USMLE-like pharmacology quiz. Part 5: Autonomic pharmacology. Sympathetic nervous system

The following are multiple choice questions in a style similar to those included in the USMLE step 1. The main topic here is: Autonomic Pharmacology: Sympathetic Nervous System. This quiz has been uploaded to Scribd by medical student James Lamberg. The correct answers can be found in link at the end of this post.

Note: the underlined words don’t mean right answer but link to another page.

11 – Autonomic Pharmacology: Sympathetic Nervous System
1.1) The sympathetic nervous system (SNS) and parasympathetic nervous system are
divisions of which of the following?
a) Somatic nervous system division of peripheral nervous system
b) Somatic nervous system division of central nervous system
c) Autonomic nervous system division of peripheral nervous system
d) Autonomic nervous system division of central nervous system

1.2) Preganglionic sympathetic and parasympathetic fibers release ____, postganglionic
parasympathetic fibers release ____ (for muscarinic receptors), and
postganglionic sympathetic fibers release ____ (for adrenergic receptors).
a) ACh; ACh; NE
b) ACh; NE; ACh
c) NE; ACh; NE
d) NE; NE; ACh
1.3) Which of the following adrenergic receptors is most commonly found pre-synaptic?
a) Alpha 1 receptors
b) Alpha 2 receptors
c) Beta 1 receptors
d) Beta 2 receptors
e) Beta 3 receptors
1.4) Which of the following describes the result of adrenal medulla stimulation?
a) Mass parasympathetic discharge, 85:15 ratio of epi:norepi
b) Mass parasympathetic discharge, 15:85 ratio of epi:norepi
c) Mass sympathetic discharge, 85:15 ratio of epi:norepi
d) Mass sympathetic discharge, 15:85 ratio of epi:norepi
Match the sympathetic response with the receptor:
1.5) Increased lipid breakdown a) α1

1.6) Peripheral vasoconstriction b) β1
1.7) Increased heart rate and blood pressure c) β2
1.8) Bronchial dilation, coronary dilation, glucose conversion d) β3
1.9) What amino acids is converted into catecholamines (NE, Epi, Dopamine)?
a) Alanine
b) Proline
c) Lysine
d) Tyrosine
e) Valine
1.10) Which of the following is transported into vesicles via the vesicular monoamine
transporter (VMAT), uptake 2, a proton antiporter?
a) Epinephrine
b) Norepinephrine
c) Dopamine
1.11) Which of the following is co-stored and co-released with ATP?
a) Epinephrine
b) Norepinephrine
c) Dopamine
1.12) Which of the following form varicosities or en passant synapses, with the arrival of
an action potential leading to Ca++ influx and exocytosis?
a) Presynaptic sympathetic
b) Presynaptic parasympathetic
c) Postsynaptic sympathetic
d) Postsynaptic parasympathetic
2.1) Which of the following methods of terminating axon response is NOT a target for
drug action?
a) Reuptake via NE transporter (NET): Uptake 1
b) Metabolism of NE of inactive metabolite
c) NE diffusion away from synaptic cleft
2.2) NET is a symporter of what ion?
a) K+
b) Ca++
c) Cl-
d) Na+
e) Mg++
2.3) Which of the following is recycled via VMAT into vesicles after response
termination?
a) NE
b) L-DOPA
c) NET
d) EPI
e) DOPGAL
2.4) Which of the following is broken down by MAO-B (monoamine oxidase) more than
the others?
a) Serotonin (5-HT)
b) Norepinepherine (NE)

c) Dopamine (DA)
2.5) Where is the cytosolic catecholamine metabolizing enzyme catechol-O-methyl
transferase (COMT) primarily found?
a) Liver
b) GI tract
c) Placenta
d) Blood platelets
3.1) Which of the following receptor subtypes relaxes smooth muscle and causes liver
glycogenolysis and gluconeogenesis?
a) α1 (Gq/Gi/Go)
b) α2 (Gi/Go)
c) β1 (Gs)
d) β2 (Gs)
e) β3 (Gs)
3.2) Which of the following receptor subtypes causes vascular smooth muscle contraction
and genitourinary smooth muscle contraction?
a) α1 (Gq/Gi/Go)
b) α2 (Gi/Go)
c) β1 (Gs)
d) β2 (Gs)
e) β3 (Gs)
3.3) Which of the following receptor subtypes increases cardiac chronotropy (rate) and
inotropy (contractility), increases AV-node conduction velocity, and increases rennin
secretion in renal juxtaglomerular cells?
a) α1 (Gq/Gi/Go)
b) α2 (Gi/Go)
c) β1 (Gs)
d) β2 (Gs)
e) β3 (Gs)
3.4) Which of the following receptor subtypes decreases insulin secretion from pancreatic
β-cells, decreases nerve cell norepinephrine release, and contracts vascular smooth
muscle?
a) α1 (Gq/Gi/Go)
b) α2 (Gi/Go)
c) β1 (Gs)
d) β2 (Gs)
e) β3 (Gs)
4.1) What type(s) of second messenger(s) interact with adenylyl cyclase?
a) α1
b) α2
c) β
d) β & α1
e) β & α2
4.2) What type(s) of second messenger(s) are associated with phospholipase C (PLC)?
a) α1

b) α2
c) β
d) β & α1
e) β & α2
4.3) Which of the following adrenergic receptor activation mechanisms is involved with
ephedrine, amphetamine, and tyramine?
a) Direct binding to the receptor
b) Promoting release of norepinephrine
c) Inhibiting reuptake of norepinephrine
d) Inhibiting inactivation of norepinephrine
4.4) Which of the following adrenergic receptor activation mechanisms is involved with
MAO inhibitors?
a) Direct binding to the receptor
b) Promoting release of norepinephrine
c) Inhibiting reuptake of norepinephrine
d) Inhibiting inactivation of norepinephrine
4.5) Which of the following adrenergic receptor activation mechanisms is involved with
tricyclic antidepressants and cocaine?
a) Direct binding to the receptor
b) Promoting release of norepinephrine
c) Inhibiting reuptake of norepinephrine
d) Inhibiting inactivation of norepinephrine
4.6) Which of the following is NOT true of catecholamines?
a) Non-polar
b) Cannot cross the blood-brain barrier
c) Cannot be used as an oral drug
d) Have brief duration
e) MAO and COMT act rapidly
Match the catecholamine with the receptor(s):
4.7) Isoproterenol a) α & β
4.8) Dobutamine b) β
4.9) Norepinepherine c) β1
4.10) Dopamine d) D1 & D2
4.11) Epinepherine
4.12) The basic structure of a catecholamine involves a catechol ring and which of the
following types of amines?
a) Methyl amine
b) Ethyl amine
c) Butyl amine
d) Tert-butyl amine
e) Propyl amine
Match the noncatecholamines with the receptor agonist:
4.13) Clonidine a) α1-agonist
4.14) Metaproterenol, terbutaline, ritodine b) α2-agonist

4.15) Phenylephrine c) β2-agonist

5.1) Which of the following is a long-acting (oral) α1-agonist and not a short-acting
(nasal spray, ophthalmic drops) α1-agonist?
a) Phenylephrine
b) Oxymetazoline
c) Tetrahydrazaline
d) Pseudoephedrine
5.2) Which of the following would NOT be used as a topical vasoconstrictor for a patient
with epistaxis (nasal pack soaked in drug)?
a) Phenylephrine
b) Epinepherine
c) Oymetazoline
d) Isoproterenol
5.3) α1 drugs can be given with local anesthetics to vasoconstrictor and decrease blood
flow to the side of administration. Which of the following should not be given above the
web space?
a) Phenylephrine
b) Epinephrine
c) Methoxamine
5.4) Which of the following is the α1 drug of choice (DOC) for retinal exams and
surgery, giving mydiasis (dilation of iris)?
a) Ephedrine
b) Epinepherine
c) Oymetazoline
d) Isoproterenol
e) Phenylephrine
5.5) α2-agonists are only approved for hypertension and work by decreasing sympathetic
tone and increasing vagal tone. Which of the following is NOT a α2-agonist?
a) Clonidine
b) Methyldopa
c) Guanabenz
d) Guanfacine
e) Epinephrine
5.6) At the adrenergic synapse, what does α2 do?
a) Stimulates NE release
b) Inhibits NE release
c) Stimulates ACh release
d) Inhibits ACh release
5.7) Which of the following agonists would be used for asthma patients or to delay
premature labor?
a) α2-agonist
b) α1-agonist
c) β3-agonist
d) β2-agonist
e) β1-agonist
5.8) Which of the following agonists would be used for cardiogenic shock, cardiac arrest,
heart block, or heart failure?

a) α1-agonist
b) α2-agonist
c) β1-agonist
d) β2-agonist
e) β3-agonist
5.9) Which of the following is NOT a β2-agonist?
a) Terbutaline
b) Ritodrine
c) Metaproterenol
d) Albuterol
e) Phenylepherine
5.10) β2 stimulation leads to an increase in the cellular uptake of what ion, and thus a
decrease in plasma concentration of that ion?
a) K+
b) Ca++
c) Cl-
d) Na+
e) Mg++
5.11) Dopamine receptor activation (D1) dilates renal blood vessels at low dose. At
higher doses (treatment for shock), which of the following receptor is activated?
a) α1
b) α2
c) β1
d) β2
e) β3
5.12) Which of the following responses to sympathetic stimulation would prevent
receptors from being couples with G-proteins?
a) Sequestration
b) Down-regulation
c) Phosphorylation
5.13) Which of the following is the action of the indirect-acting sympathomimetic drug
cocaine?
a) Stimulator of NET (uptake 1)
b) Inhibitor of NET (uptake 1)
c) Stimulator of VMAT (uptake 2)
d) Inhibitor of VMAT (uptake 2)
5.14) Tricyclic antidepressants (TCAs) have a great deal of side effects. Which of the
following is the action of TCAs?
a) Stimulator of NET (uptake 1)
b) Inhibitor of NET (uptake 1)
c) Stimulator of VMAT (uptake 2)
d) Inhibitor of VMAT (uptake 2)
5.15) Which of the following is NOT a mixed sympathomimetic?
a) Amphetamine
b) Methamphetamine
c) Ephedrine

d) Phenylepherine
e) Pseudoephedrine
5.16) Prior to an operation to remove a pheochromocytoma (neuroendocrine tumor of the
medulla of the adrenal glands), which of the following should be given to the patient?
a) α-agonist
b) α-blocker
c) β-agonist
d) β-blocker
5.17) Which of the following is NOT an indication for β-blocker therapy?
a) Hypotension
b) Angina pectoris
c) Arrhythmias
d) Myocardial infarction
e) Glaucoma
5.18) Which of the following β-blockers is used for decreasing aqueous humor secretions
from the ciliary body?
a) Propranolol
b) Nadolol
c) Carvedilol
d) Timolol
e) Metoprolol
5.19) Which of the following is NOT considered cardioselective?
a) Metoprolol
b) Atenolol
c) Esmolol
d) Carvedilol
5.20) Blocking α2 presynaptic receptors will do which of the following?
a) Stimulate NE release
b) Inhibit NE release
c) Stimulate DA release
d) Inhibit DA release
5.21) Which of the following drugs irreversibly damages VMAT?
a) Tyramine
b) Guanethidine
c) Reserpine
d) Propranolol
e) Epinepherine
6.1) Which of the following is the most likely to occur with parenteral administration of a
α1-agonist drug?
a) Hypotension
b) Hypertension
c) Tissue necrosis
d) Vasodilation
e) Lipolysis
6.2) Which of the following agonists can have dose-related withdrawal syndrome if the
drug is withdrawn too quickly, leading to rebound hypertension?

a) α1-agonist
b) α2-agonist
c) β1-agonist
d) β2-agonist
e) β3-agonist
6.3) Which of the following agonists can have sedation and xerostomia (dry mouth) in
50% of patients starting therapy, sexual dysfunction in males, nauseas, dizziness, and
sleep disturbances?
a) α1-agonist
b) α2-agonist
c) β1-agonist
d) β2-agonist
e) β3-agonist
6.4) Which of the following agonists can cause hyperglycemia in diabetics?
a) α2-agonist
b) α1-agonist
c) β3-agonist
d) β2-agonist
e) β1-agonist
6.5) Angina pectoris, tachycardia, and arrhythmias are possible adverse effects of which
of the following agonists?
a) α2-agonist
b) α1-agonist
c) β3-agonist
d) β2-agonist
e) β1-agonist
6.6) If a patient is taking MAO inhibitors and ingests tyramine (red wine, aged cheese),
which of the following acute responses is most likely? (sympathomimetic)
a) Stimulation of NE release
b) Inhibition of NE release
c) Stimulation of ACh release
d) Inhibition of ACh release
e) No response due to MAO inhibitor
6.7) Which of the following occurs acutely, leading to a false neurotransmitter, with
increased guanethidine? (sympathomimetic)
a) Stimulation of NE release
b) Inhibition of NE release
c) Stimulation of ACh release
d) Inhibition of ACh release
6.8) Major adverse affects of the α1 blockade include reflex tachycardia and which of the
following?
a) Orthostatic tachycardia
b) Orthostatic bradycardia
c) Orthostatic hypertension
d) Orthostatic hypotension

e) Increased cardiac output
6.9) Which of the following effects would be intensified with the α2 blockade?
a) Reflex tachycardia
b) Reflex bradycardia
c) Orthostatic hypertension
d) Orthostatic hypotension
e) Platelet clotting
6.10) Which of the following is NOT an adverse affect of the β1 blockade?
a) Bradycardia
b) Decreased cardiac output
c) AV node block
d) Increased arrhythmias
e) Heart failure
6.11) Which of the following is the most severe adverse effect that has been associated
with sudden termination of β1-blockers?
a) Atrial fibrillation
b) Reflex bradycardia
c) Syncope (fainting)
d) Angina
e) Sudden death
6.12) Which of the following groups of patients is most at risk for adverse effect seen in
β2-blockers?
a) Asthmatics
b) Congestive heart failure patients
c) Trauma patients
d) Diabetics
e) Patients with deep vein thromboses (DVTs)
6.13) Which of the following can be detrimental in diabetics and also can lead to masking
of tachycardia, which is indicative of hypoglycemia?
a) α1-blocker
b) α2-blocker
c) β1-blocker
d) β2-blocker
e) β3-blocker

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