Drugs Affecting the Autonomic Nervous System

1. Charlie is a 65-year-old male who has been diagnosed with hypertension and benign prostatic hyperplasia. Doxazosin has been chosen to treat his hypertension because it:
a) Increases peripheral vasoconstriction
b) Decreases detrusor muscle contractility
c) Lowers supine blood pressure more than standing pressure
d) Relaxes smooth muscle in the bladder neck
Answer. Relaxes smooth muscle in the bladder neck

2.To reduce potential adverse effects, patients taking a peripherally acting alpha1 antagonist should do all of the following EXCEPT:
a) Take the dose at bedtime
b) Sit up slowly and dangle their feet before standing
c) Monitor their blood pressure and skip a dose if the pressure is less than 120/80
d) Weigh daily and report weight gain of greater than 2 pounds in one day
Answer. Monitor their blood pressure and skip a dose if the pressure is less than 120/80

3.John has clonidine, a centrally acting adrenergic blocker, prescribed for his hypertension. He should:
a) Not miss a dose or stop taking the drug because of potential rebound hypertension
b) Increase fiber in the diet to treat any diarrhea that may occur
c) Reduce fluid intake to less than 2 liters per day to prevent fluid retention
d) Avoid sitting for long periods, as this can lead to deep vein thrombosis
Answer. Not miss a dose or stop taking the drug because of potential rebound hypertension

4.Clonidine has several off-label uses, including:
a) Alcohol and nicotine withdrawal
b) Post-herpetic neuralgia
c) Both 1 and 2
d) Neither 1 nor 2
Answer. Both 1 and 2. Drugs Affecting the Autonomic Nervous System.

5.Jim is being treated for hypertension. Because he has a history of heart attack, the drug chosen is atenolol. Beta blockers treat hypertension by:
a) Increasing heart rate to improve cardiac output
b) Reducing vascular smooth muscle tone
c) Increasing aldosterone-mediated volume activity
d) Reducing aqueous humor production
Answer. Reducing vascular smooth muscle tone

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6.Which of the following adverse effects are less likely in a beta1-selective blocker?
a) Dysrhythmias
b) Impaired insulin release
c) Reflex orthostatic changes
d) Decreased triglycerides and cholesterol
Answer. Impaired insulin release

7.Richard is 70 years old and has a history of cardiac dysrhythmias. He has been prescribed nadolol. You do his annual laboratory work and find a CrCl of 25 ml/min. What action should you take related to his nadolol?
a) Extend the dosage interval.
b) Decrease the dose by 75%.
c) Take no action because this value is expected in the older adult.
d) Schedule a serum creatinine level to validate the CrCl value.
Answer. Extend the dosage interval. Drugs Affecting the Autonomic Nervous System.

8.Beta blockers are the drugs of choice for exertional angina because they:
a) Improve myocardial oxygen supply by vasodilating the coronary arteries
b) Decrease myocardial oxygen demand by decreasing heart rate and vascular resistance
c) Both 1 and 2
d) Neither 1 nor 2
Answer. Decrease myocardial oxygen demand by decreasing heart rate and vascular resistance

9.Adherence to beta blocker therapy may be affected by their:
a) Short half-lives requiring twice daily dosing
b) Tendency to elevate lipid levels
c) Effects on the male genitalia, which may produce impotence
d) None of the above
Answer. Effects on the male genitalia, which may produce impotence

10.Beta blockers have favorable effects on survival and disease progression in heart failure. Treatment should be initiated when the:
a) Symptoms are severe
b) Patient has not responded to other therapies
c) Patient has concurrent hypertension
d) Left ventricular dysfunction is diagnosed
Answer. Left ventricular dysfunction is diagnosed

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11.Abrupt withdrawal of beta blockers can be life threatening. Patients at highest risk for serious consequences of rapid withdrawal are those with:
a) Angina
b) Coronary artery disease
c) Both 1 and 2
d) Neither 1 nor 2
Answer. Both 1 and 2. Drugs Affecting the Autonomic Nervous System.

12.To prevent life-threatening events from rapid withdrawal of a beta blocker:
a) The dosage interval should be increased by 1 hour each day.
b) An alpha blocker should be added to the treatment regimen before withdrawal.
c) The dosage should be tapered over a period of weeks.
d) The dosage should be decreased by one-half every 4 days.
Answer. The dosage should be decreased by one-half every 4 days.

13.Beta blockers are prescribed for diabetics with caution because of their ability to produce hypoglycemia and block the common symptoms of it. Which of the following symptoms of hypoglycemia is not blocked by these drugs and so can be used to warn diabetics of possible decreased blood glucose?
a) Dizziness
b) Increased heart rate
c) Nervousness and shakiness
d) Diaphoresis
Answer. Diaphoresis

14.Combined alpha-beta antagonists are used to reduce the progression of heart failure because they:
a) Vasodilate the peripheral vasculature
b) Decrease cardiac output
c) Increase renal vascular resistance
d) Reduce atherosclerosis secondary to elevated serum lipoproteins
Answer. Vasodilate the peripheral vasculature

15.Carvedilol is heavily metabolized by CYP2D6 and 2C9, resulting in drug interactions with which of the following drug classes?
a) Histamine 2 blockers
b) Quinolones
c) Serotonin re-uptake inhibitors
d) All of the above
Answer. All of the above. Drugs Affecting the Autonomic Nervous System.

16.Alpha-beta blockers are especially effective to treat hypertension for which ethnic group?
a) White
b) Asian
c) African American
d) Native American
Answer. African American

17.Bethanechol:
a) Increases detrusor muscle tone to empty the bladder
b) Decreases gastric acid secretion to treat peptic ulcer disease
c) Stimulates voluntary muscle tone to improve strength
d) Reduces bronchial airway constriction to treat asthma
Answer. Increases detrusor muscle tone to empty the bladder

18.Clinical dosing of Bethanechol:
a) Begins at the highest effective dose to obtain a rapid response
b) Starts at 5 mg to 10 mg PO and is repeated every hour until a satisfactory clinical response is achieved
c) Requires dosing only once daily
d) Is the same for both the oral and parenteral route
Answer. Starts at 5 mg to 10 mg PO and is repeated every hour until a satisfactory clinical response is achieved

19.Patients who need to remain alert are taught to avoid which drug due to its antimuscarinic effects?
a) Levothyroxine
b) Prilosec
c) Dulcolax
d) Diphenhydramine
Answer. Diphenhydramine

20.Anticholinesterase inhibitors are used to treat:
a) Peptic ulcer disease
b) Myasthenia gravis
c) Both 1 and 2
d) Neither 1 nor 2
Answer. Myasthenia gravis

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21.Which of the following drugs used to treat Alzheimer’s disease is not an anticholinergic?
a) Donepezil
b) Memantine
c) Rivastigmine
d) Galantamine
Answer. Memantine

22.Taking which drug with food maximizes it bioavailability?
a) Donepezil
b) Galantamine
c) Rivastigmine
d) Memantine
Answer. Rivastigmine. Drugs Affecting the Autonomic Nervous System.

23.Which of the following drugs should be used only when clearly needed in pregnant and breastfeeding women?
a) Memantine
b) Pyridostigmine
c) Galantamine
d) Rivastigmine
Answer. Pyridostigmine

24.There is a narrow margin between first appearance of adverse reaction to AChE inhibitors and serious toxic effects. Adverse reactions that require immediate action include:
a) Dizziness and headache
b) Nausea
c) Decreased salivation
d) Fasciculations of voluntary muscles
Answer. Fasciculations of voluntary muscles

25.Adherence is improved when a drug can be given once daily. Which of the following drugs can be given once daily?
a) Tacrine
b) Donepezil
c) Memantine
d) Pyridostigmine
Answer. Donepezil

26.Nicotine has a variety of effects on nicotinic receptors throughout the body. Which of the following is NOT an effect of nicotine?
a) Vasodilation and decreased heart rate
b) Increased secretion of gastric acid and motility of the GI smooth muscle
c) Release of dopamine at the pleasure center
d) Stimulation of the locus coeruleus
Answer. Vasodilation and decreased heart rate. Drugs Affecting the Autonomic Nervous System.

27.Nicotine gum products are:
a) Chewed to release the nicotine and then swallowed for a systemic effect
b) Parked” in the buccal area of the mouth to produce a constant amount of nicotine release
c) Bound to exchange resins so the nicotine is only released during chewing
d) Approximately the same in nicotine content as smoking two cigarettes
Answer. Bound to exchange resins so the nicotine is only released during chewing

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28.Nicotine replacement therapy (NRT):
a) Is widely distributed in the body only when the gum products are used
b) Does not cross the placenta and so is safe for pregnant women
c) Delays healing of esophagitis and peptic ulcers
d) Has no drug interactions when a transdermal patch is used
Answer. Delays healing of esophagitis and peptic ulcers

29.Success rates for smoking cessation using NRT:
a) Are about the same regardless of the method chosen
b) Vary from 40% to 50% at 12 months
c) Both 1 and 2
d) Neither 1 nor 2
Answer. Vary from 40% to 50% at 12 months

30.Cholinergic blockers are used to:
a) Counteract the extrapyramidal symptoms (EPS) effects of phenothiazines
b) Control tremors and relax smooth muscle in Parkinson’s disease
c) Inhibit the muscarinic action of ACh on bladder muscle
d) All of the above
Answer. All of the above

31.Several classes of drugs have interactions with cholinergic blockers. Which of the following is true about these interactions?
a) Drugs with a narrow therapeutic range given orally may not stay in the GI tract long enough to produce an action.
b) Additive antimuscarinic effects may occur with antihistamines.
c) Cholinergic blockers may decrease the sedative effects of hypnotics.
d) Cholinergic blockers are contraindicated with antipsychotics.
Answer. Drugs with a narrow therapeutic range given orally may not stay in the GI tract long enough to produce an action.

32.Scopolamine can be used to prevent the nausea and vomiting associated with motion sickness. The patient is taught to:
a) Apply the transdermal disk at least 4 hours before the antiemetic effect is desired.
b) Swallow the tablet 1 hour before traveling where motion sickness is possible.
c) Place the tablet under the tongue and allow it to dissolve.
d) Change the transdermal disk daily for maximal effect.
Answer. Swallow the tablet 1 hour before traveling where motion sickness is possible.

33.You are managing the care of a patient recently diagnosed with benign prostatic hyperplasia (BPH). He is taking tamsulosin but reports dizziness when standing abruptly. The best option for this patient is:
a) Continue the tamsulosin because the side effect will resolve with continued treatment.
b) Discontinue the tamsulosin and start doxazosin.
c) Have him double his fluid intake and stand more slowly.
d) Prescribe meclizine as needed for the dizziness.
Answer. Discontinue the tamsulosin and start doxazosin.

34.You are treating a patient with a diagnosis of Alzheimer’s disease. The patient’s wife mentions difficulty with transportation to the clinic. Which medication is the best choice?
a) Donepezil
b) Tacrine
c) Doxazosin
d) Verapamil
Answer. Donepezil

35.A patient presents with a complaint of dark stools and epigastric pain described as gnawing and burning. Which of the medications is the most likely cause?
a) Acetaminophen
b) Estradiol
c) Donepezil
d) Bethanechol
Answer. Bethanechol

36.Your patient calls for an appointment before going on vacation. Which medication should you ensure he has an adequate supply of before leaving to avoid life-threatening complications?
a) Carvedilol
b) Donepezil
c) Bethanechol
d) Tacrine
Answer. Carvedilol

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37.Activation of central alpha2 receptors results in inhibition of cardio acceleration and ______________ centers in the brain.
a) Vasodilation
b) Vasoconstriction
c) Cardiovascular
d) Respiratory
Answer. Vasoconstriction