Muscarinic Drugs
You’re about to go on a cruise with your family. When you are at sea, you get motion sickness. Why you chose to go on a cruise when you get motion sickness is beyond me, you are not a quitter and want to enjoy some yummy strawberry daiquiris. So, instead of jumping overboard, you take a certain drug to help relieve symptoms of motion sickness. What is the mechanism of action of this drug?
A. NMJ blocker
B. Ganglion blocker
C. M1 antagonist
D. Prevents presynaptic release of acetylcholine
Answer: C M1 antagonist
A 71-year-old woman was diagnosed with Benign Prostatic Hyperplasia and was prescribed with Prazosin to help ease the process of urination. After two weeks of treatment, he returned to the doctor complaining of which of the following side effects?
A. Xerostomia
B. Constipation
C. Orthostatic hypotension
D. Increased sweating
E. Failure of accommodation
C. Orthostatic hypotension
What is true of the low dose epinephrine vs high dose of epinephrine shenanigans?
A. Low doses of epinephrine cause vasodilation via beta 2 receptors while high doses of epinephrine causes vasoconstriction via alpha 1 receptors
B. Low doses of epinephrine cause vasoconstriction via beta 2 receptors while high doses of epinephrine causes vasodilation via alpha 1 receptors
C. Low doses of epinephrine cause vasodilation via alpha 1 receptors while high doses of epinephrine causes vasoconstriction via beta 1 receptors
D. Low doses of epinephrine cause vasoconstriction via alpha 1 receptors while high doses of epinephrine cause vasodilation via beta 2 receptors
Answer: A Low doses of epinephrine cause vasodilation via beta 2 receptors while high doses of epinephrine causes vasoconstriction via alpha 1 receptors
You are at breakfast with your friend when she tells you that she is on a new diet. She states that all she consumes is grapefruits and grapefruit juice. She has lost 16 pounds in once week and is so happy about it. You explain to her that this is very unhealthy and excessive grapefruit juice will have a negative affect on drugs metabolized by the CYP 450 enzyme. What is a likely side effect that may occur if your friend ingests the following medications?
A. Increased risk of toxicity
B. Decreased risk of toxicity
C. Increased risk of clotting
D. Decreased risk of bleeding
A. Increased risk of toxicity
A researcher isolates a folate analog that inhibits the formation of active tetrafolate in eukaryotes and is used as an anticancer agent. Which of the following drugs is most likely isolated?
A. 5-fluorouracil
B. Allopurinol
C. Methotrexate
D. Trimethoprim
E. Mycophenolic acid
F. Hydroxyurea
Answer: C Methotrexate
A 33-year-old female comes to her physician with upper extremity weakness and complains that her eyes are not staying open. She is diagnosed with myasthenia gravis. What drug was likely used to lead to this diagnosis
A. Pyridostigmine
B. Physostigmine
C. Edrophonium
D. Malathion
E. Neostigmine
Answer: C Edrophonium
One of your patients presents with chest pain. You do an EKG, and blood work that shows no evidence of a myocardial infarction. Because of her age and risk factors, you want to investigate the cardiac status further. The patient uses a walker and is unable to participate in a treadmill-based stress test. What can you give her to test the health of her heart?
A. Isopreterenol
B. Pindolol
C. Dobutamine
D. Propanolol
E. Clonidine
Answer: C Dobutamine
Brittney was reviewing her finances with her mother when she realized her bank account was down $500. Her mother immediately panicked and thought it was fraud, but Brittney explained that she just got her botox done. Her mother begins to yell at her, but Brittney goes on to explain that botulinum toxin acts... to decrease facial wrinkles.
A. postsynaptically, inhibiting acetylcholine release
B. presynaptically, inhibiting acetylcholine release
C. postsynaptically, initiating acetylcholine release
D. presynaptically, initiating acetylcholine release
B. presynaptically, inhibiting acetylcholine release
A 27 year old woman meets with a geneticist to learn about recurrence risk for CF as she is planning to start a family. She has a niece who is a known carrier for the mutation of CF, and he husband is from a population where the incidence of CF is approximately 1 in 2,500. What is the best recurrence risk estimate of CF to the children of this couple?
A. 1/40
B. 1/50
C. 1/200
D. 1/400
E. 1/2500
C. 1/200
A mother brings her son to the physician after noticing that he has been repeatedly biting his lips, reopening the wound every other day. She also mentions that while changing his diaper she notices orange crystals in the urine. After a series of tests, the physician diagnoses the child with Lesch Nyhan Syndrome. What is the enzyme deficiency present in the child?
A. Ribonucleotide Reductase
B. Xanthine Oxidase
C. Dihydrofolate Reductase
D. Pyruvate Carboxylase
E. Hypoxanthine-guanine-phosphoribosyltransferase
Answer: E Hypoxanthine-guanine-phosphoribosyltransferase
A 10-year-old boy is brought to the physician by his parents because he experiences shortness of breath when he plays with his friends. Physical examination shows no abnormalities except bilateral expiratory wheezing. A spirometry is within normal limits. A provocative test with which of the following drugs would be most helpful in the diagnostic evaluation of this patient?
A. Bethanechol
B. Methacholine
C. Phenylephrine
D. Atropine
E. Pilocarpine
Answer: B Methacholine
A 24-year-old woman presented to the physician for evaluation of episodic evaluations of hypertension, sweating, and tachycardia. The patient was diagnosed with pheochromocytoma and was scheduled for surgery and was started on medication immediately prior to surgery. What is the mode of action of this drug?
A. Irreversibly binds alpha 1 and 2
B. Irreversibly inhibits b1
C. Reversibly inhibits alpha 1
D. Reversibly inhibits b2
E. Reversibly inhibits M2
Answer: A Irreversibly binds alpha 1 and 2
A 22 year old woman goes to her local pharmacy for an over-the-counter decongestant. She grabs Neo-synephrine (active ingredient is phenylephrine- an ɑ-1 agonist) and her symptoms promptly subside. Which of the following intracellular signaling changes most likely occurs after administration?
A. ↓IP3
B. ↑cAMP
C. ↓DAG
D. ↑Ca2+
E. ↓NO
Answer: D ↑Ca2+
Drug X has a half-life of 8 hours. A patient receiving Drug X begins to seize when the drug reaches steady-state levels. The drug is immediately discontinued. How long will it take until his plasma levels of Drug X are approximately 6% of the steady-state levels?
A. 8 hours
B. 16 hours
C. 24 hours
D. 32 hours
E 48 hours
D. 32 hours
A 3 month old infant is brought to the pediatrician due to failure to thrive, developmental delay, and recurrent episodes of pallor. Laboratory testing reveals macrocytic anemia with megaloblastic changes, elevated orotic acid in the urine, and normal ammonia formation. A diagnosis of orotic aciduria is suspected. Your attending turns to you and says, "Your 4 options for plan of treatment are ...." What are you going with?
A. Uridine monophosphate supplementation
B. Pyridoxine supplementation
C. Sulfonamide
D. 5- Fluorouracil
A. Uridine monophosphate supplementation
You see your neighbor being rushed to the hospital because he was doing his normal pesticide spraying routine on his farm. He prides himself on his farm and always wants to ensure maximal growth so he can provide for his customers. Physical examination shows diaphoresis, bradycardia, and lethargy. He is also complaining of having to use the bathroom “too bloody much.” What is the cause of his condition?
A. Reversible inhibition of choline acetyltransferase
B. Irreversible inhibition of acetylcholinesterase
C. Inhibition of Ach secretion
D. Irreversible inhibition of tyrosine hydroxylase
E. Irreversible inhibition of choline acetyltransferase
Answer: B Irreversible inhibition of acetylcholinesterase
Your patient presents to the emergency room with palpitations and sweating. He states that he has been monitoring his blood pressure at home and the average is 160-170/100-110. He mentions that he has a history of asthma and allergy to Penicillin. You review his chart and start him on
A. Propranolol
B. Nadalol
C. Timolol
D. Metoprolol
E. Prazosin
D. Metoprolol
A 23-year-old healthy man comes to the physician for a routine medical examination. He is a trained athlete and a regular soccer player. He does not take any medication. His pulse is 51/min, respirations are 14/min and blood pressure is 126/74 mm Hg. Physical examination shows no abnormalities except for bradycardia. The physician tells him that he is perfectly normal, and his low pulse rate is because of an increased resting vagal tone that is common in trained athletes. Which of the following receptors in the heart most likely are active by an increased vagal tone in this patient?
A. M1 muscarinic
B. M2 muscarinic
C. M3 Muscarinic
D. Nicotinic M subtype
E. Alpha-1 adrenergic
F. Beta-1 adrenergic
Answer: B M2 muscarinic
A 4 year old female presents with her mother to your pediatrics office for her regular check up. She has severe scoliosis and is very short for her age. You look at her history and see that she had a complicated birth, breaking many of her bones. She has broken many bones since. The patient also has blue sclera and dentiogenesis imperfecta. What genetic disorder is described?
A. OI Type I
B. OI Type II
C. OI Type III
D. Ehlers Danlos
C. OI Type III
You are climbing Mt. Everest when a man comes running towards you in a confused and frantic state. He complaints of shortness of breath and heart palpitations. You realize that he is in a hypoxic state and you quickly think back to your pyrimidine synthesis lecture and... OH NO! His ATP is depleted! What is the effect seen on de novo pyrimidine synthesis?
A. CPS-II inhibition
B. CPS- I inhibition
C. CPS II activation
D. CPS-I activation
E. What is ATP and why is it even relevant to this situation?...
A. CPS-II inhibition
A 19-year-old female presented to the emergency department for evaluation of a high fever of 103.4 F. Examination showed that the patient had severe dry mouth, appeared flushed, and was confused about her location. Which of the following would the patient be treated with?
A. Atropine
B. Physostigmine
C. Neostigmine
D. Pyridostigmine
E. Bethanecol
Answer: B Physostigmine
A 58 year old man with a history of major depressive disorder is brought to the emergency department by his wife due to a severe headache, palpitations, and high blood pressure after eating a meal containing aged cheese and red wine. His blood pressure is 210/110 mmHg, and he is sweating profusely. His medications include phenelzine, which he started two months ago. Which of the following best explains this patient's hypertensive crisis?
A. Direct stimulation of alpha-1 adrenergic receptors
B. Upregulation of beta-2 adrenergic receptors, causing vasoconstriction
C. Tyramine-induced norepinephrine release due to monoamine oxidase inhibition
D. Inhibition of M2 receptors, causing increased contractility of the heart
C. Tyramine-induced norepinephrine release due to monoamine oxidase inhibition
Which of the following effectors only have sympathetic innervation?
A. Blood vessels in the skeletal muscles
B. Sweat glands
C. Arrector pili muscles
D. All of the above
E. None of the above
D. All of the above
You and your best friend go to the gym for a quick session to take a break from FTM 2. He tells you that although he enjoys going to the gym for a weight lifting session, he has a love for running long distances because it helps him clear his mind. What is the most likely muscle type found in his body?
A. Slow twitch, fatigue resistant
B. Fast twitch, fatigue resistant
C. Fast twitch, fatigue prone
D. Slow twitch, fatigue prone
A. Slow twitch, fatigue resistant
A 54-year- old woman with rheumatoid arthritis is started on methotrexate therapy. After several weeks, she develops fatigue, oral ulcers, and pancytopenia. Her symptoms improve after administration with folinic acid. Which of the following best describes the mechanism of action of methotrexate?
A. Inhibition of dihydrofolate reductase, preventing tetrahydrofolate synthesis
B. Inhibition of thymidylate synthase, preventing DNA synthesis
C. Inhibition of inosine monophosphate dehydrogenase, reducing purine synthesis
D. Inhibition of folic acid, preventing tetrahydrofolic acid
A. Inhibition of dihydrofolate reductase, preventing tetrahydrofolate synthesis