Pharma 3 & 4 Summary and Questions PDF

Pharma 3 and 4 Summary and Qs Done by Leen Alhassan Anatomy and Physiology of the ANS Divisions of the Nervous System: Central Nervous System (CNS) and Peripheral Nervous System (PNS). PNS further divided into: Somatic Nervous S...

Pharma 3 and 4 Summary and Qs Done by Leen Alhassan Anatomy and Physiology of the ANS Divisions of the Nervous System: Central Nervous System (CNS) and Peripheral Nervous System (PNS). PNS further divided into: Somatic Nervous System: Voluntary control. Autonomic Nervous System (ANS): Involuntary control, divided into: Sympathetic System: Thoracolumbar origin, short preganglionic, long postganglionic fibers, generalized discharge. Parasympathetic System: Craniosacral origin, long preganglionic, short postganglionic fibers, localized discharge. Key Features and Exceptions: Adrenal medulla functions as a ganglion. Sympathetic postganglionic fibers in sweat glands are cholinergic. Receptors: Nicotinic Receptors: Found in the neuromuscular junction (NMJ), CNS, autonomic ganglia, and adrenal medulla. Muscarinic Receptors: High affinity for muscarine, divided into subtypes M1-M5: M1: GI (parietal cells) and brain. M2: Heart (bradycardia). M3: Bladder contraction, salivation, lacrimation, sweating, bronchoconstriction, and pupil constriction. Cholinergic Agonists Direct-Acting Cholinergic Agonists: Endogenous Choline Esters: Acetylcholine: Non-specific, limited therapeutic use due to rapid degradation by acetylcholinesterase (AchE).  Effects: Bradycardia, hypotension, bronchoconstriction, urination, diarrhea, and pupil constriction. Synthetic Esters of Choline: Carbachol: Non-specific agonist, resistant to AchE, longer duration. Used for glaucoma by opening trabecular meshwork. Bethanechol: Muscarinic receptor-specific, resistant to AchE. Used for atonic bladder and megacolon. Naturally Occurring Alkaloids: Pilocarpine: Muscarinic receptor action, lipophilic, and crosses the CNS. Used for glaucoma, xerostomia, and atropine overdose. Adverse effects: Sweating, blurred vision, night blindness, and eyebrow pain. Indirect-Acting Cholinergic Agonists (AchE Inhibitors): Increase Ach by inhibiting its breakdown, affecting both muscarinic and nicotinic receptors. Reversible Inhibitors: Edrophonium: Short-acting, used for diagnosing myasthenia gravis. Physostigmine: CNS-penetrative; used for atropine overdose and enhancing GI/bladder motility. Neostigmine: Poor GI absorption, CNS impermeable. Used for myasthenia gravis and anesthesia reversal. Pyridostigmine/Ambenonium: Long-acting oral tablets for chronic myasthenia gravis. Irreversible Inhibitors: Examples: Organophosphates like sarin gas. Therapeutic use: Echothiophate for glaucoma. Cholinergic Antagonists Block muscarinic or nicotinic receptors (parasympatholytics). Anti-Muscarinic Agents: Atropine: Organ effects: Mydriasis, reduced GI motility, tachycardia, reduced secretions. Used for bradycardia, cholinergic crisis, and ophthalmic exams. Adverse effects: Dry mouth, tachycardia, confusion, hyperthermia. Scopolamine: CNS effects include sedation and prevention of motion sickness. Adverse effects: Similar to atropine with potential for abuse. Ipratropium/Tiotropium: Bronchodilators for COPD with minimal systemic effects. Others: Cyclopentolate (ophthalmic exams) and oxybutynin (overactive bladder). Adrenergic Agonists Catecholamines: Short-acting, parenteral, do not cross BBB. Examples: Epinephrine, Norepinephrine, Dopamine. Non-Catecholamines: Longer-acting, oral or parenteral, cross CNS. Examples: Phenylephrine, Ephedrine. Receptor Actions: Alpha-1: Vasoconstriction, mydriasis, urinary retention. Alpha-2: Inhibits NE release, central sympatholytic. Beta-1: Increases heart rate, renin release. Beta-2: Bronchodilation, vasodilation, uterine relaxation. Beta-3: Lipolysis, urinary retention. Clinical Uses: Epinephrine: Anaphylaxis, cardiac arrest, status asthmaticus. Norepinephrine: Hypovolemic shock.  Dopamine: Shock, acute heart failure. Phenylephrine: Nasal congestion, hypotension. Albuterol: Acute asthma attacks. Adrenergic Antagonists Alpha Blockers: Selective (e.g., Prazosin): Used for hypertension, BPH. Non-Selective (e.g., Phentolamine): Used for pheochromocytoma. Side Effects: Tachycardia, orthostatic hypotension. Beta Blockers: First-Generation (e.g., Propranolol): Non-selective, used for hypertension, angina, arrhythmias. Second-Generation (e.g., Metoprolol): Beta-1 selective, used for chronic heart failure. Third-Generation (e.g., Carvedilol): Beta blocker with alpha-1 blocking effects, used in heart failure. Notes: Beta blockers with intrinsic sympathomimetic activity (e.g., Pindolol) are safer in bradycardia. Abrupt discontinuation can cause receptor upregulation. Miscellaneous Notes AchE inhibitors (e.g., Donepezil) are used for Alzheimer’s disease. Irreversible cholinesterase inhibitors (e.g., organophosphates) are toxic but can have therapeutic uses. Beta blockers can cause metabolic and CNS side effects, including fatigue and erectile dysfunction. 1. Which division of the nervous system controls involuntary actions? A) CNS B) Somatic C) Autonomic D) Peripheral Answer: C 2. Where are nicotinic receptors located? A) Skeletal muscles only B) Autonomic ganglia, adrenal medulla, CNS, skeletal muscles C) Parasympathetic postganglionic neurons D) Heart and brain Answer: B 3. What is the function of M2 muscarinic receptors? A) Stimulate bladder contraction B) Cause bradycardia C) Stimulate gastric secretion D) Promote bronchoconstriction Answer: B 4. Which muscarinic receptor subtype is involved in bladder contraction? A) M1 B) M2 C) M3 D) M5 Answer: C 5. Which of the following drugs is used for glaucoma? A) Pilocarpine B) Atropine C) Bethanechol D) Phenylephrine Answer: A 6. Which drug is a cholinergic agonist used to treat atonic bladder? A) Carbachol B) Bethanechol C) Physostigmine D) Ipratropium Answer: B 7. Which cholinergic drug acts on both muscarinic and nicotinic receptors? A) Carbachol B) Bethanechol C) Atropine D) Pilocarpine Answer: A 8. Which cholinergic agent is lipophilic and crosses the CNS? A) Carbachol B) Pilocarpine C) Bethanechol D) Edrophonium Answer: B 9. What is the role of acetylcholinesterase inhibitors? A) Enhance Ach degradation B) Block Ach receptors C) Prevent Ach degradation D) Enhance Ach reuptake Answer: C 10. Which drug is used for diagnosing myasthenia gravis? A) Pyridostigmine B) Edrophonium C) Neostigmine D) Physostigmine Answer: B 11. Which cholinergic antagonist is used for motion sickness? A) Atropine B) Scopolamine C) Cyclopentolate D) Tiotropium Answer: B 12. What is the antidote for atropine overdose? A) Edrophonium B) Pyridostigmine C) Physostigmine D) Neostigmine Answer: C 13. Which drug is used as a bronchodilator for COPD? A) Atropine B) Scopolamine C) Ipratropium D) Carbachol Answer: C 14. What is the primary use of epinephrine in clinical practice? A) Hypertension B) Nasal congestion C) Anaphylactic shock D) Bradycardia Answer: C 15. Which adrenergic receptor causes bronchodilation? A) Alpha-1 B) Alpha-2 C) Beta-1 D) Beta-2 Answer: D 16. Which adrenergic agonist is used to treat nasal congestion? A) Albuterol B) Phenylephrine C) Epinephrine D) Mirabegron Answer: B 17. Which adrenergic agonist acts on D1 receptors at low doses? A) Dopamine B) Epinephrine C) Phenylephrine D) Norepinephrine Answer: A 18. What is the primary use of dobutamine? A) Treat asthma B) Treat acute heart failure C) Treat hypertension D) Treat overactive bladder Answer: B 19. Which drug is a selective beta-2 agonist? A) Albuterol B) Propranolol C) Atenolol D) Ephedrine Answer: A 20. Which beta blocker is non-selective? A) Atenolol B) Metoprolol C) Propranolol D) Carvedilol Answer: C 21. Which beta blocker has additional alpha-1 blocking effects? A) Atenolol B) Carvedilol C) Metoprolol D) Timolol Answer: B 22. Which adrenergic antagonist is used for pheochromocytoma? A) Prazosin B) Phenoxybenzamine C) Propranolol D) Timolol Answer: B 23. Which drug is contraindicated in asthma? A) Atenolol B) Metoprolol C) Propranolol D) Albuterol Answer: C 24. What happens if beta blockers are stopped abruptly? A) Hypertension decreases B) Heart rate decreases C) Receptor upregulation occurs D) No clinical effect Answer: C 25. Which adrenergic agonist is used to delay premature labor? A) Phenylephrine B) Terbutaline C) Albuterol D) Clonidine Answer: B 26. What is the main function of alpha-2 agonists? A) Promote NE release B) Inhibit central sympathetic outflow C) Induce mydriasis D) Increase renin secretion Answer: B 27. Which drug is the drug of choice for hypertension in pregnancy? A) Clonidine B) Methyldopa C) Propranolol D) Phenylephrine Answer: B 28. Which beta blocker is safe in pregnancy? A) Nebivolol B) Carvedilol C) Betaxolol D) Timolol Answer: C 29. What is the main adverse effect of non-selective alpha blockers? A) Bradycardia B) Orthostatic hypotension C) Tachycardia D) Bronchoconstriction Answer: C 30. Which drug is used for long-term management of myasthenia gravis? A) Pyridostigmine B) Edrophonium C) Physostigmine D) Atropine Answer: A 31. Which adrenergic receptor is responsible for lipolysis? A) Alpha-1 B) Alpha-2 C) Beta-2 D) Beta-3 Answer: D 32. Which muscarinic receptor subtype is found in the parietal cells of the stomach? A) M1 B) M2 C) M3 D) M5 Answer: A 33. Which beta blocker has intrinsic sympathomimetic activity? A) Propranolol B) Pindolol C) Timolol D) Atenolol Answer: B 34.Which drug is used to reverse neuromuscular blockade after anesthesia? A) Neostigmine B) Physostigmine C) Edrophonium D) Pyridostigmine Answer: A 35. Which irreversible AchE inhibitor is used therapeutically? A) Sarin gas B) Echothiophate C) Edrophonium D) Donepezil Answer: B 36. Which drug is used to treat overactive bladder? A) Oxybutynin B) Ipratropium C) Atropine D) Scopolamine Answer: A 37. What is the primary adverse effect of beta-2 blockers? A) Hypoglycemia B) Tachycardia C) Hyperkalemia D) Increased renin secretion Answer: A 38. Which drug is the most effective anti-motion sickness agent? A) Atropine B) Scopolamine C) Albuterol D) Phenylephrine Answer: B 39. Which beta blocker is used in glaucoma? A) Propranolol B) Timolol C) Atenolol D) Metoprolol Answer: B 40. Which adrenergic receptor subtype increases renin secretion? A) Alpha-1 B) Alpha-2 C) Beta-1 D) Beta-2 Answer: C 41. Which muscarinic receptor subtype is found in the heart and reduces heart rate? A) M1 B) M2 C) M3 D) M5 Answer: B 42. Which cholinergic agonist is lipophilic and can cross the blood-brain barrier? A) Bethanechol B) Carbachol C) Pilocarpine D) Neostigmine Answer: C 43. Which drug is primarily used to treat non-obstructive urinary retention? A) Atropine B) Bethanechol C) Neostigmine D) Pilocarpine Answer: B 44. What is a major adverse effect of irreversible AchE inhibitors like sarin gas? A) Mydriasis B) Cholinergic crisis C) Bronchodilation D) Bradycardia Answer: B 45. Which AchE inhibitor is used for diagnosing myasthenia gravis due to its short action? A) Pyridostigmine B) Edrophonium C) Neostigmine D) Physostigmine Answer: B 46. Which cholinergic antagonist is effective in preventing post-operative nausea? A) Atropine B) Scopolamine C) Ipratropium D) Tropicamide Answer: B 47. Which anticholinergic drug is administered via inhalation for COPD management? A) Tiotropium B) Atropine C) Carbachol D) Physostigmine Answer: A 48. Which drug is used to reverse the effects of atropine toxicity by crossing the CNS? A) Neostigmine B) Pyridostigmine C) Physostigmine D) Edrophonium Answer: C 49. Which drug reduces GI motility and is used as an antispasmodic? A) Pilocarpine B) Atropine C) Bethanechol D) Tropicamide Answer: B 50. Which muscarinic antagonist is most effective for inducing prolonged mydriasis? A) Scopolamine B) Atropine C) Tropicamide D) Cyclopentolate Answer: B 51. Which adrenergic receptor subtype causes vasoconstriction and mydriasis? A) Alpha-1 B) Alpha-2 C) Beta-1 D) Beta-2 Answer: A 52. Which adrenergic agonist is primarily used for treating acute anaphylaxis? A) Norepinephrine B) Dopamine C) Epinephrine D) Phenylephrine Answer: C 53. Which adrenergic receptor subtype is involved in bronchodilation? A) Alpha-1 B) Beta-1 C) Beta-2 D) Alpha-2 Answer: C 54. Which drug is used in nasal decongestants due to its alpha-1 receptor action? A) Salbutamol B) Phenylephrine C) Epinephrine D) Clonidine Answer: B 55. Which adrenergic agonist is selective for beta-1 receptors and used in heart failure? A) Albuterol B) Dobutamine C) Phenylephrine D) Dopamine Answer: B 56. Which adrenergic antagonist blocks both beta and alpha receptors? A) Carvedilol B) Propranolol C) Atenolol D) Timolol Answer: A 57. What is a key adverse effect of non-selective alpha blockers like phentolamine? A) Bradycardia B) Orthostatic hypotension C) Hyperglycemia D) Bronchoconstriction Answer: B 58. Which beta-blocker is beta-1 selective and safer in chronic heart failure? A) Propranolol B) Atenolol C) Metoprolol D) Timolol Answer: C 59. What is the primary use of long-acting beta-2 agonists like salmeterol? A) Acute asthma attacks B) Chronic asthma maintenance C) Treatment of bradycardia D) Reduction of blood pressure Answer: B 60. Which beta-blocker is used in glaucoma for reducing intraocular pressure? A) Atenolol B) Timolol C) Metoprolol D) Nebivolol Answer: B 61. Which drug is the first-line treatment for pheochromocytoma? A) Phenoxybenzamine B) Prazosin C) Carvedilol D) Clonidine Answer: A 62. Which adrenergic receptor subtype increases renin release? A) Alpha-1 B) Alpha-2 C) Beta-1 D) Beta-2 Answer: C 63. What is the mechanism of action of beta-3 agonists like mirabegron? A) Bronchodilation B) Increase in heart rate C) Relaxation of bladder detrusor muscle D) Vasoconstriction Answer: C 64. Which beta-blocker also causes nitric oxide release and vasodilation? A) Propranolol B) Carvedilol C) Nebivolol D) Metoprolol Answer: C 65. Which drug class should never be abruptly discontinued due to receptor upregulation? A) Alpha blockers B) Beta blockers C) Muscarinic antagonists D) AchE inhibitors Answer: B 66. Which irreversible AchE inhibitor is therapeutically used for glaucoma? A) Edrophonium B) Echothiophate C) Sarin gas D) Neostigmine Answer: B 67. Which muscarinic antagonist is contraindicated in patients with urinary retention? A) Scopolamine B) Oxybutynin C) Atropine D) Ipratropium Answer: B 68. Which drug is used to treat hypertension in pregnancy? A) Methyldopa B) Clonidine C) Atenolol D) Propranolol Answer: A 69. Which adrenergic agonist is used off-label to delay premature labor? A) Albuterol B) Terbutaline C) Phenylephrine D) Epinephrine Answer: B 70. Which drug is a selective beta-1 blocker used to treat angina? A) Carvedilol B) Atenolol C) Timolol D) Propranolol Answer: B