Pharmacology for Rehabilitation Professionals 2nd Edition by Gladson – Test Bank


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Gladson: Pharmacology for Rehabilitation Professionals, 2nd Edition


Chapter 05: Drugs Acting on the Autonomic Nervous System


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1) Cholinergic neurotransmission involves ______________.


  1. synthesis of acetylcholine (ACh) by acetyl cholinesterase
  2. release of acetylcholine (ACh) from nerve terminal by action of Mg ions
  3. interaction of ACh with muscarinic or nicotinic receptors
  4. termination of Ach action by active re-uptake



ACh is synthesized by choline acetyltransferase. Release is mediated by Ca ions in the nerve terminal which fuse the Ach containing vesicles to the membrane initiating ACh release. Termination of action occurs by destruction of ACh by acetyl cholinesterase.


2) Noradrenergic neurotransmission involves ______________.


  1. synthesis of norepinephrine (NE) by monoamine oxidase or MAO
  2. synthesis of NE from epinephrine
  3. interaction with adrenergic gamma and delta receptors
  4. termination of action which is usually via re-uptake into the neuron



NE is synthesized from dopamine (and epinephrine from NE) and MAO metabolizes NE within nerve terminals to ensure constant intra-neuronal NE levels. NE interacts with alpha and beta receptors.


3) Nicotinic receptors are located at all of the following except the ______________.


  1. skeletal muscles
  2. autonomic ganglia
  3. brain
  4. heart


ANS: D is correct. The heart, like all end organs, contains muscarinic receptors. Nicotinic receptors located at skeletal muscles are labeled Nm, those at the ganglia and in the brain are labeled Nn receptors.


4) Muscarinic receptors are located at all of the following except the ______________.


  1. blood vessels
  2. bladder
  3. bronchi
  4. adrenal medulla



All end organs in the body have muscarinic receptors. The medulla has nicotinic receptors.


5) Alpha receptors are located at all of the following except the______________.


  1. blood vessels
  2. GI tract
  3. bronchi
  4. iris of the eye



Bronchi contain mostly beta 2 receptors.


6) Beta 1 receptors are predominantly located at the ______________.


  1. heart
  2. bronchi
  3. GI tract
  4. All of the above



All the other have mostly beta 2 receptors.


7) Drugs that mimic the action of the parasympathetic nervous system act by ______________.


  1. stimulating cholinergic receptors directly
  2. increasing the synthesis and release of ACh
  3. inhibiting acetyl cholinesterase
  4. A and B



Drugs can bind to and stimulate cholinergic receptors directly. They can also inhibit the enzyme acetyl cholinesterase and slow ACh breakdown which causes an increase in synaptic levels and increased receptor stimulation. These drugs are called anticholinesterases. Direct-acting drugs can be classified as muscarinic or nicotinic drugs and have a specific action either on muscarinic or nicotinic receptors while anticholinesterases are non-specific and will act on both types.


8) Alpha agonists ______________.


  1. constrict the sphincter muscle of the iris leading to miosis
  2. constrict blood vessels leading to decreased blood pressure
  3. constrict the sphincter of the bladder leading to urinary retention
  4. stimulate GI-tract muscles leading to diarrhea



Alpha stimulation contracts the radial muscle of the iris leading to mydriasis. Alpha stimulation constricts blood vessels leading to increased peripheral resistance and increased blood pressure. Alpha receptors constrict the bladder sphincter causing urinary retention and alpha receptors on the intestines slow peristalsis leading to mild constipation.


9) Beta 2 agonists ______________.


  1. constrict blood vessels and causes an increase in blood pressure
  2. relax bronchi and cause increased airflow
  3. stimulate the pregnant uterus leading to premature contractions
  4. affect glucose metabolism and decreases blood glucose levels



Beta 2 agonists are relatively selective for bronchi and are used frequently to treat asthma – only at higher doses or sensitive individuals do they affect beta 1 receptors in the heart. They slightly dilate blood vessels in skeletal muscles and could cause a minor fall in blood pressure which is counteracted by their stimulatory effects on the heart. Beta 2 receptors are inhibitory to the pregnant uterus and are used to prevent premature contractions. They stimulate glucose metabolism leading to increased blood glucose levels.


10) Alpha blockers ______________.


  1. dilate blood vessels and are used to treat hypertension
  2. dilate the pupil and cause photophobia
  3. constrict nasal blood vessels and cause a runny nose
  4. inhibit heart contractions and cause bradycardia



At the beginning of therapy for hypertension they can cause syncope or fainting. They constrict the pupils, which can cause vision problems during darkness when the pupils ordinarily dilate, and they cause nasal blood vessels to dilate, which makes them leaky causing nasal congestion and stuffiness. The heart has no alpha receptors which play a pharmacological role, but a fall in blood pressure can cause some reflex tachycardia.


11) Beta–blockers ______________.


  1. increase fluid influx into the eye and are contraindicated in glaucoma
  2. cause some vasodilatation and hot feet and hands
  3. decrease heart rate and mask the onset of a hypoglycemic episode
  4. are contraindicated in patients with angina pectoris



A hypoglycemic episode often starts with a tachycardia as a warning sign which is prevented by these drugs. They prevent influx of fluids into the eye, lower intraocular pressure and are used to treat glaucoma. They cause some constriction of blood vessels and cold hands and feet. They are used in patients with angina since these drugs reduce heart rate and, thus, oxygen demand by these already oxygen-deprived hearts.


12) Anticholinesterases ______________.


  1. are used to treat myasthenia gravis
  2. cause constipation
  3. dilate bronchi
  4. cause muscular spasm leading to death during an overdose



Pyridostigmine or neostigmine is used to stimulate neuromuscular receptors which are reduced in number due to destruction by the immune system. They cause diarrhea, which is one of the major problems when treating myasthenia gravis. It can be prevented by use of an anticholinergic/antimuscarinic drug which will selectively block the actions on the muscarinic receptors on the GI tract while not affecting the nicotinic receptors at the skeletal muscle. They constrict bronchi and are contraindicated in asthma. They cause muscular paralysis at overdoses – the nicotinic receptors (only one among autonomic receptors) become insensitive when over-stimulated at high doses and the muscles “escape” and do not contract – paralysis of respiratory muscles is the cause of death. The latter is aggravated by excessive bronchial secretion filling the bronchi with fluid.


13) Anticholinergic drugs cause______________.


  1. dry mouth
  2. diarrhea
  3. bradycardia
  4. frequent urination



Dry mouth is one of the side effects of anticholinergic drug therapy which is very discomforting and often leads to discontinuation of drug use (like some antidepressant drugs). They cause dry mouth and skin, constipation, urinary retention, tachycardia and blurred vision, which are the main signs of anticholinergic drug therapy.


14) A drug causing mydriasis, an increase in blood pressure and which is being used as a nasal decongesting drug is a(n) ______________.


  1. alpha agonist
  2. alpha antagonist
  3. beta agonist
  4. beta antagonist



Alpha antagonists cause miosis, hypotension and stuffy nose. Beta agonists have no effect on the iris, could increase blood pressure by increasing cardiac output and would make nasal congestion worse. Beta antagonists have no effect on the iris, cause a decrease in blood pressure and have a negligible effect on nasal blood vessels.


15) A drug causing overheating and increased body temperature in a small boy during exercise on a hot day is a(n) ______________.


  1. alpha agonist
  2. beta antagonist
  3. muscarinic agonist
  4. antimuscarinic drug



Antimuscarinic or anticholinergic drugs block sweating and prevent heat loss on hot days. The other drugs would not do so.


16) An overactive bladder is most likely to be treated with a(n) ______________.


  1. alpha antagonist
  2. beta antagonist
  3. muscarinic agonist
  4. muscarinic antagonist



Alpha receptors close the bladder sphincter and their blockade opens the sphincter promoting urination (alpha antagonists are given to elderly men with prostate problems to help with urination). Beta antagonists have little effect but might counteract bladder extension leading to less bladder filling. Muscarinic receptor stimulate the bladder and cause urination.


17) Elderly individuals are more prone to ______________.


  1. diarrhea caused by drugs with anticholinergic activities
  2. bradycardia caused by drugs with muscarinic activities
  3. excitation caused by drugs with anticholinergic activities
  4. insomnia caused by anticholinesterases



Bradycardia is more pronounced and the physical therapist should notify the physician if the heart rate is 60 or less. Elderly suffer more constipation and urinary retention (mostly men with enlarged prostate) as well as sedation with anticholinergic drugs. Anticholinesterases are used in the treatment of dementia and may cause syncope in these elderly patients (often necessitating implantation of pacemaker).


18) A patient faints while quickly getting up from a hot pool. Which of the following drugs could have caused this event?


  1. Salmeterol
  2. Prazosin
  3. Phenylephrine
  4. Metaprolol



Prazosin is an alpha antagonist and dilates blood vessels, reduces blood pressure and is prone to orthostatic hypotension which in this case is exaggerated by additional blood vessel dilatation caused by the hot water. This event can be caused by all drugs which dilate blood vessels or cause orthostatic hypotension. The patient must be advised to stand up slowly and to hold on to a firm support and, in case of elderly individuals, the therapist should support that person while exiting the pool. The other drugs are not associated with significant blood vessel dilatation and orthostatic hypotension. Salmeterol is a beta agonist used in the therapy of asthma. Phenylephrine is an alpha agonist used to dilate the pupils for eye examinations and to reduce nasal congestion during a cold. Metaprolol is a beta–blocker used to treat hypertension and dysrhythmias.


19) The actions of the sympathetic nervous system include which of the following?


  1. Constriction of the trachea and bronchioles
  2. Pupil dilation
  3. Decreased heart rate
  4. Contraction of the bladder wall



The SNS is responsible for increasing HR, increasing contractility, mydriasis, bronchhodilation, and relaxation of the bladder wall.


20) The actions of the parasympathetic nervous system include which of the following?


  1. Increased muscular motility and tone of the GI tract
  2. Increased contractility of the heart
  3. Triggering of the “fight-or-flight” response
  4. Urinary retention



The PNS is responsible for bradycardia and increases GI and GU motility.


21) The type of receptor found across autonomic ganglia in both the sympathetic and parasympathetic nervous system is ________________ receptor.


  1. Nicotinic acetylcholine
  2. Muscarinic acetylcholine
  3. Adrenergic norepinephrine
  4. Adrenergic epinephrine



The synapse between pre- and post-ganglionic neurons for both systems is the nicotinic Ach receptors. The post-synaptic receptors are either muscarinic or adrenergic.


22) Therapeutic actions of β-blockers include __________.


  1. bronchoconstriction
  2. reflex peripheral vasoconstriction
  3. decreased renin release
  4. increased sodium retention



While broncoconstriction may occur with beta–blockers, this action is not therapeutic.


23) α-Adrenoceptors show the strongest response to which of the following agonists?


  1. a2 agonists
  2. Catcholamines
  3. a agonists
  4. a2 blockers



Receptors will show the strongest activity in response to the normal endogenous catecholamines.


24) α-Adrenergic–blocking agents are responsible for which of the following?


  1. Increased blood pressure
  2. Decreased sympathetic tone of blood vessels
  3. Reflex bradycardia
  4. Asthma



Alpha blockade produces vasodilation and blocks sympathetic stimulation of the arterioles.





α2 Agonist Stimulates central presynaptic α2 receptors
Calcium channel blockers Produces vasodilation by inhibiting calcium flow
ACE inhibitor Blocks angiotensin II–converting enzymes
β-Blocker Inhibits renin release
Diuretic Decreases blood volume


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