Multiple Choice Questions

1. Cholinominetic alkaloid used for its anticestodal action is:
a. Pilocarpine b. Muscarine c. Arecholine d. Neostigmine

2. Selective cyclooxygenase -3 inhibitors among these is:
a. Meloxicam b. Aspirin c. Acetaminophen d. Phenyl butazone

3. Lisinopril acts by:
a. Antagonizing Calcium channel b. Antagonizing Potassium channel
c. Inhibit Angiotensin II formation d. Inhibit Angiotensin III formation

4. The diuretics for decreasing intracranial pressure:
a. Mannitol b. Furosemide c. Spironolactone d. Acetazolamide

5. Example of agent cause relaxation of uterus:
a. Oxytocin b. Tiaprost c. Isoxsuprine d. phenoxy benzamine

6. Appetite stimulant used in cats, with the Anti serotonergic properties is:
a. Thiamine HCL b. Stanozolol c. Medroxy progesterone d. Cyproheptadine HCL

7. Neostigmine is indicated in:
a. Ruminal atony b. Diarrhea c. Bronchoconstriction d. Miosis

8. Most important adverse effect of pefloxacin in young dogs is
a. Bone marrow depression b. Chondrotoxicity c. Anaphylaxis d. Ototoxicity

9. Non-Sedative antihistaminic:
a. terbinafine b. terfenadine c. Hydroxyzine d. buclizine

10. Vasodilation effects of cholinergic agonist is due to:
a. Nitrous oxide b. Nitric oxide c. cAMP d. reflex tachycardia

11. Dopamine agonist is:
a. Damperidone b. Droperidol c. Bromocriptine d. Acepromazine

12. Drug used for prevention and treatment of GI ulcer among:
a. terfenadine b. Nizatidine c. Azatadine d. Sodium carbonate

13. Parasympatholytic agents used for opthalmological examinations is:
a. Pilocarpine b. Scopalamine c. Cyclopentolate d. Ephedrine

14. The action of cardiac glycosides is to:
a. Decrease Na, K ATPase b. Decrease H, K ATPase c. Stimulate H, K ATPase d. Stimulate Na, K ATPase

15. Effects of dobutamine on heart is:
a. Increase force of Contraction b. Increase heart rate
c. Increase conduction of impulse d. Decrease conduction of impulse

16. Phosphodiesterase inhibitors among these is:
a. Salbutamol b. Theophylline c. Isoxsuprine d. Terbutaline

17. Preanesthetic used to block vagal reflex is:
a. Propranolol b. Scopolamine c. Glycopyrrolate d. Digoxin

18. Route of drug administration contraindicated in weak dehydrated patients is:
a. Intraperitoneal b. Intramuscular c. Subcutaneous d. Oral

19. Yohimbine HCl is indicated in overdose of:
a. Diazepams b. Ketamine c. Acepromazine d. Detomidine

20. Analgesics for nerve block during head injury:
a. Pothidine b. Methimazole c. Bupivacaine d. Sodium salicylate

21. The release of nor-adrenaline from the post ganglionic sympathetic nerve is:
a. Inhibited by nor-adrenaline via Alpha-2 receptor
b. Inhibited by Enkephaline via delta receptor
c. Facilitated by angiotensin II
d. All

22. Acetylcholine:
a. Release adrenaline from adrenal medulla b. Is released from sympathetic nerve to the sweat gland
c. Both a and b d. None of the above

23. Physostigmine is:
a. Is a quaternary ammonium ion and miotic b. Potentiate the action of carbachol
c. Drug of choice of Myasthenia gravis d. Competitor with acetylcholine for true cholinesterase 24. Mushroom poisoning is:
a. Of rapid onset type is by Amanita muscaria b. Of delayed onset type is by A. phalloides
c. Of delayed onset type is by treated symptomatically d. All

25. Regarding belladona alkaloids, following statements are correct:
a. Belladona in Italics means “beautiful lady” b. Datura stramonium contains hyoscine
c. Racemic isomers are more potent than I- isomers d. None of the above

26. The neuronal uptake of noradrenaline has the following characteristics:
a. It has equal affinity for all catecholamines

b. It is sodium dependent and is blocked selectively by cocaine and imipramine.

c. Guanithidine is a substrate for uptake 1.

d. Sympathectomy increases this process

27. Monoamine oxidase:
a. Is a mitochondrial enzymes
b. cause oxidative deamination of biogenic amines
c. Inactivates exogenous amines like tyramine to prevents its adverse effects on the body
d. All of the above

28. COMT is characterized by the following:
It is cytoplasmic enzyme in liver and kidney
It converts nor adrenaline and adrenaline into nor metanephrine and metanephrine
It converts deaminated products of catecholamine into VMA
All of the above

Correct Answer is:

1.

c. (Arecholine)

• Arecholine is a nicotinic acid based mild parasympathomimetic stimulant (Cholinomimetic alkaloid) used for its anticestodal actions.
• Pilocarpine are used to treat dryness of the mouth and throat caused by a decrease in the amount of saliva that may occurs after radiation treatment for cancer.
• Muscarine, a water soluble toxin, isolated from mushroom species, Amanita muscaria. The muscarinic acetylcholine receptors are named from M1 -M5 belong to the family of G-protein- coupled receptors.
• Neostigmine works by blocking the action of acetylcholine esterase and increases the level of acetylcholine.

2.

c. (Acetaminophen)

• Selective Cox-1 inhibitors - Aspirins
• Selective Cox-2 inhibitors- Meloxicam
• Selective Cox-3 inhibitors - Acetaminophen

Note:

• Phenyl butazone is a prostaglandin inhibitor with analgesic, anti- inflammatory and antipyretic properties.
• Chances of GI ulcer will be more with inhibition of cyclooxygenase-1

3.

c. (Inhibit Angiotensin II formation)

• Lisinopril acts by Inhibiting Angiotensin II formation.
• Lisinopril belonging to group of drug (Angiotensin- converting enzymes inhibitor), used to treat high blood pressure, heart failure and heart attack.

Renin- Angiotensin system

• In response to drop in blood pressure, drop in fluid volume, Renin releases from kidney and angiotensinogen releases from liver
• Renin acts on angiotensinogen to form Angiotensin-1
• Angiotensin converting enzymes releases from lungs, converts Angiotensin-1 to angiotensin-2
• Angiotensin-2 acts on the adrenal glands to stimulate release of aldosterone. Angiotensin-2 also acts directly on the blood vessels, stimulating vasoconstriction.
• Aldosterone acts on the kidney to stimulate reabsorption of salt and water.

4.

a. (Mannitol)
Diuretics for decreasing intracranial pressure - Mannitol

List of Diuretics with their therapeutics uses and mechanism of Action

• Hydrochlorothiazide: Used to treat hypertension; Acts on distal portion of ascending limbs of loop of Henle and early portion of distal tubules.
• Acetazolamide: Used to treat glaucoma; Inhibits carbonic anhydrase enzymes
• Spironolactone: Used to treat refractory edema due to hyperaldosterorism; Antagonist of aldosterone receptors.
• Furosemide: Used to treat acute pulmonary edema; Acts on thick ascending limbs of loop of henle
• Mannitol: Used to treat cerebral edema; Freely excreted by glomerular filtrate with no reabsorption from tubules.

5.

c. (Isoxsuprine)

• Isoxsuprine relaxes the uterine smooth muscles and is used for treatment of pre- term labor.
• Isoxsuprine is used to treat problem resulting from poor blood circulation.

Note:

• Oxytocin for contraction of uterus
• Tiaprost ( PGF2alpha analogue), play a vital role in luteolysis.
• Phenoxy benzamine Irreversibly blocks alpha-1, and alpha-2 receptors, used to treat high blood pressure condition (Hypertension).

6.

d. (Cyproheptadine HCL)

• Appetite stimulant used in cats, with the antiserotonergic properties - Cyproheptadine HCL
• Thiamine HCL is used to treat beriberi (Vitamin B1 deficiency)
• Stanozolol, Androgen analogues, used to treat hereditary angioedema.
• Medroxy progesterone, Progesterone analogues, used as birth control pills.

7.

a. (Ruminal atony)

• Neostigmine is indicated in Ruminal atony.
• Neostigmine is used to treat a muscle disease called myasthenia gravis.
• It is also used to prevent or treat certain kidney or intestinal problems.
• Neostigmine also given after surgery to help reverse the effect of certain types of medicines that have been used to relax the muscles.

8.

b. (Chondrotoxicity)
Most important adverse effects of pefloxacin in young dogs - Chondrotoxicity
Pefloxacin is the group of antibiotics, used to treat bacterial infections of the skin, soft tissue, pneumonia, urinary tract, and gonorrhoea. Also used to treat typhoid fever.

9.

b. (terfenadine)
Example of Non- sedative antihistaminic drug - Terfenadine

Examples of sedating and Non- sedating Antihistamines

• Sedating antihistamines: Alimemazine, Brompheniramine, Chlorpheniramine, Cyclizine, Cyproheptadine, Dexchlorpheniramine, Dimenhydrinate, Diphenhydramine, Doxylamine, Pheniramine, Promethazine.
• Non- sedative antihistamine: Terfenadine, Cetirizine, Desloratadine, Fexofenadine, Levocetirizine, Loratadine

10.

b. (Nitric oxide)
- Vasodilation effects of cholinergic agonist is due to Nitric oxide.

11.

c. (Bromocriptine)

• Dopamine agonist - Bromocriptine
• Dopamine agonist are the compound that activates dopamine receptors. There are 2 families of dopamine receptors, D2 -like and D1- like, and they are all G- protein coupled receptors.
• Examples of Dopamine agonists: Bromocriptine, Cabergoline, Apomorphine, Pramipexole, Ropinirole, Rotigotine etc.

12.

b. (Nizatidine)
Drug used for prevention and treatment of GI ulcer - Nizatidine.
Nizatidine is Histamine (H2) receptor antagonist that inhibits stomach acid production, help in prevention and treatment of GI ulcer.

13.

c. (Cyclopentolate)
Parasympatholytic agents used for opthalmological examination - Cyclopentolate
Cyclopentolate is used to dilate (enlarge) the pupil. It is used before eye examination.

14.

a. (Decrease Na, K ATPase)

• The action of Cardiac glycosides - Decrease Na, K ATPase
• Cardiac glycosides inhibit Na-K ATPase on Cardiac and other tissues, causing intracellular retention of sodium, followed by increased intracellular calcium concentration through the effects of Na-Calcium exchanger.
• Examples of Cardiac glycosides: Digoxin (Cardoxin and Lanoxin), digitalis and digitoxin, Oleandrin, bufalin, ouabain etc.

Note:

- Digoxin is the most commonly prescribed cardiac glycosides.

15.

a. (Increase force of Contraction)

• Effects of Dobutamine on Heart - Increase force of contraction
• Dobutamine (synthetic catecholamine) which is pure adrenergic ( beta1> Beta2> alpha)
• Increase/no change/decrease blood pressure
• Ionotropic action - more

16.

b. (Theophylline)

• Phosphodiesterase inhibitors - Theophylline
• Phosphodiesterase inhibitors are medications that causes blood vessels to relax and widen, improving circulation and lowering blood pressure.
• Phosphodiesterase5 inhibitors are Theophylline, Sildenafil, tadalafil, vardenafil, avanafil etc.
• Phosphodiesterase4 inhibitors are Roflumilast, apremilast, ibudilast
• Phosphodiesterase3 inhibitors are cilostazol and milrinone

17.

c. (Glycopyrrolate)
Pre anesthetics used to block vagal reflex is Glycopyrrolate

Note:

• Propranolol is used to treat hypertension, indicated to treat angina pectoris due to coronary atherosclerosis, atrial fibrillation, myocardial infarction, migraine, tremor, subaortic stenosis, pheochromocytoma, proliferating infantile hemangioma.
• Scopolamine are indicated to control postoperative nausea and vomiting associated with recovery from anesthesia, opiate analgesia and surgery. Also suggested in control nausea and vomiting associated with motion sickness.
• Digoxin are indicated for treatment of mild to moderate heart failure, to increase myocardial contraction, in treatment of chronic atrial fibrillation.

18.

c. (Subcutaneous )
- Subcutaneous administration of drug is contraindicated in weak dehydrated patients.

19.

d. (Detomidine)
Yohimbine HCL is indicated in overdose of Detomidine.

20.

c. (Bupivacaine)
Analgesics for nerve block during head injury: Bupivacaine
Non - narcotics analgesics - Aspirins
Acetaminophen - Analgesics- Antipyretics

Classification of analgesics

• Non- steroidal anti - inflammatory drugs: Aspirins, Acetaminophen, Nimesulide
• Opioids : Morphine, pethidine, codeine

21.

d. (All)

• The release of nor-adrenaline from the post ganglionic sympathetic nerve is:
• Inhibited by nor-adrenaline via alpha -2 receptor.
• inhibited by enkephaline via delta receptor
• Facilitated by angiotensin II

22.

c. (Both a and b)

• Acetylcholine releases from adrenaline from adrenal medulla
• Is released from sympathetic nerve to the sweat gland
• The action of acetylcholine released from the nerve terminal is limited by Acetylcholineesterase.
• The muscarinic actions of acetylcholine includes Colic pain in abdomen and excessive salivation

23.

d. (Compete with acetylcholine for true cholinesterase)

• Physostigmine and Neostigmine are carbamates and reversible inhibitors of acetylcholinesterase enzymes, leads to increase concentration of acetylcholine, causing stimulation of both muscarinic and nicotinic receptors.
• Neostigmine potentiates the parasympathomimetics effects of Methacholine.
• Cholinergic drugs are contraindicated in Bronchial asthma, Peptic ulcer, and Hyperthyroidism
• Neostigmine and physostigmine potentiates the parasympathomimetic effects of Methacholine.
• In myasthenia gravis, Atropine prevents the adverse action of neostigmine; Quinine is contraindicated.
• Therapeutics use of cholinergic drugs: Acute angle- closure glaucoma, Myasthenia gravis, Alzheimer’s disease.

Truth regarding cholinergic agents :

• Amanita muscarina is a poisonous mushroom.
• -Pilocarpine is used as miotic
• Echothiphate is used in galucoma.
• Acetylcholinesterase is present in all cholinergic neurons while butyrylcholinesterase is present in plasma, liver and other organsand may have genetic variation

24.

d. (All)

Mushroom poisoning is

• Of rapid onset type is by Amanita muscaria
• Of delayed onset type is by A. phalloides
• Of delayed onset type is by treated symptomatically
• Mushroom poisoning is poisoning resulting from ingestion of mushroom that contains toxic substances. Its symptoms vary from slight GI discomfort to death in about 10 days.
• Mushroom toxins are secondary metabolites produced by the fungus.

25.

b. (Datura stramonium contains hyoscine)

Regarding belladona alkaloids, following statements are corrects:

Datura stramonium contains hyoscine
Belladona alkaloids are esters of the tropic acids with complex organic base tropine/scopolamine
Atropine is alkaloidester, block M1 and M2 receptors
Atropine decreases seretions of sweat, salivary and lacrimal glands
Hyoscine differs from the atropine in following:
a. it is more effective in glandular secretion
b. It is more effective in Motion sickness
c. It has greater ability to cross blood brain barrier

26.

b. (It is sodium dependent and is blocked selectively by cacaine and imipramine.)
The neuronal uptake of the noradrenaline has following characteristics as it is sodium dependent and is blocked selectively by cocaine and imipramine.
The extra neuronal uptake of noradrenaline has following characteristics as it is present in non- neuronal tissues like heart, blood vessel and intestine.

27.

d. (All of the above)
Monoamine oxidase is a mitochondrial enzyme which cause oxidative deamination of biogenic amines and also inactivates exogenous amine like tyramine to prevents its adverse effects on the body.

28.

d. (All of the above)

• Characteristics of COMT (Catechol O-methyl transferease) is the enzymes responsible for the O- methylation of endogenous neurotransmitters and of xenobiotics substances and hormones incorporating catecholic structures.
• It is cytoplasmic enzymes found in liver and kidney.
• Converts noradrenaline and adrenaline into nor metanephrine and Metanephrine
• Converts diaminated products of catecholamines into VMA ( Vanillylmandelic acid).
• Note: The main excretory products of catecholamine in the urine in normal individuals are VMA (Vanillylmandelic acid), Homovanillic acid (HVA) and Normetanephrine and Metanephrine.