?
?
physostigmine (Antilirium)
neostigmine (Prostigmin)
edrophonium (Tensilon)
tacrine (Cognex)
atropine
A.
B.
C.
A.
B.
?
?
neostigmine (Prostigmin)
most organophosphate acetylcholinesterase inhibitors
A.
B.
C.
D.
E.
?
?
?
?
?
atropine
pilocarpine (Pilocar)
mecamylamine (Inversine)
2-PAM
all of the above
A.
B.
C.
D.
?
?
?
?
A.
B.
C.
D.
?
?
?
?
primary
secondary
congenital
all the above
A.
B.
C.
?
?
?
primary
secondary
congenital
A.
B.
?
?
echothiophate (Phospholine)
demecarium (Humorsol)
C.
D.
E.
?
?
?
atropine (generic)
A&B
A, B, & C
A.
B.
C.
D.
26. Rationale for prescribing anticholinesterase drugs to patients with myasthenia gravis:
A.
B.
C.
D.
E.
?
?
?
?
?
A.
B.
C.
D.
E.
F.
?
?
?
?
?
thymic abnormalities
hyperthyroidism
other autoimmune disorders
ventilatory dysfunction
all the above
A.
B.
C.
D.
E.
A.
B.
C.
D.
E.
?
?
?
?
?
acetylcholine
physostigmine (Antilirium)
DFP
edrophonium (Tensilon)
all of the above
A.
B.
C.
D.
?
?
?
?
31. When our anticholinesterase agents usually administered to enhance neuromuscular blockade
reversal?
A.
B.
C.
32. Pharmacologic antagonism (anticholinesterase drugs) would likely be more effective for
which type of neuromuscular blocking drug?
A.
B.
C.
?
?
?
A.
B.
C.
?
?
?
34. which antimuscarinic agent might be used in combination with an anticholinesterase when
desiring reversal of neuromuscular-blockade and opioid-based maintenance anesthesia has
been used:
A.
B.
C.
?
?
?
edrophonium (Tensilon)
high-dose atropine (10-15 ug/kg)
neostigmine (Prostigmin)
A.
B.
C.
?
?
?
edrophonium (Tensilon)
neostigmine (Prostigmin)
both are equally effective
A.
B.
C.
D.
E.
?
?
?
?
?
hyperthermia
respiratory alkalosis
hyperkalemia
certain antibiotics
all of the above
A.
B.
C.
D.
?
?
?
?
edrophonium (Tensilon)
neostigmine (Prostigmin)
both
neither
A.
A.
B.
?
?
true
false
40. Current primary therapeutic rationale for using anticholinergic preoperative medication:
A.
B.
C.
D.
?
?
?
?
sedation
antisialagogue effects
both
neither
41. Usual anticholinergic drug doses for preoperative medication does not affect either gastric
volume or pH
A.
B.
? true
? false
42. In using anticholinergic drugs as preoperative medication in a patient with glaucoma: drug
least likely to have an effect on pupil size
A.
B.
C.
? scopolamine
? atropine
? glycopyrrolate (Robinul)
43. Preferred anticholinergic drug when sedation is the principal objective, preoperatively:
A.
B.
C.
? atropine
? glycopyrrolate (Robinul)
? scopolamine
44. Atropine: most likely to increase heart rate in this patient population:
A.
B.
C.
? young adult
? infants
? elderly
A.
B.
C.
D.
E.
?
?
?
?
?
IV atropine
aerosolized atropine
aerosolized ipratropium bromide (ipratropium (Atrovent))
scopolamine
all of the above
A.
B.
C.
A.
B.
? parasympatholytic
? sympathomimetic
48. Management of severe bradycardia and A-V block associated with acute myocardial
infarction:
A.
B.
? atropine
? neostigmine (Prostigmin)
A.
B.
C.
D.
E.
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D) peptic ulcer
E) hyperthyroidism
Question # 5 (Multiple Choice) Cardiac muscarinic Type M2 receptor effects:
A) decreased phase 4 depolarization
B) decreased atrial contractility
C) decreased conduction velocity through the AV node
D) decreased ventricular contractility
E) all the above
Question # 6 (Multiple Answer) Anticholinesterase agents used in antagonistassisted neuromuscular-blockade reversal:
A) edrophonium (Tensilon)
B) neostigmine (Prostigmin)
C) physostigmine (Antilirium)
D) pyridostigmine (Mestinon)
Question # 7 (Multiple Answer) Drug:correct clinical application
A) bethanechol (Urecholine)l: treatment of paralytic ileus
B) bethanechol (Urecholine): treatment of postpartum urinary
retention
C) methacholine (Provocholine): testing for bronchial hyperreactivity
D) bethanechol (Urecholine): treatment of esophageal reflux
Question # 8 (Multiple Choice) Major of route of elimination for
anticholinesterase drugs:
A) pulmonary
B) hepatic
C) renal
Question # 9 (Multiple Choice) Determines recovery rate following
neuromuscular blockade:
A) A, spontaneous recovery rate from the blocking drug
B) B. activity the pharmacologic antagonist
C) A plus B
D) A minus B
Question # 10 (Multiple Choice) Probable cause of myasthenia gravis:
A) defect in acetylcholine synthesis
B) decreased receptor turnover
C) binding of anti-nicotinic receptor antibodies to the nicotinic
receptor
Question # 11 (Multiple Choice) Probably most important ion for transmission to
the AV node -A) sodium
B) potassium
C) chloride
D) calcium
E) magnesium
Question # 12 (Multiple Choice) In clinical anesthesia (anesthetized patients):
longer duration of action -A) edrophonium (Tensilon)
B) neostigmine (Prostigmin)
C) both about the same
Question # 13 (Multiple Choice) Rationale of combining atropine and
anticholinesterases in reversal of nondepolarizing neuromuscular-blockade
A) the antimuscarinic increases the rate of recovery
B) the antimuscarinic reduces muscarinic-receptor-mediated side
effects
C) both
D) neither
Question # 14 (Multiple Choice) Renal clearance of anticholinesterase drugs:
A) glomerular filtration
B) active secretion into renal tubule lumen
Question # 15 (Multiple Choice) Dominant autonomic tone in the ventricle:
A) adrenergic
B) cholinergic
Question # 16 (Multiple Choice) Quaternary ammonium compound;
anticholinesterase -- permanently positively charged:
A) neostigmine (Prostigmin)
B) physostigmine (Antilirium)
Question # 17 (Multiple Answer) Cardiovascular effects of cholinomimetics:
A) negative chronotropic
B) vasoconstriction
C) decreased AV nodal conduction velocity
D) negative inotropism
Question # 18 (Multiple Choice) Reactivation of acetylcholinesterase following
inhibition by organophosphates:
A) atropine
B) pilocarpine (Pilocar)
C) 2-PAM-- pralidoxime (Protopam)
D) scopolamine
E) mecamylamine (Inversine)
Question # 19 (Multiple Choice) Longest duration of acetylcholinesterase
inhibition:
A) DFP
B) neostigmine (Prostigmin)
C) physostigmine (Antilirium)
D) edrophonium (Tensilon)
E) tacrine (Cognex)
Question # 20 (Multiple Answer) Muscarinic receptor activation: effects on
cardiac currents
A) increase potassium conductance in atrial muscle, S.A., AV nodal
tissue
B) decreased inward calcium current
Question # 11 (Multiple Choice) Probably most important ion for transmission to the
AV node -Answer: (D) calciumBACKQuestion # 12 (Multiple Choice) In clinical anesthesia
(anesthetized patients): longer duration of action -Answer: (C) both about the same
BACKQuestion # 13 (Multiple Choice) Rationale of combining atropine and
anticholinesterases in reversal of nondepolarizing neuromuscular-blockade
A) atropine
B) glycopyrrolate (Robinul)
C) scopolamine
D) ipratropium (Atrovent)
E) neostigmine (Prostigmin)
Question # 3 (Multiple Choice) Preoperative medication: atropine -A) sedation
B) antisialagogue
C) both
D) neither
Question # 4 (Multiple Answer) Atropine should be effective in blocking
which of the following cardiac responses?
A) positive inotropism in response to significant increases in
circulating epinephrine
B) reflex slowing of the heart due to peritoneal stimulation
occurring during surgery
C) reflex slowing of the heart due to pressure on the eyeballs
D) A-V blockade associatet with acute myocardial infarction
E) all of the above
Question # 5 (True/False) Intrathecal neostigmine injection -- produces
postoperative analgesia without respiratory depression seen with
neuraxial opioids:
A) true
B) false
Question # 6 (Multiple Choice) Anticholinesterase better for reversing
atracurium blockade:
A) neostigmine (Prostigmin)
B) edrophonium (Tensilon)
C) equally effective
A) edrophonium (Tensilon)
B) physostigmine (Antilirium)
C) neostigmine (Prostigmin)
D) pyridostigmine (Mestinon)
E) vecuronium (Norcuron)
Question # 18 (Multiple Answer) Effects of ganglionic blockade on these
anatomical sites:
A) veins: dilation, decreased venous return, decreased
cardiac output
B) arterioles: vasoconstriction, decreaset peripheral blood
flow, hypertension
C) heart: bradycardia
Question # 19 (Multiple Choice) Drug category of choice in
management of intraoperative bradycardia -- especially if bradycardia
results from increased vagal tone:
A) anticholinesterase
B) nicotinic receptor agonist
C) muscarinic receptor agonist
D) nicotinic receptor antagonist
E) muscarinic receptor antagonist
Question # 20 (Multiple Answer) Comparing ipratropium (Atrovent)
and atropine in management of asthma:
A) ipratropium (Atrovent) does not inhibit mucociliary
clearance --atropine does
B) ipratropium (Atrovent) has no significant CNS effects
C) ipratropium (Atrovent) is limited or no systemic effects
D) ipratropium (Atrovent) generally it is advantageous
compared atropine in management of asthma
Question # 21 (Multiple Choice) Anesthetic that probably increases
central venous tone:
A) enflurane (Ethrane)
B) halothane (Fluothane)
C) both
D) neither
r) Factors influencing the speed and extent of neuromuscular-blockade reversal by
anticholinesterases
(A) intensity of neuromuscular-blockade when reversal is initiated
(B) which nondepolarizing neuromuscular-blocking drug is being reversed
(C) hypothermia
(D) hypokalemia
(E) respiratory acidosis
BACK
Question # 2 (Multiple Choice) Preferred anticholinergic drug when the objective (in
preoperative medication) is sedation:
Answer: (C) scopolamine
BACK