CHOLINOCEPTOR BLOCKING DRUGS
1. The group of nicotinic receptor-blocking drugs consists of:
a) Ganglion-blockers
b) Atropine-similar drugs
c) Neuromuscular junction blockers
d) Both a and c
2. M3 receptor subtype is located:
a) In the myocardium
b) In sympathetic postganglionic neurons
c) On effector cell membranes of glandular and smooth muscle cells
d) On the motor end plates
3. Which of the following drugs is both a muscarinic and nicotinic blocker?
a) Atropine
b) Benztropine
c) Hexamethonium
d) Succinylcholine
4. Indicate a muscarinic receptor-blocking drug:
a) Scopolamine
b) Pipecuronium
c) Trimethaphan
d) Pilocarpine
5. Which of the following agents is a ganglion-blocking drug?
a) Homatropine
b) Hexamethonium
c) Rapacuronium
d) Edrophonium
6. Indicate the skeletal muscle relaxant, which is a depolarizing agent:
a) Vencuronium
b) Scopolamine
c) Succinylcholine
d) Hexamethonium
7. Which of the following drugs is a nondepolarizing muscle relaxant?
a) Pancuronium
b) Succinylcholine
c) Hexamethonium
d) Scopolamine
8. Indicate the drug, which is rapidly and fully distributed into CNS and has a greater effect than most other antimuscarinic
agents?
a) Atropine
b) Scopolamine
c) Homatropine
d) Ipratropium
9. The effect of the drug on parasympathetic function declines rapidly in all organs EXCEPT:
a) Eye
b) Heart
c) Smooth muscle organs
d) Glands
10. The mechanism of atropine action is:
a) Competitive ganglion blockade
b) Competitive muscarinic blockade
c) Competitive neuromuscular blockade
d) Noncompetitive neuromuscular blockade
11. The tissues most sensitive to atropine are:
a) The salivary, bronchial and sweat glands
b) The gastric parietal cells
c) Smooth muscle and autonomic effectors
d) The heart
12. Atropine is highly selective for:
a) M1 receptor subtype
b) M2 receptor subtype
c) M3 receptor subtype
d) All of the above
13. Which of the following antimuscarinic drugs is often effective in preventing or reversing vestibular disturbances,
especially motion sickness?
a) Atropine
b) Ipratropium
c) Scopolamine
d) Homatropine
14. Atropine causes:
a) Miosis, a reduction in intraocular pressure and cyclospasm
b) Mydriasis, a rise in intraocular pressure and cycloplegia
c) Miosis, a rise in intraocular pressure and cycloplegia
d) Mydriasis, a rise in intraocular pressure and cyclospasm
15. Patients complain of dry or “sandy” eyes when receiving large doses of:
a) Atropine
b) Hexamethonium
c) Pilocarpine
d) Carbachol
16. All of the following parts of the heart are very sensitive to muscarinic receptor blockade except:
a) Atria
b) Sinoatrial node
c) Atrioventricular node
d) Ventricle
17. Atropine causes:
a) Bradycardia, hypotension and bronchoconstriction
b) Tachycardia, little effect on blood pressure and bronchodilation
c) Decrease in contractile strength, conduction velocity through the AV node
d) Tachycardia, hypertensive crisis and bronchodilation
18. Atropine is frequently used prior to administration of inhalant anesthetics to reduce:
a) Muscle tone
b) Secretions
c) Nausea and vomiting
d) All of the above
19. Atropine is now rarely used for the treatment of peptic ulcer because of:
a) Slow gastric empting and prolongation of the exposure of the ulcer bed to acid
b) Low efficiency and necessity of large doses
c) Adverse effects
d) All of the above
20. Which of the following antimuscarinic drugs is a selective M1 blocker?
a) Atropine
b) Scopolamine
c) Pirenzepine
d) Homatropine
21. Atropine causes:
a) Spasmolitic activity
b) Intestinal hypermotility
c) Stimulation of contraction in the gut
d) Stimulation of secretory activity
22. Which of the following drugs is useful in the treatment of uterine spasms?
a) Carbachol
b) Vecuronium
c) Atropine
d) Edrophonium
23. Atropine may cause a rise in body temperature (atropine fever):
a) In adults
b) In pregnant women
c) In infants and children
d) All of the above
24. The pharmacologic actions of scopolamine most closely resemble those of:
a) Hexamethonium
b) Atropine
c) Succinylcholine
d) Pilocarpine
25. Compared with atropine, scopolamine has all of the following properties EXCEPT:
a) More marked central effect
b) Less potent in decreasing bronchial, salivary and sweat gland secretion
c) More potent in producing mydriasis and cycloplegia
d) Lower effects on the heart, bronchial muscle and intestines
26. Which of the following drugs is useful in the treatment of Parkinson's disease?
a) Benztropine
b) Edrophonium
c) Succinylcholine
d) Hexamethonium
27. Indicate the antimuscarinic drug, which is used as a mydriatic:
a) Pilocarpine
b) Neostigmine
c) Homatropine
d) Ipratropium
28. Which of the following agents is used as an inhalation drug in asthma?
a) Atropine
b) Ipratropium
c) Lobeline
d) Homatropine
29. Which of the following agents is most effective in regenerating cholinesterase associated with skeletal muscle
neuromuscular junctions?
a) Suscinilcholine
b) Pralidoxime
c) Pirenzepine
d) Propiverine
30. Indicate an antimuscarinic drug, which is effective in the treatment of mushroom poising:
a) Pralidoxime
b) Pilocarpine
c) Homatropine
d) Atropine
31. Antimuscarinics are used in the treatment of the following disorders EXCEPT:
a) Motion sickness
b) Glaucoma
c) Hyperhidrosis
d) Asthma
32. The atropine poisoning includes all of the following symptoms EXCEPT:
a) Mydriasis, cycloplegia
b) Hyperthermia, dry mouth, hot and flushed skin
c) Agitation and delirium
d) Bradicardia, orthostatic hypotension
33. The treatment of the antimuscarinic effects can be carried out with:
a) Neostigmine
b) Hexametonium
c) Homatropine
d) Acetylcholine
34. Contraindications to the use of antimuscarinic drugs are all of the following except:
a) Glaucoma
b) Myasthenia
c) Bronchial asthma
d) Paralytic ileus and atony of the urinary bladder
35. Hexamethonium blocks the action of acethylcholine and similar agonists at:
a) Muscarinic receptor site
b) Neuromuscular junction
c) Autonomic ganglia
d) Axonal transmission
36. The applications of the ganglion blockers have disappeared because of all of the following reasons EXCEPT:
a) Orthostatic hypotension
b) Lack of selectivity
c) Homeostatic reflexes block
d) Respiratory depression
37. Which of the following agents is a short-acting ganglion blocker?
a) Homatropine
b) Trimethaphane
c) Hexamethonium
d) Pancuronium
38. Indicate the ganglion-blocking drug, which can be taken orally for the treatment of hypertension?
a) Mecamylamine
b) Scopolamine
c) Trimethaphane
d) Vecocuronium
39. The systemic effects of hexamethonium include all of the following EXCEPT:
a) Reduction of both peripheral vascular resistance and venous return
b) Partial mydriasis and loss of accommodation
c) Constipation and urinary retention
d) Stimulation of thermoregulatory sweating
40. Ganglion blocking drugs are used for the following emergencies EXCEPT:
a) Hypertensive crises
b) Controlled hypotension
c) Cardiovascular collapse
d) Pulmonary edema
41. Agents that produce neuromuscular blockade act by inhibiting:
a) Interaction of acetylcholine with cholinergic receptors
b) Release of acetylcholine from prejunctional membrane
c) Packaging of acetylcholine into synaptic vesicles
d) Reuptake of acetylcholine into the nerve ending
42. Skeletal muscle relaxation and paralysis can occur from interruption of functions at several sites, including all of the
following EXCEPT:
a) Nicotinic acethylcholine receptors
b) Muscarinic acethylcholine receptors
c) The motor end plate
d) Contractile apparatus
43. Nondepolarisation neuromuscular blocking agents:
a) Block acetylcholine reuptake
b) Prevent access of the transmitter to its receptor and depolarization
c) Block transmission by an excess of a depolarizing agonist
d) All of the above
44. Which of the following drugs has “double-acetylcholine” structure?
a) Rocuronium
b) Carbachol
c) Atracurium
d) Succylcholine
45. Indicate the long-acting neuromuscular blocking agent:
a) Rapacuronium
b) Mivacurium
c) Tubocurarine
d) Rocuronium
46. Which of the following neuromuscular blocking drugs is an intermediate-duration muscle relaxant?
a) Vecuronium
b) Tubocurarine
c) Pancuronium
d) Rapacuronium
47. Indicate the nondepolarizing agent, which has the fastest onset of effect?
a) Succinylcholine
b) Rapacuronium
c) Pancuronium
d) Tubocurarine
48. Indicate the neuromuscular blocker, whose breakdown product readily crosses the blood-brain barrier and may cause
seizures:
a) Pancuronium
b) Succinylcholine
c) Tubocurarine
d) Atracurium
49. Which competitive neuromuscular blocking agent could be used in patients with renal failure?
a) Atracurium
b) Succinylcholine
c) Pipecuronium
d) Doxacurium
50. Indicate the nondepolarizing agent, which has short duration of action:
a) Succinylcholine
b) Tubocurarine
c) Mivacurium
d) Pancuronium
51. Which depolarizing agent has the extremely brief duration of action?
a) Mivacurium
b) Rapacuronium
c) Rocuronium
d) Succinylcholine
52. Neuromuscular blockade by both succinylcholine and mivacurium may be prolonged in patients with:
a) Renal failure
b) An abnormal variant of plasma cholinesterase
c) Hepatic disease
d) Both b and c
53. Depolarizing agents include all of the following properties EXCEPT:
a) Interact with nicotinic receptor to compete with acetylcholine without receptor activation
b) React with the nicotinic receptor to open the channel and cause depolarisation of the end plate
c) Cause desensitization, noncompetive block manifested by flaccid paralysis
d) Cholinesterase inhibitors do not have the ability to reverse the blockade
54. Which of the following neuromuscular blockers causes transient muscle fasciculations?
a) Mivacurium
b) Pancuronium
c) Succinylcholine
d) Tubocurarine
55. Indicate muscles, which are more resistant to block and recover more rapidly:
a) Hand
b) Leg
c) Neck
d) Diaphragm
56. Which neuromuscular blocking agent has the potential to cause the greatest release of histamine?
a) Succylcholine
b) Tubocurarine
c) Pancuronium
d) Rocuronium
57. Which of the following muscular relaxants causes hypotension and bronchospasm?
a) Vecuronium
b) Succinylcholine
c) Tubocurarine
d) Rapacuronium
58. Indicate the neuromuscular blocker, which causes tachycardia:
a) Tubocurarine
b) Atracurium
c) Pancuronium
d) Succinylcholine
59. Which of the following neuromuscular blocking agents cause cardiac arrhythmias?
a) Vecuronium
b) Tubocurarine
c) Rapacuronium
d) Succinylcholine
60. Effects seen only with depolarizing blockade include all of the following EXCEPT:
a) Hypercaliemia
b) A decrease in intraocular pressure
c) Emesis
d) Muscle pain
61. Which neuromuscular blocking agent is contraindicated in patients with glaucoma?
a) Tubocurarine
b) Succinylcholine
c) Pancuronium
d) Gallamine
62. Indicate the following neuromuscular blocker, which would be contraindicated in patients with renal failure:
a) Pipecuronium
b) Succinylcholine
c) Atracurium
d) Rapacuronium
63. All of the following drugs increase the effects of depolarizing neuromuscular blocking agents EXCEPT:
a) Aminoglycosides
b) Antiarrhythmic drugs
c) Nondepolarizing blockers
d) Local anesthetics
64. Which of the following diseases can augment the neuromuscular blockade produced by nondepolarizing muscle
relaxants?
a) Myasthenia gravis
b) Burns
c) Asthma
d) Parkinsonism
65. Indicate the agent, which effectively antagonizes the neuromuscular blockade caused by nondepolarizing drugs:
a) Atropine
b) Neostigmine
c) Acetylcholine
d) Pralidoxime
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