FRONTIER MEDICAL & DENTAL COLLEGE ABBOTTABAD

Department of Pharmacology & Therapeutics MCQs (Autonomic Pharmacology) Total Marks-50

Choose the one best Ans

(KEY: 1b, 2e, 3c, 4d, 5e, 6b, 7d, 8c, 9c, 10c,11c,12c,13c,14c,15c, 16c, 17c, 18e, 19e, 20c, 21c, 22a, 23c, 24c, 25a, 26d, 27a, 28d, 29b, 30a, 31c, 32b, 33a, 34a, 35a, 36b, 37b, 38a, 39c, 40c, 41b, 42d, 43b, 44a, 45e, 46a, 47a, 48a, 49a, 50e ) Q1. At Ayub Medical Complex, in medical OPD, Just as a trial, final year MBBS students injected a drug to 3rd year MBBS student USMAN. Drug injected was in a clinical dose. Route of administration was S/C. After 30 minutes there was dilation of pupil and a rise in systolic blood pressure of USMAN. The drug could be: (a)Morphine (( (b) Adrenaline (c) Atropine (d) Acting by blocking ganglia (e) Stimulating beta receptors throughout the body

2. At Mansehra DHQ teaching Hospital, a Physician was discussing autonomic pharmacology with house officers. He asked when given to man a drug causes bradycardia, increased GI motility and pupilary constriction. Which one of the following drug produces these combined effects: (a) morphine (b) Histamine (c) anti-histamine (d) nor-epinephrine (((e) neostigmine 3.In emergency ward of DHQ hospital Kohistan junior doctors were treating a comatose patient. They were differentiating effects of adrenaline and noradrenaline. One said which was true, subcutaneous injection of noradrenaline in man cuases: (a) Decrease in systolic BP (b) Decrease in diastolic BP (c) Tachycardia (d) Lowers peripheral resistance (e) Predominantly alpha-actions 4.Beta-action of adrenaline include: a) Decreased glycogenolysis in skeletal muscles (b) Constriction of arterioles

in skin (c) Decrease in force of cardiac contraction (d) Increase in rate of cardiac contraction (e) Constriction of bronchioles 5.3rd year MBBS students were discussing about ephedrine. There are 5 statements about the drug. Which one is correct: a) It is contraindicated by oral route (b) Is especially indicated in patients already taking monoamine oxidase inhibitors (c) Causes depression of the CNS (d) Stimulates predominantly alpha-receptors (e) It is a mixed acting amine, ie; acts directly on receptors and by causing release of transmitter from sympathetic nerves 6.Epinephrine is: (a) not used in anaphylaxis (b) used in hypersensitivity reactions (c) contraindicated in epistaxis (d) occasionally used for reducing pyrexia (e) generally used for reducing pyrexia 7. A 35 years old patient Muhammad Nawaz was admitted in emergency deptt of Ayub Medical Complex at 11 am. He had have breathlessness. A Junior doctor was on duty, who nebulized him with SALBUTAMOL. This drug: (a) Is selective beta1 agonist (b) Has its actions competitively antagonised by chlorpheneramine (c) Produces constriction of blood vessels in skeletol muscles (((d) Is used in asthma (e) Produces accommodation for near vision 8. A young medical graduate of FM&DC was observing treatment of his 22 years brother-in-law at Shaheena Jamil Trust Hospital, Abbottabad. When injected a drug to that young man, drug has no effect on resting pulse rate, does not produce a dry mouth, and depresses tachycardia, that normally follows the Valsave manoeuvre. What do you think that the drug: (a) Would be expected to block the tachycardia induced by inhalation of amyl nitrate (b) Could be atropine (c) Could be bethanecol (d) Could be ipratropium (e) Is surely H2 receptor antagonist 9. The transmitter substance at: (a) Parasympathetic postganglionic nerve endings is usually nor-epinephrine (b) Parasympathetic ganglia is epinephrine (((c) Sympathetic ganglia is nicotine (d) Parasympathetic preganglionic nerve endings is muscarine (e) Parasympathetic postganglionic nerve endings is adrenaline 10. A 12 years old child was admitted in casualty of Ayub Complex Hospital

ATD. History revealed that he has taken 2 bottles of a drug which was used by his mother for nasal decongestion. It is basically alpha adrenoceptor agonist drug. What will you observe in this patient: (a) tachycardia (b) mydriasis (c) bronchodilation (d) vasodilation (e) none of the above 11. 23 years nurse at SHAHEENA JAMIL TRUST TEACHING HOSPITAL, ATD was observing management of patient in shock. Doctor used drug adrenaline in that patient. Nurse was considering about the drug. Regarding ADRENALINE: (a) It is a catalytic agent (b) It is useful drug to relieve constipation (c) It is indicated in glaucoma (d) It is commonly used by oral route (e) It is commonly used in hypertensive patients 12. Practolol has been withdrawn from general clinical use because it: (a) Is a non-selective beta-blocker (b) Is dangerous to give it to asthmatics (c) Cause hyperurecemia (d) Induces thyrotoxicosis (e) Causes ocular damage 13. Salivary secretion is under autononmic control. Sympathetic activity produces a small amount of thick mucus secretion rich in enzyme content, whilst parasympathetic activity produces a copious watery secretion. Ganglion blockade blocks all secretion,and an unpleasant dry mouth results.Which drug of the following has ganglion blocking activity: (a)adrenaline (b)nor-adrenaline (c)hexamethonium (d)haloperidol (e)carbachol 14. FM&DC graduate of 2005 Dr. Amin is GP at Jhugiyan, ATD. He prescribed tablet alpha methyl dopa, in patient who was suffering from.. a) hyperlipidemia (b) Diabetes mellitus (c) hypertension (d) gout (e) Peptic ulcer 15. Which of the statement is correct: a) Adrenaline is a rational choice in the treatment of sinus bradycardia (b) Noradrenaline is useful in all types of cardiac arrhythmias (c) Guanethidine prevents release of noradrenaline from sympathetic neurons (d) Pempidine is a useful antihistamine (e) Salbutamol produces more tachycardia than isoprenaline 16. Sympathetic ganglia can be

(a) Blocked by alpha methyl dopa (b) Stimulated by acetylcholine (c) Stimulated by nicotine (d) Blocked by pempidine (e) Stimulated by bradykinin 17. 25 years old male patient was admitted in General Hospital Haripur at 4 pm, due to hypersensitivity reaction to some drug ingestion 4 hours before. At emergency he was treated by a drug which causes dilattion of vessels in muscle, constriction of cutaneous vessels, and positive inotropic and chronotropic effects on the heart. The drug given may be: (a) isoproterenol (b) acetylcholine (c) adrenaline (d) metaproterenol (e) noradrenaline 18. A 9 years old baby was brought at medicine OPD of the hospital. Mother told physician that child has bed-wetting problem. Which drug may be prescribed for this problem: (a) phenylephrine (b) adrenaline (c) ephedrine (d) antihistamine (((e) tricyclic antidepressant 19. In Opthalmology OPD doctors are used to administered following drug for routine examination of EYE. That drug should be mydriatic but not cycloplegic. Which one of the following drugs has that property: (a) tropicamide (b) pilocarpine (c) phenylephrine (d) homatropine (e) isoproterenol 20. SEXUAL DYSFUNCTION IS COMMON SIDE EFFECT OF: (a) Lorazepam (b) Antihistamines (((c) Beta blockers (d) Ephedrine (e) Sildenafil 21. Acetylcholine is: (a) contraindicated in glaucoma, even in experimental animals (b) pseudo neurotransmitter in autonomic nervous system (((c) true neurotransmitter in ANS, metabolized by acetylcholine esterase (d) is usually metabolized by buterylcholinestrase (e) very effective drug used for the treatment of schizophrenia 22. 14 years old Ms. Fahmida was brought at casualty of FMDC Block of DHQ hospital Mansehra, complain with epistaxis. It was due to fragile vessels of the nose. Doctor on duty kept adrenaline swab at her nose. Which of the following effects of adrenaline would be blocked by phentolamine but not by metoprolol:

(a)Contraction of radial smooth muscle in the iris (b) Cardiac stimulation (c) Increase of cAMP in fat (d) Relaxation of bronchial smooth muscle (e) Relaxation of uterus 23. Phenoxybenzamine is not used in: (a) Pheochromocytoma (b) Raynauds phenomenon (c) Essential hypertension (d) Carcinoid (e) Mastocytosis 24. 28 years male patient, already diagnosed case of pheochromocytoma was admitted in Surgical ward of DHQ Hospital Haripur. At day-0, surgeon started IV injection of Phentolamine Mesylate for this patient. Phentolamine was used in this patient, because: (a) It has antipsychotic effects (b) It increases BP by increasing peripheral resistance (c) It decreases BP by blocking -receptors, both 1 and 2 (d) It has anxiolytic effect (e) It decreases adrenaline presynaptically 25. 28 years Haq Nawaz was hypertensive since last 5 years. He came to GP at Mustafabad, Mandiyan, ATD, for his treatment. GP prescribed tablet Minipress (prazosin) 5 mg OD for him, for three days. Regarding PRAZOSIN: (a) It is highly -1 selective blocker agent (b) It dilates arterioles more than veins (c) It causes postural hypotension (d) Dizziness and fainting occurs as 1st DOSE EFFECT (e) All are true about prazosin 26. An accident occured at Mezaeel Chowk, Mansehra road, near DYAL HOUSE. Driver of that car was severely injured and shifted to Ayub Medical Complex. There was remarkable blood & fluid loss in the patient. PATIENT IS INFRONT OF YOU. What will you do? (a) Start fresh blood and dextrose saline, immediately (b) You will start adrenaline s/c immediately (c) You will observe all vital functions then you will decide what to do? (d) Immediately inject corticosteroids (SOLUCORTEF) (e) Do not think, just administer atropine IV 27. 47 years old patient has benign hypertrophy of prostate. He visited surgical OPD of AADIL HOSPITAL, Nawanshehar ATD. Before surgical treatment of the case, Doctor may prescribe some drugs for this patient. Which drugs should be prescribed: (a) -1 adrenergic blocker like prazosin (b) Propranolol (c) Atenolol (d) Combined propranolol + atenolol (e) None of the above

28. 35 years old patient was operated for inguinal hernia. Surgeon decided to operate him under GA. After recovery from anesthesia, on routine investigations at ICU, tachycardia and extrasystoles were observed by doctor. For this patient at this stage, which drugs are helpful: (a) Bethanichol may improve extrasystoles (b) Ipratropium may be helpful to control tachycardia (c) Beta blockers suppress extrasystoles and tachycardia (d) Esmolol is special beta blocker used in this case (e) No any drug available to control tachycardia & extrasystoles 29. Regarding d-Tubocurarine: (a) it inhibit release of histamine from mast cells (b) intradermal injection of dTubocurarine produces a wheal similar to that produced by injecting histamine (c) d-Tubocurarine is commonly used for the treatment of glaucoma (d) it has prominent analgesic effect (e) is drug of choice for management of organophosphorus compound poisoning 30. Acetylcholine: (a) is not used therapeutically because it has very short half life and is metabolized quickly by acetylcholinestrase (b) may be used for the management of fever of uknown origin (c) may be used to relieve of somatic pain of uknown origin (d) is used as antidepressant agent (e) is metabolized mainly by buterylcholinestrase 31. Plasma cholinesterase: (a) metabolizes epinephrine (b) metabolizes nor epinephrine (c) is another name for pseudo-cholinesrase (d) metabolizes all neurotransmitters present in syneptic cleft (e) is glandular secretion 32. Isoprenaline: (a) Is commonly used drug for the treatment of atony of bladder (b) is sympathomimetic agent (c) corrects the cardiac rhythm in suraventricular tachycardia (d) is used as antipyretic (e) is used as antihypertensive 33. Mecamylamine: (a) is primarily used to decrease BP in emergency states (b) is used in orthostatic hypotension (c) is contraindicated in malignant hypertension (d) is indicated in low grade fever (e) is not absorbed by oral route of administration

34. Nicotine: (a) is component of cigarette smoke and is poison without therapeutic benefit (b) is used to cause sleep (c) is only present in sympathetic ganglion (d) is only present in parasympathetic ganglion (e) is drug of choice for decreasing intraocular pressure 35. Choose the right statement: (a) All NM blocking agents are injected intravenously because their uptake via oral absorption is minimal (b) all antimuscrinic drugs are indicated in glaucoma (c) all cholinergic drugs are contraindicated in glaucoma (d) pralidoxime is drug of choice for blocking beta-1 adrenoceptors used in hypertension (e) neostigmine , physostigmine and pyridostigmine can overcome the action of non-depolarizing NM blockers but with very low dose 36. Cocaine: (a) is used to treat paralytic ileus after abdominal surgery (b) inhibits nor adrenaline uptake parasyneptically (c) is primarily CNS depresent drug used as anxiolytic agent(d) is indicated in withdrawal symptoms in drug addiction (e) reduces sympathetic activity by increasing nor-adrenaline uptake presyneptically 37. Salbutamol: (a) is contraindicated in asthma (b) is indicated in asthma (c) is primarily used in glaucoma (d) causes glaucoma if used in high doses (e) prevents glaucoma by reducing aquous humor production 38. Succinylcholine: (a) attaches with nicotinic receptors and acts like acetylcholine to depolarize the junction (b) is drug used to facilitate urination in patients after any surgical procedure (c) is one of the vitamin of B-complex group (d) acts like atropine (e) is synonymous of acetylcholine 39. Ephedrine: (a) is primarily indicated in organophosphorous compound poisoning (b) is drug having characteristic of local anesthesia (c) causes bronchodilation but is less potent than adrenaline and isprenaline (d) is used to treat malignant hypertension (e) is used to treat primary hypertension

40. Choose the best: (a) all muscles are equally sensitive to be blockade by competitive NM blockers (b) NM blockers are primarily used to treat myasthenia gravis (c) NM blockers increase the safety of anesthesia because less anesthesia is required to produce muscle relaxation allowing patients to recover quickly and completely after surgery (d) very low dose of cholinesterase inhibitors can overcome the action of non-depolarizing NM blockers (e) Non-depolarizing NM blockers interact with muscarinic receptors to prevent the binding of nor adrenaline 41. Scopolamine: (a) is non-depolarizing NM blocker (b) is used as anti-motion sickness agent (c) is depolarizing NM blocker drug (d) is sympatholytic drug (e) is sympathomimetic drug 42. Echothiophate: (a) causes generalized cholinergic stimulation, paralysis of motor function and convulsions (b) is universly known drug of choice for management of orthostatic hypotension (c) is contraindicated in open angle glaucoma (d) is acetylcholinestrase activator agent (e) is sympathomimetic drug used in hypovolumic shock 43. A 68 years old man presents to the emergency department with acute heart failure. You decide that this patient requires immediate drug therapyto improve his cardiac function. Which one of the following drugs would be most beneficial? (a)albuterol (b) dobutamine (c) epinephrine (d) nor epinephrine (e) phenylephrine 44. which one of the following drugs, when administered IV, can decrease blood flow to the skin, increase blood flow to the skeletal muscle, and increase the force of contraction and heart rate: (a) adrenaline (b) isoproterenol (c) nor adrenaline (d) phenylephrine (e) terbutaline

45. A 39 years old male has recently started monotherapy for mild hypertension. At his most recent office visit, he complains of tiredness and not

being able to complete three sets of tennis. Which one of the following drugs is most likely to be taking for hypertension? (a) albuterol(b) atenolol (c) ephedrine (d) phentolamine (e) prazosin 46. A 60 years old asthmatic man comes in for a check up and complains that he is having some difficulty in starting to urinate. Physical examination indicates that the man has a blood pressure of 160/100 mm of Hg and a slightly enlarge prostate. Which of the fllowing medications would be usefull in treating both of these conditions: (a) Doxazosin (b) labetalol(c) phentolamine (d) propranolol (e) isoproterenol 47. regarding beta-adrenergic receptors: (a) beta-2 receptors in liver causes increase in glucose metabolism and lypolysis (b) in liver beta-2 receptors cause decrease in glucose metabolism (c) beta-1 receptors in kidney decrease rennin release (d) beta-2 receptors in eye-cilliary muscle cause contraction (e) beta-2 receptors in GIT cause increase in gut motility 48. regarding therapeutic uses of adrenergic agonists: (a) adrenaline is used in acute asthma (b) noradrenaline is contraindicated in shock (c) phenylephrine is absolutely contraindicated in nasal decongestion (d) clonidine is contraindicated in hypertension (e) amphetamine is contraindicated in narcolepsy

49. regarding adrenergic receptor specificity: (a) nadolol has specificity for beta-1 and beta-2 recptors (b) atenolol has affinity for beta-3 receptors (c) carvedilol has affinity for alpha-2, and beta-3 recptors (d) Labetolol has affinity for alpha-2 and beta-3 receptors (e) Propranolol has affinity for alpha-2 recptors 50. Bronchoconstriction is main side effect of : (a) atropine (b) ipratropium (c) salbutamol (d) terbutaline (e) propranolol

21. Write short note on: 1) Indications of beta blockers 2) SEs of non-selective beta blockers 3) Dobutamine 4) Contra-indications of epinephrine 5) Clinical uses of Phenoxybenzamine