Pharmacology Chapters 5&6

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Questions and Answers

What is the primary mechanism by which succinylcholine induces muscle relaxation during surgical procedures?

  • By directly blocking acetylcholine esterase (AChE)
  • By directly blocking nicotinic receptors
  • By hyperpolarizing the muscle cell membrane
  • By causing persistent depolarization of the muscle cell membrane (correct)

What happens to nicotinic receptors when exposed to continuous agonist stimulation?

  • They cause hyperpolarization of cell membranes
  • They desensitize due to persistent depolarization. (correct)
  • They become supersensitive, leading to increased responsiveness.
  • They undergo immediate and permanent destruction.

How do muscarinic receptors modulate neuronal activity?

  • By directly binding to ion channels and allowing influx of sodium ions
  • By directly causing the release of dopamine
  • By acting as ionotropic receptors
  • By activating intracellular enzyme cascades via G-proteins (correct)

Through what mechanism does activation of muscarinic receptors cause hyperpolarization?

<p>Opening of $K^+$ channels via G-protein linked channels (B)</p> Signup and view all the answers

Which second messenger system is inhibited by some muscarinic receptors?

<p>Cyclic adenosine monophosphate (cAMP)-PKA (D)</p> Signup and view all the answers

In which area of the brain do muscarinic receptors modulate smooth locomotor activity?

<p>Striatum (basal ganglia) (B)</p> Signup and view all the answers

Which brain area utilizes muscarinic receptors to modulate dopamine neurons in the VTA, influencing reward and drug dependence?

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

Which muscarinic receptor subtype is specifically involved in the activation of dopamine neurons in the VTA?

<p>M5 (C)</p> Signup and view all the answers

Which of the following mechanisms describes how botulinum toxin leads to muscular paralysis?

<p>Hydrolyzing proteins involved in priming synaptic vesicles, inhibiting ACh release. (A)</p> Signup and view all the answers

What is the primary function of acetylcholinesterase (AChE) at the neuromuscular junction?

<p>To break down ACh into choline and acetic acid, allowing the muscle to repolarize. (C)</p> Signup and view all the answers

How does hemicholinium-3 (HC-3) affect acetylcholine (ACh) production?

<p>By blocking the choline transporter, reducing the reuptake of choline and thus limiting ACh synthesis. (D)</p> Signup and view all the answers

What is the rationale behind using acetylcholinesterase (AChE) inhibitors to treat Alzheimer's disease?

<p>To increase the availability of ACh in the synapse, compensating for the loss of cholinergic neurons. (A)</p> Signup and view all the answers

If a drug inhibits acetylcholinesterase (AChE) at the neuromuscular junction, what would be the most likely effect on muscle contraction?

<p>Prolonged muscle contraction due to the extended presence of ACh in the synaptic cleft. (B)</p> Signup and view all the answers

In what ways is acetylcholinesterase (AChE) strategically located within the nervous and muscular systems to perform its function?

<p>Inside presynaptic axons, on the postsynaptic membrane, and secreted into the neuromuscular junction. (B)</p> Signup and view all the answers

A researcher is studying a new drug that is believed to enhance cognitive function in Alzheimer's patients. Which mechanism of action would best support the drug's potential effectiveness?

<p>Inhibiting acetylcholinesterase (AChE) to increase the availability of ACh. (B)</p> Signup and view all the answers

What is the immediate consequence of blocking the choline transporter in a cholinergic neuron?

<p>Depletion of ACh due to lack of precursor. (C)</p> Signup and view all the answers

Which of the following is a primary function of cholinergic synapses in the peripheral nervous system (PNS)?

<p>Initiating and controlling muscle contraction. (C)</p> Signup and view all the answers

In the autonomic nervous system, which combination of neurons are cholinergic?

<p>Preganglionic neurons in sympathetic branches and postganglionic neurons in parasympathetic branches. (A)</p> Signup and view all the answers

What is the primary function of the basal forebrain cholinergic system (BFCS)?

<p>Playing an important role in cognitive functioning. (B)</p> Signup and view all the answers

In Parkinson's disease, what role do anticholinergic drugs play, particularly in the early stages?

<p>To compensate for the neurotransmitter imbalance caused by the loss of dopaminergic neurons. (B)</p> Signup and view all the answers

How do axons from the lateraldorsal tegmental (LDTg) influence dopamine (DA) neuron activity in the midbrain VTA?

<p>By exerting a powerful excitatory influence, activating nicotinic receptors involved in nicotine reinforcement. (A)</p> Signup and view all the answers

What function do acetylcholine (ACh) pathways from the pons, projecting to the reticular formation and thalamic areas, primarily serve?

<p>Playing important roles in behavioral arousal, sensory processing, and initiation of rapid-eye-movement sleep. (C)</p> Signup and view all the answers

A patient exhibits symptoms of cognitive decline and memory loss. Damage to which cholinergic system is most likely contributing to these symptoms?

<p>The basal forebrain cholinergic system (BFCS). (A)</p> Signup and view all the answers

If a drug selectively blocked muscarinic cholinergic receptors in the midbrain VTA, what effect would it likely have?

<p>It would diminish the rewarding-producing effects of morphine and cocaine. (C)</p> Signup and view all the answers

Which of the following is a key difference between physostigmine and neostigmine in treating myasthenia gravis?

<p>Physostigmine crosses the blood-brain barrier, allowing it to affect the CNS, while neostigmine does not. (C)</p> Signup and view all the answers

Why is multiple administration of neostigmine or pyridostigmine needed in the treatment of myasthenia gravis?

<p>These drugs are metabolized, leading to reduced drug concentration and a decrease in effect over time. (A)</p> Signup and view all the answers

How does pyridostigmine act as a preemptive antidote against irreversible AChE inhibitors like Sarin?

<p>It temporarily binds to and protects AChE, preventing irreversible inactivation by Sarin and Soman. (A)</p> Signup and view all the answers

What is the primary mechanism by which neostigmine and pyridostigmine improve muscle function in patients with myasthenia gravis?

<p>By prolonging the action of acetylcholine at the neuromuscular junction, increasing stimulation of remaining receptors. (B)</p> Signup and view all the answers

What are the expected consequences of organophosphate exposure on the central nervous system (CNS)?

<p>Overstimulation of cholinergic synapses, potentially leading to convulsions, coma, and death. (D)</p> Signup and view all the answers

Why are organophosphates considered dangerous nerve agents?

<p>They irreversibly inhibit AChE, leading to rapid acetylcholine accumulation and overstimulation of cholinergic synapses. (D)</p> Signup and view all the answers

A patient with myasthenia gravis is being treated with neostigmine. If the patient begins to experience muscle weakness despite ongoing treatment, what is the most likely explanation?

<p>The progression of myasthenia gravis has led to further loss of functional acetylcholine receptors, overwhelming the effect of neostigmine. (B)</p> Signup and view all the answers

How do the antibodies developed in myasthenia gravis cause muscle weakness and fatigue?

<p>By blocking cholinergic receptors in the muscle, reducing the muscle's sensitivity to acetylcholine. (D)</p> Signup and view all the answers

In the study using place conditioning, what effect did the knockout of M5 receptors have on the mice's response to morphine?

<p>It eliminated the place preference normally produced by morphine. (A)</p> Signup and view all the answers

Which of the following is a physiological effect of activating M2 muscarinic receptors in cardiac muscle?

<p>Decreased heart rate and decreased strength of contraction (C)</p> Signup and view all the answers

Activation of M3 muscarinic receptors in secretory glands results in which of the following effects?

<p>Salivation, sweating, and lacrimation (A)</p> Signup and view all the answers

How does the activation of M3 receptors in pancreatic β-cells contribute to the regulation of blood glucose levels?

<p>It stimulates insulin secretion to regulate blood glucose during food consumption. (B)</p> Signup and view all the answers

A drug that acts as a muscarinic antagonist is MOST likely to cause which side effect?

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

Based on the information provided, which of the following strategies might be investigated to develop non-addictive analgesic drugs?

<p>Developing drugs that avoid M5 receptors to maintain analgesia without reward. (C)</p> Signup and view all the answers

A patient is experiencing increased gut motility. Which receptor, when activated, is MOST likely responsible for this condition?

<p>M3 (B)</p> Signup and view all the answers

Which of the following is NOT an area with a high density of muscarinic receptors?

<p>Smooth muscle of blood vessels (B)</p> Signup and view all the answers

What is the primary mechanism by which acetylcholine (ACh) is taken up and stored within synaptic vesicles?

<p>Active transport via a vesicular ACh transporter (VAChT) (C)</p> Signup and view all the answers

Vesamicol is a drug known to interfere with vesicular ACh uptake. What is the primary effect of Vesamicol on cholinergic neurotransmission when administered?

<p>Reduces the amount of ACh stored in vesicles and subsequently released (D)</p> Signup and view all the answers

Unlike monoamine neurotransmitters, acetylcholine (ACh) does not have a reuptake system. What is the alternative primary mechanism that cholinergic neurons use to recycle/reutilize the transmitter?

<p>Enzymatic degradation of ACh into choline and acetate, followed by choline reuptake (B)</p> Signup and view all the answers

Acetylcholinesterase (AChE) inhibitors are a class of drugs that affect cholinergic transmission. What is the general effect of AChE inhibitors on cholinergic neurotransmission?

<p>Prolong the action of ACh in the synapse (D)</p> Signup and view all the answers

In the context of nicotinic acetylcholine receptors, what distinguishes the 'desensitized' state from the 'open' and 'closed' states?

<p>The receptor is bound by an agonist, but the channel is closed and unresponsive (D)</p> Signup and view all the answers

Muscarinic acetylcholine receptors are found in various locations in the brain. Which statement best describes the role of the basal forebrain cholinergic system (BFCS) in cognitive function?

<p>The BFCS plays a crucial role in attention, learning, and memory (D)</p> Signup and view all the answers

M5 muscarinic receptors are implicated in the rewarding effects of drugs. How do M5 receptors modulate dopaminergic cell firing in the context of drug abuse?

<p>M5 receptors enhance dopaminergic cell firing, increasing reward (C)</p> Signup and view all the answers

Antipsychotic drugs can sometimes induce insulin resistance. Which specific muscarinic receptor subtype, expressed in the pancreas, is implicated in this side effect, and how does it contribute to insulin resistance?

<p>M3 receptors, by disrupting normal insulin secretion (D)</p> Signup and view all the answers

Flashcards

Botulinum toxins

Toxins that inhibit ACh release at the neuromuscular junction by hydrolyzing proteins.

Neuromuscular junction

The synapse where motor neurons connect with muscle fibers for contraction.

Acetylcholinesterase (AChE)

Enzyme that breaks down acetylcholine (ACh) into choline and acetic acid.

ACh breakdown locations

AChE is found in presynaptic axons, postsynaptic membrane, and neuromuscular junctions.

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Choline uptake

After ACh breakdown, choline is recycled back into the nerve terminal for ACh production.

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Hemicholinium-3 (HC-3)

Drug that blocks choline transporter, decreasing ACh production by limiting choline availability.

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AChE inhibitors

Drugs used to treat mild to moderate Alzheimer's by increasing available ACh.

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Cognitive benefit in Alzheimer's

AChE inhibitors modestly improve cognition due to increased ACh, but do not stop disease progression.

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Physostigmine

An AChE inhibitor that crosses the blood-brain barrier and affects the CNS.

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Neostigmine

An AChE inhibitor used to treat myasthenia gravis that does not cross the BBB.

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Pyridostigmine

A reversible AChE inhibitor for managing myasthenia gravis.

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Myasthenia Gravis

An autoimmune disorder where antibodies block muscle cholinergic receptors.

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Cholinergic Receptors

Receptors that respond to the neurotransmitter acetylcholine.

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Irreversible AChE Inhibitors

Compounds that permanently inhibit AChE, leading to persistent ACh presence.

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Nerve Gas Poisoning

A condition caused by excessive ACh due to irreversible AChE inhibition, leading to severe symptoms.

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Cholinergic Synapses

Synapses that use acetylcholine as a neurotransmitter, found in the neuromuscular junction.

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Peripheral Nervous System (PNS)

Part of the nervous system outside the brain and spinal cord, including autonomic functions.

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Preganglionic Neurons

Cholinergic neurons located in the CNS that project to autonomic ganglia.

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Basal Forebrain Cholinergic System (BFCS)

A system of cholinergic neurons linked to cognitive function and memory.

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Cholinergic Interneurons in Basal Ganglia

Interneurons that maintain balance with dopaminergic neurons in the striatum.

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Lateral Dorsal Tegmental Nucleus (LDTg)

Brainstem nucleus that influences dopamine neuron activity through cholinergic signaling.

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Acetylcholine (ACh) Loss

Loss of ACh neurons associated with dementia in Alzheimer's disease.

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Nicotinic Receptors

Receptors that respond to acetylcholine and are involved in reward pathways.

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Desensitization

A reduction in receptor response after continuous agonist exposure.

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Re-sensitization

The process of receptors regaining sensitivity after agonist concentration drops.

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Depolarization block

Loss of cell membrane potential due to continuous stimulation.

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Succinylcholine

A chemical that continuously stimulates nicotinic receptors, causing depolarization block.

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Curare poisoning

Blockade of muscle nicotinic receptors leading to paralysis.

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Muscarinic receptors

Metabotropic receptors with five subtypes (M1-M5) involved in various signaling pathways.

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PKC activation

Activation of the phosphoinositide signaling pathway by some muscarinic receptors.

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Cognitive effects of ACh

Effects of acetylcholine on cognition mediated by receptors in the forebrain and hippocampus.

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Vesicular ACh uptake

The process by which acetylcholine is transported into synaptic vesicles for storage.

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Botulinum toxin effects

Botulinum toxins prevent ACh release, causing muscle paralysis.

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ACh recycling mechanism

Cholinergic neurons recycle ACh through a process involving choline uptake after breakdown.

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Effects of AChE inhibitors

AChE inhibitors increase ACh levels, enhancing cholinergic transmission, particularly in cognition.

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Nicotinic receptors states

Nicotinic receptors can be open, closed, or desensitized, affecting ACh binding and channel state.

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M5 muscarinic receptors function

M5 receptors influence dopaminergic activity and are involved in reward pathways in the brain.

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Pancreatic M3 receptors

M3 receptors regulate insulin secretion and can contribute to insulin resistance with certain medications.

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Muscarinic receptor locations

Muscarinic receptors are found in various peripheral organs and glands, affecting functions like digestion.

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M5 receptor knockout mice

Mice lacking M5 receptors show reduced rewards from morphine and cocaine.

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Place conditioning

A method to measure reward responses by associating a substance with a specific environment.

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M2 muscarinic receptors

Receptors in cardiac muscles that slow heart rate and reduce contraction strength.

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M3 muscarinic receptors

Receptors that activate gut muscles, increasing movement.

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Parasympathetic innervation

Nerve supply from the parasympathetic system that regulates bodily functions.

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Role of ACh in insulin secretion

ACh activates M3 receptors in pancreatic β-cells to release insulin.

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Insulin insufficiency

Condition leading to type 2 diabetes due to low insulin levels.

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Muscarinic antagonists

Drugs used for psychiatric disorders that can cause dry mouth as a side effect.

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Study Notes

Acetylcholine (ACh) Synthesis and Storage

  • Acetylcholine (ACh) is the oldest neurotransmitter
  • Two precursors required for ACh synthesis: choline and acetyl coenzyme A (acetyl CoA)
  • Choline acetyltransferase (ChAT) transfers an acetyl group from acetyl CoA to choline, forming ACh
  • ChAT is only located in cholinergic neurons, allowing identification
  • ACh synthesis rate controlled by precursor availability and neuronal firing rate
  • ACh packaged into synaptic vesicles by vesicular acetylcholine transporter (VAChT)
  • Vesamicol blocks VAChT, reducing ACh release

ACh Release and Breakdown

  • Neural (Ca²⁺)-dependent release: Influx of Ca²⁺ triggers vesicle fusion
  • Non-neural dependent release: Neurotoxins can dramatically affect ACh release.
    • Black widow spider venom causes massive ACh release
  • Physiologically, ACh release at the neuromuscular junction triggers muscle contraction
  • Botulinum toxin blocks ACh release by preventing vesicle fusion
  • Enzymatic breakdown of ACh catalyzed by acetylcholinesterase (AChE) into choline and acetic acid
  • AChE located intracellularly and at the postsynaptic membrane. It rapidly removes ACh after release
  • Choline taken back into the cholinergic nerve terminal by choline transporter
  • Hemicholinium-3 (HC-3) blocks choline transporter, reducing ACh production.

AChE Inhibitors and Their Clinical Significance

  • AChE inhibitors are used for mild to moderate Alzheimer's disease. Loss of cholinergic neurons in the forebrain lead to cognitive impairment.
  • Physostigmine, neostigmine, and pyridostigmine block AChE activity, increasing ACh levels
  • Physostigmine crosses the blood-brain barrier, affecting the CNS. Overactivation of cholinergic synapses may cause symptoms like slurred speech, confusion, and potentially coma or death.
  • Neostigmine and pyridostigmine don't cross the blood-brain barrier. They are used to treat myasthenia gravis, an autoimmune disease causing neuromuscular junction problems.
  • They maintain sufficient ACh concentration for muscle contraction to occur
  • Irreversible inhibitors like organophosphates (e.g., Sarin, Soman) are used as chemical weapons. They lead to overstimulation of cholinergic synapses, resulting in serious symptoms and potentially death.

Cholinergic Synapses: Organization and Function

  • Cholinergic synapses are essential for neuromuscular junction function, enabling muscle contraction
  • In the PNS, cholinergic neurons innervate target organs throughout sympathetic and parasympathetic activity.
  • Preganglionic neurons are cholinergic in both the parasympathetic and sympathetic branches. Postganglionic neurons in the parasympathetic branch are also cholinergic. Sympathetic postganglionic neurons are adrenergic.

Cholinergic Systems in the Brain

  • Basal forebrain cholinergic system (BFCS) plays crucial role in cognitive function. Damage to this system can lead to dementia, as seen in Alzheimer's disease.
  • The cholinergic interneurons in the basal ganglia play a role in balance with dopaminergic neurons and dopamine imbalances can lead to Parkinson's disease.
  • The laterodorsal tegmental (LDTg) and pedunculopontine tegmental (PPTg) nuclei in the brainstem exert excitatory influences on DA neuron activity in the midbrain VTA.

Cholinergic Receptor Subtypes

  • Nicotinic receptors: Ionotropic, allowing Na⁺ and Ca²⁺ influx. Located at neuromuscular junctions, autonomic ganglia, and various brain regions
  • Muscarinic receptors: Metabotropic, linked to second messenger pathways. Located in various brain regions and peripheral tissues, like the heart and gut. There are 5 subtypes (M1, M2, M3, M4, M5) with different physiological roles

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