BLOCK - XII| PHARMACOLOGY|
MENTOR GROUP 11 & 12
QUESTIONS
RATIONALE
1. The following are G-coupled receptors except:
a. Dopamine receptors
b. Alpha receptors
c. Muscarinic
d. Nicotinic
Reference: MADIWA PHB12L1 pp. 2,5
*dopamine receptors are adrenergic receptors
2. A patient was brought into the ER Department with
weakness, hypersalivation, a lot of pulmonary secretions,
miosis, and increased tearing. You suspect that he has some
form of toxicity. This is probably due to an overdose/toxicity
of:
a. Parathion
b. Atropine
c. Tubocurarine
d. Pralidoxime
The clinical presentation is consistent with
organophosphate poisoning. Parathion is a very
long acting organophosphate.
Both Atropine and Pralidoxime are given as
antidotes/ treatment to organophosphate
poisoning or toxicity.
Tubocurarine is a nicotinic receptor antagonist and
the clinical manifestations should be the opposite.
3. Full activation of the parasympathetic nervous system will Reference: MADIWA PHB12L1 pp.1-2
produce:
a. bronchodilation
b. increased heart rate
c. miosis
d. decreased intestinal motility
BLOCK - XII| PHARMACOLOGY|
MENTOR GROUP 11 & 12
4. The treatment for organophosphate poisoning is
Atropine. What will be your clue that the patient is receiving
an adequate dose of Atropine?
a. mydriasis
b. hypersalivation
c. hypothermia
d. increased gastrointestinal motility
5. Muscarinic cholinergic drugs can be used to treat the Remember DUMBBELLS:
following conditions EXCEPT:
Diarrhea
a. Sjogren's syndrome
Urination
b. Post-op urinary retention
Miosis
c. Bowel atony
Bradycardia
d. Bronchial asthma
Bronchoconstriction
Emesis
Lacrimation
Lethargy
Salivation
Muscarinic
cholinergic
drugs
cause
bronchoconstriction
and
may
aggravate
symptoms of bronchial asthma.
6. A 57 year old male patient undergoes radiotherapy for a Reference: MADIWA PHB12L1 p. 4
neck tumor. He develops salivary gland hypofunction which
manifests as dry mouth. Which of the following drugs can
BLOCK - XII| PHARMACOLOGY|
MENTOR GROUP 11 & 12
you use to improve his dry mouth?
a. Atropine
b. Nicotine
c. Pilocarpine
d. Ipratropium
7. A patient who underwent abdominal surgery experiences Reference: MADIWA PHB12L1 p. 4
post-op urinary retention. What can you give him?
a. Atropine
b. Scopolamine
c. Betanechol
d. Succinylcholine
8. A patient who presents with drooping of the eyelids and Reference: MADIWA PHB12L1 p. 5
generalized muscle fatigue after exertion, but relieved after
the test, is suspected to have Myasthenia gravis. What drug
is used to test for the presence of this condition?
a. Edrophonium
b. Atropine
c. Neostigmine
d. Succinylcholine
9. What is the better drug to give chronically as a treatment Reference: Katzung Basic Clinical Pharmacology
for myasthenia gravis that doesn’t cross the blood brain 14th ed pg. 119-121
barrier?
a. Endrophonium
B. Neostigmine
c. Physostigmine
d. Pyridostigmine
BLOCK - XII| PHARMACOLOGY|
MENTOR GROUP 11 & 12
10. What are the expected findings in a patient who is given since atropine is a cholinergic antagonist, it has
atropine?
effects opposite to cholinergic drugs
a. Bronchodilation
b. Tachycardia
c. Mydriasis
d. All of the above
11. Before applying topical eye drops in order to dilate the
pupils, what must first be considered/examined?
a. All of the above
b. Temperature
c. Intraocular pressure
d. Blood pressure
Di ko sure pero;
Medications like Atropine cause an increase in
intraocular pressure while Pilocarpine causes a
decrease in intraocular pressure. Assessing the
ocular pressure prior to administration of
eyedrops enables the physician to decide whether
to continue administration or not.
Reference:
MADIWA PHB12L1
BLOCK - XII| PHARMACOLOGY|
MENTOR GROUP 11 & 12
12. Muscarinic receptors which are primarily associated with
the heart:
a. M3
b. M5
c. M2
d. M1
Reference: MADIWA PHB12L1 page 3, table 3
13. Stimulation of M2 receptor will cause:
a. Increased phase 4 depolarization
b. Decreased atrial and ventricular contractility
c. Increased AV nodal conduction velocity
d. All of the above
14. A carpenter was rushed to the Emergency room because
of severe bradycardia and hypotension. What drug will you
give this patient?
A. Ipratropium
B. Betanechol
C. Atropine
D. Pralidoxime
Reference: See number 12 above.
BLOCK - XII| PHARMACOLOGY|
MENTOR GROUP 11 & 12
Reference: MADIWA PHB12L1 page 6
BLOCK - XII| PHARMACOLOGY|
MENTOR GROUP 11 & 12
15. Where is Acetylcholine not the neurotransmitter?
A. Sympathetic preganglionic neuron
B. Sympathetic postganglionic neuron
C. Parasympathetic postganglionic neuron
D. parasympathetic preganglionic neurons
Reference: MADIWA PHB12L1 page 1 table 1
16.
17. A 43 -year old housewife was rushed to the ER
Department with lacrimation, nausea drooling, pinpoint
pupils, and bradycardia. Asked about her history, the family
mentioned that the patient had previously madea salad
from various stuff found growing in an abandoned lot near
her house. You believe this is a case of food poisoning
caused by this active ingredient:
A. Atropine
B. Cocaine
C. Nicotine
D. Muscarine
BLOCK - XII| PHARMACOLOGY|
MENTOR GROUP 11 & 12
Reference: Katzung, Bertram G., and Anthony J.
Trevor. 2018. Basic and Clinical Pharmacology,
14th Edition, pp 110, 120, 132
18.
19. Parasympathetic preganglionic ganglia originate in all of
the following except:
a. T1-T12
b. S2-S4
c. Cranial Nerve X
d. Cranial Nerve III
Reference: MADIWA PHB12L1 page 1 table 1
20. Patient with myasthenia gravis and on meds came back
with complaints of weakness and recurrent eyelid drooping.
After testing on edrophonium, her condition worsens. you
can conclude that the patient:
a. myasthenic crisis
A patient with symptoms (fluctuating muscle
weakness, ocular and bulbar symptoms, and
proximal muscle weakness) given Edrophonium
and improves mean patient is undermedicated
and is in myasthenic crisis; if worsened symptoms
with Edrophonium, patient is overmedicated and
BLOCK - XII| PHARMACOLOGY|
MENTOR GROUP 11 & 12
b. cholinergic crisis
c. is in need of changing her meds
d. underdosed
is in cholinergic crisis
Reference: MADIWA PHB1L2 pg5
21. Treatment of a patient presenting with seizures , Organ System Effects of Atropine
bronchoconstriction, diarrhea:
● Central nervous system - In the doses usually
used, atropine has minimal stimulant effects
A. Pralidoxime
on the CNS, especially the parasympathetic
B. Succinylcholine
medullary centers, and a slower, longerC. Betanechol
lasting sedative effect on the brain.
D. Atropine
● Respiratory system - Both smooth muscle and
secretory glands of the airway receive vagal
innervation and contain muscarinic receptors.
Even in normal individuals, administra- tion of
atropine can cause some bronchodilation and
reduce secretion.
● Gastrointestinal tract - Gastrointestinal
smooth muscle motility is affected from the
stomach to the colon. In general,
antimuscarinic drugs diminish the tone and
propulsive movements; the walls of the
viscera are relaxed. Therefore, gastric
emptying time is prolonged, and intestinal
transit time is lengthened. Diarrhea due to
overdosage with parasympathomimetic
agents is readily stopped, and even diarrhea
caused by non-autonomic agents can usually
be temporarily controlled.
Reference: Katzung's Basic Clinical Pharmacology;
14th ed; pages 127, 129
22. This drug inhibits the transport of choline into the nerve Choline is transported from the extracellular fluid
terminal:
into the neuron terminal by a sodium-dependent
membrane choline transporter (CHT; Figure 6–3).
A. Vesamicol
This symporter can be blocked by a group of
B. Hemicholinium
research drugs called hemicholiniums.
C. Epinephrine
D. Atropine
Reference: Katzung's Basic Clinical Pharmacology;
BLOCK - XII| PHARMACOLOGY|
MENTOR GROUP 11 & 12
14th ed; page 93
23. Botulinum, which causes poisoning, has been used by
dermatologists to smoothen wrinkles. Which of the
following statements about botulinum is correct?
A. Is a very large molecule and needs to bind to
membrane receptors and enter by endocytosis
B. Botulinum prevents the synthesis of acetylcholine
C. Botulinum-binding receptors for endocytosis are
present in both adrenergic and cholinergic neurons
D. Botulinum poisoning presents with diarrhea, and
skeletal and bronchial muscle spasm
“…All BoNTs enter human or animal neuronal cells
via receptor mediated endocytosis and cleave
cytosolic SNARE proteins, resulting in a block of
synaptic vesicle exocytosis, leading to the flaccid
paralysis…”
“… The acetylcholine vesicle release process is
blocked by botulinum toxin through the
enzymatic cleavage of two amino acids from one
or more of the fusion proteins.”
“... Signs and symptoms might include: Difficulty
swallowing, Muscle weakness, Double vision,
Drooping eyelids, Blurry vision, Slurred speech,
Difficulty breathing, Difficulty moving the eyes.”
References:
Pellett, S., Tepp, W. H., Scherf, J. M., & Johnson, E.
A. (2015). Botulinum Neurotoxins Can Enter
Cultured Neurons Independent of Synaptic Vesicle
Recycling.
PloS
one,
10(7),
e0133737.
https://doi.org/10.1371/journal.pone.0133737
Katzung's Basic Clinical Pharmacology; 14th ed;
page 95
Centers for Disease control and Prevention (CDC)
BLOCK - XII| PHARMACOLOGY|
MENTOR GROUP 11 & 12
24. The rate-limiting step in the synthesis of epinephrine and
norepinephrine
A. Tyrosine is transported across the cell membrane
B. Tyrosine hydroxylase acts on tyrosine to be
hydroxylated to DOPA
C. Decarboxylation to dopamine
D. Hydroxylation to epinephrine
Reference: Katzung's Basic Clinical Pharmacology;
14th ed; page 95
25. Drug that blocks catecholamine storage were initially
used in the treatment of hypertension before it was
replaced by safer drugs:
A. Reserpine
B. Guanethidine
C. Amphetamines
D. Metyrosine
BLOCK - XII| PHARMACOLOGY|
MENTOR GROUP 11 & 12
Reference:
Katzung's Basic Clinical Pharmacology; 14th ed;
page 182
Madiwa Trans PHB12L2 page 3
26.A depressed patient bought a nasal decongestant which
contained Phenylephrine. He took several tablets of it at
once. What may possibly happen to him?
A. Tachycardia
B. Vasodilation
C. Bronchodilation
D. Mydriasis
Reference: Katzung's Basic Clinical Pharmacology;
14th ed; page 149
27. Which of the following is not expected in a patient on a
B2 agonist:
A. Stimulation of uterine muscle contraction
B. Tachycardia
C. Tremors
D. Bronchodilation
MADIWA PHB12L1 pp. 10
BLOCK - XII| PHARMACOLOGY|
MENTOR GROUP 11 & 12
28. Dopamine produces different effects depending on the
dose given. Which is expected at low doses?
A. Vasoconstriction of smooth muscles on blood vessels
B. Renal vasodilation
C. Increase in total peripheral resistance
D. Marked hypertension
MADIWA PHB12L1 pp.10
29. An 8 year old boy was rushed to the Emergency
Department because of an anaphylactic reaction to peanuts
which he has a known allergy. What is your drug of choice?
a. Atropine
b. Epinephrine
c. Dopamine
d. Methylprednisolone, a corticosteroid
Anaphylactic shock is a syndrome of
bronchospasm, mucous membrane congestion,
angioedema and severe hypotension. Epinephrine
activates α and β receptors.
Atropine is for anticholinesterase or cholinergic
poisoning.
Dopamine is used in cardiogenic shock and heart
failure.
Methylprednisolone is commonly used in asthma.
Katzung, B.G., Basic and Clinical Pharmacology,
14th ed, pg152
30. In fight or flight situations, epinephrine is released by the
adrenal glands into the bloodstream. What vascular
receptor subtype, which though not usually innervated,
results in increased blood flow to the skeletal muscles?
Relaxation of β2 receptors causes vasodilation thus
a. Alpha 2 receptors
increasing blood flow.
b. Alpha 1 receptors
c. Beta 2 receptors
Katzung, B.G., Basic and Clinical Pharmacology,
d. Beta 1 receptors
14th ed, pg101
BLOCK - XII| PHARMACOLOGY|
MENTOR GROUP 11 & 12
31. The following drugs selectively bind to alpha 1 receptors, Methyldopa is selective to alpha 2 receptors
except:
a. Methyldopa
Oxymetazoline and phenylephrine are both alpha
b. Oxymetazoline
1 agonist
c. Phenylephrine
d. None of the above
32. Which of the following is a nonselective alpha agonist?
a. Clonidine
b. Terbutaline
c. Epinephrine
d. phenylephrine
C should be correct based on the trans
Source: PHB12L2 page 6
33. A elderly px with hypertension and advised to take
antihypertensive drugs instead chooses a herbal
supplement. She was found unconscious a week after with
hypotension and bradycardia. Which of the following would
most effectively cause cardiostimulation?
a. Isoproterenol
b. Norepinephrine
Source: PHB12L2 page 8
c. Clonidine
d. All of the above
34. You were in a mall when suddenly there was an
earthquake of significant magnitude thus you rushed out of
the mall. Which of the following are expected physiological
changes?
a. Increased urination
Epinephrine, similar to glucagon, stimulates
glycogenolysis in the liver, resulting in the raising
of the level of blood glucose. However, that
process is generally initiated by the fight-or-flight
response, as opposed to the physiological drop in
BLOCK - XII| PHARMACOLOGY|
MENTOR GROUP 11 & 12
b. Bradycardia
c. Bronchoconstriction
d. glycogenolysis
blood glucose levels that stimulates glucagon
secretion.
Source:
https://www.britannica.com/science/glycogenoly
sis
35. Which of the following is a beta 1 selective agonist given
to a patient in cardiogenic shock to increase stroke volume?
a. Epinephrine
b. Dobutamine
c. Norepinephrine
d. Any of the above
Source: PHB12L2 page 9
36. In order to avoid sleeping to study for a pharmacologic
quiz, this student takes this drug which is taken up by the
nerve terminals where it is taken by nerve terminals where
it then stimulates the release of norepinephrine and
dopamine from their vesicular storage sites. This drug is:
a. An amphetamine
Source: PHB12L2 page 3
b. Nicotine
c. Cocaine
d. Any of the above
37. All of the following are endogenous catecholamines,
except:
a. Dobutamine
b. Norepinephrine
c. Epinephrine
d. Dopamine
Source: PHB12L2 page 5
BLOCK - XII| PHARMACOLOGY|
MENTOR GROUP 11 & 12
38. Which of the following has the highest alpha agonist
activity?
a. Isoproterenol
b. Phenylephrine
c. Terbutamine
d. epinephrine
Highest due to its specificity. Walang kahati,
walang kabit.
Source: PHB12L2 page 4
39. This drug is a nonselective alpha blocker is used in the
treatment of pheochromocytoma:
a. Phenoxybenzamine
b. Prazosine
c. Labetalol
d. Methyldopa
Source: PHB12L2 page 11
40. Which of the following is a mixed alpha and beta
blocker?
a. Carvediol
b. Propranolol
c. Timolol
d. Pindolol
Source: PHB12L2 page 13
BLOCK - XII| PHARMACOLOGY|
MENTOR GROUP 11 & 12
41. This drug is given in addition to atropine in px with
organophosphate poisoning:
a. Pralidoxime
b. Betanechol
c. Scopolamine
d. Neostigmine
Source: PHB12L1 page 7
42. An organophosphate poisoning was given atropine.
Which of the following manifestation is/are signs and
symptoms of atropine toxicity?
a. High body temperature
b. Mydriasis and cycloplegia
c. Disorientation
d. All of the above
Source: PHB12L1 page 7
43. This drug inhibits the hydroxylation of tyrosine to DOPA
by tyrosine hydroxylase:
a. Guanethidine
b. Amphetamine
c. Metyrosine
d. Reserpine
BLOCK - XII| PHARMACOLOGY|
MENTOR GROUP 11 & 12
Hydroxylation of tyrosine to DOPA is part of the
synthesis stage.
Source: PHB12L2 page 3
44. Which of the following is an indirect-acting adrenergic
agonist?
a. Phenylephrine
b. Amphetamine
c. Dobutamine
Source: PHB12L2
d. Epinephrine
45. Contraindication/s to the use of non-selective beta
blocker, except:
a. Severe AV block
b. Esophageal varices
c. Bronchial asthma
d. None of the above
Principal contraindication to BB use:
Pre-existing AV heart block or cardiac failure not
caused
by
tachycardia
S/Es: Bronchospasm, AV block, heart failure, CNS
sedation, erectile dysfunction, increased VLDL and
decreased HDL, bradycardia, increased plasma
potassium
Beta blockers + bronchial asthma = choke me
daddy
Source: PHB12L2 page 12