Applied Pharmacology for the Dental Hygienist 7th Edition by Elena Bablenis Haveles – Test Bank

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Applied Pharmacology for the Dental Hygienist 7th Edition by Elena Bablenis Haveles – Test Bank

Chapter 02: Drug Action and Handling

Haveles: Applied Pharmacology for the Dental Hygienist, 7th Edition

 

MULTIPLE CHOICE

 

  1. A drug is defined as a biologically active substance that can modify:
a. the environment.
b. the pH of tissue.
c. cellular function.
d. immune response.

 

 

ANS:  C

Correct: A drug can modify cellular function. A general understanding of drug action allows the dental hygienist to make informed decisions regarding possible drug interactions or adverse reactions for the patient.

Incorrect choices: It is a concern that discarded drugs may be affecting the environment, but this is not the definition of a drug. Some drugs may have the capacity to modify body compartment pH; however, this is not the definition for a drug. Some drugs may have the capacity to modify the immune response, but this is not the definition of a drug.

 

REF:   Introduction | p. 11                         OBJ:   2

 

  1. In comparing two drugs, the dose-response curve for the drug that is more efficacious would:
a. be closer to the y axis.
b. be farther from the y axis.
c. have a greater curve height.
d. have a higher median effective dose (ED50).

 

 

ANS:  C

Correct: Efficacy is an expression of maximum intensity of effect or response that can be produced by a drug.

Incorrect choices: The other choices refer to indicators of drug potency, not efficacy. The potency of a drug is a function of the amount of drug required to produce an effect. The potency of drug is shown by the location of that drug’s curve along the log-dose axis (x axis).

 

REF:   Characterization of Drug Action (Efficacy) | p. 12          OBJ:   1

 

  1. Administering a drug of greater potency is better because drugs of greater potency do not require as high a dose.
a. Both parts of the statement are true.
b. Both parts of the statement are false.
c. The first part of the statement is true; the second part is false.
d. The first part of the statement is false; the second part is true.

 

 

ANS:  D

Correct: The first part of the statement is false, the second part is true. The absolute potency of a drug is immaterial as long as the appropriate dose is administered. If equally efficacious, both drugs will produce the same effect.

Incorrect choices: Both meperidine and morphine, for example, have the ability to treat severe pain, but approximately 100 mg of meperidine would be required to produce the same action as 10 mg of morphine. The dose of meperidine needed to produce pain relief is larger than that for morphine. Less potent drugs require higher doses to produce therapeutic effects whereas more potent drugs can reach toxic levels at lower doses.

 

REF:   Characterization of Drug Action (Potency) | pp. 11-12   OBJ:   1

 

  1. Which of the following statements is true regarding the therapeutic index (TI) of a drug?
a. A drug with a large TI is more dangerous than a drug with a small TI.
b. The formula for TI is ED50/LD50.
c. ED50 is 50% of the effective clinical dose.
d. TI is the ratio of the median lethal dose to the median effective dose.

 

 

ANS:  D

Correct: LD50 is the dose causing death in 50% of test animals and ED50 is the dose required to produce the desired clinical effect in 50% of test animals.

Incorrect choices: The greater the TI, the safer the drug. The formula is TI = LD50/ED50. The ED50 is the dose required to produce the desired clinical effect in 50% of test animals, not 50% of the effective clinical dose.

 

REF:   Characterization of Drug Action (Therapeutic Index) | p. 13

OBJ:   1

 

  1. Which of the following statements is true concerning the mechanism of action of drugs?
a. Drugs are capable of imparting a new function to the organism.
b. Drugs either produce the same action as an exogenous agent or block the action of an exogenous agent.
c. Drugs either produce the same action as an exogenous agent or block the action of an endogenous agent.
d. Drugs either produce the same action as an endogenous agent or block the action of an endogenous agent.

 

 

ANS:  D

Correct: Drugs either produce the same action as an endogenous agent or block the action of an endogenous agent.

Incorrect choices: Drugs do not impart a new function to the organism; they merely either produce the same action as an endogenous agent or block the action of an endogenous agent.

 

REF:   Mechanism of Action of Drugs | p. 13                            OBJ:   2

 

  1. When different drugs compete for the same receptor sites, the drug with the stronger affinity for the receptor will bind to:
a. more receptors than the drug with the weaker affinity.
b. fewer receptors than the drug with the weaker affinity.
c. all of the available receptors.
d. none of the available receptors.

 

 

ANS:  A

Correct: When different drugs compete for the same receptor sites, the drug with the stronger affinity for the receptor will bind to more receptors than the drug with the weaker affinity.

Incorrect choices: More of the drug with weaker affinity will be required to produce a pharmacologic response. Drugs with a stronger affinity for receptor sites are more potent than drugs with weaker affinities for the same site.

 

REF:   Mechanism of Action of Drugs (Receptors) | p. 13         OBJ:   2

 

  1. When a drug has affinity for a receptor and produces no effect, it is called a(n):
a. agonist.
b. competitive antagonist.
c. competitive agonist.
d. physiologic agonist.

 

 

ANS:  B

Correct: A competitive antagonist has affinity for a receptor, combines with the receptor, competes with the agonist for the receptor, and produces no effect.

Incorrect choices: An agonist has affinity for a receptor, combines with the receptor, and produces an effect. Competitive agonist is nonsensical terminology. A physiologic antagonist has affinity for a site different from that of the agonist in question.

 

REF:   Mechanism of Action of Drugs (Agonists and Antagonists) | p. 13

OBJ:   2

 

  1. A noncompetitive antagonist:
a. binds to the same receptor site as the binding site for the agonist.
b. causes a shift to the right in the dose-response curve.
c. enhances the maximal response of the agonist.
d. reduces the maximal response of the agonist.

 

 

ANS:  D

Correct: A noncompetitive antagonist reduces the maximal response of the agonist.

Incorrect choices: Noncompetitive antagonists bind to a receptor site that is different from the binding site for the agonist. A competitive antagonist will cause a shift to the right in the dose-response curve.

 

REF:   Mechanism of Action of Drugs (Agonists and Antagonists) | p. 14

OBJ:   2

 

  1. Which of the following is not a subject of pharmacokinetics?
a. Physiologic action of drugs
b. Metabolism of drugs
c. Elimination of drugs
d. Absorption of drugs

 

 

ANS:  A

Correct: The physiologic action of drugs is a subject of pharmacology, not pharmacokinetics.

Incorrect choices: Pharmacokinetics does have to do with the subjects of absorption, distribution, metabolism, and excretion of drugs.

 

REF:   Pharmacokinetics | p. 14                 OBJ:   3

 

  1. Which of the following statements is (are) true concerning passage across body membranes?
a. The membrane lipids make the membrane relatively permeable to ions and polar molecules.
b. The lipid molecules orient themselves so that they form a fluid bimolecular leaflet structure with the hydrophobic ends of the molecules shielded from the surrounding aqueous environment.
c. Membrane carbohydrates make up the structural components of the membrane and help move the molecules across the membrane during the transport process.
d. Both a and b are true.
e. Both b and c are true.

 

 

ANS:  B

Correct: The lipid molecules orient themselves so that they form a fluid bimolecular leaflet structure with the hydrophobic ends of the molecules shielded from the surrounding aqueous environment. The hydrophilic ends are in contact with water.

Incorrect choices: The membrane lipids make the membrane relatively impermeable to ions and polar molecules. Membrane proteins make up the structural components of the membrane and help move the molecules across the membrane during the transport process.

 

REF:   Pharmacokinetics (Passage Across Body Membranes) | p. 14

OBJ:   3

 

  1. Which of the following choices is the process by which a substance is transported against a concentration gradient?
a. Passive transfer
b. Active transport
c. Facilitated diffusion
d. Filtration

 

 

ANS:  B

Correct: Active transport is a mechanism for movement of substances, often against a concentration gradient, that uses the energy of the cell to actively pump the substance from one side of a membrane to the other.

Incorrect choices: Passive transfer and filtration entail the passage of substances in a manner proportional to their concentration on each side of the membrane. The substances move without any assistance. Facilitated transport uses a carrier protein but cannot transport substances against a gradient.

 

REF:   Pharmacokinetics (Specialized Transport) | p. 14            OBJ:   3

 

  1. Drugs that are weak electrolytes will cross body membranes best when they are (1) nonionized, (2) ionized, (3) polar, (4) nonpolar, (5) lipid soluble, (6) water soluble.
a. 1, 3, 5
b. 1, 3, 6
c. 1, 4, 5
d. 1, 4, 6
e. 2, 4, 5

 

 

ANS:  C

Correct: Drugs that are weak electrolytes will cross body membranes best when they are nonionized, nonpolar, and lipid soluble. These drugs dissociate in solution and equilibrate into a nonionized form and an ionized form. The nonionized, or uncharged, portion acts as a nonpolar, lipid-soluble compound that readily crosses body membranes.

Incorrect choices: The ionized portion of drugs that are weak electrolytes will traverse membranes with greater difficulty because they are less lipid soluble.

 

REF:   Pharmacokinetics (Effect of Ionization) | p. 15               OBJ:   3

 

  1. Increasing the pH of a solution will cause:
a. a greater percentage of a weak base in the solution to be in the ionized form.
b. a greater percentage of a weak acid in the solution to be in the un-ionized form.
c. the hydrogen ion concentration to increase.
d. a greater percentage of a weak base in the solution to be in the un-ionized form.
e. no change in the relative ionization of weak acids or weak bases.

 

 

ANS:  D

Correct: Weak bases become ionized at low pH and unionized at higher pH.

Incorrect choices: If the pH of the site rises, the hydrogen ion concentration will fall. For weak bases, this results in the unionized form (B), which can more easily penetrate tissues. Conversely, if the pH of the site falls, the hydrogen ion concentration will rise. This results in an increase in the ionized form (BH+), which cannot easily penetrate tissues.

 

REF:   Pharmacokinetics (Effect of Ionization) | p. 15               OBJ:   3

 

  1. When the acidity of the tissue increases, as in instances of infection, the effect of a local anesthetic decreases; therefore, the local anesthetic is a weak acid.
a. Both parts of the statement are true.
b. Both parts of the statement are false.
c. The first part of the statement is true; the second part is false.
d. The first part of the statement is false; the second part is true.

 

 

ANS:  C

Correct: The first part of the statement is true, the second part is false. Infections lead to an accumulation of acidic waste products, which lowers the pH of the local area. Local anesthetics must penetrate the nerve cell membrane to cause their action. They become more ionized as the pH drops. This property is a characteristic of weak bases, not weak acids.

Incorrect choices: Local anesthetics are weak bases. Weak bases are better absorbed when the pH is greater than the pKa. A weak base is associated and ionized when the pH is less than the pKa.

 

REF:   Pharmacokinetics (Effect of Ionization) | p. 15               OBJ:   3

 

  1. Which of the following is true regarding basic principles of drug distribution in the bloodstream?
a. All drugs in the blood are either bound to plasma proteins or free.
b. Only the drug that is bound to plasma proteins can exert the pharmacologic effect.
c. Only the drug that is bound to plasma proteins can pass across cell membranes.
d. The free drug is a reservoir for the drug.

 

 

ANS:  A

Correct: All drugs in the blood are either bound to plasma proteins or free.

Incorrect choices: Only the drug that is free can exert the pharmacologic effect. Only the free drug can pass across cell membranes. The bound drug is a reservoir for the drug.

 

REF:   Pharmacokinetics (Basic Principles) | p. 15                                OBJ:    3

 

  1. The movement of a drug from one site in the body to other sites is called:
a. distribution.
b. disruption.
c. dispersion.
d. active transport.

 

 

ANS:  A

Correct: Distribution is the movement of a drug from the site of absorption or injection to other sites.

Incorrect choices: Disruption is the initial destruction of a tablet coating or capsule during oral absorption. Dispersion is the spread of concentrated drug particles throughout the stomach or intestines. Active transport is a process involved in the passage of certain agents, including some drugs, across membrane barriers and may be involved in not only drug redistribution but also drug absorption, distribution, or excretion.

 

REF:   Pharmacokinetics (Basic Principles) | p. 15                                OBJ:    3

 

  1. The distribution of a drug is determined by:
a. blood flow to the organ.
b. presence of certain barriers.
c. plasma protein–binding capacity.
d. solubility of the drug.
e. all of the above.

 

 

ANS:  E

Correct: All of the above choices are correct. If the blood circulation to an organ is low, it will receive less drug. The more membranes and barriers a drug needs to cross, the slower the rate at which it will reach the organ in question. The binding of drugs to plasma proteins reduces the concentration of drug that can leave the circulation and be taken up by an organ. The relative level of fat or water solubility of a drug will influence where and how rapidly a drug will distribute.

Incorrect choices: The distribution of a drug is determined by several factors, such as the size of the organ, the blood flow to the organ, the solubility of the drug, the plasma protein–binding capacity, and the presence of certain barriers (e.g., blood-brain barrier, placenta).

 

REF:   Pharmacokinetics (Basic Principles) | pp. 15-16              OBJ:   3

 

  1. If one dose of a drug is administered and the drug’s half-life in the body is 3 hours, what percentage of the drug would be left after four half-lives?
a. 50%
b. 6.25%
c. 2%
d. Insufficient information to determine

 

 

ANS:  B

Correct: The half-life is the time required for a drug level to fall to one half of its concentration. The drug concentration would go to 50%  25%  12.5%  6.25% in four half-lives.

Incorrect choices: The information given is more than sufficient to answer the question. One needs merely to count the number of half-lives and divide the percentage drug in half for every half-life passed since the drug was administered.

 

REF:   Clinical Pharmacokinetics (Half-Life) | p. 18                  OBJ:   3

 

  1. One dose of a drug is administered that has a half-life of 8 hours. Assuming first-order kinetics, how much time is needed for this drug to be over 96% eliminated from the body?
a. 8 hours
b. 40 hours
c. 60 hours
d. 120 hours

 

 

ANS:  B

Correct: Assuming first-order kinetics, 40 hours would be required for this drug to be over 96% eliminated from the body.

Incorrect choices: Five half-lives are needed to reduce the levels of a drug to 3.125% of the original levels, or eliminate over 96%. For a drug with an 8-hour half-life, this amounts to five half-lives ´ 8 hours per half-life, or 40 hours.

 

REF:   Clinical Pharmacokinetics (Kinetics) | p. 19                               OBJ:    3

 

  1. The half-life of a drug is most related to its:
a. onset.
b. duration.
c. safety.
d. time to peak concentration.

 

 

ANS:  B

Correct: Half-life is the amount of time required for a drug to fall to one half of its blood level. It is an expression of how long the drug lasts in the body.

Incorrect choices: Onset is the time at which a drug starts to take effect. The half-life does not predict the relative safety of a drug; safe drugs can have long or short half-lives. Time to peak concentration refers to how much time is required for a drug to reach effective levels in the body, not how long a drug lasts in the body.

 

REF:   Clinical Pharmacokinetics (Half-Life) | p. 18                  OBJ:   3

 

  1. Enterohepatic circulation of a drug involves the secretion of a metabolized drug into the intestine. If enterohepatic circulation is blocked, the level of the drug in the serum will fall.
a. Both statements are true.
b. Both statements are false.
c. The first statement is true, the second statement is false.
d. The first statement is false, the second statement is true.

 

 

ANS:  A

Correct: Both statements are true. Enterohepatic circulation involves the secretion of a metabolite, such as a conjugated drug, via the bile into the intestine. While in the intestine, the metabolite is broken down (deconjugated), and the active drug can be reabsorbed into the circulation. If this process is blocked, then the reactivated drug cannot reenter the circulation, and the serum level will fall accordingly.

Incorrect choices: Both of the statements are true as written. The circular pattern continues with some drug escaping with each passing. This process prolongs the effect of a drug.

 

REF:   Pharmacokinetics (Enterohepatic Circulation) | p. 16      OBJ:   3

 

  1. If redistribution occurs between specific sites and nonspecific sites, a drug’s action will be:
a. prolonged.
b. extended.
c. decreased.
d. terminated.

 

 

ANS:  D

Correct: If redistribution occurs between specific sites and nonspecific sites, a drug’s action will be terminated.

Incorrect choices: Redistribution of a drug is the movement of a drug from the site of action to nonspecific sites of action. A drug’s duration of action can be affected by redistribution of the drug from one organ to another.

 

REF:   Pharmacokinetics (Redistribution) | p. 16                        OBJ:   3

 

  1. The _____ is the most common site for biotransformation.
a. kidney
b. blood plasma
c. liver
d. small intestine

 

 

ANS:  C

Correct: The liver is the most common site for biotransformation. Biotransformation is the body’s way of changing a drug so that the kidneys can more easily excrete it.

Incorrect choices: The liver rather than kidney, blood plasma, or small intestine is the most common site for biotransformation.

 

REF:   Pharmacokinetics (Metabolism [Biotransformation]) | p. 16

OBJ:   3

 

  1. The metabolite formed during metabolism (biotransformation) is usually _____ polar and _____ lipid soluble than its parent compound.
a. more; more
b. more; less
c. less; more
d. less; less

 

 

ANS:  B

Correct: The metabolite is usually more polar and less lipid soluble than its parent compound, meaning that renal tubular reabsorption of the metabolite will be reduced because reabsorption favors lipid-soluble compounds. Metabolites are also less likely to bind to plasma or tissue proteins and less likely to be stored in fat tissue.

Incorrect choices: Drugs must pass through various membranes such as cellular membranes, blood capillary membranes, and intracellular membranes. The lipid in the membranes makes them relatively impermeable to ions and polar molecules. Decreased renal tubular absorption, decreased binding to the plasma or tissue proteins, and decreased fat storage cause the metabolite to be excreted more easily.

 

REF:   Pharmacokinetics (Metabolism [Biotransformation]) | p. 16

OBJ:   3

 

  1. All of the following choices are true with regard to cytochrome P-450 hepatic microsomal enzymes except that they:
a. can be induced to speed up drug metabolism.
b. can be inhibited to slow down drug metabolism.
c. exist as numerous isoenzymes.
d. inactivate drugs through conjugation reactions.

 

 

ANS:  D

Correct: Cytochrome P-450 hepatic microsomal enzymes inactivate drugs but not through conjugation. They are involved in phase I metabolism and metabolize drugs through oxidation, reduction, and hydrolysis reactions. Phase II reactions involve conjugation with glucuronic acid, sulfuric acid, acetic acid, or an amino acid.

Incorrect choices: Cytochrome P-450 hepatic microsomal enzymes can be induced to speed up drug metabolism or inhibited to reduce or slow down drug metabolism. They exist as numerous isozymes that have specificity for certain drugs. Examples of isoenzymes include cytochrome P-450 and 3A4.

 

REF:   Pharmacokinetics (First-Pass Effect) | p. 17 | Pharmacokinetics (Cytochrome P-450 Induction and Inhibition) | p. 17                                       OBJ:              3

 

  1. Which of the following reactions is considered to be in the category of phase II drug metabolism?
a. Conjugation
b. Reduction
c. Hydrolysis
d. Oxidation

 

 

ANS:  A

Correct: Phase II reactions involve conjugation with glucuronic acid, sulfuric acid, acetic acid, or an amino acid. The most common conjugation occurs with glucuronic acid.

Incorrect choices: Reduction, hydrolysis, and oxidation are all examples of phase I drug metabolism.

 

REF:   Pharmacokinetics (First-Pass Effect) | p. 17                               OBJ:    3

 

  1. If a drug displays zero-order elimination kinetics:
a. elimination increases as the dose of the drug is increased.
b. a constant amount is eliminated per unit time.
c. the drug is not eliminated and is retained in the body.
d. the elimination of the drug cannot be predicted mathematically.

 

 

ANS:  B

Correct: With zero-order kinetics, the metabolism or excretion mechanisms for a drug in the body are saturated, meaning that they are at their maximal level. If more drug is given, then the body cannot keep up, and the drug levels will increase.

Incorrect choices: The body cannot adjust to more drug, and elimination of a drug will remain the same as the dose of the drug is increased. If the drug is eliminated but a longer time is required, then it would for a first-order elimination. The elimination of the drug can be mathematically predicted.

 

REF:   Clinical Pharmacokinetics (Kinetics) | p. 19                               OBJ:    3

 

  1. Which of the following processes in the kidney can result in retention of a drug in the body?
a. Glomerular filtration
b. Active tubular secretion
c. Passive tubular diffusion
d. All of the above

 

 

ANS:  C

Correct: Passive tubular diffusion is a process whereby solutes such as drugs, which are concentrated in the renal tubular fluid, can diffuse out of the tubule and back into the circulation. The drugs must be un-ionized and lipid soluble to passively diffuse back to the circulation.

Incorrect choices: Glomerular filtration and active tubular secretion are ways in which drugs and their metabolites enter the renal tubular fluid on their way to the collecting duct and the urine.

 

REF:   Pharmacokinetics (Excretion) | p. 18                                         OBJ:    3

 

  1. Which of the following is (are) true when tubular urine is more acid?
a. Weak acids are excreted more rapidly.
b. Weak bases are excreted more rapidly.
c. Weak acids are excreted more slowly.
d. Both a and b are true.
e. Both b and c are true.

 

 

ANS:  E

Correct: The process of passive tubular diffusion favors the reabsorption of nonionized, lipid-soluble compounds. The more ionized, less lipid-soluble metabolites have more difficulty penetrating the cell membranes of the renal tubules and are likely to be retained in the tubular fluid and eliminated in the urine. When tubular urine is more acid, weak acids are excreted more slowly and weak bases are excreted more rapidly.

Incorrect choices: When the tubular urinary pH is more alkaline than the plasma, weak acids are excreted more rapidly and weak bases are excreted more slowly.

 

REF:   Pharmacokinetics (Excretion) | p. 18                                         OBJ:    3

 

  1. Which term refers to the time required for a drug to begin to have its effect?
a. First pass
b. Duration
c. Onset
d. Efficacy

 

 

ANS:  C

Correct: Onset is the time at which a drug starts to take effect.

Incorrect choices: First pass refers to the metabolism of drugs by the liver during their movement from the gastrointestinal tract to the systemic circulation via the portal circulation. Duration is the amount of time the drug is active in the body. Efficacy is an assessment of the effectiveness of a drug and does not refer to how quickly or how long a drug acts in the body.

 

REF:   Routes of Administration and Dose Forms (Routes of Administration) | p. 20

OBJ:   5

 

  1. An enteral route of administration would be:
a. intravenous.
b. oral.
c. sublingual.
d. transdermal.

 

 

ANS:  B

Correct: Enteral means situated or occurring inside of the gastrointestinal tract (intestines).

Incorrect choices: Intravenous, sublingual, and transdermal routes of administration bypass the gastrointestinal tract.

 

REF:   Routes of Administration and Dose Forms (Routes of Administration) | p. 20

OBJ:   5

 

  1. What of the following choices is considered the safest, least expensive, and most convenient route for administering drugs?
a. Inhalation
b. Rectal
c. Oral
d. Subcutaneous

 

 

ANS:  C

Correct: Oral administration requires no sophisticated devices, is slow enough in onset to gauge reactions and stop the next dose, and is easy for a patient to administer without assistance.

Incorrect choices: Inhalation and subcutaneous administration require devices, such as inhalers and needles, and the drug is irretrievable once administered. Rectal dosing has lower patient acceptance, and absorption can be variable.

 

REF:   Routes of Administration and Dose Forms (Routes of Administration) | p. 20

OBJ:   5

 

  1. Advantages of oral administration of a drug include all the following except:
a. large surface area for drug absorption.
b. many different dose forms that may be administered orally.
c. more predictable response than intravenous administration.
d. the simplest way to introduce a drug into the body.

 

 

ANS:  C

Correct: Intravenous administration offers a more predictable response than the oral route because the drug is injected directly into the bloodstream, bypassing many physiologic barriers, the hostile environment of the gastrointestinal tract, and drug-metabolizing enzymes that are encountered during oral absorption of a drug.

Incorrect choices: Others are all characteristics of oral administration.

 

REF:   Routes of Administration and Dose Forms (Oral Route) | p. 20

OBJ:   5

 

  1. Which organ is involved in the first-pass effect after oral administration of a drug?
a. Kidney
b. Lungs
c. Liver
d. Spleen

 

 

ANS:  C

Correct: On oral administration, drugs are absorbed and are carried via the portal circulation to the liver, where a percentage of the drug may be metabolized before entering the systemic circulation.

Incorrect choices: After oral dosing, drugs reach the kidney, lungs, and spleen after passing through the liver.

 

REF:   Pharmacokinetics (First-Pass Effect) | p. 17                               OBJ:    3

 

  1. Which of the following routes of drug administration produces the most rapid drug response?
a. Intravenous
b. Intramuscular
c. Subcutaneous
d. Intradermal

 

 

ANS:  A

Correct: Intravenous administration produces the most rapid drug response, with an almost immediate onset of action. Because the injection is made directly into the blood, the absorption phase is bypassed.

Incorrect choices: The intramuscular route, subcutaneous route, and intradermal route all have slower drug response rates than intravenous drug administration.

 

REF:   Routes of Administration and Dose Forms (Intravenous Route) | p. 20

OBJ:   5

 

  1. What route is used to administer the tuberculosis skin test?
a. Intramuscular
b. Intradermal
c. Intravenous
d. Subcutaneous

 

 

ANS:  B

Correct: Intradermal administration is used to provide local, rather than systemic, action. Local anesthetics are also given this way. The other routes are all chosen when systemic action is desired.

Incorrect choices: Intramuscular, intradermal, and subcutaneous routes of administration are not used to administer the tuberculosis skin test.

 

REF:   Routes of Administration and Dose Forms (Intradermal Route) | p. 21

OBJ:   5

 

  1. What type of administration involves the injection of solutions into the spinal subarachnoid space?
a. Intrathecal route
b. Intraperitoneal route
c. Intravenous route
d. Intradermal route

 

 

ANS:  A

Correct: The intrathecal route is used for injection of solutions into the spinal subarachnoid space.

Incorrect choices: Intraperitoneal route refers to placing fluids into the peritoneal cavity. Intravenous route refers to administering drugs directly into the blood circulation. Intradermal route refers to injecting a drug just under the skin.

 

REF:   Routes of Administration and Dose Forms (Intrathecal Route) | p. 21

OBJ:   5

 

  1. Drug preparations may be administered for local or systemic effects. Which is an example of a dose form used for a local effect?
a. Sublingual tablet
b. Transdermal patch
c. Ophthalmic ointment
d. Subcutaneous injection

 

 

ANS:  C

Correct: Ophthalmic ointments and drops are used specifically for treating the eye, not for treating a systemic disorder.

Incorrect choices: Administration of a sublingual tablet leads to rapid entry of the drug into the systemic circulation. A transdermal patch is a specialized dose form for the controlled delivery of a drug into the systemic circulation. A subcutaneous injection is applied into the subcutaneous areolar tissue to gain access to the systemic circulation.

 

REF:   Table 2-2: Routes of Administration | p. 21                               OBJ:    5

 

  1. Application of a transdermal patch is an example of parenteral administration because the drug is delivered in a manner that bypasses the gastrointestinal tract.
a. Both parts of the statements are true.
b. Both parts of the statements are false.
c. The first part of the statement is true; the second part is false.
d. The first part of the statement is false; the second part is true.

 

 

ANS:  A

Correct: Both parts of the statement are true. A transdermal patch is designed to provide continuous controlled release of medication through a semipermeable membrane over a given period after application to the intact skin.

Incorrect choices: Drugs given by the enteral route are placed directly into the gastrointestinal tract by oral or rectal administration. Parenteral means situated or occurring outside of the gastrointestinal tract (intestines). Examples of routes that bypass the gastrointestinal tract include various injection routes, inhalation, and topical administration. In practice, the term parenteral usually refers to an injection.

 

REF:   Routes of Administration and Dose Forms (Routes of Administration) | p. 20

OBJ:   5

 

  1. A patient’s perception that a pill without active ingredients is having a pharmacologic effect is termed:
a. tachyphylaxis.
b. hypersensitivity.
c. neurosis.
d. compliance.
e. placebo effect.

 

 

ANS:  E

Correct: Placebo effect is the term used to report when a patient perceives a pharmacologic effect after administration of a medication without active ingredients.

Incorrect choices: Tachyphylaxis is a rapid loss of drug sensitivity, akin to tolerance; the other choices are nonsensical answers. Compliance is the ability of a patient to adhere to the instructions of his or her physician.

 

REF:   Factors that Alter Drug Effects | p. 19                             OBJ:   4

 

  1. The need for an increasingly larger dose of a drug to obtain the same effects as the original dose is:
a. drug dependency.
b. insufficiency.
c. drug tolerance.
d. craving.

 

 

ANS:  C

Correct: Tolerance is a phenomenon in which the body changes in some way so that the same dose of drug has a weaker effect over time.

Incorrect choices: Persons who display drug dependency may also display tolerance, but they are two different phenomena. Insufficiency is not a term used to describe the tolerance phenomenon. Craving, similar to tolerance, may occur alongside drug dependence, but the desire to have more drug is not synonymous with tolerance to a drug’s effects.

 

REF:   Factors that Alter Drug Effects | p. 19                             OBJ:   4

 

MULTIPLE RESPONSE

 

  1. Which of the following statements are true regarding drug-receptor interactions? (Select all that apply.)
a. Drug receptors appear to consist of many large molecules that exist either on the cell membrane or within the cell itself.
b. A specific drug will usually bind with a specific receptor in a lock-and-key fashion.
c. Only a single receptor type is found at the site of action.
d. The energy formed by a drug-receptor interaction is very strong and the bond is difficult to break.

 

 

ANS:  A, B

Correct: Drug receptors may exist either on the cell membrane or within the cell. Usually, a specific drug will bind with a specific receptor.

Incorrect choices: More than one receptor type or identical receptors can be found at the site of action. Many drug-receptor interactions consist of weak chemical bonds, and the energy formed during the interaction is very low. As a result, the bonds can be formed and broken easily. Once a bond is broken, another drug molecule immediately binds to the receptor.

 

REF:   Mechanism of Action of Drugs (Receptors) | p. 13         OBJ:   2

 

TRUE/FALSE

 

  1. A prodrug is an inactive drug compound that becomes transformed into an active drug compound.

 

ANS:  T

Correct: This statement represents an example of drug metabolism (converting a drug from inactive to active).

 

REF:   Pharmacokinetics (Metabolism [Biotransformation]) | p. 16

OBJ:   3

 

  1. Drugs, after undergoing phase I drug metabolism, are more likely to be distributed to fat tissue.

 

ANS:  F

Correct: Phase I drug metabolism usually makes a drug more polar and with less affinity for fatty tissue.

 

REF:   Pharmacokinetics (Metabolism [Biotransformation]) | p. 16

OBJ:   3

 

  1. If a drug is a weak base that is excreted via the kidneys, then acidifying the urine will enhance its excretion.

 

ANS:  T

Correct: Weak bases will become ionized in an acid environment and will not be able to passively diffuse out of the kidney tubule.

 

REF:   Pharmacokinetics (Excretion) | p. 18                                         OBJ:    3

 

  1. The route of administration of a drug affects both the onset and duration of response.

 

ANS:  T

Correct: Onset refers to the time required the drug to begin to have its effect. Duration is the length of a drug’s effect.

 

REF:   Routes of Administration and Dose Forms (Routes of Administration) | p. 30

OBJ:   5

 

 

Chapter 04: Autonomic Drugs

Haveles: Applied Pharmacology for the Dental Hygienist, 7th Edition

 

MULTIPLE CHOICE

 

  1. The autonomic nervous system (ANS) functions as a(n) _____ system for many bodily functions.
a. somatic negative feedback
b. somatic modulating
c. automatic negative feedback
d. automatic modulating

 

 

ANS:  D

Correct: The ANS functions largely as an automatic modulating system for many bodily functions, including the regulation of blood pressure and heart rate, gastrointestinal tract motility, salivary gland secretions, and bronchial smooth muscle.

Incorrect choices: Autonomic means that the system functions automatically without conscious thought, in contrast to somatic, which is voluntary or willful. The system modulates body functions because, in general, the divisions of the ANS tend to act in opposite directions.

 

REF:   Autonomic Nervous System | p. 32           OBJ:               1

 

  1. In the autonomic nervous system (ANS), the target organ is innervated by the _____ neuron.
a. preganglionic afferent
b. preganglionic efferent
c. postganglionic afferent
d. postganglionic efferent

 

 

ANS:  D

Correct: The target organ is innervated by the postganglionic efferent neuron. The preganglionic neuron originates in the central nervous system (CNS) and passes out to form the ganglia at the synapse with the postganglionic neuron. The postganglionic neuron originates in the ganglia and innervates the effector organ or tissue.

Incorrect choices: The preganglionic nerve fiber originates in the brain. It ends at the synapse, where the neurotransmitter carries the message to the postganglionic fiber. Afferent fibers are sensory and efferent fibers are motor.

 

REF:   Autonomic Nervous System (Anatomy) | pp. 32-33        OBJ:   1

 

  1. The parasympathetic fibers originate in the nuclei of the _____ segments of the spinal cord.
a. sacral and lumbar
b. cranial nerves and sacral
c. cranial nerves and lumbar
d. thoracic and lumbar
e. None of the above are correct.

 

 

ANS:  B

Correct: Preganglionic fibers of the parasympathetic division originate in the nuclei of the third, seventh, ninth, and tenth cranial nerves, as well as the second through the fourth sacral segments of the spinal cord.

Incorrect choices: Preganglionic fibers of the sympathetic division span from the thoracic and lumbar portion of the spinal cord.

 

REF:   Autonomic Nervous System (Parasympathetic Autonomic Nervous System) | p. 33

OBJ:   1

 

  1. The anatomy of what system contains long preganglionic nerves and short postganglionic nerves?
a. Parasympathetic autonomic
b. Sympathetic autonomic
c. Somatic
d. Sensory afferent

 

 

ANS:  A

Correct: The parasympathetic nerves travel and terminate at the ganglia that are close to the organs they are innervating.

Incorrect choices: Sympathetic preganglionic neurons terminate close to the spinal cord and synapse with long postganglionic fibers. Somatic and sensory afferent systems do not have ganglia.

 

REF:   Autonomic Nervous System (Parasympathetic Autonomic Nervous System) | p. 33

OBJ:   1

 

  1. Which of the following statements is true concerning the organization of the sympathetic division of the autonomic nervous system (SANS)?
a. The cell bodies that give origin to the postganglionic fibers of the SANS span from the thoracic (T1) to the lumbar (L2) portion of the spinal cord.
b. The preganglionic fibers exit the spinal column to enter the sympathetic chain located along each side of the vertebral column.
c. Once a part of the sympathetic chain, preganglionic fibers form a single synaptic connection, with postganglionic cell bodies located up and down the sympathetic chain.
d. Stimulation of the SANS produces a more targeted effect than stimulation of the parasympathetic division of the autonomic nervous system (PANS).

 

 

ANS:  B

Correct: Preganglionic fibers of the SANS exit the spinal column to enter the sympathetic chain located along each side of the vertebral column.

Incorrect choices: The cell bodies that give origin to the preganglionic fibers of the SANS span from the thoracic (T1) to the lumbar (L2) portion of the spinal cord. Once a part of the sympathetic chain, preganglionic fibers form multiple synaptic connections with postganglionic cell bodies located up and down the sympathetic chain. Stimulation of the SANS produces a more diffuse effect than stimulation of the PANS.

 

REF:   Autonomic Nervous System (Sympathetic Autonomic Nervous System) | p. 33

OBJ:   1

 

  1. When the SANS is stimulated, the adrenal _____ releases primarily _____ into the systemic circulation.
a. cortex; epinephrine
b. cortex; acetylcholine
c. medulla; epinephrine
d. medulla; acetylcholine

 

 

ANS:  C

Correct: The adrenal medulla releases primarily epinephrine and a small amount of norepinephrine into the systemic circulation. Thus epinephrine is the neurotransmitter of the postganglionic neuron of the SANS.

Incorrect choices: The adrenal glands are endocrine glands that are found at the superior pole of each kidney. Each gland contains an outer cortex and inner medulla. The adrenal medulla serves as a sympathetic ganglion and secretes catecholamines, mainly epinephrine, while the adrenal cortex secretes several steroid hormones with multiple actions.

 

REF:   Autonomic Nervous System (Sympathetic Autonomic Nervous System) | p. 33

OBJ:   1

 

  1. Which of the following choices would occur during a generalized discharge of the sympathetic nervous system?
a. Diarrhea
b. Urination
c. Glycogen breakdown
d. Miosis
e. None of the above

 

 

ANS:  C

Correct: The sympathetic system makes additional energy available for fight or flight.

Incorrect choices: Diarrhea, urination, and miosis are all effects of stimulation of the parasympathetic nervous system.

 

REF:   Sympathetic Autonomic Nervous System (Pharmacologic Effects) | p. 42

OBJ:   1

 

  1. Which of the following statements is true concerning the organization of the autonomic nervous system (ANS)?
a. All body tissues are innervated by the ANS.
b. All organs receive both parasympathetic and sympathetic innervation.
c. If a tissue receives both innervations, the response will be equal to the sum of excitatory and inhibitory influences of the two divisions of the ANS.
d. Sensory fibers in one division cannot influence the motor fibers in the other.

 

 

ANS:  C

Correct: The response will be equal to the sum of excitatory and inhibitory influences of the two divisions of the ANS, known as modulation.

Incorrect choices: Almost all body tissues are innervated by the ANS, with many, but not all, organs receiving both parasympathetic and sympathetic innervation. Sensory fibers in one division can influence the motor fibers in the other.

 

REF:   Autonomic Nervous System (Functional Organization) | p. 33

OBJ:   1

 

  1. The neurotransmitter released from a preganglionic neuron in the sympathetic division of the autonomic nervous system (ANS) is:
a. epinephrine.
b. norepinephrine.
c. dopamine.
d. acetylcholine.

 

 

ANS:  D

Correct: The neurotransmitter released from all autonomic preganglionic neurons is acetylcholine.

Incorrect choices: Epinephrine is released from the adrenal medulla. Norepinephrine is released from postganglionic sympathetic neurons. Dopamine is not a transmitter of the ANS.

 

REF:   Autonomic Nervous System (Neurotransmitters) | p. 34  OBJ:   1

 

  1. Which of the following substances will block the action of acetylcholine at the postganglionic endings in the parasympathetic autonomic nervous system (PANS)?
a. Atropine
b. Curare
c. Hexamethonium
d. Acetic acid

 

 

ANS:  A

Correct: Atropine will block the action of acetylcholine at the postganglionic endings in the PANS. Differences exist among receptors that have acetylcholine as a neurotransmitter—subtypes of acetylcholine-innervated receptors that are located in anatomically different synapses.

Incorrect choices: Curare blocks the response of skeletal muscle to acetylcholine but does not block its effect on tissues such as the salivary gland. Hexamethonium blocks the action of acetylcholine at the ganglia.

 

REF:   Parasympathetic Autonomic Nervous System (Adverse Reactions) | p. 37

OBJ:   2

 

  1. Which of the following statements is true concerning direct- and indirect-acting cholinergic agents?
a. A direct agent causes release of neurotransmitter and an indirect agent acts on the receptor.
b. The indirect-acting agents include the choline derivatives and pilocarpine.
c. The indirect-acting cholinesterase inhibitors act by stimulating release of acetylcholine.
d. Inhibiting the enzyme that normally destroys acetylcholine results in stimulation of the PANS.

 

 

ANS:  D

Correct: When the enzyme that normally destroys acetylcholine is inhibited, the concentration of acetylcholine builds up, resulting in PANS stimulation.

Incorrect choices: A direct agent acts on the receptor, and an indirect agent causes release of the neurotransmitter. The direct-acting agents include the choline derivatives and pilocarpine. The indirect-acting cholinesterase inhibitors act by inhibiting the enzyme cholinesterase.

 

REF:   Parasympathetic Autonomic Nervous System (Cholinergic [Parasympathomimetic] Agents) | p. 36     OBJ:    2

 

  1. The direct effect of acetylcholine on the heart is _____ chronotropic and _____ inotropic.
a. negative; negative
b. positive; positive
c. negative; positive
d. positive; negative
e. None of the above are correct.

 

 

ANS:  A

Correct: Acetylcholine produces a negative chronotropic (reduced rate) and negative inotropic (force) of heart contraction.

Incorrect choices: Cholinergic agents are classified as direct acting (acts on receptor) or indirect acting (causes release of neurotransmitter). The direct-acting agents include the choline derivatives and pilocarpine. The choline derivatives include both acetylcholine and other, more stable choline derivatives. A decrease in cardiac output is associated with these agents.

 

REF:   Parasympathetic Autonomic Nervous System (Pharmacologic Effects) | p. 36

OBJ:   2

 

  1. Which of the following is true concerning the pharmacologic effects associated with cholinergic agents?
a. Tachycardia and an increase in blood pressure and cardiac output
b. Stasis of intestinal motility
c. Miosis
d. An increase in intraocular pressure

 

 

ANS:  C

Correct: Cholinergic agents produce miosis and cause cycloplegia. Cycloplegia is a paralysis of the ciliary muscles of the eye that results in loss of visual accommodation.

Incorrect choices: Generally, bradycardia and a decrease in blood pressure and cardiac output occur. Cholinergic agents excite the smooth muscle of the gastrointestinal tract, producing an increase in activity, motility, and secretion. These agents decrease intraocular pressure, and are useful in the treatment of glaucoma.

 

REF:   Parasympathetic Autonomic Nervous System (Pharmacologic Effects) | p. 37

OBJ:   2

 

  1. The acronym SLUD denotes adverse reactions associated with administration of _____ agents.
a. cholinergic
b. anticholinergic
c. adrenergic
d. antiadrenergic

 

 

ANS:  A

Correct: SLUD (salivation, lacrimation, urination, and defecation) is associated with administration of cholinergic agents. These adverse reactions are essentially extensions of their pharmacologic effects.

Incorrect choices: Acetylcholine is the principal neurotransmitter of the parasympathetic autonomic nervous system (PANS). Norepinephrine (NE) and epinephrine are the major neurotransmitters of the sympathetic autonomic nervous system (SANS). In general, the two divisions of the autonomic nervous system (ANS) tend to act in opposite directions. Cholinergic stimulation is most like antiadrenergic stimulation and the opposite of adrenergic and anticholinergic stimulation.

 

REF:   Parasympathetic Autonomic Nervous System (Adverse Reactions) | p. 37

OBJ:   2

 

  1. The S in SLUD stands for:
a. sympathetic.
b. salivation.
c. severe.
d. secretion.

 

 

ANS:  B

Correct: SLUD is the acronym used to describe the toxic effects noted when large doses of cholinergic agents are ingested. With even larger doses, neuromuscular paralysis can occur as a result of the effect on the neuromuscular junction. CNS effects, such as confusion, can be seen if toxic doses are administered.

Incorrect choices: The S in SLUD stands for salivation, the L stands for lacrimation (or tearing), the U stands for urination, and the D for defecation.

 

REF:   Parasympathetic Autonomic Nervous System (Adverse Reactions) | p. 37

OBJ:   2

 

  1. A combination of pralidoxime and atropine is used to treat an overdose of _____ inhibitors.
a. acetylcholine
b. cholinesterase
c. epinephrine
d. norepinephrine

 

 

ANS:  B

Correct: Pralidoxime (2-PAM, Protopam) and atropine may be used to treat an overdose of cholinesterase inhibitors, such as the insecticides or organophosphates (parathion).

Incorrect choices: The action of acetylcholine is terminated by hydrolysis by acetylcholinesterase to yield the inactive metabolites choline and acetic acid. Pralidoxime regenerates the irreversibly bound acetylcholine receptor sites that are bound by the inhibitors, and atropine blocks the muscarinic effects of the excess acetylcholine present. Epinephrine and norepinephrine are the major neurotransmitters of the sympathetic autonomic nervous system (SANS).

 

REF:   Parasympathetic Autonomic Nervous System (Adverse Reactions) | p. 37

OBJ:   2

 

  1. Which of the following agents is used in the treatment of an overdose of acetylcholinesterase inhibitors?
a. Malathion
b. Epinephrine
c. Pralidoxime
d. Physostigmine

 

 

ANS:  C

Correct: Pralidoxime regenerates irreversibly bound acetylcholinesterase enzymes that had been inactivated by covalently bound acetylcholinesterase inhibitors.

Incorrect choices: Malathion and physostigmine are acetylcholinesterase inhibitors. Epinephrine is a sympathomimetic.

 

REF:   Parasympathetic Autonomic Nervous System (Adverse Reactions) | p. 37

OBJ:   2

 

  1. Which of the following conditions is not a relative contraindication or caution with the use of cholinergic agents?
a. Bronchial asthma
b. Hypothyroidism
c. Myasthenia gravis treated with neostigmine
d. Peptic ulcer

 

 

ANS:  B

Correct: Hypothyroidism is not a relative contraindication or caution with the use of cholinergic agents; however, hyperthyroidism is because it may cause an increased risk of atrial fibrillation.

Incorrect choices: Bronchial asthma, hyperthyroidism, gastrointestinal tract or urinary tract obstruction, severe cardiac disease, myasthenia gravis treated with neostigmine, and peptic ulcer all represent relative contraindications to or cautions with the use of cholinergic agents.

 

REF:   Parasympathetic Autonomic Nervous System (Contraindications) | p. 37

OBJ:   2

 

  1. The primary objective of cholinergic drug therapy in the treatment of glaucoma is:
a. increasing the convexity of the lens.
b. dilating the vessels of the eye.
c. dilating the pupil.
d. reducing intraocular pressure.
e. inhibiting cholinesterase.

 

 

ANS:  D

Correct: The cholinergic agents reduce intraocular pressure, produce miosis, and cause cycloplegia. Pilocarpine is an example of a direct acting cholinergic agent that is used to treat glaucoma. Cycloplegia is a paralysis of the ciliary muscles of the eye that results in loss of visual accommodation.

Incorrect choices: Glaucoma is a disease characterized by increased intraocular pressure. Blindness may result if the high pressure persists. The main object of drug therapy with cholinergic agents is to reduce that pressure.

 

REF:   Parasympathetic Autonomic Nervous System (Pharmacologic Effects) | p. 37

OBJ:   2

 

  1. Which drug would be best to treat xerostomia?
a. Atropine
b. Propranolol
c. Pilocarpine
d. Pseudoephedrine

 

 

ANS:  C

Correct: Xerostomia is best treated with a cholinergic agent such as pilocarpine, and it is prescribed for this condition. Its success may be limited because of the myriad of potential side effects. Common side effects from pilocarpine include perspiration, nausea, rhinitis, chills, and flushing.

Incorrect choices: Atropine causes xerostomia. Propranolol is b-adrenergic blocker. Pseudoephedrine is an adrenergic agonist, which often decreases secretions.

 

REF:   Parasympathetic Autonomic Nervous System (Uses) | p. 38

OBJ:   2

 

  1. Neostigmine is an indirect-acting cholinergic agent that is classified as (1) indirect acting and (2) irreversible.
a. Both claims are true.
b. Claim 1 is true; claim 2 is false.
c. Claim 1 is false; claim 2 is true.
d. Neither claim 1 nor claim 2 is true.

 

 

ANS:  B

Correct: The cholinesterase inhibitors are divided into groups based on the degree of reversibility with which they are bound to the enzyme. Edrophonium is rapidly reversible, whereas physostigmine and neostigmine are slowly reversible. These agents are used to treat glaucoma and myasthenia gravis.

Incorrect choices: Neostigmine is a cholinergic agent that is indirect acting and reversible.

 

REF:   Parasympathetic Autonomic Nervous System (Uses) | p. 38

OBJ:   2

 

  1. Sarin was used on a subway in Japan to poison riders. Sarin is a(n):
a. sympathomimetic.
b. anticholinergic.
c. anticholinesterase.
d. sympatholytic.

 

 

ANS:  C

Correct: Sarin inhibits the action of acetylcholinesterase, inhibiting the breakdown of acetylcholine.

Incorrect choices: Sarin leads to stimulation of the cholinergic receptors, not antagonism, and it is not classified as a sympathomimetic or a sympatholytic.

 

REF:   Parasympathetic Autonomic Nervous System (Uses) | p. 38

OBJ:   2

 

  1. Anticholinergic agents prevent the action of acetylcholine at the _____ endings.
a. preganglionic sympathetic
b. postganglionic parasympathetic
c. preganglionic sympathetic
d. postganglionic parasympathetic

 

 

ANS:  D

Correct: The anticholinergic drugs block the action of acetylcholine postganglionic parasympathetic targets such as smooth muscles, glandular tissue, and the heart. These agents are called antimuscarinic agents because they block the muscarinic receptors and not the nicotinic receptors.

Incorrect choices: The anticholinergic agents prevent the action of acetylcholine at the postganglionic parasympathetic endings. The release of acetylcholine is not prevented, but the receptor site is competitively blocked by the anticholinergics.

 

REF:   Parasympathetic Autonomic Nervous System (Anticholinergic [Parasympatholytic] Agents) | p. 38     OBJ:    3

 

  1. Tertiary anticholinergic agents are _____ soluble and _____ penetrate the brain.
a. lipid soluble; easily
b. lipid soluble; do not
c. not lipid soluble; easily
d. not lipid soluble; do not

 

 

ANS:  A

Correct: Atropine and scopolamine are tertiary agents. Propantheline and glycopyrrolate are quaternary agents. Because of their water solubility, quaternary agents do not penetrate the CNS well. The quaternary agents have fewer CNS effects because they are less likely than other agents to enter the brain.

Incorrect choices: Tertiary agents are lipid soluble and can easily penetrate the brain.

 

REF:   Parasympathetic Autonomic Nervous System (Pharmacologic Effects) | p. 38

OBJ:   3

 

  1. Ipratropium is a(n) _____ found in an inhaler used to treat asthma.
a. cholinergic
b. anticholinergic
c. adrenergic
d. antiadrenergic

 

 

ANS:  B

Correct: Anticholinergics relax smooth muscle in the respiratory and gastrointestinal tracts. Relaxation of smooth muscle in the respiratory tract causes bronchial dilation.

Incorrect choices: Ipratropium an anticholinergic. A beta-2 adrenergic effect causes a relaxation of bronchiole smooth muscle. Due to the largely opposite actions of the divisions of the autonomic nervous system, an anticholinergic drug will function much like an adrenergic drug and will have a similar effect on bronchiolar smooth muscle.

 

REF:   Parasympathetic Autonomic Nervous System (Pharmacologic Effects) | p. 38

OBJ:   3

 

  1. Anticholinergics:
a. accelerate gastric emptying.
b. decrease esophageal and gastric motility.
c. cause miosis.
d. do not have an effect on heart rate.

 

 

ANS:  B

Correct: Anticholinergics decrease esophageal and gastric motility. The effect of anticholinergics on gastrointestinal motility has given rise to the name spasmolytic agents. If these drugs are used repeatedly, constipation can result.

Incorrect choices: Anticholinergics delay gastric emptying. Parasympatholytics paralyze the ciliary muscles of the eye, resulting in a loss of accommodation. Bradycardia predominates with small doses of anticholinergic agents; however, tachycardia predominates with large doses because the anticholinergic agents can produce vagal blockade.

 

REF:   Parasympathetic Autonomic Nervous System (Pharmacologic Effects) | p. 38

OBJ:   3

 

  1. Which of the following choices represents potential cardiac effects of anticholinergic agents?
a. Bradycardia exclusively
b. Tachycardia exclusively
c. Variable; bradycardia predominates with small doses and tachycardia with large doses
d. No cardiac effect from the use of these agents

 

 

ANS:  C

Correct: This variable response in the heart rate occurs because heart rate is a function of both direct and indirect effects. This effect has been used therapeutically to prevent cardiac slowing during general anesthesia.

Incorrect choices: Bradycardia predominates with small doses; however, with large therapeutic doses, the anticholinergic agents can produce vagal blockade, resulting in tachycardia.

 

REF:   Parasympathetic Autonomic Nervous System (Pharmacologic Effects) | p. 39

OBJ:   3

 

  1. A drug with anticholinergic side effects might exhibit all of the following except:
a. mydriasis.
b. salivation.
c. tachycardia.
d. constipation.

 

 

ANS:  B

Correct: Cholinergic agents increase secretions, such as salivation, and anticholinergics prevent this action.

Incorrect choices: Mydriasis, tachycardia, and constipation are all characteristic effects of antagonizing the cholinergic system, which anticholinergics do.

 

REF:   Parasympathetic Autonomic Nervous System (Pharmacologic Effects) | p. 38

OBJ:   3

 

  1. Which of the following categories of autonomic nervous system (ANS) agents can cause an acute rise in intraocular blood pressure in patients with narrow-angle glaucoma?
a. Cholinergic
b. Anticholinergic
c. Adrenergic
d. Antiadrenergic

 

 

ANS:  B

Correct: Anticholinergics are the only ANS drug group that can cause an acute rise in intraocular pressure in patients with narrow-angle glaucoma. Glaucoma is divided into narrow-angle (5% of glaucoma cases) and open-angle glaucoma (95% of glaucoma cases). Incorrect choices: Anticholinergic drugs can precipitate an acute attack in unrecognized cases of this rare condition.

 

REF:   Parasympathetic Autonomic Nervous System (Contraindications) | p. 39

OBJ:   3

 

  1. Indications for the use of anticholinergic agents include:
a. stimulation of salivary secretion for xerostomic patients
b. treatment of gastrointestinal disorders associated with decreased motility
c. treatment in combination with levodopa for patients with Parkinson disease
d. use as an antipsychotic

 

 

ANS:  C

Correct: At present, anticholinergic agents are used occasionally in combination with levodopa for the treatment of Parkinson disease. Before the introduction of levodopa, anticholinergic agents were commonly used to reduce the tremors and rigidity associated with Parkinson disease. Patients treated with these agents predictably experienced the side effects of dry mouth and blurred vision.

Incorrect choices: Anticholinergic agents inhibit the secretions of saliva and bronchial mucus that can be stimulated by general anesthesia. Many types of gastrointestinal disorders associated with increased motility or acid secretion have been treated with anticholinergic agents. Anticholinergic agents, such as trihexyphenidyl and benztropine, are often administered concurrently with the phenothiazines to reduce rigidity and tremor; however, anticholinergics themselves are not antipsychotic medications.

 

REF:   Parasympathetic Autonomic Nervous System (Uses) | p. 39

OBJ:   3

 

  1. Which of the following is a catecholamine?
a. Isoproterenol
b. Norepinephrine
c. Epinephrine
d. Both b and c
e. All of the above

 

 

ANS:  E

Correct: The term catecholamine is made up of two terms that relate to their structure. Catechol refers to 1,2-dihydroxybenzene. Amine refers to the chemical structure –NH2. Norepinephrine, epinephrine, and dopamine are endogenous sympathetic neurotransmitters that are catecholamines.

Incorrect choices: Isoproterenol (Isuprel) is an exogenous catecholamine.

 

REF:   Sympathetic Autonomic Nervous System | p. 40             OBJ:   4

 

  1. Which of the following agents is an indirect-acting sympathetic agonist?
a. Albuterol
b. Pseudoephedrine
c. Amphetamine
d. Physostigmine
e. Epinephrine

 

 

ANS:  C

Correct: Indirect sympathetic agonist agents, such as amphetamine, release endogenous norepinephrine, which then produces a response.

Incorrect choices: Albuterol and epinephrine are direct-acting sympathetic agonists. Pseudoephedrine is a mixed agonist that can either stimulate the receptor directly or release endogenous norepinephrine to cause a response. Physostigmine is not a sympathetic agent.

 

REF:   Sympathetic Autonomic Nervous System | p. 40             OBJ:   4

 

  1. Which of the following agents is known to deplete endogenous norepinephrine?
a. Propranolol
b. Reserpine
c. Phentolamine
d. Yohimbine
e. None of the above

 

 

ANS:  B

Correct: Reserpine reduces sympathetic neurotransmission by entering the nerve terminal and disrupting storage of norepinephrine.

Incorrect choices: Propranolol is a b-adrenergic receptor blocker; phentolamine and yohimbine are a-adrenergic receptor blockers.

 

REF:   Sympathetic Autonomic Nervous System | p. 40             OBJ:   4

 

  1. The action of norepinephrine is terminated by which of the following choices?
a. Uptake into the presynaptic nerve terminal by an amine-specific pump
b. Action of catechol-O-methyltransferase (COMT)
c. Action of monoamine oxidase (MAO)
d. All of the above
e. None of the above

 

 

ANS:  D

Correct: The action of norepinephrine can be terminated by any of the above mechanisms.

Incorrect choices: The action of norepinephrine is terminated primarily by reuptake into the presynaptic nerve terminal by an amine-specific pump. In addition, two enzyme systems, MAO and COMT, are involved in the breakdown of a portion of both epinephrine and norepinephrine.

 

REF:   Sympathetic Autonomic Nervous System | p. 40             OBJ:   4

 

  1. a-Adrenergic agonists cause:
a. vasoconstriction.
b. vasodilation.
c. tachycardia.
d. miosis.

 

 

ANS:  A

Correct: a-Adrenergic receptors are found on blood vessels and stimulation of them causes vasoconstriction.

Incorrect choices: a-Adrenergic agonists cause vasoconstriction and mydriasis. b-adrenergic agonists, but not á-adrenergic agonists, cause tachycardia.

 

REF:   Sympathetic Autonomic Nervous System (a-Receptors) | p. 40

OBJ:   4

 

  1. Stimulation of b2-receptors results in:
a. vasoconstriction of skin and skeletal muscle.
b. increase in heart rate and force of contraction.
c. smooth-muscle relaxation.
d. bronchoconstriction.

 

 

ANS:  C

Correct: The stimulation of b2-receptors results in smooth-muscle relaxation. Because the blood vessels of the skeletal muscle are innervated by b2-receptors, stimulation causes vasodilation. Relaxation of the smooth muscles of the bronchioles, also containing b2-receptors, results in bronchodilation.

Incorrect choices: The stimulation of the á-receptors results in smooth-muscle excitation or contraction, which then causes vasoconstriction of skin and skeletal muscle. b1-receptor stimulation excitation causes stimulation of the heart muscle, resulting in a positive chronotropic effect (increased rate) and a positive inotropic effect (increased strength).

 

REF:   Sympathetic Autonomic Nervous System (b-Receptors) | p. 40

OBJ:   4

 

  1. On administration of an agent, heart rate increases because of a direct effect on the heart. However, total peripheral resistance decreases dramatically. As a consequence, systolic blood pressure increases only slightly, and mean arterial pressure typically falls. This agent is:
a. epinephrine.
b. norepinephrine.
c. phenylephrine.
d. isoproterenol.

 

 

ANS:  D

Correct: This response is characteristic of a pure b-adrenergic agonist, of which isoproterenol is an example. The primary actions are stimulation of the heart and relaxation of the vessels supplying the skeletal muscles. This leads to tachycardia and decreased peripheral resistance.

Incorrect choices: Epinephrine is a mixed a- and b-adrenergic agonist. This balance leads to little change or an increase in mean arterial pressure. Norepinephrine and phenylephrine are a-adrenergic agonists, which constrict blood vessels and lead to a clear rise in mean arterial pressure.

 

REF:   Sympathetic Autonomic Nervous System (Pharmacologic Effects) | p. 41

OBJ:   5

 

  1. Agents such albuterol (Proventil, Ventolin) cause bronchodilation by binding to _____ receptors.
a. alpha
b. beta1
c. beta2
d. nicotinic

 

 

ANS:  C

Correct: b2-Selective receptor agonists such as albuterol (Proventil, Ventolin) and metaproterenol (Alupent) are indicated for the treatment of asthma. Epinephrine is the drug of choice for the treatment of anaphylaxis.

Incorrect choices: Albuterol is a b2-selective receptor agonist.

 

REF:   Table 4-5: Examples of Adrenergic Receptor Agonists [Sympathomimetic Adrenergic Agonists]) | p. 41           OBJ:               5

 

  1. Sympathomimetic agents will stimulate salivary flow from which of the following salivary glands: (1) parotid, (2) submandibular, (3) sublingual?
a. 1, 2, 3
b. 1, 2
c. 1, 3
d. 2, 3

 

 

ANS:  D

Correct: The mucus-secreting cells of the submandibular gland and sublingual gland are stimulated by the sympathomimetic agents to release a small amount of thick, viscous saliva.

Incorrect choices: Because the parotid gland has no sympathetic innervation (only parasympathetic) and the sympathomimetics produce vasoconstriction, the flow of saliva is often reduced, resulting in xerostomia.

 

REF:   Sympathetic Autonomic Nervous System (Pharmacologic Effects) | p. 42

OBJ:   5

 

  1. Sympathomimetic agents should be used with caution in patients with (1) angina, (2) hypertension, (3) hypothyroidism.
a. 1, 2, 3
b. 1, 2
c. 1, 3
d. 2, 3

 

 

ANS:  B

Correct: Sympathomimetic agents should be used with caution in patients with angina, hypertension, and hyperthyroidism. The adverse reactions associated with the adrenergic drugs are extensions of their pharmacologic effects. Anxiety and tremors may occur, and the patient may have palpitations. Serious arrhythmias can result. Agents with a-adrenergic action can also cause a dramatic rise in blood pressure.

Incorrect choices: These drugs stimulate a- and b-receptors in the heart and as such would further increase blood pressure and heart rate in persons with already increased blood pressure and heart rates, which could lead to arrhythmias or a myocardial infarction.

 

REF:   Sympathetic Autonomic Nervous System (Adverse Reactions) | p. 42

OBJ:   5

 

  1. Which of the following sympathomimetic agents is commonly used in dentistry?
a. Ephedrine
b. Terbutaline
c. Dipivefrin
d. Levonordefrin

 

 

ANS:  D

Correct: Levonordefrin is a derivative of norepinephrine. Although claims made for this drug include less CNS excitation and cardiac stimulation, the dose required to produce vasoconstriction equal to that caused by epinephrine is higher.

Incorrect choices: Levonordefrin is a vasoconstrictor often added to local anesthetic solutions of mepivacaine.

 

REF:   Sympathetic Autonomic Nervous System (Specific Adrenergic Agents) | p. 43

OBJ:   5

 

  1. Which of the following agents is being used to produce methamphetamine?
a. Phenylephrine
b. Pseudoephedrine
c. Dopamine
d. Dipivefrin

 

 

ANS:  B

Correct: Pseudoephedrine is present in over-the-counter products designed for the treatment of the common cold or allergies. The newest use of these agents is to “cook” them to produce methamphetamine, which is used illicitly. Because of this use, their availability has been restricted.

Incorrect choices: Phenylephrine is used as a mydriatic and in nose sprays to relieve congestion. Dopamine is a neurotransmitter in parts of the CNS. It is used primarily in the treatment of shock. Dipivefrin and epinephrine are sympathomimetic ophthalmics that are used to treat glaucoma.

 

REF:   Sympathetic Autonomic Nervous System (Specific Adrenergic Agents) | p. 43

OBJ:   5

 

  1. Patients pretreated with _____ agents are prone to epinephrine reversal.
a. cholinergic
b. anticholinergic
c. a-adrenergic
d. a-adrenergic blocking

 

 

ANS:  D

Correct: The a-adrenergic blocking agents competitively inhibit the vasoconstricting effects of the adrenergic agents. This reduces the sympathetic tone in the blood vessels, producing a decrease in the total peripheral resistance. The resulting decrease in blood pressure stimulates the vagus, thereby producing a reflex tachycardia. Patients who are pretreated with a-adrenergic blocking agents and given epinephrine exhibit a predominance of beta effects, which lowers blood pressure.

Incorrect choices: Epinephrine reversal is caused by adrenergic blocking agents.

 

REF:   Sympathetic Autonomic Nervous System (a-Adrenergic Blocking Agents) | p. 43

OBJ:   5

 

  1. The following statements are true of d-tubocurarine except which one?
a. It is a competitive nondepolarizing blocker.
b. It binds to nicotinic receptors.
c. It precipitates malignant hyperthermia in susceptible patients when combined with halothane.
d. It has been used in the Amazon for hunting animals.
e. Its action can be overcome by administering neostigmine.

 

 

ANS:  C

Correct: The depolarizing neuromuscular blocker succinylcholine can cause malignant hyperthermia. Tubocurarine does not.

Incorrect choices: The other statements accurately describe d-tubocurarine.

 

REF:   Sympathetic Autonomic Nervous System (Nondepolarizing [Competitive] Blockers) | p. 44

OBJ:   6

 

MULTIPLE RESPONSE

 

  1. Muscarinic receptors are found in which of the following? (Select all that apply.)
a. Central nervous system
b. Sympathetic nervous system
c. Parasympathetic nervous system
d. Neuromuscular junction
e. Adrenal medulla

 

 

ANS:  A, B, C

Correct: Muscarinic receptors are found only in the central nervous system, sympathetic nervous system, and parasympathetic nervous system. Small doses of acetylcholine (Ach) bind to muscarinic receptors and duplicate the effects of the chemical substance muscarine.

Incorrect choices: Nicotinic receptors are found in the neuromuscular junction and adrenal medulla as well as in the central nervous system and sympathetic and parasympathetic divisions of the autonomic nervous system. Large doses of Ach bind to nicotinic receptors and duplicate the effects of nicotine.

 

REF:   Parasympathetic Autonomic Nervous System | p. 36      OBJ:   2

 

TRUE/FALSE

 

  1. Pathways innervating smooth muscles and glands are considered afferent pathways.

 

ANS:  F

Correct: Pathways innervating smooth muscles and glands are efferent pathways. They send impulses outward from the CNS to the periphery and produce an action.

 

REF:   Autonomic Nervous System (Anatomy) | pp. 32-33        OBJ:   1

 

  1. The fight-or-flight response refers to activation of the parasympathetic nervous system in response to stress.

 

ANS:  F

Correct: The fight-or-flight response refers to activation of the sympathetic nervous system.

 

REF:   Autonomic Nervous System (Functional Organization) | p. 33

OBJ:   1

 

  1. Salivation, lacrimation, urination, and defecation refer to toxic effects seen with adrenergic agents.

 

ANS:  F

Correct: SLUD (salivation, lacrimation, urination, and defecation) refers to the actions of cholinergic (parasympathomimetic) agents and cholinesterase inhibitors.

 

REF:   Parasympathetic Autonomic Nervous System (Adverse Reactions) | p. 37

OBJ:   2

 

  1. Tertiary (ammonium) agents cross the blood-brain barrier better than quaternary (ammonium) agents.

 

ANS:  T

Correct: Quaternary ammonium compounds have a permanent positive charge and cannot cross the blood-brain barrier.

 

REF:   Parasympathetic Autonomic Nervous System (Pharmacologic Effects) | p. 38

OBJ:   3

 

  1. Glycopyrrolate is an a-adrenergic agonist used to produce a dry field before some dental procedures.

 

ANS:  F

Correct: Glycopyrrolate is an anticholinergic agent used to produce a dry field before some dental procedures.

 

REF:   Parasympathetic Autonomic Nervous System (Pharmacologic Effects) | p. 38

OBJ:   3

 

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