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Autonomic Drugs1. Muscarinic agonists may producea. Mydriasisb. Vasodilatationc. Uterine contractiond. Bronchodilatatione. B and C <=2. Effects of isoprenaline include:a. Reflex bradycardiab. Decreased peripheral resistance <= b1=b2>>>a so +ve chrono/ino and vasodilates leading to +ve CO and –ve BPc. Marked hypertensiond. Reduced pulse pressure – reduced MAPe. A and C3. In the eyea. Alpha adrenoceptors cause contraction of the circular papillary muscle - dilationb. Cyclospasm is a feature of organophosphate poisoning <= ciliary muscle contraction, opening the trabecular meshwork so useful in glaucoma (echothiophate, OGP, long duration of action)c. Beta agonist will reduce intraocular pressure – b blockerd. Antipsychotic agents such as chlorpromazine have no effect on the eyee. Diuretics have no use in glaucoma4. Which agonist is not correctly paired with its adrenoceptor?a. Phenylephrine – alpha 1b. Clonidine – alpha 2 – partial agonistc. Dobutamine – beta 1 – inotrope, minimal chronotopy, mild pressord. Procaterol – beta 2e. Prazosin – alpha 2 <=selective a1 blocker5. Regarding beta-receptor antagonist drugs the following has no local anaesthetic action:a. Labetalolb. Atenolol <= hydrophillic b1 selective, renally excreted unchangedc. Metoprolold. Propranolole. Pindolol6. regarding isoprenalinea. it is a potent bronchodilator <=b. it is a selective beta1 agonist – b1=b2c. it can be used in tachyarrythmias to decrease AV conductiond. it has negative inotropic effectse. it causes peripheral vasoconstriction7. regarding beta blockersa. inhibits renin release via beta2 receptors – b1 increases, a2 decreasesb. metoprolol has intrinsic sympathomimetic effectsc. all are well absorbed – esmolol IV onlyd. beta1 selective antagonists don’t cause bronchoconstriction – none are elective enoughe. can treat ventricular tachycardia’s <=8. IV drug that causes tachycardia, decreases diastolic BP, dilates pupil, doesn’t affect ejaculation, decreases sweating:a. Beta agonistb. Alpha antagonistc. Muscarinic antagonist <=d. Nicotinic antagoniste. Nicotinic agonist9. Which has pure beta agonist effects in the circulation?a. Adrenalineb. Noradrenalinec. Isoprenaline <= b1=b2d. ?e. ?10. Choose the odd one out:a. Muscarine – agonistb. Acetylcholine – agonist c. Hyoscine <= is scolpolamine, a muscurinic antagonistd. Bethanachol – agonist e. ?11. A young patient is given a normal dose of a drug in the emergency department. He develops tachycardia, increased BP and dilated pupils. The drug is most likely to be:a. Adrenaline <=b. Atropine - ?c. ?d. ?e. ?12. dobutaminea. results in ATPàAMPb. can decrease systemic vascular resistance/afterload <= b1>b2>>>a, but complex. Is basically an inotrope with mixed a effects due to raemic mixture having opposing effects on alpha receptors. c. ?d. ?e. ?13. regarding propranolola. is a highly selective beta receptor antagonist – non-selective prototypicalb. is poorly lipid soluble – highly, poor = atenololc. has sodium channel blocking activity <= correctd. ?e. ?14. A young man presents with dilated pupils, confusion and hyperpyrexia. Which of the following could not account for these effectsa. Atropineb. Daturac. Morphine <= would constrictd. ?e. ?15. pralidoxime acts toa. inhibit presynaptic acetylcholine releaseb. cleave organophosphates from acetylcholinesterase <= used for OGP poisoning w/ atropine nad benzosc. regenerate acetylcholined. ?e. ?16. A patient comes in staggering, agitated and hyperthermic with dilated pupils. Which is LEAST likely to be the cause?a. Atropine overdoseb. Amphetaminesc. Angels trumpetd. Tricyclic overdose – anticholinergic effectse. Aspirin overdose <=17. benztropine causes:a. miosisb. diarrhoeac. confusion <=d. bronchorrhoeae. GIT haemorrhage18. All of the following are characteristics of propranolol EXCEPT:a. Lipid solubleb. Local anaesthetic actionc. Half life 3-6 hoursd. Beta sympathetic selectivity <= is is b1=b2>>>>ae. 30% bioavailability19. regarding prazosin, which is NOT true?a. It is a selective alpha 1 blocker - trueb. It dilates arterioles only, not veins <= both arteries and veinsc. It undergoes extensive first pass metabolism – 50% BAd. Recipients may develop a positive test for anti-nuclear factore. With negative feedback of noradrenaline on its own, release can still occur20. dopaminea. has less alpha agonist effect than dobutamine – dobutamine is b1>b2>>>a,, dopamine D1=D2>>b>>a (at high doses mimicks adrenaline) b. dilates the renal vascular bed by its action of beta 1 receptors – D1c. causes a profound rise in peripheral vascular resistanced. is inactivated by sodium bicarbonate <=e. causes vasoconstriction at all doses21. propranolola. has no central effectsb. can be used safely in type I respiratory failure because of its reliable beta 1 selectivityc. in overdose may be effectively treated by administering glucagons <=d. needs to be given in relatively large oral doses because of its poor absorptione. does not produce withdrawal symptoms on abrupt cessation because beta receptors do not up regulate22. hyoscinea. may potentiate the anticholinergic effects of phenothiazines – additive effects?b. is well absorbed from the gastrointestinal tract <= true, delayed effect via transdermal patchc. readily crosses the blood brain barrier - ?d. has its main effect at nicotinic receptorse. produces pronounced tachycardia in therapeutic doses23. beta blockersa. are class III antiarrythmic drugs - 2b. are selective for beta 1 adrenoreceptorsc. are useful agents in acute heart failured. may mask the symptoms of hypoglycaemia <= by blunting the adrenaline response w/ tremor and palpitations AND may make the hypoglycaemia last longere. are particularly safe and effective in combination with verapamil24. atropinea. causes ureter and bladder wall contractionb. acts by blocking adrenoceptorsc. is an example of a surmountable blockade <=d. results in miosise. causes bradycardia in a moderate to high therapeutic dose – brady then tachy25. noradrenalinea. is more potent than salbutamol at beta 1 receptorsb. is less potent than isoprenaline at alpha receptors – isopren is b1=b2>>>ac. antagonizes the effects of dopamined. has similar potency to adrenaline at beta 1 receptors <=e. is less potent than adrenaline at alpha receptors26. which of the following drugs utilises camp as a second messenger?a. Adrenalineb. Dopaminec. Milrinoned. Glucagonse. All of the above <=27. which of the following statements is incorrect?a. Noradrenaline and adrenaline exert beta effects at low doses and alpha effects at high dosesb. Dobutamine exerts its actions via alpha effects <= b1>b2>ac. Inotropic agents act ultimately by increasing intracellular calciumd. Dopamine exerts different effects at different dosese. Theophylline is a positive inotrope28. milrinonea. has a short half life because of rapid reuptake and breakdown intravascularly by COMTb. is extensively metabolized by the liver – 12%c. is in the same class of drugs as dobutamine – it is a phosphodiesterase inhibtiord. is a competitive inhibitor of phosphodiesterase <= increasing cAMP, Ca2+ and therefore contractility , also vasodilatione. is one of the most commonly used inotropes in the intensive care setting29. alpha-adrenoceptors utilisea. camp as a second messenger – a2 decrease cAMPb. cGMP as a second messengerc. phosphodiesterase inhibition to achieve positive inotropic effectsd. phospholipase C to achieve positive inotropic effects <= a1 via PLC -> IP3 and DAGe. a second messenger system that is yet to be discovered30. beta 1 effects includea. positive inotropy <=b. peripheral vasoconstrictionc. bronchodilationd. peripheral vasodilatione. a and b only31. the following statements are true for catecholamines, EXCEPT:a. they all have a very short half lifeb. noradrenaline is used mainly when peripheral vasoconstriction is desirablec. dopamine in doses od <2mcg/kg/min has been proven to directly improve renal perfusion <= ???d. dobutamine is a synthetic derivative of isoprenalinee. they increase myocardial contractility at the expense of increased oxygen consumption32. Which of the following drugs does not cause the same effect?a. Muscarineb. Acetylchoinec. Hyoscine <=d. Carbachole. Methacholine33. A young man is injected with an IV drug. He shows a resultant tachycardia, midriasis, normal blood pressure and reduced sweating. The most likely drug isa. Nicotinic antagonistb. Muscarinic antagonist <=c. Cholinomimeticd. Adrenergic agoniste. Adrenergic antagonist34. The most lipid soluble beta blocker isa. Propranolol <=b. Atenololc. Metoprolold. Pindolole. Sotalol35. propranolola. is a highly selective beta receptor antagonistb. is poorly lipid solublec. has sodium channel blocking action <=d. has intrinsic sympathomimetic activitye. has an oral bioavailability of >50%36. the cholinesterase inhibitor with the shortest duration of action isa. physostigmineb. edrophonium <=c. neostigmined. parathione. malathion ................
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