1 BIOLOGY 4480 EXAM 2- FALL 2006 1.

Your neighbor Mel Gibson was taken to the hospital suffering from the following symptoms: skeletal muscle fasciculation (twitching), excessive sweating, diarrhea and drooling. Exposure to which of the following would explain all these symptoms? 1. 2. 3. 4. 2. an indirect-acting cholinergic agonist a non-depolarizing neuromuscular blocking agent a ganglionic antagonist a muscarinic agonist

The muscarinic agonist bethanechol (URECHOLINE) increases _____________ which is useful in the treatment of ________________, but can cause ______________________. 1. 2. 3. 4. heart rate; bradycardia; tachycardia GI tone and motility, post-operative constipation; diarrhea the force of skeletal muscle contraction; myasthenia gravis; skeletal muscle paralysis blood pressure; hypotension; hypertension

3.

Which of the following is a side effect associated with the use of a muscarinic antagonist like atropine? 1. 2. 3. 4. hypotension diarrhea tachycardia skeletal muscle paralysis

4.

Muscarinic agonists can __________ and their use in _______________ should be avoided if possible. 1. 2. 3. 4. reduce gastric acid production; those with peptic ulcers cause constipation; post-operative diarrhea increase blood pressure; hypertensive individuals cause bronchiole constriction; asthmatics

5.

At therapeutic doses, the non-depolarizing neuromuscular agent pancuronium (PAVULON) 1. 2. 3. 4. paralyzes gastrointestinal smooth muscle causes skeletal muscle paralysis by blocking nicotinic receptors at the NMJ inhibits the activity of acetylcholinesterase (AChE) All of the above.

For question 6-9, select the BEST answer from the choices listed below. Each is used once. 1. 2. 3. 4. ganglionic antagonist depolarizing neuromuscular blocking agent indirect-acting cholinergic agonist non-depolarizing neuromuscular blocking agent

The muscle paralysis caused by a(n)_______6______ can be reversed with a(n) ________7________. 8. 9. Decreased blood pressure and heart rate followed by constipation and urine retention are responses associated with the use of a(n)_________________ Acetylcholinesterase found at the neuromuscular junction reverses the effects of a(n) ___________.

2 10. Indirect-acting cholinergic agents like neostigmine (PROSTIGMIN) are used to treat the skeletal muscle weakness associated with myasthenia gravis but can also cause muscle paralysis. Which of the following statements BEST explains how this occurs? 1. 2. 3. 4. 11. These highly charged drugs prevent the activation of ganglionic nicotinic receptors. ACh is not broken down at the NMJ, causing continual activation of nicotinic receptors and an inability to repolarize the muscle. The extension of AChs half-life at the NMJ leads to muscarinic receptor downregulation. ACh induces the activity of acetylcholinesterase at the NMJ causing the more rapid turnover of ACh.

Muscarinic receptor antagonists produce which of the following effects at the NMJ? 1. 2. 3. 4. They cause an initial muscle contraction followed by flaccid muscle paralysis. They block ACh access to receptors and cause flaccid paralysis. They downregulate receptors which weakens skeletal muscle contraction. They have little or no effect at the NMJ.

12.

Which of the following drugs would be the BEST choice for producing the short-lived muscle paralysis required to set a dislocated shoulder? 1. 2. 3. 4. a ganglionic antagonist an indirect-acting cholinergic agonists a depolarizing neuromuscular blocking agent a non-depolarizing neuromuscular blocking agent

13.

At therapeutic doses, which of the following drugs will affect heart rate? 1. 2. 3. 4. a muscarinic antagonist a non-selective antagonist norepinephrine (NE) All of these drugs will affect heart rate.

14.

In the pancreas, 1 receptor activation by epinephrine (EPI) inhibits insulin secretion while 2 receptor activation by isoproterenol (ISO) stimulates insulin secretion. Based on your knowledge of catecholamines, which of the following statements BEST explains these results? 1. 2. 3. 4. EPI is an 1 agonist and a 2 antagonist. EPI is an 1 antagonist and a 2 agonist There are more 1 than 2 receptors in the pancreas. EPI is converted to NE which has no effect at 2 receptors.

15.

An i.v. injection of NE can produce which of the following responses? 1. 2. 3. 4. bronchiole dilation hypertension CNS excitation bradycardia

16.

Since a 1 antagonist ______________ it can be used to treat ________________. 1. 2. 3. 4. reduces heart rate; tachycardia dilates both arteries and veins; hypertension increases the force of cardiac muscle contraction; heart failure relaxes bronchiole smooth muscle; asthma

3 17. At therapeutic doses, which of the following drugs would affect respiratory function? 1. 2. 3. 4. 18. a 1 antagonist a 2 agonist norepinephrine a 1 agonist

Indirect-acting adrenergic agonists produce their effects by ________________. 1. 2. 3. 4. inhibiting the activity of the inactivating enzymes monoamine oxidase and catechol-Ometheyltransferase inhibiting the re-uptake of NE antagonizing the activation of presynaptic 2 receptors All of the above.

For questions 19-22, select the BEST answer from the choices listed below. Each is used once. 1. 2. 3. 4. 19. 20. 21. 22. 23. The 1 agonist phenylephrine (NEO-SYNEPHRINE) The 2 agonist albuterol (VENTOLIN) The 1 antagonist prazosin (MINPRESS) The non-selective antagonist propranolol

____________ is used to treat arrhythmias but should be used cautiously in asthmatics. ____________ is the best choice for a bronchiole dilator in patients with a history of cardiac arrhythmia. ____________ reduces blood pressure by relaxing vascular smooth muscle. ____________ can relieve nasal congestion but can also elevate blood pressure. Which of the following is(are) characteristics of all catecholamines? 1. 2. 3. 4. They are subject to extensive first pass metabolism in the liver. They have cause intense CNS excitation following i.v. injection. They are effective after oral administration. All of the above.

24.

Inhibitory neurotransmitters like gamma amino butyric acid (GABA) ___________ post-synaptic nerves by ____________ channels. 1. 2. 3. 4. hyperpolarize; opening chloride (Cl-) depolarize; closing sodium (Na+) inhibit; blocking K+ activate; opening Ca2+

25.

Excitatory post-synaptic potentials (EPSPs) ________________. 1. 2. 3. 4. occur in response to Cl- channel blockade are the result of Na+ channel opening and depolarization of post-synaptic nerves lead to hyperpolization of post-synaptic nerves are caused by Ca2+ channel blockade and the hyperpolarization of post-synaptic nerves

4 26. Which of the following statements is TRUE? 1. 2. 3. 4. 27. The loss of 70-80% of the cholinergic nerves in the motor cortex is the underlying cause of PD. The loss of dopaminergic neurons is found only in patients with PD. Most treatments for PD involve elevating DA activity. All of these statements are TRUE.

_________________ directly activate DA receptors without prior conversion to DA. 1. 2. 3. 4. MAO-B inhibitors like selegiline (ELDEPRYL) DA receptor agonists like bromocriptine (PARLODEL) amino acid decarboxylase inhibitos like carbidopa catechol-O-methyltransferase (COMT) inhibitors like tolcapone (TASMAR)

28.

Underlying inflammatory problems may contribute to the pathology of neurodegenerative disorders like Parkinsons Disease (PD). Which of the following statements BEST supports that hypothesis? 1. 2. 3. 4. Hydroxyl free radicals are generated in the normal course of DA metabolism. Inhibition of mitochondrial electron transport compromises ATP production. Excitotoxic injury may result from the activation of neurotransmitter receptors which gate Ca2+ rather than Na+ channels. PD is less prevalent in people taking NSAIDs for chronic arthritis pain.

29.

The dyskinesia (involuntary movements of the limbs, hands and head) observed with long-term high dose drug therapy with L-dopa/carbidopa may be the result of _________ and seem to be relieved by ___________. 1. 2. 3. 4. conversion of L-Dopa into a dopamine (DA) receptor antagonist; lowering the dose of L-Dopa upregulation of DA receptors; increasing the dose of L-Dopa administered the anti-muscarinic effects of L-Dopa; administering a muscarinic receptor agonist fluctuating levels of DA; maintaining constant blood levels of DA with sustained release preparations

30.

The amino acid decarboyxlase inhibitor carbidopa and the catecho-O-methyltransferase inhibitor talcapone are used together to ___________ but do not affect dopamine conversion in the brain because______________. 1. 2. 3. 4. prevent the peripheral conversion of DA to L-dopa; they are subject to first pass metabolism in the liver prevent the peripheral conversion of L-dopa to DA; they do not cross the blood-brain barrier stimulate the peripheral metabolism of L-dopa to DA; their half-lives are too short to affect DA metabolism in the brain stimulate the peripheral metabolism of DA to DOPAC; they cannot be administered orally

31.

Which of the following statements is TRUE? 1. 2. 3. 4. Neuropathic pain is the consequence of nerve damage and responds well to treatment with NSAIDs or opioids. The subjective aspects of pain require interpretation by higher cortical centers of the brain and are effectively inhibited by the administration of NSAIDs. Nociceptive pain is caused by activating nociceptive receptors and the transmission of this activation along nerve pathways. In most circumstances, pain serves no useful protective function.

5 32. Aspirin suppresses platelet aggregation by ________________. 1. 2. 3. 4. 33. inhibiting the production of thromboxane stimulating vasodilation and local edema suppressing the activity of COX1 but not COX2 reducing prostaglandin production

Aspirin _____________________________. 1. 2. 3. 4. inhibits COX1 but not COX2 reduces fever through peripheral vasodilation overdoses are not lethal even when large doses are consumed stimulates prostaglandin synthesis in the stomach

34.

The newest NSAIDs (celecoxib {CELEBREX] and the recently withdrawn roficoxib [VIOXX]) ________. 1. 2. 3. 4. do not reduce fever or relieve pain have limited effects on prostaglandin synthesis is the stomach target the constitutively active form of COX All of the above.

35.

Acetaminophen (TYLENOL) ___________________. 1. 2. 3. 4. effectively inhibits the production of inflammatory mediators should not be used to reduce fever in children suffering from a viral infection like a cold or the flu can cause liver damage and should not be taken by someone has consumed alcohol suppresses the activity of both COX1 and COX2

36.

Which of the following is a CNS effect associated with the use of the opioid analgesic morphine? 1. 2. 3. 4. vasodilation urine retention emesis constipation

37.

________________________ limits the dose of morphine that can be delivered to relieve pain. 1. 2. 3. 4. Emesis (nausea and vomiting) Cough supression Reduced GI tone and motility Respiratory depression

38.

Post-synaptic opioid receptors increase K+ entrance which ______________________. 1. 2. 3. 4. hyperpolarizes the post-synaptic cell and prevents nerve transmission prevents Ca2+ entrance and the release of neurotransmitter from the presynaptic cells enhances Na+ entry into post-synaptic cells causing excitatory post-synaptic potentials (EPSPs) phosphorylates and opens Na+ channels and produces an inhibitory post-synaptic potential (IPSP)

6 39. Repeated administration of the opioid analgesic methadone (DOLOPHIN) extends its half-life from about 2 hours to 24-48 hours. Why would this be useful in detoxifying heroin addicts? 1. 2. 3. 4. Methadones duration of action will be substantially shortened and its analgesic properties diminished. The dose of methadone could slowly be reduced making withdrawal symptoms be more tolerable. Methadone would be converted from a receptor agonist into receptor antagonist which would block withdrawal symptoms. Methadone would no longer cause respiratory depression making it safe to administer higher and higher doses.

40.

Which of the following statements is TRUE? 1. 2. 3. 4. Because of their distinct mechanisms of action, the combination preparation of the opioid oxycodone and the NSAID aspirin (PERCODAN) can provide the same degree of analgesia as a larger dose of oxycodone alone. The dose of morphine administered to a patient tolerant to its analgesic effects could be lethal for a patient receiving the same dose for the first time. Abstinence syndrome is a collection of physical symptoms that occur in response to opioid withdrawal. All of these statement are TRUE.

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