Pharmacology: Gouty Arthritis Class Lecture
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Questions and Answers

Which receptor subtype, when activated, stimulates a G protein that inhibits adenylyl cyclase and increases K+ conduction, leading to decreased heart rate and contraction force?

  • M1
  • M3
  • Nicotinic receptors
  • M2 (correct)

    • Which of the following receptors is found on parietal cells of the stomach?

  • M1 (correct)
  • M3
  • M2
  • Nicotinic receptors

    • What is the primary effect of activating M1 or M3 receptors?

  • Increase in intracellular Ca++ (correct)
  • Inhibition of adenylyl cyclase
  • Inhibition of Ca++ channels
  • Stimulation of phospholipase A2

    • Which of the following drugs selectively inhibits M1 receptors in the gastric mucosa and is useful in the treatment of gastric and duodenal ulcers?

    <p>Pirenzepine</p> Signup and view all the answers

    Which of the following receptors are found in the central nervous system (CNS), adrenal medulla, autonomic ganglia, and the neuromuscular junction?

    <p>Nicotinic receptors</p> Signup and view all the answers

    What is the primary effect of activating the M2 subtype on cardiac muscle?

    <p>Inhibition of adenylyl cyclase and increased K+ conduction</p> Signup and view all the answers

    Which of the following is a direct-acting cholinergic agonist that mimics the effects of acetylcholine by binding directly to cholinoceptors?

    <p>Muscarine</p> Signup and view all the answers

    Which of the following receptors show only a weak affinity for muscarine?

    <p>Nicotinic receptors</p> Signup and view all the answers

    What is the primary use of pilocarpine in the context provided?

    <p>To promote salivation in xerostomia and Sjogren's syndrome</p> Signup and view all the answers

    What is the mechanism of action of acetylcholinesterase inhibitors in the treatment of Alzheimer's disease?

    <p>They prolong the lifetime of acetylcholine in the synaptic cleft</p> Signup and view all the answers

    What is the primary use of physostigmine in the context provided?

    <p>To increase intestinal and bladder motility</p> Signup and view all the answers

    What is the mechanism of action of physostigmine as an acetylcholinesterase inhibitor?

    <p>It forms a relatively stable enzyme-substrate intermediate that reversibly inactivates acetylcholinesterase</p> Signup and view all the answers

    What is the effect of placing physostigmine topically in the eye?

    <p>It causes miosis (pupil constriction), spasm of accommodation, and lowers intraocular pressure</p> Signup and view all the answers

    What is the duration of action of physostigmine?

    <p>2-4 hours</p> Signup and view all the answers

    What is the primary side effect of pilocarpine mentioned in the text?

    <p>Severe sweating and salivation</p> Signup and view all the answers

    What is the primary mechanism of action of acetylcholinesterase inhibitors?

    <p>They prolong the lifetime of acetylcholine in the synaptic cleft</p> Signup and view all the answers

    What is the primary mechanism of action of epinephrine in relieving bronchospasm?

    <p>β2 receptor agonist action leading to bronchodilation</p> Signup and view all the answers

    Which of the following is NOT a mechanism by which epinephrine can increase blood glucose levels?

    <p>Promotion of gluconeogenesis in the kidneys</p> Signup and view all the answers

    Which of the following is NOT a potential adverse effect of epinephrine?

    <p>Hypoglycemia due to excessive insulin release</p> Signup and view all the answers

    In which of the following conditions should the dose of epinephrine be reduced?

    <p>Hyperthyroidism</p> Signup and view all the answers

    Which enzyme is primarily responsible for the metabolism of epinephrine?

    <p>Both MAO and COMT</p> Signup and view all the answers

    In which of the following scenarios would the use of epinephrine be contraindicated?

    <p>A patient with glaucoma requiring a reduction in intraocular pressure</p> Signup and view all the answers

    Which of the following drug interactions is most significant when using epinephrine?

    <p>With cocaine, epinephrine may have an exaggerated cardiovascular effect</p> Signup and view all the answers

    Which route of administration of epinephrine is most appropriate in an emergency situation like anaphylactic shock?

    <p>Intravenous (IV)</p> Signup and view all the answers

    Which statement about atropine is correct?

    <p>It can cause tachycardia at low doses due to central activation of vagal efferent outflow.</p> Signup and view all the answers

    What is recommended as part of the nonpharmacologic therapy for acute gouty arthritis?

    <p>Avoid alcohol and increase fluid intake</p> Signup and view all the answers

    Which adverse effect is specifically associated with oral colchicine during an acute gout attack?

    <p>Gastrointestinal disturbances</p> Signup and view all the answers

    Which of the following is NOT a use of atropine?

    <p>To increase gastric acid secretion in the gastrointestinal tract.</p> Signup and view all the answers

    Which receptor type does atropine primarily target?

    <p>Muscarinic receptors</p> Signup and view all the answers

    When is colchicine most effective in relieving acute gout attacks?

    <p>When started within the first 24 hours after symptom onset</p> Signup and view all the answers

    Which statement about the duration of action of atropine is correct?

    <p>It has a half-life of 4 hours and is eliminated via the kidneys.</p> Signup and view all the answers

    What can worsen the neutropenia and axonal neuromyopathy associated with colchicine use?

    <p>Renal insufficiency</p> Signup and view all the answers

    Which of the following is NOT a common non-GI adverse effect of colchicine?

    <p>Cardiotoxicity</p> Signup and view all the answers

    Which statement about the effects of atropine on the eye is correct?

    <p>It causes a dangerous elevation in intraocular pressure.</p> Signup and view all the answers

    Which statement about the effects of atropine on secretions is correct?

    <p>It decreases salivation, sweat, and lacrimation.</p> Signup and view all the answers

    What effect does joint rest for 1 to 2 days have on acute gouty arthritis?

    <p>Improves the symptoms</p> Signup and view all the answers

    Why may patients be advised to reduce intake of foods high in purines?

    <p>To prevent occurrence of gout attacks</p> Signup and view all the answers

    What impact does losing weight have on the treatment of acute gouty arthritis?

    <p>Improves the effectiveness of treatment</p> Signup and view all the answers

    Which statement about the use of atropine in the respiratory system is correct?

    <p>It is used to decrease bronchial secretions prior to surgery.</p> Signup and view all the answers

    Which statement about the use of atropine in the gastrointestinal tract is correct?

    <p>It is used as an antispasmodic to reduce gastrointestinal motility.</p> Signup and view all the answers

    Which of the following is the most important factor in determining if prophylactic treatment for gout should be instituted immediately after resolution of an acute attack?

    <p>Elevated serum uric acid level greater than 10 mg/dL</p> Signup and view all the answers

    What is the recommended oral dose of colchicine for prophylactic treatment of gout in patients with no evidence of visible tophi and a normal or slightly elevated serum urate concentration?

    <p>0.5 to 0.6 mg twice daily</p> Signup and view all the answers

    When should patients on prophylactic colchicine treatment increase the dose during an acute gout attack?

    <p>Immediately upon sensing the onset of an acute attack</p> Signup and view all the answers

    When can discontinuation of prophylactic gout treatment be attempted?

    <p>When the serum urate concentration remains normal and the patient is symptom-free for 1 year</p> Signup and view all the answers

    What is the primary criterion for using uricosuric drugs like probenecid and sulfinpyrazone for gout prophylaxis?

    <p>Documented underexcretion of uric acid</p> Signup and view all the answers

    What is the recommended approach when starting treatment with uricosuric drugs for gout prophylaxis?

    <p>Start at a low dose to avoid marked uricosuria and possible stone formation</p> Signup and view all the answers

    What is the primary reason patients with gout are advised to reduce intake of foods high in purines?

    <p>To lower serum uric acid levels</p> Signup and view all the answers

    What is the recommended duration of joint rest for acute gouty arthritis?

    <p>1 to 2 days</p> Signup and view all the answers

    Which phase is associated with the initial depolarization of the receptor and transient muscle fasciculation caused by depolarizing neuromuscular blockers?

    <p>Phase I</p> Signup and view all the answers

    What is the primary mode of action of non-depolarizing (competitive) neuromuscular blockers at low doses?

    <p>They prevent acetylcholine from binding to the nicotinic receptor</p> Signup and view all the answers

    Which of the following agents can be used to reverse the effects of non-depolarizing neuromuscular blockers?

    <p>Neostigmine</p> Signup and view all the answers

    Which of the following statements is true regarding the use of depolarizing neuromuscular blockers for endotracheal intubation?

    <p>They are used to induce muscle fasciculations, which aid in intubation</p> Signup and view all the answers

    What is the primary reason for the development of newer non-depolarizing neuromuscular blockers over older agents like tubocurarine?

    <p>Improved safety profile and reduced side effects</p> Signup and view all the answers

    Which phase is characterized by the gradual repolarization of the receptor and flaccid paralysis caused by depolarizing neuromuscular blockers?

    <p>Phase II</p> Signup and view all the answers

    Which of the following is a potential side effect associated with the use of depolarizing neuromuscular blockers?

    <p>Hyperkalemia</p> Signup and view all the answers

    What is the primary advantage of using non-depolarizing neuromuscular blockers over depolarizing agents during general anesthesia?

    <p>Ability to control the depth of muscle relaxation</p> Signup and view all the answers

    What is the primary mechanism of action of carbachol (carbamylcholine) in the context provided?

    <p>It has both muscarinic and nicotinic actions, and is a poor substrate for acetylcholinesterase.</p> Signup and view all the answers

    What is the primary use of pilocarpine mentioned in the text?

    <p>To cause miosis and spasm of accommodation for the treatment of glaucoma.</p> Signup and view all the answers

    What is the primary side effect of pilocarpine mentioned in the text?

    <p>Bronchospasm</p> Signup and view all the answers

    What is the primary effect of activating M2 receptors on cardiac muscle?

    <p>Decreased heart rate and contraction force</p> Signup and view all the answers

    Which of the following is a direct-acting cholinergic agonist that mimics the effects of acetylcholine by binding directly to cholinoceptors?

    <p>Pilocarpine</p> Signup and view all the answers

    What is the primary mechanism of action of acetylcholinesterase inhibitors, such as physostigmine, in the context provided?

    <p>To inhibit the breakdown of acetylcholine, leading to its accumulation and prolonged action</p> Signup and view all the answers

    What is the duration of action of carbachol (carbamylcholine) compared to acetylcholine?

    <p>Longer than acetylcholine</p> Signup and view all the answers

    What is the primary mechanism by which ephedrine causes bronchodilation?

    <p>Stimulation of beta-2 adrenergic receptors</p> Signup and view all the answers

    Which of the following is the LEAST potent among the bronchodilators mentioned in the text?

    <p>Ephedrine</p> Signup and view all the answers

    Which of the following is the primary reason why ephedrine is better suited for prophylactic use in asthma than for acute attacks?

    <p>Ephedrine has a slower onset of action compared to other bronchodilators</p> Signup and view all the answers

    How does phenoxybenzamine primarily differ from other alpha-adrenergic antagonists in its mechanism of action?

    <p>Phenoxybenzamine binds irreversibly to alpha receptors, while others bind reversibly</p> Signup and view all the answers

    What is the primary effect of phenoxybenzamine on the cardiovascular system?

    <p>Decreases heart rate and contractility</p> Signup and view all the answers

    How does phenoxybenzamine's effect on alpha-2 receptors contribute to its overall cardiovascular effects?

    <p>Blockade of alpha-2 receptors increases norepinephrine release, leading to increased cardiac output</p> Signup and view all the answers

    What is the primary mechanism by which phenoxybenzamine reverses the actions of epinephrine?

    <p>By blocking the alpha-adrenergic effects of epinephrine, but not the beta-adrenergic effects</p> Signup and view all the answers

    What is the primary therapeutic use of ephedrine mentioned in the text?

    <p>To treat myasthenia gravis</p> Signup and view all the answers

    Which muscle group is typically paralyzed first when using non-depolarizing muscle relaxants?

    <p>Muscles of the eye and face</p> Signup and view all the answers

    Which of the following is NOT a reason why non-depolarizing muscle relaxants are not administered orally?

    <p>They are rapidly metabolized by gastric acid</p> Signup and view all the answers

    Which of the following non-depolarizing muscle relaxants undergoes spontaneous degradation in plasma, followed by ester hydrolysis?

    <p>Atracurium</p> Signup and view all the answers

    Which of the following is a potential adverse effect associated with the metabolite laudanosine, produced during the metabolism of atracurium?

    <p>Seizures</p> Signup and view all the answers

    Which class of antibiotics can potentiate the neuromuscular blockade caused by non-depolarizing muscle relaxants?

    <p>Aminoglycosides</p> Signup and view all the answers

    Which of the following non-depolarizing muscle relaxants is an aminosteroid drug that undergoes deacetylation in the liver?

    <p>Rocuronium</p> Signup and view all the answers

    Which of the following statements regarding the interaction between halogenated hydrocarbon anesthetics and non-depolarizing muscle relaxants is correct?

    <p>Halogenated hydrocarbon anesthetics sensitize the neuromuscular junction to the action of non-depolarizing muscle relaxants</p> Signup and view all the answers

    Which of the following drugs can overcome the neuromuscular blockade caused by non-depolarizing muscle relaxants?

    <p>Cholinesterase inhibitors</p> Signup and view all the answers

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