Chapter 14. 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:
1. Increases peripheral vasoconstriction
2. Decreases detrusor muscle contractility
3. Lowers supine blood pressure more than standing pressure
4. 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:
1. Take the dose at bedtime
2. Sit up slowly and dangle their feet before standing
3. Monitor their blood pressure and skip a dose if the pressure is less than 120/80
4. Weigh daily and report weight gain of greater than 2 pounds in one day
3. John has clonidine, a centrally acting adrenergic blocker, prescribed for his hypertension. He should:
1. Not miss a dose or stop taking the drug because of potential rebound hypertension
2. Increase fiber in the diet to treat any diarrhea that may occur
3. Reduce fluid intake to less than 2 liters per day to prevent fluid retention
4. Avoid sitting for long periods, as this can lead to deep vein thrombosis
4. Clonidine has several off-label uses, including:
1. Alcohol and nicotine withdrawal
2. Post-herpetic neuralgia
3. Both 1 and 2
4. Neither 1 nor 2
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:
1. Increasing heart rate to improve cardiac output
2. Reducing vascular smooth muscle tone
3. Increasing aldosterone-mediated volume activity
4. Reducing aqueous humor production
6. Which of the following adverse effects are less likely in a beta1-selective blocker?
1. Dysrhythmias
2. Impaired insulin release
3. Reflex orthostatic changes
4. Decreased triglycerides and cholesterol
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?
1. Extend the dosage interval.
Copyright © 2016 F. A. Davis
Company
, 2. Decrease the dose by 75%.
3. Take no action because this value is expected in the older adult.
4. Schedule a serum creatinine level to validate the CrCl value.
8. Beta blockers are the drugs of choice for exertional angina because they:
1. Improve myocardial oxygen supply by vasodilating the coronary arteries
2. Decrease myocardial oxygen demand by decreasing heart rate and vascular
resistance
3. Both 1 and 2
4. Neither 1 nor 2
9. Adherence to beta blocker therapy may be affected by their:
1. Short half-lives requiring twice daily dosing
2. Tendency to elevate lipid levels
3. Effects on the male genitalia, which may produce impotence
4. None of the above
10. Beta blockers have favorable effects on survival and disease progression in heart failure. Treatment
should be initiated when the:
1. Symptoms are severe
2. Patient has not responded to other therapies
3. Patient has concurrent hypertension
4. Left ventricular dysfunction is diagnosed
11. Abrupt withdrawal of beta blockers can be life threatening. Patients at highest risk for serious
consequences of rapid withdrawal are those with:
1. Angina
2. Coronary artery disease
3. Both 1 and 2
4. Neither 1 nor 2
12. To prevent life-threatening events from rapid withdrawal of a beta blocker:
1. The dosage interval should be increased by 1 hour each day.
2. An alpha blocker should be added to the treatment regimen before withdrawal.
3. The dosage should be tapered over a period of weeks.
4. 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?
1. Dizziness
2. Increased heart rate
3. Nervousness and shakiness
4. Diaphoresis
Copyright © 2016 F. A. Davis
Company
,14. Combined alpha-beta antagonists are used to reduce the progression of heart failure because they:
1. Vasodilate the peripheral vasculature
2. Decrease cardiac output
3. Increase renal vascular resistance
4. Reduce atherosclerosis secondary to elevated serum lipoproteins
15. Carvedilol is heavily metabolized by CYP2D6 and 2C9, resulting in drug interactions with which of
the following drug classes?
1. Histamine 2 blockers
2. Quinolones
3. Serotonin re-uptake inhibitors
4. All of the above
16. Alpha-beta blockers are especially effective to treat hypertension for which ethnic group?
1. White
2. Asian
3. African American
4. Native American
17. Bethanechol:
1. Increases detrusor muscle tone to empty the bladder
2. Decreases gastric acid secretion to treat peptic ulcer disease
3. Stimulates voluntary muscle tone to improve strength
4. Reduces bronchial airway constriction to treat asthma
18. Clinical dosing of Bethanechol:
1. Begins at the highest effective dose to obtain a rapid response
2. Starts at 5 mg to 10 mg PO and is repeated every hour until a satisfactory
clinical response is achieved
3. Requires dosing only once daily
4. Is the same for both the oral and parenteral route
19. Patients who need to remain alert are taught to avoid which drug due to its antimuscarinic effects?
1. Levothyroxine
2. Prilosec
3. Dulcolax
4. Diphenhydramine
20. Anticholinesterase inhibitors are used to treat:
1. Peptic ulcer disease
2. Myasthenia gravis
3. Both 1 and 2
4. Neither 1 nor 2
21. Which of the following drugs used to treat Alzheimer’s disease is not an anticholinergic?
1. Donepezil
2. Memantine
Copyright © 2016 F. A. Davis
Company
, 3. Rivastigmine
4. Galantamine
22. Taking which drug with food maximizes it bioavailability?
1. Donepezil
2. Galantamine
3. Rivastigmine
4. Memantine
23. Which of the following drugs should be used only when clearly needed in pregnant and
breastfeeding women?
1. Memantine
2. Pyridostigmine
3. Galantamine
4. Rivastigmine
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:
1. Dizziness and headache
2. Nausea
3. Decreased salivation
4. 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?
1. Tacrine
2. Donepezil
3. Memantine
4. Pyridostigmine
26. Nicotine has a variety of effects on nicotinic receptors throughout the body. Which of the following
is NOT an effect of nicotine?
1. Vasodilation and decreased heart rate
2. Increased secretion of gastric acid and motility of the GI smooth muscle
3. Release of dopamine at the pleasure center
4. Stimulation of the locus coeruleus
27. Nicotine gum products are:
1. Chewed to release the nicotine and then swallowed for a systemic effect
2. “Parked” in the buccal area of the mouth to produce a constant amount of nicotine
release
3. Bound to exchange resins so the nicotine is only released during chewing
4. Approximately the same in nicotine content as smoking two cigarettes
28. Nicotine replacement therapy (NRT):
1. Is widely distributed in the body only when the gum products are used
Copyright © 2016 F. A. Davis
Company
.
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:
1. Increases peripheral vasoconstriction
2. Decreases detrusor muscle contractility
3. Lowers supine blood pressure more than standing pressure
4. 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:
1. Take the dose at bedtime
2. Sit up slowly and dangle their feet before standing
3. Monitor their blood pressure and skip a dose if the pressure is less than 120/80
4. Weigh daily and report weight gain of greater than 2 pounds in one day
3. John has clonidine, a centrally acting adrenergic blocker, prescribed for his hypertension. He should:
1. Not miss a dose or stop taking the drug because of potential rebound hypertension
2. Increase fiber in the diet to treat any diarrhea that may occur
3. Reduce fluid intake to less than 2 liters per day to prevent fluid retention
4. Avoid sitting for long periods, as this can lead to deep vein thrombosis
4. Clonidine has several off-label uses, including:
1. Alcohol and nicotine withdrawal
2. Post-herpetic neuralgia
3. Both 1 and 2
4. Neither 1 nor 2
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:
1. Increasing heart rate to improve cardiac output
2. Reducing vascular smooth muscle tone
3. Increasing aldosterone-mediated volume activity
4. Reducing aqueous humor production
6. Which of the following adverse effects are less likely in a beta1-selective blocker?
1. Dysrhythmias
2. Impaired insulin release
3. Reflex orthostatic changes
4. Decreased triglycerides and cholesterol
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?
1. Extend the dosage interval.
Copyright © 2016 F. A. Davis
Company
, 2. Decrease the dose by 75%.
3. Take no action because this value is expected in the older adult.
4. Schedule a serum creatinine level to validate the CrCl value.
8. Beta blockers are the drugs of choice for exertional angina because they:
1. Improve myocardial oxygen supply by vasodilating the coronary arteries
2. Decrease myocardial oxygen demand by decreasing heart rate and vascular
resistance
3. Both 1 and 2
4. Neither 1 nor 2
9. Adherence to beta blocker therapy may be affected by their:
1. Short half-lives requiring twice daily dosing
2. Tendency to elevate lipid levels
3. Effects on the male genitalia, which may produce impotence
4. None of the above
10. Beta blockers have favorable effects on survival and disease progression in heart failure. Treatment
should be initiated when the:
1. Symptoms are severe
2. Patient has not responded to other therapies
3. Patient has concurrent hypertension
4. Left ventricular dysfunction is diagnosed
11. Abrupt withdrawal of beta blockers can be life threatening. Patients at highest risk for serious
consequences of rapid withdrawal are those with:
1. Angina
2. Coronary artery disease
3. Both 1 and 2
4. Neither 1 nor 2
12. To prevent life-threatening events from rapid withdrawal of a beta blocker:
1. The dosage interval should be increased by 1 hour each day.
2. An alpha blocker should be added to the treatment regimen before withdrawal.
3. The dosage should be tapered over a period of weeks.
4. 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?
1. Dizziness
2. Increased heart rate
3. Nervousness and shakiness
4. Diaphoresis
Copyright © 2016 F. A. Davis
Company
,14. Combined alpha-beta antagonists are used to reduce the progression of heart failure because they:
1. Vasodilate the peripheral vasculature
2. Decrease cardiac output
3. Increase renal vascular resistance
4. Reduce atherosclerosis secondary to elevated serum lipoproteins
15. Carvedilol is heavily metabolized by CYP2D6 and 2C9, resulting in drug interactions with which of
the following drug classes?
1. Histamine 2 blockers
2. Quinolones
3. Serotonin re-uptake inhibitors
4. All of the above
16. Alpha-beta blockers are especially effective to treat hypertension for which ethnic group?
1. White
2. Asian
3. African American
4. Native American
17. Bethanechol:
1. Increases detrusor muscle tone to empty the bladder
2. Decreases gastric acid secretion to treat peptic ulcer disease
3. Stimulates voluntary muscle tone to improve strength
4. Reduces bronchial airway constriction to treat asthma
18. Clinical dosing of Bethanechol:
1. Begins at the highest effective dose to obtain a rapid response
2. Starts at 5 mg to 10 mg PO and is repeated every hour until a satisfactory
clinical response is achieved
3. Requires dosing only once daily
4. Is the same for both the oral and parenteral route
19. Patients who need to remain alert are taught to avoid which drug due to its antimuscarinic effects?
1. Levothyroxine
2. Prilosec
3. Dulcolax
4. Diphenhydramine
20. Anticholinesterase inhibitors are used to treat:
1. Peptic ulcer disease
2. Myasthenia gravis
3. Both 1 and 2
4. Neither 1 nor 2
21. Which of the following drugs used to treat Alzheimer’s disease is not an anticholinergic?
1. Donepezil
2. Memantine
Copyright © 2016 F. A. Davis
Company
, 3. Rivastigmine
4. Galantamine
22. Taking which drug with food maximizes it bioavailability?
1. Donepezil
2. Galantamine
3. Rivastigmine
4. Memantine
23. Which of the following drugs should be used only when clearly needed in pregnant and
breastfeeding women?
1. Memantine
2. Pyridostigmine
3. Galantamine
4. Rivastigmine
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:
1. Dizziness and headache
2. Nausea
3. Decreased salivation
4. 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?
1. Tacrine
2. Donepezil
3. Memantine
4. Pyridostigmine
26. Nicotine has a variety of effects on nicotinic receptors throughout the body. Which of the following
is NOT an effect of nicotine?
1. Vasodilation and decreased heart rate
2. Increased secretion of gastric acid and motility of the GI smooth muscle
3. Release of dopamine at the pleasure center
4. Stimulation of the locus coeruleus
27. Nicotine gum products are:
1. Chewed to release the nicotine and then swallowed for a systemic effect
2. “Parked” in the buccal area of the mouth to produce a constant amount of nicotine
release
3. Bound to exchange resins so the nicotine is only released during chewing
4. Approximately the same in nicotine content as smoking two cigarettes
28. Nicotine replacement therapy (NRT):
1. Is widely distributed in the body only when the gum products are used
Copyright © 2016 F. A. Davis
Company
