Block 9 Rx Adrenergic MCQ's
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Questions and Answers
- 1.
A 12-year-old boy was stung by a wasp while walking in the woods. Few minutes later he developed pruritus and erythema, a generalized feeling of warm and impending doom, dyspnea, wheezing and dizziness. Increasing swelling of the face, eyes, lips and tongue was prominent. Paramedics were called and they administered a SC drug upon arrival. Which of the following drugs was most likely given?
- A.
Norepinephrine
- B.
Isoproterenol
- C.
Epinephrine
- D.
Ephedrine
- E.
Phenylephrine
Correct Answer
C. EpinephrineExplanation
The symptoms described in the scenario are consistent with an anaphylactic reaction, which is a severe allergic reaction. The symptoms include pruritus and erythema (itching and redness), generalized feeling of warm and impending doom, dyspnea (difficulty breathing), wheezing, dizziness, and increasing swelling of the face, eyes, lips, and tongue. The drug of choice for treating anaphylaxis is epinephrine, as it helps to reverse the allergic response by constricting blood vessels, opening airways, and increasing heart rate. Therefore, the most likely drug given by the paramedics in this situation would be epinephrine.Rate this question:
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- 2.
A 58-year-old man underwent surgery for the removal of a necrotic bowel tissue. Five days later he became confused and disoriented. Physical finding included fever of 103F, blood pressure of 90/50 mm Hg, pulse 130 bpm, respiratory rate 30 breath/min. Pertinent lab values were PaCO2 30 mm Hg (normal 33-45), HCO 3- 18 mEq/L (normal 22-28), serum pH 7.31, WBC count 22,000 cells/mm3. Arterial and pulmonary artery catheters were inserted, revealing a cardiac output of 6L/min and a systemic vascular resistance of 610 dyneCsecCcm-5 (normal 800-1400). A fluid therapy was initiated but one hour later the mean blood pressure was still 60 mm Hg. An IV infusion of a drug was started . Which of the following drugs was most likely administered?
- A.
Isoproterenol
- B.
Epinephrine
- C.
Norepinephrine
- D.
Albuterol
- E.
Clonidine
Correct Answer
C. NorepinephrineExplanation
The patient's symptoms and lab values suggest that he is experiencing septic shock, which is a life-threatening condition characterized by low blood pressure, increased heart rate, and organ dysfunction. In septic shock, there is a decrease in systemic vascular resistance, leading to hypotension. Norepinephrine is a vasopressor drug commonly used in the treatment of septic shock to increase blood pressure by constricting blood vessels. Therefore, the most likely drug administered in this case would be norepinephrine to help stabilize the patient's blood pressure.Rate this question:
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- 3.
A 56-year-old woman suffering from idiopathic orthostatic hypotension is brought unconscious to the emergency department. She regains consciousness after a supportive treatment and an IV administratlon of phenylephrine. Which of the following actions most likely account for the therapeutic effectiveness of the drug in the present case?
- A.
Dilation of cerebral vessels
- B.
Increased heart rate
- C.
Increased cardiac output
- D.
Increased systemic blood pressure
- E.
Increased levels of angiotensin II
Correct Answer
D. Increased systemic blood pressureExplanation
Phenylephrine is a sympathomimetic drug that acts as a vasoconstrictor, leading to an increase in systemic blood pressure. In this case, the patient's unconsciousness was likely due to a decrease in blood flow to the brain caused by orthostatic hypotension. By increasing systemic blood pressure, phenylephrine improves blood flow to the brain, leading to the patient regaining consciousness. The other options, such as dilation of cerebral vessels, increased heart rate, increased cardiac output, and increased levels of angiotensin II, are not directly related to the therapeutic effectiveness of phenylephrine in this case.Rate this question:
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- 4.
A new autonomic drug that does not enter the brain was given IV to healthy volunteers. The cardiovascular effects are tabulated beow; Parameter ---------------Control-------- Peak drug effect Systolic BP (mm Hg)- 125--------------145 Diastolic BP(rnm Hg)- 75----------------95 Heart rate (bpm)------- 70--------------- 58 Cardiac output (limin) 5.0---------------- 4.5 Ejection fraction------- 60%------------- 60% The effects of the new drug are most similar to those of which of the following agents?
- A.
Dobutamine
- B.
Epinephrine
- C.
Isoproterenol
- D.
Norepinephrine
- E.
Phenylephrine
Correct Answer
E. PhenylephrineExplanation
The effects of the new drug are most similar to those of Phenylephrine. This is because Phenylephrine is a vasoconstrictor that primarily acts on alpha-1 adrenergic receptors, causing an increase in blood pressure and a decrease in heart rate. The new drug also causes an increase in systolic and diastolic blood pressure, a decrease in heart rate, and no change in ejection fraction, which is consistent with the effects of Phenylephrine.Rate this question:
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- 5.
A 28-year-old woman was experiencing preterrn labor in the 30th week of a twin gestation. Five hours after receiving tocolytic therapy to suppress preterm labor, progressive dyspnea associated with severe hypoxemia developed. A diagnosis of pulmonary edema was made and the woman was given intubation, oxygen and ventilatory support. A drug from which of the following classes did most likely contribute to the development of the patient's syndrome?
- A.
Beta-2 antagonists
- B.
Beta-2 agonists
- C.
Prostaglandins
- D.
Alpha-1 agonists
- E.
Alpha-1 antagonists
Correct Answer
B. Beta-2 agonistsExplanation
Terbutaline is a β2-adrenergic receptor agonist.
Terbutaline is currently used to delay preterm labor for 48 hours to allow for fetal lung maturity through steroid injections. It should not be used to prevent preterm labor or delay labor past 48-72 hours. In February 2011, the Food and Drug Administration has ordered to put a boxed warning on the drug's label. Pregnant women should not be given injections of the drug terbutaline for the prevention of preterm labor or for long-term (beyond 48-72 hours) management of preterm labor, and should not be given oral terbutaline for any type of prevention or treatment of preterm labor "due to of the potential for serious internal heart problems and death."
Potential Adverse Effects
Findings indicate Beta-2 stimulants, especially when they are given by parenteral or oral route, can induce adverse effects:
• tachycardia secondary to peripheral vasodilation and cardiac stimulation; tachycardia can be accompanied by palpitations.
• tremor, sweats, agitation.
• more severe effects, PULMONARY EDEMA, myocardial ischemia, cardiac arrythmia, are exceptional.Rate this question:
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- 6.
A 52-year-old woman, recently diagnosed with severe bronchial asthma, complained to her physician of tremors, muscle cramping, palpitatIons and anxiety. She had started an appropriate therapy two weeks previously. Which of the following drugs most likely caused the patient's symptoms?
- A.
Isoproterenol
- B.
Salmeterol
- C.
Propranolol
- D.
Dobutamine
- E.
Prazosin
Correct Answer
B. SalmeterolExplanation
These side effects are more common with the Long-Acting B2 agonist. (but not exclusive)
Isoproterenol is a medication used primarily for the treatment of bradycardia (slow heart rate), heart block, and -RARELY- for asthma. It is a non-selective beta-adrenergic agonist and structurally similar to adrenaline.
SALMETEROL is a long-acting beta-adrenoceptor agonist (LABA), usually prescribed only for severe persistent asthma following previous treatment with a short-acting beta agonist such as salbutamol and is prescribed concurrently with a corticosteroid, such as beclomethasone. The primary noticeable difference of salmeterol to salbutamol is that the duration of action lasts approximately 12 hours in comparison with 4–6 hours of salbutamol.Rate this question:
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- 7.
A 6 year-old girl presented to the family physician in company of her mother, who was distraught over the teacher's comment that the child was "unmanageable" at school. The teacher had referred that the girl was unable to remain seated for the duration of a structured activity and to listen when spoken to directly. She also often fidgeted with hands and feet, squirmed and talked excessively. Similar symptoms were noted during the doctor's visit. Which of the following drugs would be appropriate to treat this condition?
- A.
Phenylephrine
- B.
Epinephrine
- C.
Albuterol
- D.
Dextroamphetamine
- E.
Norepinephrine
Correct Answer
D. DextroamphetamineExplanation
or maybe we could suggest that the mother put the child in a school with a COMPETENT teacher. one who didn't teach to the bottom of the class, leaving the rest of the students to get bored and become distracted.
We might also suggest that the mother cut back on the childs intake of Dr Pepper, Cheetos and Skittles.
I wonder how we were able to build the atom bomb, and reach the moon all without Ritalin.
What has changed since those folks went to school. 3 things
1. academic standards are lower
2. more processed food
3. removal of God from the class room.
Why is there no ADD in the countries who are kicking our butts in math and science.
could it be because American students lead the world in "self esteem"Rate this question:
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- 8.
A 44-year-old man presented to his local doctor complaining of an impaired voluntary raising of the eyelid. Physical examination showed miosis, ptosis, flushed facial skin and loss of sweating over the left side of the body. The physician instilled into the conjunctival sac of each eye one drop of cocaine, then (after washing) one drop of phenylephrine. The size of the pupils before and after the two treatments are shown in the table below. From the above data the physician concluded that there was a localized lesion in which of the following anatomical structures? Pupil size (mm) Right eye Left eye Without treatment 3 2.5 After cocaine 3,5 2.5 After phenylephrine 3.5 3.5
- A.
Postganglionic sympathetic nerves innervating the face
- B.
Preganglionic sympathetic nerves innervating the face
- C.
Postganglionic parasympathetic nerves innervating the face
- D.
Preganghonic parasympathetic nerves innervating the face
- E.
Medulla oblongata
Correct Answer
A. Postganglionic sympathetic nerves innervating the faceExplanation
The physician concluded that there was a localized lesion in the postganglionic sympathetic nerves innervating the face based on the changes in pupil size after the two treatments. The miosis (constriction of the pupil) observed after cocaine administration suggests that the sympathetic nerves responsible for dilating the pupil were impaired. However, the pupil size returned to normal after phenylephrine administration, indicating that the parasympathetic nerves responsible for constriction were intact. This suggests that the lesion is localized to the postganglionic sympathetic nerves innervating the face.Rate this question:
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- 9.
A 33-year-old man was brought to the emergency room after a car accident. Upon admission the patient was lucid but completely paralyzed with loss of all sensation and reflex activity below the thorax. Vital signs were: blood pressure 80/40 mm Hg, heart rate 42 bpm, respiration 36 breaths/min. A preliminary diagnosis of spinal shock, due to spinal cord injury, was made and an IV infusion of a drug was started . Which of the following drugs was most likely administered?
- A.
Isoproterenol
- B.
Clonidine
- C.
Norepinephrine
- D.
Albuterol
- E.
Ephedrine
Correct Answer
C. NorepinephrineExplanation
Norepinephrine is a sympathomimetic drug that acts on alpha-1 adrenergic receptors to increase systemic vascular resistance and blood pressure. In this scenario, the patient's low blood pressure and bradycardia indicate neurogenic shock, which is a form of distributive shock caused by loss of sympathetic tone. Administering norepinephrine would help restore sympathetic tone and increase blood pressure. Isoproterenol, albuterol, and ephedrine are beta-agonists that would increase heart rate but not necessarily improve blood pressure. Clonidine is an alpha-2 agonist that would further decrease sympathetic tone and worsen the patient's condition.Rate this question:
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- 10.
A 65-year-old man is undergoing a prostate biopsy because of a suspected prostate cancer. Before the operation the prostate is infiltrated with a solution of lidocaine plus epinephrine in order to provide local anesthesia. Which of the following statements best explains why epinephrine prolongs the effect of lidocaine in this patient?
- A.
It inhibits microsomal enzymes which metabolize lidocaine
- B.
It blocks Ca++ channels in prostate nerves
- C.
It constricts prostate vessels
- D.
It blocks Na+ channels in prostate nerves
- E.
It relaxes prostate capsule
Correct Answer
C. It constricts prostate vesselsExplanation
Adrenaline is added to injectable forms of a number of local anesthetics, such as bupivacaine and lidocaine, as a vasoconstrictor to slow the absorption and, therefore, prolong the action of the anesthetic agent. Some of the adverse effects of local anesthetic use, such as apprehension, tachycardia, and tremor, may be caused by adrenalineRate this question:
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- 11.
A 15-year-old girl was treated topically with eye drops during a routine ophthalmoscopic examination. After fifteen minutes the ophthalmologist registered a moderate increase in pupillary diameter, with negligible changes in lens curvature and intraocular pressure. Which of the following drugs was most likely administered to the patient?
- A.
Phenylephrine
- B.
Timolol
- C.
Acetylcholine
- D.
Apraclonidine
- E.
Epinephrine
Correct Answer
A. PhenylephrineExplanation
Phenylephrine is a sympathomimetic drug that acts as a selective alpha-1 adrenergic receptor agonist. It causes pupillary dilation by stimulating the dilator muscle of the iris, resulting in an increase in pupillary diameter. It does not significantly affect lens curvature or intraocular pressure. Therefore, the moderate increase in pupillary diameter observed after the topical administration of eye drops suggests that Phenylephrine was most likely administered to the patient.Rate this question:
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- 12.
A 22-year-old man complained to his physician that his nasal stuffiness was getting worse. The man started two days ago an over-the-counter topical preparation containing phenylephrine because of an annoying common cold. Initially the preparation was effective but later the patient noticed that when the drug effect subsided, nasal stuffiness was worse than it originally had been. Which of the following statements best explains this averse drug effect?
- A.
Poor patient compliance
- B.
Insufficient dosing
- C.
Drug induced increased blood pressure
- D.
Drug induced reflex bradycardia
- E.
Drug induced allergic reaction
- F.
Rebound congestion
Correct Answer
F. Rebound congestionExplanation
The man's worsening nasal stuffiness after the drug effect subsided suggests that the over-the-counter topical preparation containing phenylephrine is causing rebound congestion. Rebound congestion occurs when the use of nasal decongestants, like phenylephrine, leads to a temporary relief of symptoms followed by a worsening of congestion once the drug wears off. This is a common adverse effect of nasal decongestant medications and can be attributed to the body's compensatory response to the initial vasoconstriction caused by the drug.Rate this question:
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- 13.
A new autonomic drug that does not enter the brain was given IV to healthy volunteers in a phase 1 clinical trial. The cardiovascular effects are tabulated below. Which of the following drugs does the new agent most resemble?
- A.
Dobutamine
- B.
Albuterol
- C.
Isoproterenol
- D.
Norepinephrine
- E.
Phenylephrine
Correct Answer
A. DobutamineExplanation
The new autonomic drug that does not enter the brain and has cardiovascular effects most resembles Dobutamine. This is because Dobutamine is a medication that primarily affects the heart and increases cardiac output. It is commonly used in situations where the heart is not pumping enough blood, such as in heart failure or during certain types of surgery. Since the new drug also has cardiovascular effects and does not enter the brain, it is likely to have similar mechanisms of action as Dobutamine.Rate this question:
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- 14.
A 52-year-old man suffering from renovascular hypertension was admitted to the hospital because of 24 hours anuria, Pertinent plasma levels on admission were K+ ............7.9 mEq/L, Ca++....... 3 mEg/L, creatinine.. 7 mg/dL, BUN.......... 52 mg/dL, An appropriate therapy was initiated which included albuterol IV. Which of the following statements best explains why this drug was given to the patient?
- A.
To counteract the high creatinine values
- B.
To counteract the hyperkalemia
- C.
To counteract the hypocalcemia
- D.
To increase kidney blood flow
- E.
To activate diuresis
- F.
To improve micturition
Correct Answer
B. To counteract the hyperkalemiaExplanation
The patient's high plasma level of potassium (hyperkalemia) is a concerning condition that can have serious consequences, such as cardiac arrhythmias. Albuterol, a medication commonly used for asthma, has been found to have a potassium-lowering effect. Therefore, it is given to counteract the hyperkalemia and bring the potassium levels back to a normal range.Rate this question:
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- 15.
Which of the following adrenergic drugs given by IV infusion car decrease total peripheral resistance at lower doses and increase it at higher doses?
- A.
Norepinephrine
- B.
Albuterol
- C.
Isoproterenol
- D.
Phenylephrine
- E.
Dopamine
- F.
Dobutamine
Correct Answer
E. DopamineExplanation
Dopamine is the correct answer because it is an adrenergic drug that can decrease total peripheral resistance at lower doses and increase it at higher doses. Dopamine acts on different receptors at different doses, and at low doses, it primarily stimulates dopamine receptors, leading to vasodilation and a decrease in total peripheral resistance. However, at higher doses, dopamine also stimulates beta-1 adrenergic receptors, leading to an increase in total peripheral resistance. This dose-dependent effect makes dopamine unique among the listed adrenergic drugs.Rate this question:
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- 16.
A 35-year-old man admitted to the hospital because of a car accident, started a blood transfusion. Few minutes later he complained of nausea and pruritus and developed dyspnea with audible wheezing. His skin was mottled and cold, heart rate was 120 bpm and blood pressure fell to 80/50 mm Ha. An injection of epinephrine was given. which of the following actions most likely contributed to the therapeutic efficacy of the drug in the in the patient's disease?
- A.
Inhibition of mast cell degranulation
- B.
Stimulation of eicosanoid biosynthesis
- C.
Beta-2 receptor mediated vasodilation
- D.
Inhibition of insulin secretion
- E.
Stimulation of platelet aggregation
Correct Answer
A. Inhibition of mast cell degranulationExplanation
Due to its --vasoconstrictive-- effects, Epinephrine is the drug of choice for treating anaphylaxis.
Epinephrine stabilizes mast cells and basophils, dilates the airways, and constricts the capillary pores, keeping fluids in the circulationRate this question:
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