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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5337_Библиотеки_им_академика_М_И_Перельмана.pdf
2) Cardiovascular system
Most prominent effect of atropine is to cause tachycardia.
Due to blockage of M2 receptor on SA node through
which vagal tone decreases heart rate.
3) Blood pressure
Cholinergic impulses are not involved in maintenance of
vascular tone, it has no effect on blood pressure.
4) Eye
Causes mydriasis, cycloplegia, results in photophobia
and blurring of vision
5) Smooth muscle
All visceral smooth muscles are relaxed so constipation
may occur spasm main relieved
Ureter and urinary bladder may relax so urinary
retention may occur elderly
6) Glands
Decrease sweat, salivary, trachiobronchial and
lacrimation.
Decrease secretion of gastric content but relatively large
dose needed compared to H2-blocker
2) Antispasmodic
Decrease intestinal, renal colic, abdominal cramps
Effective in biliary colic
Drugs-induced diarrhea
Spastic constipation
To relieve urinary frequency and urgency
3) Bronchial asthma
Chronic obstructive pulmonary disease
They are bronchodialator, less effective than adrenergic
drug
4) As mydriatic and cycloplegic
For testing error of refraction both mydriatic cycloplegia
are needed, so homatropine, tropicamide was needed,
cyclopentolate, atropine or hyoscine may be used
For fundoscopy only mydriatic needed, phenylephrine
is pretended.
Atropine is very valuable in treatment of iritis,
iridocyclitis, keratitis corneal ulcer
5) Cardiac
Atropine useful in counter-acting bradycardia and partial
heart block selected patient
6) For Central action
Ipratropium Bromide:
Used for asthmatic patients
Through inhalation acts on bronchial muscle without
altering volume or consistency of respiratory secretions
It has gradual onset and late peak of bronchodilator effect
so suitable for regular prophylactic use. So rather than
symptomatic relief in an attack
Action lasts for 4 to 6 hours. more effective in COPD then
in bronchial asthma
Local side effects
Dryness of eyes
Dry and hot skin
Scratching in trachea
Dilated pupil
Photophobia
Cough
Uses
1) Antisecretory
As preanesthetic medication
In peptic ulcer
To check excessive sweating and salivation in
parkinsonism
Previously, irritant general anaesthesia (ether) are used
which increase salivation, trachiobronchial secretions so
atropine and hyoscine are used
Atropine is used to prevent laryngospasm by decreasing
respiratory secretions that reflexly predispose to
laryngospasm
Vasovagal attack during anaesthetic also prevented
Peptic ulcer: Atropine decrease gastric secretion
a) Parkinsonism
Less effective than levodopamine
b) Motion sickness
Hyoscine is preferred
Transdermal preparation applied behind pinna 4 hr
before journey for protection
Contraindications
In hot, in narrow iridocorneal angle
Causations used in elderly patient with BPH.
Adverse effects
Dry mouth
Difficult in swelling and talking
Dry and hot skin
Dilated pupil and photophobia
Local anaesthetics
There are the drugs which act upon topical application or
local injection cause reversible loss of sensory perception,
specially of pain in a restricted area of body, they block
conduction of nerve without causing any structural
damage.
Classification
1. Injectable
Short duration— procaine, chloroprocaine
Intermediate duration— lignocaine
Long duration— tetracaine, bupivacaine
2. Surface
Cocaine
Lidocaine
Section 1 Pharmacology
19
Tetracaine
Benzocaine
Oxithazaine
Butamben
Mechanism of action
Local anaesthetic block nerve conduction by decrease
the entry of sodium during action potential. As the
concentration of local anaesthetics is increased, rate of
action potential and maximum depolarization decrease
causing slowing of conduction.
Pharmacological action
1. CNS: All local anaesthetic stimulation followed by
depression cocaine is a powerful CNS stimulant
Euphoria, excitement, mental confusion tremors
convulsion, unconsciousness respiratory depression
and death.
2. CVS: Cardiac depressant, they decrease automaticity,
excitability, contractibility, conductivity and increase
effective refractory period
Side effect
CNS: Light headedness, dizziness, auditory and visual
disturbance, tremor, convulsion, respiration arrest. This
is prevented and treated by diazepam
CVS: Bradycardia, hypotension, vascular collapse,
hypersensitivity reaction rashes, angioedema, dermatitis,
asthma, anaphylaxis
Uses
Surface anaesthesia produced by lignocaine, benzocaine
Infiltration
Conduction block (intravenously in the trunk)
Spinal anaesthesia complications
a) Headache due to seepage of CSF
b) Cause equina syndrome, loss of control over bladder
and bowel, especially septic meningitis
c) Respiratory paralysis
Epidermal thoracic, lumbar, sacral
Type of anaesthesia
1. Surface anaesthesia
z
It is produced by topical application of local anaesthetics
to mucous membrane and skin
z
It is produced by lignocaine, benzocaine and it is
topically applied in mouth for stomatitis (inflammation
of mucous membrane)
2. Infiltration anaesthesia
z
Local anaesthesia is infiltrated subcutaneously in area
of operation
z
Here, endings are anesthetized by their direct exposure
to drug
z
Onset of action is immediate
z
2% procaine and 2% lignocaine commonly used
z
This anaesthesia is used in incision, excision
3. Conduction block
z
Intravenously in a nerve trunk
z
It is of 2 types:
a) Field block: Dental procedure
b) Nerve block: Used for tooth extraction
4. Spinal anaesthesia
z
Local anaesthesia is injected in supraachnoid space
between L2-3 or L3-4.
z
This anaesthesia is used for operation of lower limb,
caesarean section
5. Epidural anaesthesia
z
It is produced when local anaesthesia is injected
outside drug
z
Lignocaine and bupivacaine are commonly used in
epidural anaesthesia
Uses
It is used in surface anaesthesia
It is used n nerve block
It is given subcutaneously in field block
It is used in dental procedures
It is used in epidural anaesthesia
It is used in spinal anaesthesia
It is used as antiarrhythmic agent
Idea on myasthenia gravis
It is an autoimmune disorder due to development of
antibodies directed to nicotinic receptors at the muscle
end plate
reduction in number of NM cholinoceptors and structural
damage to the neuromuscular junction
weakness and easy fatigue ability. Neostigmine and its
congeners improve muscle contraction by increasing
ACh released from prejunction endings to accumulate
and acts on receptor over a larger area, and by directly
depolarizing the end plate.
Treatment: It is started with neostigmine 15 mg orally
6 hourly dose and frequency is then adjusted according
to response. Corticosterod is afforded considerable
improvement in such cases by their immunosuppressant
action, but their long-term use has problems of its own.
Thymectomy produces gradual improvement in
majority of cases. Even complete remission can be achieved.
It is becoming increasingly popular. Overtreatment with
anti-AChEs also produces weakness by causing persistent
depolarization of muscle end plate, this is called cholinergic
crisis or weakness.
Section 1 Pharmacology
20
MULTIPLE CHOICE QUESTIONS
1. The nervous system can be divided into:
A. Brain and the spinal cord
B. CNS and the PNS
C. Neurons and the neuroglial cells
D. Motor neurons, mixed and sensory neurons
2. Nicotinic receptors are
A. Found in all autonomic ganglia
B. Found in sweat glands
C. Increases digestion
D. A and B both
3. Choose one incorrect option regarding the basic
function of nervous system.
A.
Provides responses to sensory stimulation
B. Communicates through signals between
various body parts
C. Generates body fluids like plasma and interstitial
tissue fluid
D. Detects sense stimuli
4. Which of the following is useful in the treatment of
both organophosphate and muscarine intoxication?
A.
Nicotine B. Echothiophate
C. Atropine D. Pilocarpine
5. Cholinergic activity on stomach acid secretion:
A. In increased B. In decreased
C. Does not change D. None of the above
6. An involuntary response by the nervous system
to a stimulus is a:
A.
Synapse B. Reflex
C. Motor response D. Smooth muscle
7. Depolarization and repolarization occur during
the action potential by
A.
Ions movement across the cell membrane
B. Small neuroglial cells that act as batteries
C. Various types of negative stimuli
D. Various enzymes
8. Arrange the correct sequence of following action
potential events
1. Stimulation of neuron at dendrites
2. K+gates open
3. The neuron is in a polarized “resting” state
4. Na+ gates open
5. Full cell depolarization
6. Full cell repolarization
A. 3, 2, 4, 1, 5, 6 B. 4, 6, 2, 1, 5, 3
C. 3, 1, 4, 5, 2, 6 D. 1, 3, 2, 6, 5, 4
9. A receptor present on surface of target cell, causes
the target cell to have a (n)…
A.
Repolarization
B. Growth phase
C. Growth inhibition
D. Action potential
10. Sensations from the integumentary layer are
converted to perceptions in which part of the
cerebrum?
The primary motor area
A.
B. The primary sensory area
C. Wernicke's area
D. Broca’s area
11. Damage to the cerebellum causes:
A. Uncontrollable hunger
B. Coma
C. Loss of speech
D. Loss of balance
12. Peripheral nervous system of human has ____ pairs
of spinal nerves.
21 B. 11
A.
C. 31 D. 12
13. Involuntary muscles and glands are stimulated by
neurons of the ______nervous system:
Somatic B. Sensory
A.
C. Autonomic D. Central
14. Following organs are the targets of the autonomic
nervous system, except:
Cardiac muscle
A.
B. Unicellular glands
C. Skeletal muscle
D. Smooth muscle organs
15. In autonomic nervous system motor signals always
pass through ____ (a number) motor neuron(s)
before reaching a muscle. Motor signals in the
SNS always pass through ____ (a number) motor
neuron(s) before reaching a muscle.
2, 2 B. 2, 1
A.
C. 1, 3 D. 1, 2
16. All the following statements are true, except:
A. Accommodation to near vision is mediated by
increased acetylcholine secreted in the ciliary
muscle of the eye.
B. Noradrenaline is not secreted by the adrenal
medulla.
C. Vagotomy may cause the heart rate to increase
significantly.
D. Catecholamines from the adrenal medulla.
17. In general, parasympathetic activation will
produce effects that are ______________ to those
produced by activation of sympathetic neurons.
Similar B. Antagonistic
A.
C. Complimentary D. Identical
18. Which of the following releases norepinephrine
as a neurotransmitter?
Preganglionic sympathetic neurons
A.
B. Postganglionic sympathetic neurons
C. Preganglionic parasympathetic neurons
D. Postganglionic parasympathetic neurons
Section 1 Pharmacology
21
19 . All statements are incorrect regarding preganglionic
sympathetic neurons of ANS, except:
They are longer than postganglionic sympathetic
A.
neurons.
B. They receive signals from interneurons
C. They release norepinephrine.
D. They synapse with muscles
20. Sensory nerve signals converge in the _____, where
they are sorted and relayed to the proper sensory
areas of the cerebrum for interpretation.
Pons B. Thalamus
A.
C. Medulla D. All
21. The dendrites of a neuron contain _____, which
allow the neuron to bind to and respond to
neurotransmitters.
Myelin B. Receptor proteins
A.
C. Na+ and K+ ions D. None of these
22. Part of brain named _______________ is responsible
for conscious, thought, intellect, memory storage
and processing, controlling the movement of
skeletal muscles, and sensation.
Thalamus B. Cerebellum
A.
C. Medulla oblongata D. Cerebrum
23. Example of an a-adrenergic response is:
Relaxation of the intestinal motility
A.
B. Dilation of the bronchioles in the lung
C. Increasing the force and rate of the heart
contractions
D. Dilating the smooth muscle of blood vessels in
the skin and intestinal area
24. The production of norepinephrine is prevented
by:
Alpha–methyldopa B. Ephedrine
A.
C. Pilocarpine D. Reserprine
25. Part of brain which has the vital centers for
regulating breathing rate, heart rate, and blood
pressure is known as:
Thalamus B. Cerebrum
A.
C. Medulla oblongata D. Cerebellum
26. A postganglionic neuron has myelinated axons:
A. Which releases neurotransmitter at the effector
cell
B. It always present before preganglionic neuron
in ANS motor pathway
C. Has its cell body in the brain or spinal cord
D. Has its axons exiting the CNS through cranial
nerves
27. The PNS contains these types of neurons (two
answers)
Sensory B. Motor neurons
A.
C. Neuroglial neurons D. A and C
28. Which of the following may be produced by
Section 1 Pharmacology
22
parasympathetic stimulation?
Acceleration of the heart
A.
B. Contraction of the urinary bladder wall
C. VD of skeletal muscle blood vessels
D. Relaxation of the GIT wall
29. Parasympathetic nerves:
A. Produce opposite effects as compared to
sympathetic nerves when both supply the same
organ.
B. Produces vasodilatation in skeletal muscle
during prolonged exercise.
C. Release acetylcholine at both level of
preganglionic and postganglionic nerve
endings.
D. All of the above
30. The chromafn cells:
A. Are found in the adrenal cortex
B. Are developed from the part of the same tissue
from which sympathetic nervous system
developed
C. Secrete hormones that decrease heart rate
D. All of the above
31. Blockade of alpha adrenoreceptor is likely to cause:
A. Decrease production of sweat
B. Bronchoconstriction
C. Decrease in the arterial blood pressure due to
arterial vasodilation
D. A reduction in gastrointestinal motility
32. The alpha-adrenergic receptors
A. Are not stimulated by epinephrine.
B. Reduce the gastrointestinal (GI) motility after
their stimulation
C. Propranolol blocks these receptors
D. They accelerate the heart after their stimulation
33. Autonomic nervous system act on the following
systems, except:
A.
Cardiac muscle B. Exocrine glands
C. Skeletal muscle D. Endocrine glands
34. Choose one correct statement about autonomic
parasympathetic neurons.
A.
They activated as a single unit
B. They originate from the brain and sacral regions
C. They involve in the formation of white rami
communicates fibers
D. They may have ganglia located along the spinal
cord
35. Which of the following ganglia is not a collateral
(prevertebral) ganglion?
A.
Celiac B. Superior mesenteric
C. Inferior mesenteric D. Cervical
3 6. Choose one correct statement about parasympathetic
neurons.
A.
It is responsible for excitatory type of action in
the body
B. They synapse in terminal ganglia, either next
to or within the organs innervated
C. They originate from thoracic and lumbar
vertebra
D. Postganglionic fibers are longer as compared to
sympathetic neurons
37. Which neuron releases an adrenaline as a
neurotransmitter?
A.
Preganglionic sympathetic fibers
B. Postganglionic sympathetic fibers
C. Preganglionic parasympathetic fibers
D. Postganglionic parasympathetic fibers
38. Reuptake of catecholamines is blocked by cocaine.
So, what would cocaine should call?
A.
Sympathetic agonist.
B. Sympathetic antagonist.
C. Sympathetic neurotransmitter.
D. Parasympathetic agonist.
39. All of the following reexes are autonomic, except:
A. Salivary secretion
B. Micturition
C. Flexion of the arm
D. Acceleration of the heart rate
40 . Choose one incorrect statement about acetylcholine.
A. It is synthesized and released by some symp.
postganglionic nerve fibres
B. It is an example of neurotransmitter which is
released by all preganglionic neurons
C. Choline esterase enzyme is responsible for the
breakdown
D. It causes relaxation of the ciliary muscle which
makes reading difficult
41. Which of the following cells is found in peripheral
nervous system?
A.
Microglia B. Astrocytes
C. Schwann cells D. Oligodendrocytes
42. Comparing autonomic and somatic nerves:
A. Somatic nerves, like autonomic nerves contain
ganglia
B. Vagus nerve have most of the sensory fibers
C. Denervated smooth muscle show spontaneous
activity
D. Motor nerves are typically unmyelinated in
nature
43. Spinal cord and brain are wrapped in protective
membranes known as ___________.
A.
Nodes of Ranvier B. Meninges
C. Axomembranes D. Mylein sheath
44. Which system is not regulated by a center in the
medulla oblongata?
A.
The cardiovascular system
B. The respiratory system
C. The immune system
D. The digestive system
45. A drug causes after blocking of beta adrenoceptors:
A. Relaxation of sphincters present in the
alimentary tract
B. Bronchodilation
C. In the patient of heart failure decrease force of
myocardial
D. A decreased dilatation by the blood vessels of
skeletal muscles in
46. "True" acetylcholinesterase is found in:
A. Glia B. Liver
C. Erythrocytes D. Plasma
47. Antidote of organophosphorus poisoning is:
A. Physostigmine
B. Pralidoxime
C. Neostigmine
D. Tubocurarine
48. Catalyzes rate-limiting step in catecholamine
biosynthesis:
A.
DOPA decarboxylase
B. Phenyl ethanolamine N-methyl transferase
C. Tyrosine hydroxylase
D. Dopamine-beta-hydroxylase
49. Example of nervous tissue cell other than neurons
that actually assist neurons are known as:
A.
Amyloid plaques B. Fibroblasts
C. Leukocytes D. Neuroglia
50. If sympathetic nervous system is activated will
cause which change in the skeletal muscle versus
cutaneous vascular beds.
A.
Vasoconstriction, vasoconstriction
B. Vasodilatation, vasodilatation
C. Vasodilatation, vasoconstriction
D. Vasoconstriction, vasodilation
51. The white fatty substance that coats axons to
increase signal speed is
A.
Myelin B. Microfibrils
C. Dendrites D. Adipocytes
52. Alkaloid agonist acting at muscarinic, cholinergic
receptors:
A.
DFP B. Pilocarpine
C. Physostigmine D. Ipratropium
53. Which of the following system is innervated by
postganglionic bers arising from the cervical
ganglia?
A.
The digestive system.
B. The urinary system.
C. The eyes
D. The reproductive system
54. White matter consists of _____________
A. Neuron cell bodies
B. Unmyelinated axons and neuron cell bodies
C. Myelinated axons
D. Unmyelinated dendrites
55. Adult spinal cord often terminates inferiorly at
the vertebral level of:
A.
T 12. B. L 1–2.
C. L 2–3. D. S1–S2
56. _________ system is reponsible to control smooth
and heart muscle as well as glandular activity.
A.
Somatic nervous system.
B. Autonomic nervous system.
C. Skeletal division.
D. Sensory nervous system.
Section 1 Pharmacology
23
57. Choline ester substrate for acetylcholinesterase:
A. Carbachol
B. Methacholine (provocholine)
C. Both
D. Neither
58. Location of cell bodies of somatic motor neurons
is ____ the CNS that project axons only to ____;
and are usually under ____ control.
Outside; skeletal muscle; involuntary
A.
B. Inside; the viscera; voluntary
C. Inside; the viscera; involuntary
D. Inside; skeletal muscle; voluntary
59. The ganglia of the _____ division are closer to the
spine than the ganglia of the ______division.
A.
Sympathetic, parasympathetic
B. Parasympathetic, peripheral
C. Sympathetic, peripheral
D. Parasympathetic, sympathetic
60. The sympathetic preganglionic nerve bers:
A. Originated from the cervical segments of the
spinal cord
B. Originate at the autonomic ganglia
C. Are myelinated nerve fibers belonging to the
B group of the nerve fibers
D. Exhibit less branching in the autonomic ganglia
61. The sympathetic supply is not responsible for:
A. Constriction of the pupil.
B. Erection of hair.
C. Vasodilatation of skeletal muscle blood vessels.
D. Spleen contraction.
62. Ptosis is caused due to the damage of:
A. Third cranial nerve
B. Parasympathetic innervation to the eye
C. Sympathetic innervation to the eye
D. Lesion in lumbar 2,3
63. All of the following are the characteristic features
of sympathetic nervous system, except:
A.
It is mostly noradrenergic
B. It is involved more frequently in generalized
actions
C. It antagonizes mostly parasympathetic functions
D. It is anabolic
64. Preganglionic neurons lie within _____________
A. CNS
B. Parasympathetic nervous system
C. Peripheral nervous system
D. Sympathetic nervous system
65. The autonomic ganglia:
Section 1 Pharmacology
24
A. Are 5 types
B. Are the sites of relay of afferent neurons
C. Work as a distributing center
D. Found inside the CNS
66. The functions of parasymp. Innervation to the
salivary glands is:
A.
VD and secretion
B. VD and secretion
C. VD and inhibition of secretion
D. Secretion of scanty viscous saliva
67. Which of the following drugs? do(es) not cross the
blood–brain barrier?
A.
Physostigmine B. Neostigmine
C. Atropine D. All the above
68. The parasympathetic nervous system affects all
these organs, except:
A.
Heart.
B. Pupillary smooth muscles.
C. Salivary glands.
D. Adrenal glands.
69. Double innervation does not apply:
A. The heart. B. The bladder.
C. Splenic capsule. D. The stomach.
70. Which of the following structures is a component
of reex arc?
A.
Afferent neuron. B. Efferent neuron.
C. Effector organ. D. All the above.
71. From the following choose one incorrect statement
about the vagus nerve
A.
It originates from medulla oblongata part of
brain
B. It has no direct effect on ventricular contraction
of heart
C. It causes enhanced the peristaltic movements
of the intestinal wall
D. It produces micturition
72. Sympathetic system performs
A. Regulation of cardiac rhythm.
B. Regulation of gastrointestinal motility.
C. Regulation of normal arterial blood pressure.
D. Regulation of basic sleep cycle
73. The parasympathetic system can be stimulated by:
A. Atropine which produces similar effects as
muscarine.
B. Ephedrine which trigger the synthesis of
acetylcholine.
C. Physostigmine which inhibits the
acetylcholinesterase enzyme.
D. Alpha methyldopa which stimulate the release
of acetylcholine.
74. Curare is a drug of choice before surgical
operations because:
A.
Prevent bronchial secretion.
B. Maintain the arterial blood pressure.
C. Induce bronchodilatation.
D. Relax the skeletal muscles.
75. All preganglionic autonomic neurons secrete:
A. Epinephrine. B. Acetylcholine.
C. Nicotine. D. Dopamine.
76. Part of brain which directly regulate the activity
of the autonomic nervous system, is the:
Medulla oblongata. B. Pituitary gland.
A.
C. Cerebellum. D. Hypothalamus.
77. Regarding autonomic ganglia, all of the following
is true except:
They work as a distributing centers.
A.
B. They are 5 types.
C. Their chemical transmitter is acetylcholine.
D. Their receptors are blocked by atropine.
78. Stimulation of the pelvic nerve produces:
A. Contraction of the bronchial muscle.
B. Stoppage of urination
C. Vasodilation of the blood vessels of the external
genitalia.
D. Blockage of prostatic secretions.
79. Which catecholamine LEAST likely to generate
relaxation in bronchiolar smooth muscle?
Epinephrine B. Terbutaline
A.
C. Phenylephrine D. Phentolamine
80. Acetylcholine does not secreted at following site
A. Postganglionic sympathetic nerve terminals at
skeletal muscles.
B. Paraganglionic sympathetic and
parasympathetic nerve terminals.
C. Myoneural junctions.
D. Postganglionic sympathetic noradrenergic
nerve terminals.
81. The parasympathetic system
A. Play important role in emergency situations like
fight and flight reactions
B. Play important functions in skin and skeletal
muscles.
C. Perform catabolic actions.
D. Mostly exert effects opposite to those done by
the sympathetic nervous system
82. ……………….. contains large numbers of neuronal
cell bodies and located within the peripheral
neurons system
Ganglion. B. Nerve.
A.
C. Nucleus. D. Tract.
83. An enhanced secretion of epinephrine causes:
A. Increased myocardial contraction and
vasodilation
B. Decreased myocardial contraction and
vasodilation
C. Decreased myocardial contraction and
vasodilation
D. Increased myocardial contraction and
decreased heart rate.
84. If an injury occurs to the rst 4 sacral segments of
the spinal cord then it produces:
Hyperglycemia.
A.
B. Vasodilation of blood vessels.
C. Decreased of sweat secretion.
D. Lack of erection of the penis in case of males
and clitoris in case of females.
85. Stimulation of the alpha-adrenergic receptors
produces:
A.
Increase gastrointestinal motility.
B. Bronchodilatation.
C. Relaxation of the sphincters found in alimentary
canal.
D. Spleen capsule contraction
86. Noradrenaline (norepinephrine):
A. Is liberated by the sympathetic Praganglionic
fibers that supply theadrenal medulla.
B. Is released by the sympathetic Postganglionic
Neurons that supply theadrenal medulla.
C. Acts only on the alpha-adrenergic receptors.
D. Is secreted with adrenaline from the adrenal
medulla at an equal rate.
E. Is blocked by the choline esterase enzyme.
87. The alpha-adrenergic receptors mediate all the
following effects except:
A.
Vasoconstriction.
B. Pupil dilatation.
C. Spleen contraction.
D. Increased cardiac activity.
88. A drug that blocks the beta-adrenergic receptors
in likely to cause:
A.
Relaxation of the sphincters of the GIT.
B. Increased glycogenolysis and lipolysis in
response to epinephrine.
C. Bronchoconstriction.
D. Excessive VD in skeletal muscles in response to
epinephrine.
89. All the following statements are true except:
A. The nicotine receptors of acetylcholine can be
blocked by large dosesof nicotine.
B. The release of noradrenaline from the
sympathetic endings isprevented by
guanethidine.
C. The muscarinic receptors of acetylcholine are
blocks atropine.
D. The beta-adrenergic receptors are blocked by
guanethidine.
90. Following effects produces after an administration
of an injection of atropine except:
A.
Increase heart rate.
B. Difficult micturition.
C. Constriction in the bronchi.
D. Diminished intestinal motility.
91. Injection of atropine is liable to cause:
A. Constipation.
B. Diarrhoea.
C. Bronchial constriction.
D. Bradycardia.
Section 1 Pharmacology
25
92. All enlisted functions are related with the
autonomic nervous system except:
A.
Contraction of smooth muscle contraction
B. Sweat secretion
C. Initiation of heart beats
D. Suppression of GIT motility
93. Sympathetic postganglionic neurons supplying
intra-abdominalviscera originate from:
A.
The lower 6 thoracic ganglia of the sympathetic
chain
B. The lower 6 thoracic segments of the spinal cord
C. The prevertebral ganglia
D. Terminal ganglia in the walls of the viscera
94. All of the following about adrenal medulla is true
except:
A.
It is sympathetic ganglion
B. Secretes more noradrenaline than adrenaline
C. It releases epinephrine into circulating blood
D. it's innervated by sympathetic cholinergic fibres
95. Parasympathetic preganglionic neurons:
A. Are much shorter than the postganglionic
neurons
B. Are more in number as compared to
postganglionic neurons
C. Secrete the same transmitter as the postganglionic
neurons
D. None of the above
96. Parasympathetic innervation is antagonistic to
sympatheticinnervation on:
A.
Constrictor pupillae muscle
B. Cutaneous blood vessels
C. Salivary glands secretion
D. The act of micturition
97. Sympathetic and parasympathetic systems have
cooperativeeffects on:
A.
Heart rate
B. Motility of GIT
C. Sexual activity
D. Ciliary muscle contraction
98. Sympathetic tone:
A. In initiated by exposure to stress
B. Determines heart rate at rest
C. Controls the level of arterial blood pressure
D. Is increased by use of a ganglion blocking drugs
99. These send postganglionic axons to the parotid
salivary gland.
A.
Ciliary ganglia
B. Pterygopalatine ganglia
C. Submandibular ganglia
D. Otic ganglia
100. Acetylcholine:
Section 1 Pharmacology
26
A. Binds with nicotinic receptors in cells of
autonomic effector tissues
B. Stimulates nicotinic receptors, but inhibits
muscarinic receptors
C. Synthesis is catalysed by choline esterase
enzyme
D. Is released in response to Ca++ influx into
synaptic knobs
101. Chromafn cells adrenal medulla:
A. Have both alpha- and beta-adrenergic receptors
B. Have cholinergic receptor
C. Release more norepinephrine than epinephrine
D. Are activated by adrenergic receptor agonist
102. When adrenergic receptors become activated:
A. Alpha1 receptors are stimulatory to heart rate
B. Beta1 receptors are stimulatory to heart rate
C. Beta2 receptors cause coronary vasoconstriction
D. Beta1 causes lipolysis
1 03. Activation of muscarinic receptors by acetylcholine:
A. Increase Na
+
B. Always inhibits the effector cells
C. Always stimulates the effector cells
D. Could either stimulate or inhibit the effector cell
104. Sympatholytic drugs:
A. Inhibit adrenergic receptors but not beta
receptors
B. Inhibit norepinephrine reuptake by nerve
terminals
C. Inhibit enzymatic degradation of norepinephrine
D. Block adrenergic receptors
105. Inhibitors of choline esterase enzymes:
A. Enhance the effects of parasympathetic
stimulation
B. Inhibit the effect of parasympathetic stimulation
C. Inhibit acetylcholine release by cholinergic
nerve terminals
D. Block the action of acetylcholine in autonomic
ganglia
106. Parasympathetic postganglionic cholinergic bres
innervate all the following except:
Salivary glands
A.
B. Lacrimal glands
C. Sweat glands
D. Exocrine cells of pancreas
107. Which of the following visceral tissues receives
sympathetic postganglionic neurons only?
Adrenal medulla
A.
B. Sweat glands
C. Anal sphincters
D. The iris
108. Denervation super sensitivity:
A. Occurs after cutting sympathetic nerves, but
not after cutting parasympathetic nerves
B. Occurs after cutting the preganglionic or
postganglionic nerve fibres
C. Is due to increased number of neurotransmitter
receptors in effectors cells
D. Is due to increased reuptake of the
neurotransmitter by the damaged nerve
terminals
109. Parasympathetic neurons are inhibitory to smooth
muscles in:
A.
The ciliary muscle
B. Dilator pupillae muscle
C. The bronchial tree
D. Mucosal blood vessels
110. Dual innervation of viscera means:
A. Visceral organs receive both preganglionic and
postganglionic autonomic nerve fibres
B. Visceral organ receives both autonomic and
somatic nerve fibres
C. The sympathetic and parasympathetic nerves
to viscera produce the same effect
D. Several visceral organs are innervated from both
divisions of the autonomic nervous system
111. Which of the following drug is an example of
nonselective alpha adrenergic receptor antagonist:
A.
Prazosin
B. Yohimbine
C. Phentolamine
D. Terazosin
112. Block of beta 2 adrenergic receptors causes:
A. Decreased heart rate
B. Bronchodilatation
C. Increased insulin secretion from the pancreas
D. Inhibition of renin secretion from the kidney
113. Vagal tone on the heart:
A. Increases the heart rate
B. Weakens contraction of the atrial muscle
C. Is blocked by use of a muscarinic receptor
agonist
D. Decreases during rest
114. Dendrites:
A. Present in neurolgial cells
B. May contribute to the formation of synapses
C. Contain synaptic vesicles
115. All are the examples of effector organs of the ANS,
except:
A.
Medulla oblongata
B. Arteriolar smooth muscle
C. Heart
D. Visceral smooth muscles
116. Cholinergic M2- and M3-receptors produce
following effects:
[P] Decreased heart rate
[Q] Dilatation effect on salivary gland
[R] Increased heart rate
[S] Effect on erectile tissue
A. P and Q B. Q and R
C. Q and S D. P and S
117. The main side effect of tubocurarine is:
[P] Bradycardia [Q] Bronchoconstriction
[R] Hypotension [S] Cardiac arrhythmia
A. R and S B. P and R
C. Q and S D. Q and R
118. Most of the parasympathetic outow is provided by:
A. The pelvic nerves
B. The vagus nerve
C. The collateral ganglia
D. The glossopharyngeal nerve
119. Following statements are true:
[P] Substance P is located at sympathetic ganglia
[Q] Neuropeptide Y is located at postganglionic
sympathetic neurons
[R] Nitric oxide located at enteric neurons
[S] Gonadotrophin-releasing hormone is not
located atsympathetic ganglia
A.
P and Q B. P and R
C. Q and R D. R and S
120. Activation of alpha-adrenergic receptors would:
A. Increase rennin secretion from the kidney
B. Constrict pulmonary arterioles
C. Constrict bronchioles
D. Dilate cerebral arterioles
121. Neurotransmitters released by the parasympathetic
preganglionic and postganglionic nerve bers are:
A.
Acetylcholine and norepinephrine
B. Acetylcholine and epinephrine
C. Norepinephrine and acetylcholine
D. Acetylcholine and acetylcholine
122. Administration of a muscarinic receptor antagonist
leads to:
A.
Enhanced sweat secretion
B. Decreased sweat secretion
C. Enhanced gastric motility
D. Produces constriction of bronchioles
123. A sympathomimetic drug:
A. Could act through enhancing norepinephrine
release
B. Could act through blocking transmission in
autonomic ganglia
C. is useful for lowering blood pressure in
hypertensive patients
D. Acts by blocking alpha1 adrenergic receptors
124. In the parasympathetic system:
A. Axons of the postganglionic neurons are shorter
than those of preganglionic neurons
B. Number of preganglionic neurons are more as
compared to the postganglionic neurons
C. Choline acetylase is the transmitter between the
preganglionic and postganglionic neurons
D. Axons of preganglionic neurons from the spinal
sacral segments passthrough the ventral roots
of the spinal sacral nerves
125. Following are the agonist of muscarinic receptor M2:
[P] Dicycloverine [Q] Ipratropium
[R] Carbachol [S] Talsaclidine
A. Q and S B. Q and R
C. P and Q D. R and S
Section 1 Pharmacology
27
126. M2 receptor is responsible for following effects:
[P] Cardiac inhibition [Q] Neural inhibition
[R] Gastric secretion [S] Vasodilatation
A. P and Q B. P and R
C. Q and S D. Q and R
127. A drug which inhibits norepinephrine synthesis
is expected to:
A.
Produces bronchodilatation
B. Inhibit gasrointestinal motility
C. Inhibit insulin secretion by pancreas
D. Decrease the heart rate
128. In urinary incontinence following drug is widely
used:
A.
Pirenzepine B. Cyclopentolate
C. Darifenacin D. Hyoscine
129. Drug of choice in motion sickness is
A. Atropine B. Scopolamine
C. Carbamazepine D. Metoclopramide
130. Parasympathetic drugs:
A. Inhibit muscarinic receptors
B. Inhibit nicotinic receptors
C. Stimulate muscarinic receptors only
D. Stimulate muscarinic or nicotinic receptors
131. In the treatment of myasthenia gravis, the best
agent for distinguishing between myasthenic
crisis and cholinergic crisis, given intravenously,
is:
A.
Pyridostigmine B. Edrophonium
C. Physostigmine D. Neostigmine
132. Which of the following drug may cause cycloplegia
when used topically in the eye?
A.
Bethanechol B. Physostigmine
C. Atropine D. Pilocarpine
133. Following are the antagonist of muscarinic
receptor:
[P] Oxotremorine [Q] Oxybutynin
[R] Tolterodine [S] Carbachol
A. Q and S B. Q and R
C. P and Q D. R and S
134. An abnormally high level of acetylcholine in
tissues all over them body is due to:
A.
Exposure to stress
B. Widespread physiological activation of the
parasympathetic nervous system
C. Increased activity of muscarinic receptors
D. Decreased activity of cholinesterase enzyme
135. Epinephrine is added to local anaesthetics
A. To cause haemeostasis
B. To prolong the action of local anaesthetics
C. To stimulate wound healing
D. All of the above
136. Neostigmine may cause all the followings except:
Section 1 Pharmacology
28
A. Block accommodation reflex
B. Reversible inhibition of acetyl cholinesterase
C. Constipation
D. Bronchoconstriction
137. Pilocarpineis classied as
A. Cholinesterase inhibitor
B. Sympathomimetic
C. Cholinomimetic
D. Cholinolytics
138. Epinephrine from release adrenal medulla is
increased during muscular exercise:
A.
Stimulates glycogenolysis in the liver
B. Stimulates glycogenesis in the liver
C. Causes vasoconstriction of arterioles all over
the body
D. Constricts the ciliary muscle in the eye
139. Atropine over dosage may causes all of the
following except
A.
Miosis
B. Increased heart rate
C. Relaxation of GIT smooth muscle
D. Mental aberration
140. The characters of adrenaline include:
A. It is the chemical transmitter at the adrenergic
postganglionic sympathetic nerve endings.
B. It has a greater vasoconstrictor effect than
noradrenaline.
C. It is hydrolyzed by the phosphodiesterase
enzyme.
D. It has a greater effect upon cardiac muscle than
noradrenaline.
141. Propranolol is contraindicated in patients with
A. Angina pectoris
B. Supraventricular arrhythmias
C. Glaucoma
D. Hypertension
142. In belladonna poisoning convulsions can be
controlled by
A.
Paraldehyde B. Phenytoin
C. Diazepam D. Carbamazepine
143. All of the following statements related to
neostigmine are correct except:
A.
Neostigmine is a quaternary ammonium
compound
B. Neostigmine is medium duration of action
C. Neostigmine has direct effect on neuromuscular
junctions
D. All of the above
144. Muscarinic receptor M4 are mainly located at:
A. Exocrine gland B. Cerebral cortex
C. Heart D. CNS
145. Atropine are is used prior the administration of a
general A anaesthetics agent due to because it:
A.
Inhibits salivation and secretions of respiratory
tract
B. Inhibits GIT motility
C. Prevents miosis
D. Causes skeletal muscle relaxation