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PMC 537 EXAMINATION 2 1999
DATE: October 12th
FROM: Edward JN Ishac, Course Director
NOTE: This exam is scheduled to last for 2 HOURS. Apportion your time to
approximate 1 minute per point value.
Please write the last 4 digits of your social security number on each page of the
exam.
Also please answer the questions from each lecturer on separate pages from
those of the others.
Finally, before answering the following questions, read and analyze them carefully
to identify the information being requested. When you have done this, write your
response, using the same organizational format as the question. Be sure to
address each point raised in the question, but you are strongly discouraged from
including extraneous information not asked for (even though you may be very
eager to demonstrate your knowledge).
There are FIVE exams scheduled for this course. The questions will be as they
were in the past, i.e., short answer and/or essay type. Each exam will be worth
100 points, so figure on an 8-10 point question that should take 8-10 minutes to
answer per lecture hour. There is no cumulative final exam, so all exams are
weighted evenly in the final grade.
GOOD LUCK
PHTX 537-Fall Semester
Autonomic Pharmacology
Examination 2
Dr. Smith
Tue. Oct 12th, 1999
30 points total
Question 1 (10 points).
Heart transplantation occurs on a daily basis within the U.S. Both SNS and PNS
innervation of the transplanted heart has been ablated (i.e., cut-off or removed).
Based on this information, briefly describe the actions of atropine and dobutamine
on heart rate. Second, are exercise induced increases in heart rate possible? If
so, how?
Question 2 (20 points).
This question will require you to consider the entire range of drugs taught in the
autonomic nervous system lectures.
An asthma attack is inadvertently
precipitated in a patient challenged with methacholine (Provocholine) by inhalation
administration. Describe at least three drugs that might be used to reverse the
attack, their route of administration, and their mechanism of action on bronchial
smooth muscle tone. Include, if possible, the concepts of competitive receptor
antagonists and physiological antagonists in your discussion.
Molecular Biology of Adrenoceptors
Dr. Gao
8 points total
Question 2 (8 points).
Please discuss three major common features and three major specific features of
adrenergic receptors (alpha 1, alpha 2 and beta-adrenergic receptors).
Autonomic Pharmacology
Dr. Ishac
40 points total
You have a choice of three (3) questions, answer any two (2) questions. Each
question is worth 20 points.
Question choice 1 (20 points).
Schematic representation of the cardiovascular effects (blood pressure, BP; total
peripheral resistance, TPR; heart rate, HR) of intravenous infusions of
norepinephrine (NE) and epinephrine (EPI) in a human are depicted below.
a. Describe the receptors and mechanisms involved (direct & indirect) in
these responses.
b. Describe the cardiovascular changes (BP, HR, TPR) that would result
from an intravenous infusion of the -adrenoceptor antagonist,
propranolol alone.
c. Discuss how the responses to norepinephrine and epinephrine would
be modified by the presence of the propranolol.
Question choice 2 (20 points).
Drugs that act on beta-adrenoceptors (agonists and antagonists) represent major
tools in the arsenal of a physician available for the treatment of various medical
disorders. List two drugs from each division (agonists and antagonists) and
discuss the following points:
i)
ii)
iii)
iv)
v)
Diseases/conditions appropriate for their use
Mechanism of action (if known)
Effect of route of administration
Effect of receptor selectivity
Possible side effects
Question choice 3 (20 points).
(Ishac continued)
Interaction with other medications and food is a serious problem with the use of
monoamine oxidase inhibitors. The "cheese reaction" or "tyramine effect" occurs
when normally innocuous amines (mainly tyramine) are injested in an individual
being treated with an MAO inhibitor.
Discuss:
a.
b.
c.
d.
e.
The mechanisms involved in this interaction.
The cardiovascular consequences of the interaction.
The drug(s) used in the treatment of an individual
presenting with this emergency.
The significance of MAO enzyme isoforms.
Explain the term “tachyphylaxis” in response to the
actions of amphetamine.
NMJ and Cholinesterase Inhibitors
Dr. Satin
22 points total
Question 1 (5 points).
Briefly outline the steps of neuromuscular transmission, starting with stimulation of
the motor nerve and ending with muscle contraction. Then name two ways you
could inhibit with the release of transmitter.
Question 2 (4 points).
Name the two major classes of neuromuscular blockers, briefly characterize their
respective mechanisms of action, and then list two examples from each class (4
points).
Question 3 (9 points)
List each of the 3 classes of anticholinesterases, then provide a very brief outline
of their mechanism of action to inhibit acetylcholinesterase, and give one example
from each class. Be sure to include how they interact with the enzyme.
Question 4 (4 points)
Briefly discuss TWO clinical uses for anticholinesterases.