Autonomic Nervous System: Parasympathetic vs Sympathetic Activity

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Questions and Answers

What are the two opposing branches of the autonomic nervous system (ANS) that maintain the resting activity of organs?

  • Peripheral nervous system and somatic nervous system
  • Enteric nervous system and autonomic nervous system
  • Central nervous system and autonomic nervous system
  • Sympathetic nervous system and parasympathetic nervous system (correct)

Which neurotransmitter is associated with the parasympathetic nervous system (PNS)?

  • Norepinephrine
  • Epinephrine
  • Dopamine
  • Acetylcholine (correct)

How can changes in resting activity occur in organs according to the text?

  • By decreasing the activity of either the PNS or the SNS (correct)
  • By increasing the activity of both the PNS and the SNS
  • By decreasing only the activity of the sympathetic nervous system (SNS)
  • By increasing only the activity of the parasympathetic nervous system (PNS)

Which statement about adverse drug effects (ADRs) is accurate based on the text?

<p>ADRs may have a therapeutic effect on target organs and an adverse effect on ancillary organs (A)</p> Signup and view all the answers

What is the primary focus of this chapter according to the text?

<p>Use of drugs in primary care by advanced practice nurses to treat various conditions (B)</p> Signup and view all the answers

Which type of drugs target the sympathetic nervous system (SNS) by direct receptor binding or mimicking the action of norepinephrine (NE) or epinephrine?

<p>Peripherally acting alpha-adrenergic agonists (B)</p> Signup and view all the answers

Which of the following is NOT a common adverse reaction in trials of methyldopa?

<p>Insomnia (A)</p> Signup and view all the answers

What is the metabolic fate of approximately 50% of guanfacine's oral dose?

<p>Converted to inactive sulfate metabolites (A)</p> Signup and view all the answers

In patients with renal failure, why do adverse effects of methyldopa increase?

<p>Accumulation of methyldopa and its metabolites (C)</p> Signup and view all the answers

Which of the following drugs has a significant first-pass effect?

<p>Guanfacine (A)</p> Signup and view all the answers

What is the primary reason for cautious use of clonidine in patients with a history of bradycardia?

<p>Risk of mental depression (D)</p> Signup and view all the answers

Why should methyldopa and clonidine be used cautiously in patients with cerebrovascular disease?

<p>They cross the blood-brain barrier (B)</p> Signup and view all the answers

What is the effect of stimulation of central alpha2 receptors by methyldopa's active metabolite?

<p>Decrease in sympathetic outflow to the heart (D)</p> Signup and view all the answers

Which of the following receptors are primarily associated with excitation or stimulation?

<p>Alpha1 receptors (A)</p> Signup and view all the answers

Where are alpha2 receptors primarily located?

<p>Presynaptic nerve terminals of smooth muscles and islet cells of the pancreas (C)</p> Signup and view all the answers

What is the primary function of beta1 receptors?

<p>Stimulation of adenylyl cyclase to increase cAMP production (D)</p> Signup and view all the answers

Which of the following receptors are stimulated by both norepinephrine (NE) and epinephrine?

<p>Alpha1, alpha2, beta1, and beta2 receptors (B)</p> Signup and view all the answers

What is the primary use of alpha1 agonists?

<p>Decongestants (A)</p> Signup and view all the answers

Which of the following is a central effect of alpha2 agonists?

<p>Inhibition of cardioacceleration and vasoconstriction centers in the brain (B)</p> Signup and view all the answers

Which of the following is a potential adverse effect of centrally acting alpha2 agonists used for hypertension?

<p>Dry mouth (A)</p> Signup and view all the answers

What is a potential consequence of abruptly stopping centrally acting alpha2 agonists?

<p>Impaired homeostatic balance regulating SNS action (D)</p> Signup and view all the answers

Which of the following is an approved use for guanfacine?

<p>Both A and B (C)</p> Signup and view all the answers

How does guanfacine reduce blood pressure?

<p>By reducing sympathetic outflow by activating alpha2 receptors in the brain (C)</p> Signup and view all the answers

Which alpha1 receptor subtype is the most prevalent in the prostate?

<p>alpha1a (B)</p> Signup and view all the answers

Which statement regarding the metabolism of tamsulosin is accurate?

<p>It is extensively metabolized by CYP450 enzymes, with less than 10% eliminated unchanged. (A)</p> Signup and view all the answers

Which of the following statements about alfuzosin metabolism is correct?

<p>Approximately 11% of the administered drug is eliminated unchanged in the urine. (B)</p> Signup and view all the answers

What is the primary reason that selective alpha1a receptor antagonists are advantageous for treating BPH?

<p>They demonstrate fewer adverse drug reactions (ADRs) (A)</p> Signup and view all the answers

Which enzyme is involved in the metabolism of silodosin?

<p>CYP3A4 (D)</p> Signup and view all the answers

Which of the following is NOT a characteristic of the pharmacokinetics of the alpha1 antagonist drugs?

<p>Demonstrate low protein binding (D)</p> Signup and view all the answers

Which of the following alpha1 antagonist drugs has the lowest bioavailability?

<p>Silodosin (A)</p> Signup and view all the answers

Based on the information provided, what is true about the active metabolite of silodosin?

<p>It has a half-life of approximately 24 hours. (D)</p> Signup and view all the answers

Which alpha1 antagonist drug is known to accumulate in breast milk at a concentration 20 times that in maternal plasma?

<p>Doxazosin (C)</p> Signup and view all the answers

Which of the following statements about drug interactions with alpha-blockers is accurate?

<p>They can lead to additive hypotension, with increased risk. (A)</p> Signup and view all the answers

What is the primary reason that the absorption of alfuzosin is reduced when taken in a fasting state?

<p>Alfuzosin should be administered with food (D)</p> Signup and view all the answers

Which statement about the metabolism and excretion of doxazosin is true?

<p>Doxazosin exhibits biphasic plasma elimination (C)</p> Signup and view all the answers

What is the primary mechanism by which selective alpha1a receptor antagonists are thought to relieve lower urinary tract symptoms (LUTS) in BPH?

<p>By a mechanism unrelated to prostate smooth-muscle relaxation (D)</p> Signup and view all the answers

Which alpha1 antagonist drug demonstrates the highest selectivity for the alpha1a receptor subtype?

<p>Silodosin (D)</p> Signup and view all the answers

How does taking tamsulosin in a fasting state affect its pharmacokinetics?

<p>Increases bioavailability by 30% and increases Cmax by 40-70% (C)</p> Signup and view all the answers

Which of the following statements about clonidine is correct?

<p>It can cause nightmares and insomnia as an adverse reaction. (B)</p> Signup and view all the answers

Which drugs are well-suited for monotherapy in treating hypertension according to the text?

<p>None of the drugs mentioned are well-suited for monotherapy (B)</p> Signup and view all the answers

Which of the following statements about methyldopa is true?

<p>It is the first-line therapy for hypertension in pregnant patients. (C)</p> Signup and view all the answers

How can methyldopa and clonidine be used effectively for treating hypertension?

<p>By combining them with a diuretic to address sodium and water retention (A)</p> Signup and view all the answers

Which of the following adverse reactions is NOT associated with centrally acting alpha2 agonists?

<p>Hypoglycemia (C)</p> Signup and view all the answers

What is the recommended approach for dosing methyldopa and clonidine in treating hypertension?

<p>Start with the lowest recommended dose and increase gradually (D)</p> Signup and view all the answers

How can the sedation side effect associated with clonidine and methyldopa be minimized?

<p>By dividing the dose with a higher dose in the evening (D)</p> Signup and view all the answers

Which drug interaction is mentioned in the text for centrally acting alpha2 agonists?

<p>Beta-adrenergic blockers should not be used concurrently with them. (C)</p> Signup and view all the answers

Which of the following statements about the use of centrally acting alpha2 agonists in children is correct?

<p>Methyldopa can be safely used in children, but clonidine cannot. (C)</p> Signup and view all the answers

Which drug in this class is approved by the FDA for the treatment of ADHD in children?

<p>Clonidine (C)</p> Signup and view all the answers

For which age group is clonidine considered to work better in treating hypertension?

<p>Adults (B)</p> Signup and view all the answers

Which of the following adverse reactions is specifically associated with guanabenz?

<p>Abdominal pain and vomiting (B)</p> Signup and view all the answers

What should be done if a patient needs to discontinue both a centrally acting alpha2 agonist and a beta-adrenergic blocker?

<p>Discontinue the beta-adrenergic blocker first. (B)</p> Signup and view all the answers

Which drug formulation is available for patients who have difficulty taking pills or remembering frequent doses?

<p>Transdermal clonidine (B)</p> Signup and view all the answers

Which of the following is NOT a recommended monitoring parameter for patients taking methyldopa?

<p>Liver function tests (A)</p> Signup and view all the answers

What should be monitored for patients taking clonidine or methyldopa, especially those with renal impairment?

<p>Serum creatinine levels (A)</p> Signup and view all the answers

Which drug was traditionally considered the drug of choice for pregnant women with hypertension?

<p>Methyldopa (D)</p> Signup and view all the answers

Which of the following statements about the use of centrally acting alpha2 agonists in hypertension is correct?

<p>They are used as second-line drugs when other drugs are not effective in achieving blood pressure control. (A)</p> Signup and view all the answers

What is the recommended approach for monitoring blood pressure when using clonidine or methyldopa?

<p>Take baseline blood pressure before initiating therapy and monitor with each dosage change (A)</p> Signup and view all the answers

Which of the following adverse reactions is specifically associated with clonidine?

<p>Pruritic rash (C)</p> Signup and view all the answers

What is the primary reason for conducting liver function studies before and during methyldopa therapy?

<p>To monitor for potential hepatotoxicity associated with methyldopa (C)</p> Signup and view all the answers

How should patients take methyldopa to ensure proper dosing?

<p>Take the missed dose as soon as possible, unless it's almost time for the next dose (C)</p> Signup and view all the answers

What is a potential consequence of missing doses of methyldopa?

<p>Increased risk of experiencing rebound hypertension (C)</p> Signup and view all the answers

What should patients be aware of regarding potential drug-herbal interactions with methyldopa?

<p>Methyldopa may interact with certain herbal supplements, so patients should inform their prescribers about any herbal use (D)</p> Signup and view all the answers

How should patients apply the transdermal clonidine patch?

<p>Apply the patch to a hairless area of intact skin on the upper arm or torso once every 7 days, using a different site from the previous application (B)</p> Signup and view all the answers

What is the most common adverse reaction associated with methyldopa and clonidine?

<p>Hypotension (low blood pressure) (D)</p> Signup and view all the answers

What should patients do to minimize the risk of hypotension while taking methyldopa or clonidine?

<p>Avoid alcohol and other CNS depressants, and drink an adequate amount of non-caffeinated fluids (D)</p> Signup and view all the answers

What should patients report to their healthcare provider while taking methyldopa?

<p>Any weight gain of more than 2 lb (1 kg) in 1 day, which may indicate fluid retention (C)</p> Signup and view all the answers

What should patients be encouraged to do in addition to taking medication for hypertension management?

<p>Adhere to lifestyle interventions such as weight loss, exercise, low-sodium diet, smoking cessation, and stress management (D)</p> Signup and view all the answers

What is the primary mechanism of action of adrenergic antagonists in the treatment of hypertension?

<p>They block adrenergic receptors or decrease norepinephrine release within sympathetic nervous system terminals (A)</p> Signup and view all the answers

What is the main reason nonselective alpha antagonists are not used in the treatment of hypertension?

<p>They block presynaptic alpha2 receptors resulting in reflex cardiac stimulation (D)</p> Signup and view all the answers

Which statement about selective alpha1 antagonists is true?

<p>Tamsulosin, alfuzosin, and silodosin have minimal effect on blood pressure (C)</p> Signup and view all the answers

What is the primary pharmacodynamic effect of reversible alpha1 antagonists?

<p>Decrease in peripheral vascular resistance (C)</p> Signup and view all the answers

Why are prazosin and terazosin less likely to cause reflex tachycardia compared to other alpha1 antagonists?

<p>They are more selective for alpha1 receptors in the vasculature (A)</p> Signup and view all the answers

Which drug was found to have an increased risk of heart failure (HF) in comparison to chlorthalidone according to the ALLHAT trial?

<p>Doxazosin (C)</p> Signup and view all the answers

What is one of the reasons tamsulosin, silodosin, and alfuzosin have not been approved for hypertension treatment?

<p>Increased selectivity for alpha1 receptors in the prostate (C)</p> Signup and view all the answers

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