AGENTS, CONTROLLING THE FUNCTIONS OF THE PERIPHERAL NERVOUS SYSTEM

PART I Local anesthetics

001. Local anesthetics produce:

a) Analgesia, amnesia, loss of consciousness

b) Blocking pain sensation without loss of consciousness

c) Alleviation of anxiety and pain with an altered level of consciousness

d) A stupor or somnolent state

002. A good local anesthetic agent shouldn’t cause:

a) Local irritation and tissue damage

b) Systemic toxicity

c) Fast onset and long duration of action

d) Vasodilatation

003. Most local anesthetic agents consist of:

a) Lipophylic group (frequently an aromatic ring)

b) Intermediate chain (commonly including an ester or amide)

c) Amino group

d) All of the above

004. Which one of the following groups is responsible for the duration of the local anesthetic action?

a) Intermediate chain

b) Lipophylic group

c) Ionizable group

d) All of the above

005. Indicate the local anesthetic agent, which has a shorter duration of action:

a) Lidocaine

b) Procaine

c) Bupivacaine

d) Ropivacaine

006. Which one of the following groups is responsible for the potency and the toxicity of local anesthetics?

a) Ionizable group

b) Intermediate chain

c) Lipophylic group

d) All of the above

007. Indicate the drug, which has greater potency of the local anesthetic action:

a) Lidocaine

b) Bupivacaine

c) Procaine

d) Mepivacaine

008. Ionizable group is responsible for:

a) The potency and the toxicity

b) The duration of action

c) The ability to diffuse to the site of action

d) All of the above

009. Which one of the following local anesthetics is an ester of benzoic acid?

a) Lidocaine

b) Procaine

c) Ropivacaine

d) Cocaine

010. Indicate the local anesthetic, which is an ester of paraaminobenzoic acid:

a) Mepivacaine

b) Cocaine

c) Procaine

d) Lidocaine

011. Which of the following local anesthetics is an acetanilide derivative?

a) Tetracaine

b) Lidocaine

c) Cocaine

d) Procaine

012. Indicate the local anesthetic, which is a toluidine derivative:

a) Lidocaine

b) Bupivacaine

c) Prilocaine

d) Procaine

013. Which of the following local anesthetics is a thiophene derivative?

a) Procaine

b) Ultracaine

c) Lidocaine

d) Mepivacaine

014. Local anesthetics are:

a) Weak bases

b) Weak acids

c) Salts

d) None of the above

015. For therapeutic application local anesthetics are usually made available as salts for the reasons of:

a) Less toxicity and higher potency

b) Higher stability and greater lipid solubility

c) Less local tissue damage and more potency

d) More stability and greater water solubility

016. Which of the following statements is not correct for local anesthetics?

a) In a tissue they exist either as an uncharged base or as a cation

b) A charged cationic form penetrates biologic membranes more readily than an uncharged form

c) Local anesthetics are much less effective in inflamed tissues

d) Low ph in inflamed tissues decreases the dissociation of nonionized molecules

017. Which one of the following statements about the metabolism of local anesthetics is incorrect?

a) Metabolism of local anesthetics occurs at the site of administration

b) Metabolism occurs in the plasma or liver but not at the site of administration

c) Ester group of anesthetics like procaine, are metabolized systemically by pseudocholinesterase

d) Amides such as lidocaine, are metabolized in the liver by microsomal mixed function oxidases

018. Indicate the anesthetic agent of choice in patient with a liver disease:

a) Lidocaine

b) Bupivacaine

c) Procaine

d) Etidocaine

019. Which of the following local anesthetics is preferable in patient with pseudocholinesterase deficiency?

a) Procaine

b) Ropivacaine

c) Tetracaine

d) Benzocaine

020. The primary mechanism of action of local anesthetics is:

a) Activation of ligand-gated potassium channels

b) Blockade of voltage-gated sodium channels

c) Stimulation of voltage-gated N-type calcium channels

d) Blockade the GABA-gated chloride channels

021. Which of the following local anesthetics is more water-soluble?

a) Tetracaine

b) Etidocaine

c) Procaine

d) Bupivacaine

022. Indicate the local anesthetic, which is more lipid-soluble:

a) Bupivacaine

b) Lidocaine

c) Mepivacaine

d) Procaine

023. The more lipophylic drugs:

a) Are more potent

b) Have longer duration of action

c) Bind more extensively to proteins

d) All of the above

024. Which of the following fibers is the first to be blocked?

a) Type A alpha fibers

b) B and C fibers

c) Type A beta fibers

d) Type A gamma fibers

025. Indicate the function, which the last to be blocked:

a) Pain, temperature

b) Muscle spindles

c) Motor function

d) Touch, pressure

026. Which of the following fibers participates in high-frequency pain transmission?

a) Type A delta and C fibers

b) Type A alpha fibers

c) Type B fibers

d) Type A beta fibers

027. Which of the following local anesthetics is an useful antiarrhythmic agent?

a) Cocaine

b) Lidocaine

c) Bupivacaine

d) Ropivacaine

028. Indicate the route of local anesthetic administration, which is associated with instillation within epidural or subarachnoid spaces:

a) Topical anesthesia

b) Infiltrative anesthesia

c) Regional anesthesia

d) Spinal anesthesia

029. The choice of a local anesthetic for specific procedures is usually based on:

a) The duration of action

b) Water solubility

c) Capability of rapid penetration through the skin or mucosa with limited tendency to diffuse away from the site of application

d) All of the above

030. Which of the following local anesthetics is a short-acting drug?

a) Procaine

b) Tetracaine

c) Bupivacaine

d) Ropivacaine

031. Indicate the local anesthetic, which is a long-acting agent:

a) Lidocaine

b) Bupivacaine

c) Procaine

d) Mepivacaine

032. The anesthetic effect of the agents of short and intermediate duration of action can not be prolonged by adding:

a) Epinephrine

b) Norepinephrine

c) Dopamine

d) Phenylephrine

033. A vasoconstrictor does not:

a) Retard the removal of drug from the injection site

b) Hence the chance of toxicity

c) Decrease the blood level

d) Reduce a local anesthetic uptake by the nerve

034. Vasoconstrictors are less effective in prolonging anesthetic properties of:

a) Procaine

b) Bupivacaine

c) Lidocaine

d) Mepivacaine

035. Which of the following local anesthetics is only used for surface or topical anesthesia?

a) Cocaine

b) Tetracaine

c) Procaine

d) Bupivacaine

036. Indicate the local anesthetic, which is mainly used for regional nerve block anesthesia:

a) Dibucaine

b) Bupivacaine

c) Tetracaine

d) Cocaine

037. Which of the following local anesthetics is used for infiltrative and regional anesthesia?

a) Procaine

b) Lidocaine

c) Mepivacaine

d) All of the above

038. Indicate the local anesthetic, which is used for spinal anesthesia:

a) Tetracaine

b) Cocaine

c) Dibucaine

d) Bupivacaine

039. Which of the following local anesthetics is called a universal anesthetic?

a) Procaine

b) Ropivacaine

c) Lidocaine

d) Bupivacaine

040. Most serious toxic reaction to local anesthetics is:

a) Seizures

b) Cardiovascular collapse

c) Respiratory failure

d) All of the above

041. Correct statements concerning cocaine include all of the following EXCEPT:

a) Cocaine is often used for nose and throat procedures

b) Limited use because of abuse potential

c) Myocardial depression and peripheral vasodilatation

d) Causes sympathetically mediated tachycardia and vasoconstriction

042. Which of the following local anesthetics is more cardiotoxic?

a) Procaine

b) Bupivacaine

c) Lidocaine

d) Mepivacaine

043. Most local anesthetics can cause:

a) Depression of abnormal cardiac pacemaker activity, excitability, conduction

b) Depression of the strength of cardiac contraction

c) Cardiovascular collapse

d) All of the above

044. Which one of the following local anesthetics causes methemoglobinemia?

a) Prilocaine

b) Procaine

c) Lidocaine

d) Ropivacaine

045. Procaine has all of the following properties EXCEPT:

a) It has ester linkage

b) Its metabolic product can inhibit the action of sulfonamides

c) It readily penetrates the skin and mucosa

d) It is relatively short-acting

046. Correct statements concerning lidocaine include all of the following EXCEPT:

a) It is an universal anesthetic

b) It has esteratic linkage

c) It widely used as an antiarrhythmic agent

d) It is metabolized in liver

047. Which of the following local anesthetics is more likely to cause allergic reactions?

a) Lidocaine

b) Bupivacaine

c) Procaine

d) Ropivacaine

048. Tetracaine has all of the following properties EXCEPT:

a) Slow onset

b) Low potency

c) Long duration

d) High toxicity

049. Correct statements concerning bupivacaine include all of the following EXCEPT:

a) It has low cardiotoxicity

b) It has amide linkage

c) It is a long-acting drug

d) An intravenous injection can lead to seizures

PART II Cholinomimetic drugs

001. Acetylcholine is not a specific neurotransmitter at:

a) Sympathetic ganglia

b) Sympathetic postganglionic nerve endings

c) Parasympathetic ganglia

d) Parasympathetic postganglionic nerve endings

002. Muscarinic receptors are located in:

a) Autonomic ganglia

b) Skeletal muscle neuromuscular junctions

c) Autonomic effector cells

d) Sensory carotid sinus baroreceptor zone

003. Indicate the location of M2 cholinoreceptor type:

a) Heart

b) Glands

c) Smooth muscle

d) Endothelium

004. The symptoms of mushroom poisoning include all of the following EXCEPT:

a) Salivation, lacrimation, nausea, vomiting

b) Dryness of mouth, hyperpyrexia, hallucination

c) Headache, abdominal colic

d) Bradycardia, hypotension and shock

005. Which of the following cholinomimetics activates both muscarinic and nicotinic receptors? a) Lobeline

b) Pilocarpine

c) Nicotine

d) Bethanechol

006. Indicate a cholinomimetic agent, which is related to direct-acting drugs:

a) Edrophonium

b) Physostigmine

c) Carbachol

d) Isoflurophate

007. Characteristics of carbachol include all of the following EXCEPT:

a) It decreases intraocular pressure

b) It causes mydriasis

c) It exerts both nicotinic and muscarinic effects

d) It is resistant to acethylcholiesterase

008. Acetylcholine is not used in clinical practice because:

a) It is very toxic

b) The doses required are very high

c) It is very rapidly hydrolyzed

d) It is very costly

009. Parasympathomimetic drugs cause:

a) Bronchodilation

b) Mydriasis

c) Bradycardia

d) Constipation

010. Which of the following direct-acting cholinomimetics is mainly muscarinic in action?

a) Bethanechol

b) Carbachol

c) Acetylcholine

d) None of the above

011. Which of the following direct-acting cholinomimetics has the shortest duration of action?

a) Acetylcholine

b) Methacholine

c) Carbachol

d) Bethanechol

012. Bethanechol has all of the following properties EXCEPT:

a) It is extremely resistant to hydrolysis

b) Purely muscarinic in its action

c) It is used for abdominal urinary bladder distention

d) It exerts both nicotinic and muscarinic effects

013. A M-cholinimimetic agent is:

a) Carbachol

b) Pilocarpine

c) Acetylcholine

d) Bethanechol

014. Characteristics of pilocarpine include all of the following EXCEPT:

a) It is a tertiary amine alkaloid

b) It causes miosis and a decrease in intraocular pressure

c) Causes a decrease in secretory and motor activity of gut

d) It is useful in the treatment of glaucoma

015. Which of the following cholinomimetics is a plant derivative with lower potency than nicotine but with a similar spectrum of action?

a) Lobeline

b) Pilocarpine

c) Carbochol

d) Acetylcholine

016. Which of the following cholinomimetics is indirect-acting?

a) Lobeline

b) Edrophonium

c) Pilocarpine

d) Carbachol

017. The mechanism of action of indirect-acting cholinomimetic agents is:

a) Binding to and activation of muscarinic or nicotinic receptors

b) Inhibition of the hydrolysis of endogenous acetylcholine

c) Stimulation of the action of acetylcholinesterase

d) Releasing acetylcholine from storage sites

018. Indicate a reversible cholinesterase inhibitor:

a) Isoflurophate

b) Carbochol

c) Physostigmine

d) Parathion

019. Which of the following cholinesterase inhibitors is irreversible?

a) Physostigmine

b) Edrophonium

c) Neostigmine

d) Isoflurophate

020. Indicate cholinesterase activator:

a) Pralidoxime

b) Edrophonium

c) Pilocarpine

d) Isoflurophate

021. Isofluorophate increases all of the following effects except:

a) Lacrimation

b) Bronchodilation

c) Muscle twitching

d) Salivation

022. Indicate a cholinesterase inhibitor, which has an additional direct nicotinic agonist effect:

a) Edrophonium

b) Carbochol

c) Neostigmine

d) Lobeline

023. Сholinesterase inhibitors do not produce:

a) Bradycardia, no change or modest fall in blood pressure

b) Increased strength of muscle contraction, especially in muscles weakened by myasthenia gravis c) Miosis and reduction of intraocular pressure

d) Dramatic hypertension and tachycardia

024. Which of the following cholinomimetics is commonly used in the treatment of glaucoma?

a) Pilocarpine

b) Lobeline

c) Acethylcholine

d) Neostigmine

025. Indicate the organophosphate cholinesterase inhibitor, which can be made up in an aqueous solution for ophthalmic use and retains its activity within a week:

a) Physoctigmine

b) Edrophonium

c) Echothiophate

d) Neostigmine

026. Which of the following cholinomimetics is most widely used for paralytic ileus and atony of the urinary bladder?

a) Lobeline

b) Neostigmine

c) Pilocarpine

d) Echothiophate

027. Chronic long-term therapy of myasthenia is usually accomplished with:

a) Edrophonium

b) Neostigmine

c) Echothiophate

d) Carbachol

028. Which of the following cholinomimetics is a drug of choice for reversing the effects of nondepolarizing neuromuscular relaxants?

a) Echothiophate

b) Physostigmine

c) Edrophonium

d) Pilocarpine

029. Indicate the reversible cholinesterase inhibitor, which penetrates the blood-brain barrier:

a) Physostigmine

b) Edrophonium

c) Neostigmine

d) Piridostigmine

030. Which of the following cholinomimetics is used in the treatment of atropine intoxication?

a) Neostigmine

b) Carbochol

c) Physostigmine

d) Lobeline

031. The symptoms of excessive stimulation of muscarinic receptors include all of the following EXCEPT:

a) Abdominal cramps, diarrhea

b) Increased salivation, excessive bronchial secretion

c) Miosis, bradycardia

d) Weakness of all skeletal muscles

032. The excessive stimulation of muscarinic receptors by pilocarpine and choline esters is blocked competitively by:

a) Edrophonium

b) Atropine

c) Pralidoxime

d) Echothiophate

033. The toxic effects of a large dose of nicotine include all of the following EXCEPT:

a) Hypotension and bradycardia

b) Convulsions, coma and respiratory arrest

c) Skeletal muscle depolarization blockade and respiratory paralysis

d) Hypertension and cardiac arrhythmias

034. The dominant initial sights of acute cholinesterase inhibitors intoxication include all of the following except:

a) Salivation, sweating

b) Mydriasis

c) Bronchial constriction

d) Vomiting and diarrhea

035. Which of the following drugs is used for acute toxic effects of organophosphate cholinesterase inhibitors? a) Atropine

b) Pilocarpine

c) Pralidoxime

d) Edrophonium

PART III Cholinoreceptor blocking drugs

001. The group of nicotinic receptor-blocking drugs consists of:

a) Ganglion-blockers

b) Atropine-similar drugs

c) Neuromuscular junction blockers

d) Both a and c

002. M3 receptor subtype is located:

a) In the myocardium

b) In sympathetic postganglionic neurons

c) On effector cell membranes of glandular and smooth muscle cells

d) On the motor end plates

003. Which of the following drugs is both a muscarinic and nicotinic blocker?

a) Atropine

b) Benztropine

c) Hexamethonium

d) Succinylcholine

004. Indicate a muscarinic receptor-blocking drug:

a) Scopolamine

b) Pipecuronium

c) Trimethaphan

d) Pilocarpine

005. Which of the following agents is a ganglion-blocking drug?

a) Homatropine

b) Hexamethonium

c) Rapacuronium

d) Edrophonium

006. Indicate the skeletal muscle relaxant, which is a depolarizing agent:

a) Vencuronium

b) Scopolamine

c) Succinylcholine

d) Hexamethonium

007. Which of the following drugs is a nondepolarizing muscle relaxant?

a) Pancuronium

b) Succinylcholine

c) Hexamethonium

d) Scopolamine

008. Indicate the drug, which is rapidly and fully distributed into CNS and has a greater effect than most other antimuscarinic agents?

a) Atropine

b) Scopolamine

c) Homatropine

d) Ipratropium

009. The effect of the drug on parasympathetic function declines rapidly in all organs EXCEPT:

a) Eye

b) Heart

c) Smooth muscle organs

d) Glands

010. The mechanism of atropine action is:

a) Competitive ganglion blockade

b) Competitive muscarinic blockade

c) Competitive neuromuscular blockade

d) Noncompetitive neuromuscular blockade

011. The tissues most sensitive to atropine are:

a) The salivary, bronchial and sweat glands

b) The gastric parietal cells

c) Smooth muscle and autonomic effectors

d) The heart

012. Atropine is highly selective for:

a) M1 receptor subtype

b) M2 receptor subtype

c) M3 receptor subtype

d) All of the above

013. Which of the following antimuscarinic drugs is often effective in preventing or reversing vestibular disturbances, especially motion sickness?

a) Atropine

b) Ipratropium

c) Scopolamine

d) Homatropine

014. Atropine causes:

a) Miosis, a reduction in intraocular pressure and cyclospasm

b) Mydriasis, a rise in intraocular pressure and cycloplegia

c) Miosis, a rise in intraocular pressure and cycloplegia

d) Mydriasis, a rise in intraocular pressure and cyclospasm

015. Patients complain of dry or “sandy” eyes when receiving large doses of:

a) Atropine

b) Hexamethonium

c) Pilocarpine

d) Carbachol

016. All of the following parts of the heart are very sensitive to muscarinic receptor blockade except:

a) Atria

b) Sinoatrial node

c) Atrioventricular node

d) Ventricle

017. Atropine causes:

a) Bradycardia, hypotension and bronchoconstriction

b) Tachycardia, little effect on blood pressure and bronchodilation

c) Decrease in contractile strength, conduction velocity through the AV node

d) Tachycardia, hypertensive crisis and bronchodilation

018. Atropine is frequently used prior to administration of inhalant anesthetics to reduce:

a) Muscle tone

b) Secretions

c) Nausea and vomiting

d) All of the above

019. Atropine is now rarely used for the treatment of peptic ulcer because of:

a) Slow gastric empting and prolongation of the exposure of the ulcer bed to acid

b) Low efficiency and necessity of large doses

c) Adverse effects

d) All of the above

020. Which of the following antimuscarinic drugs is a selective M1 blocker? a) Atropine

b) Scopolamine

c) Pirenzepine

d) Homatropine

021. Atropine causes:

a) Spasmolitic activity

b) Intestinal hypermotility

c) Stimulation of contraction in the gut

d) Stimulation of secretory activity

022. Which of the following drugs is useful in the treatment of uterine spasms?

a) Carbachol

b) Vecuronium

c) Atropine

d) Edrophonium

023. Atropine may cause a rise in body temperature (atropine fever):

a) In adults

b) In pregnant women

c) In infants and children

d) All of the above

024. The pharmacologic actions of scopolamine most closely resemble those of:

a) Hexamethonium

b) Atropine

c) Succinylcholine

d) Pilocarpine

025. Compared with atropine, scopolamine has all of the following properties EXCEPT:

a) More marked central effect

b) Less potent in decreasing bronchial, salivary and sweat gland secretion

c) More potent in producing mydriasis and cycloplegia

d) Lower effects on the heart, bronchial muscle and intestines

026. Which of the following drugs is useful in the treatment of Parkinson′s disease?

a) Benztropine

b) Edrophonium

c) Succinylcholine

d) Hexamethonium

027. Indicate the antimuscarinic drug, which is used as a mydriatic:

a) Pilocarpine

b) Neostigmine

c) Homatropine

d) Ipratropium

028. Which of the following agents is used as an inhalation drug in asthma?

a) Atropine

b) Ipratropium

c) Lobeline

d) Homatropine

029. Which of the following agents is most effective in regenerating cholinesterase associated with skeletal muscle neuromuscular junctions?

a) Suscinilcholine

b) Pralidoxime

c) Pirenzepine

d) Propiverine

030. Indicate an antimuscarinic drug, which is effective in the treatment of mushroom poising:

a) Pralidoxime

b) Pilocarpine

c) Homatropine

d) Atropine

031. Antimuscarinics are used in the treatment of the following disorders EXCEPT:

a) Motion sickness

b) Glaucoma

c) Hyperhidrosis

d) Asthma

032. The atropine poisoning includes all of the following symptoms EXCEPT:

a) Mydriasis, cycloplegia

b) Hyperthermia, dry mouth, hot and flushed skin

c) Agitation and delirium

d) Bradicardia, orthostatic hypotension

033. The treatment of the antimuscarinic effects can be carried out with:

a) Neostigmine

b) Hexametonium

c) Homatropine

d) Acetylcholine

034. Contraindications to the use of antimuscarinic drugs are all of the following except:

a) Glaucoma

b) Myasthenia

c) Bronchial asthma

d) Paralytic ileus and atony of the urinary bladder

035. Hexamethonium blocks the action of acethylcholine and similar agonists at:

a) Muscarinic receptor site

b) Neuromuscular junction

c) Autonomic ganglia

d) Axonal transmission

036. The applications of the ganglion blockers have disappeared because of all of the following reasons EXCEPT:

a) Orthostatic hypotension

b) Lack of selectivity

c) Homeostatic reflexes block

d) Respiratory depression

037. Which of the following agents is a short-acting ganglion blocker?

a) Homatropine

b) Trimethaphane

c) Hexamethonium

d) Pancuronium

038. Indicate the ganglion-blocking drug, which can be taken orally for the treatment of hypertension?

a) Mecamylamine

b) Scopolamine

c) Trimethaphane

d) Vecocuronium

039. The systemic effects of hexamethonium include all of the following EXCEPT:

a) Reduction of both peripheral vascular resistance and venous return

b) Partial mydriasis and loss of accommodation

c) Constipation and urinary retention

d) Stimulation of thermoregulatory sweating

040. Ganglion blocking drugs are used for the following emergencies EXCEPT:

a) Hypertensive crises

b) Controlled hypotension

c) Cardiovascular collapse

d) Pulmonary edema

041. Agents that produce neuromuscular blockade act by inhibiting:

a) Interaction of acetylcholine with cholinergic receptors

b) Release of acetylcholine from prejunctional membrane

c) Packaging of acetylcholine into synaptic vesicles

d) Reuptake of acetylcholine into the nerve ending

042. Skeletal muscle relaxation and paralysis can occur from interruption of functions at several sites, including all of the following EXCEPT:

a) Nicotinic acethylcholine receptors

b) Muscarinic acethylcholine receptors

c) The motor end plate

d) Contractile apparatus

043. Nondepolarisation neuromuscular blocking agents:

a) Block acetylcholine reuptake

b) Prevent access of the transmitter to its receptor and depolarization

c) Block transmission by an excess of a depolarizing agonist

d) All of the above

044. Which of the following drugs has “double-acetylcholine” structure?

a) Rocuronium

b) Carbachol

c) Atracurium

d) Succylcholine

045. Indicate the long-acting neuromuscular blocking agent:

a) Rapacuronium

b) Mivacurium

c) Tubocurarine

d) Rocuronium

046. Which of the following neuromuscular blocking drugs is an intermediate-duration muscle relaxant?

a) Vecuronium

b) Tubocurarine

c) Pancuronium

d) Rapacuronium

047. Indicate the nondepolarizing agent, which has the fastest onset of effect?

a) Succinylcholine

b) Rapacuronium

c) Pancuronium

d) Tubocurarine

048. Indicate the neuromuscular blocker, whose breakdown product readily crosses the blood-brain barrier and may cause seizures:

a) Pancuronium

b) Succinylcholine

c) Tubocurarine

d) Atracurium

049. Which competitive neuromuscular blocking agent could be used in patients with renal failure?

a) Atracurium

b) Succinylcholine

c) Pipecuronium

d) Doxacurium

050. Indicate the nondepolarizing agent, which has short duration of action:

a) Succinylcholine

b) Tubocurarine

c) Mivacurium

d) Pancuronium

051. Which depolarizing agent has the extremely brief duration of action? a) Mivacurium

b) Rapacuronium

c) Rocuronium

d) Succinylcholine

052. Neuromuscular blockade by both succinylcholine and mivacurium may be prolonged in patients with:

a) Renal failure

b) An abnormal variant of plasma cholinesterase

c) Hepatic disease

d) Both b and c

053. Depolarizing agents include all of the following properties EXCEPT:

a) Interact with nicotinic receptor to compete with acetylcholine without receptor activation

b) React with the nicotinic receptor to open the channel and cause depolarisation of the end plate

c) Cause desensitization, noncompetive block manifested by flaccid paralysis

d) Cholinesterase inhibitors do not have the ability to reverse the blockade

054. Which of the following neuromuscular blockers causes transient muscle fasciculations?

a) Mivacurium

b) Pancuronium

c) Succinylcholine

d) Tubocurarine

055. Indicate muscles, which are more resistant to block and recover more rapidly:

a) Hand

b) Leg

c) Neck

d) Diaphragm

056. Which neuromuscular blocking agent has the potential to cause the greatest release of histamine?

a) Succylcholine

b) Tubocurarine

c) Pancuronium

d) Rocuronium

057. Which of the following muscular relaxants causes hypotension and bronchospasm?

a) Vecuronium

b) Succinylcholine

c) Tubocurarine

d) Rapacuronium

058. Indicate the neuromuscular blocker, which causes tachycardia:

a) Tubocurarine

b) Atracurium

c) Pancuronium

d) Succinylcholine

059. Which of the following neuromuscular blocking agents cause cardiac arrhythmias?

a) Vecuronium

b) Tubocurarine

c) Rapacuronium

d) Succinylcholine

060. Effects seen only with depolarizing blockade include all of the following EXCEPT:

a) Hypercaliemia

b) A decrease in intraocular pressure

c) Emesis

d) Muscle pain

061. Which neuromuscular blocking agent is contraindicated in patients with glaucoma?

a) Tubocurarine

b) Succinylcholine

c) Pancuronium

d) Gallamine

062. Indicate the following neuromuscular blocker, which would be contraindicated in patients with renal failure:

a) Pipecuronium

b) Succinylcholine

c) Atracurium

d) Rapacuronium

063. All of the following drugs increase the effects of depolarizing neuromuscular blocking agents EXCEPT:

a) Aminoglycosides

b) Antiarrhythmic drugs

c) Nondepolarizing blockers

d) Local anesthetics

064. Which of the following diseases can augment the neuromuscular blockade produced by nondepolarizing muscle relaxants?

a) Myasthenia gravis

b) Burns

c) Asthma

d) Parkinsonism

065. Indicate the agent, which effectively antagonizes the neuromuscular blockade caused by nondepolarizing drugs:

a) Atropine

b) Neostigmine

c) Acetylcholine

d) Pralidoxime

PART IV Adrenoreceptor activating drugs

001. Sympathetic stimulation is mediated by:

a) Release of norepinephrine from nerve terminals

b) Activation of adrenoreceptors on postsynaptic sites

c) Release of epinephrine from the adrenal medulla

d) All of the above

002. Characteristics of epinephrine include all of the following EXCEPT:

a) It is synthesized into the adrenal medulla

b) It is synthesized into the nerve ending

c) It is transported in the blood to target tissues

d) It directly interacts with and activates adrenoreceptors

003. Which of the following sympathomimetics acts indirectly?

a) Epinephrine

b) Norepinephrine

c) Ephedrine

d) Methoxamine

004. Indirect action includes all of the following properties EXCEPT:

a) Displacement of stored catecholamines from the adrenergic nerve ending

b) Inhibition of reuptake of catecholamines already released

c) Interaction with adrenoreceptors

d) Inhibition of the release of endogenous catecholamines from peripheral adrenergic neurons

005. Catecholamine includes following EXCEPT:

a) Ephedrine

b) Epinephrine

c) Isoprenaline

d) Norepinephrine

006. Epinephrine decreases intracellular camp levels by acting on:

a) α1 receptor

b) α2 receptor

c) beta1 receptor

d) beta2 receptor

007. Which of the following statements is not correct?

a) ALFA receptors increase arterial resistence, whereas beta2 receptor promote smooth muscle relaxation

b) The skin and splanchic vessels have predominantly alfa receptors

c) Vessels in a skeletal muscle may constrict or dilate depending on whether alfa or beta2 receptors are activated

d) Skeletal muscle vessels have predominantly alfa receptors and constrict in the presence of epinephrine and norepinephrine

008. Direct effects on the heart are determined largely by:

a) Alfa1 receptor

b) Alfa2 receptor

c) Beta1 receptor

d) Beta2 receptor

009. Which of the following effects is related to direct beta1-adrenoreceptor stimulation? a) Bronchodilation

b) Vasodilatation

c) Tachycardia

d) Bradycardia

010. Distribution of alfa adrenoreceptor subtypes is associated with all of the following tissues except those of:

a) Heart

b) Blood vessels

c) Prostate

d) Pupillary dilator muscle

011. Beta adrenoreceptor subtypes is contained in all of the following tissues EXCEPT:

a) Bronchial muscles

b) Heart

c) Pupillary dilator muscle

d) Fat cells

012. In which of the following tissues both alfa and beta1 adrenergic stimulation produces the same effect?

a) Blood vessels

b) Intestine

c) Uterus

d) Bronchial muscles

013. The effects of sympathomimetics on blood pressure are associated with their effects on:

a) The heart

b) The peripheral resistance

c) The venous return

d) All of the above

014. A relatively pure alfa agonist causes all of the following effects EXCEPT:

a) Increase peripheral arterial resistance

b) Increase venous return

c) Has no effect on blood vessels

d) Reflex bradycardia

015. A nonselective beta receptor agonist causes all of the following effects EXCEPT:

a) Increase cardiac output

b) Increase peripheral arterial resistance

c) Decrease peripheral arterial resistance

d) Decrease the mean pressure

016. Which of the following statement is not correct?

a) Αlfa agonists cause miosis

b) Αlfa agonists cause mydriasis

c) Beta antagonists decrease the production of aqueous humor

d) Αlfa agonists increase the outflow of aqueous humor from the eye

017. A bronchial smooth muscle contains:

a) Αlfa1 receptor

b) Αlfa2 receptor

c) Beta 1 receptor

d) Beta 2 receptor

018. All of the following agents are beta receptor agonists EXCEPT:

a) Epinephrine

b) Isoproterenol

c) Methoxamine

d) Dobutamine

019. Which of the following drugs causes bronchodilation without significant cardiac stimulation?

a) Isoprenaline

b) Terbutaline

c) Xylometazoline

d) Methoxamine

020. Αlfa-receptor stimulation includes all of the following effects EXCEPT:

a) Relaxation of gastrointestinal smooth muscle

b) Contraction of bladder base, uterus and prostate

c) Stimulation of insulin secretion

d) Stimulation of platelet aggregation

021. Beta1 receptor stimulation includes all of the following effects EXCEPT:

a) Increase in contractility

b) Bronchodilation

c) Tachycardia

d) Increase in conduction velocity in the atrioventricular node

022. Beta2 receptor stimulation includes all of the following effects EXCEPT:

a) Stimulation of renin secretion

b) Fall of potassium concentration in plasma

c) Relaxation of bladder, uterus

d) Tachycardia

023. Hyperglycemia induced by epinephrine is due to:

a) Gluconeogenesis (beta2)

b) Inhibition of insulin secretion (alfa)

c) Stimulation of glycogenolysis (beta2)

d) All of the above

024. Which of the following effects is associated with beta3-receptor stimulation?

a) Lipolysis

b) Decrease in platelet aggregation

c) Bronchodilation

d) Tachycardia

025. Which of the following statements is not correct?

a) Epinephrine acts on both alfa- and beta-receptors

b) Norepinephrine has a predominantly beta action

c) Methoxamine has a predominantly alfa action

d) Isoprenaline has a predominantly beta action

026. Indicate the drug, which is a direct-acting both alfa- and beta-receptor agonist:

a) Norepinephrine

b) Methoxamine

c) Isoproterenol

d) Ephedrine

027. Which of the following agents is an alfa1 alfa2 beta1 beta2 receptor agonist?

a) Methoxamine

b) Albuterol

c) Epinephrine

d) Norepinephrine

028. Indicate the direct-acting sympathomimetic, which is an alfa1 alfa2 beta1 receptor agonist:

a) Isoproterenol

b) Ephedrine

c) Dobutamine

d) Norepinephrine

029. Which of the following agents is an alfa1-selective agonist?

a) Norepinephrine

b) Methoxamine

c) Ritodrine

d) Ephedrine

030. Indicate the alfa2-selective agonist:

a) Xylometazoline

b) Epinephrine

c) Dobutamine

d) Methoxamine

031. Which of the following agents is a nonselective beta receptor agonist?

a) Norepinephrine

b) Terbutaline

c) Isoproterenol

d) Dobutamine

032. Indicate the beta1-selective agonist:

a) Isoproterenol

b) Dobutamine

c) Metaproterenol

d) Epinephrine

033. Which of the following sympathomimetics is a beta2-selective agonist?

a) Terbutaline

b) Xylometazoline

c) Isoproterenol

d) Dobutamine

034. Indicate the indirect-acting sympathomimetic agent:

a) Epinephrine

b) Phenylephrine

c) Ephedrine

d) Isoproterenol

035. Epinephrine produces all of the following effects EXCEPT:

a) Positive inotropic and chronotropic actions on the heart (beta1 receptor)

b) Increase peripheral resistance (alfa receptor)

c) Predominance of alfa effects at low concentration

d) Skeletal muscle blood vessel dilatation (beta2 receptor)

036. Epinephrine produces all of the following effects EXCEPT:

a) Decrease in oxygen consumption

b) Bronchodilation

c) Hyperglycemia

d) Mydriasis

037. Epinephrine is used in the treatment of all of the following disorders EXCEPT:

a) Bronchospasm

b) Anaphylactic shock

c) Cardiac arrhythmias

d) Open-angle glaucoma

038. Compared with epinephrine, norepinephrine produces all of the following effects EXCEPT:

a) Similar effects on beta1 receptors in the heart and similar potency at an alfa receptor

b) Decrease the mean pressure below normal before returning to the control value

c) Significant tissue necrosis if injected subcutaneously

d) Increase both diastolic and systolic blood pressure

039. Norepinephrine produces:

a) Vasoconstriction

b) Vasodilatation

c) Bronchodilation

d) Decresed potassium concentration in the plasma

040. Which of the following direct-acting drugs is a relatively pure alfa agonist, an effective mydriatic and decongestant and can be used to raise blood pressure?

a) Epinephrine

b) Norepinephrine

c) Phenylephrine

d) Ephedrine

041. Characteristics of methoxamine include all of the following EXCEPT:

a) It is a direct-acting alfa1-receptor agonist

b) It increases heart rate, contractility and cardiac output

c) It causes reflex bradycardia

d) It increases total peripheral resistance

042. Which of the following agents is an alfa2-selective agonist with ability to promote constriction of the nasal mucosa?

a) Xylometazoline

b) Phenylephrine

c) Methoxamine

d) Epinephrine

043. Indicate the sympathomimetic, which may cause hypotension, presumably because of a clonidine-like effect:

a) Methoxamine

b) Phenylephrine

c) Xylometazoline

d) Isoproterenol

044. Isoproterenol is:

a) Both an alfa- and beta-receptor agonist

b) beta1-selective agonist

c) beta2-selective agonist

d) Nonselective beta receptor agonist

045. Isoproterenol produces all of the following effects EXCEPT:

a) Increase in cardiac output

b) Fall in diastolic and mean arterial pressure

c) Bronchoconstriction

d) Tachycardia

046. Characteristics of dobutamine include all of the following EXCEPT:

a) It is a relatively beta1-selective synthetic catecholamine

b) It is used to treat bronchospasm

c) It increases atrioventricular conduction

d) It causes minimal changes in heart rate and systolic pressure

047. Characteristics of salmeterol include all of the following EXCEPT:

a) It is a potent selective beta2 agonist

b) It causes uterine relaxation

c) It stimulates heart rate, contractility and cardiac output

d) It is used in the therapy of asthma

048. Characteristics of ephedrine include all of the following EXCEPT:

a) It acts primarily through the release of stored cathecholamines

b) It is a mild CNS stimulant

c) It causes tachyphylaxis with repeated administration

d) It decreases arterial pressure

049. Ephedrine causes:

a) Miosis

b) Bronchodilation

c) Hypotension

d) Bradycardia

050. Compared with epinephrine, ephedrine produces all of the following features EXCEPT:

a) It is a direct-acting sympathomimetic

b) It has oral activity

c) It is resistant to MAO and has much longer duration of action

d) Its effects are similar, but it is less potent

051. Which of the following sympathomimetics is preferable for the treatment of chronic orthostatic hypotension?

a) Epinephrine

b) Norepinephrine

c) Ephedrine

d) Salmeterol

052. Indicate the sympathomimetic drug, which is used in a hypotensive emergency:

a) Xylometazoline

b) Ephedrine

c) Terbutaline

d) Phenylephrine

053. Which of the following sympathomimetics is preferable for the emergency therapy of cardiogenic shock?

a) Epinephrine

b) Dobutamine

c) Isoproterenol

d) Methoxamine

054. Indicate the sympathomimetic agent, which is combined with a local anesthetic to prolong the duration of infiltration nerve block:

a) Epinephrine

b) Xylometazoline

c) Isoproterenol

d) Dobutamine

055. Which of the following sympathomimetics is related to short-acting topical decongestant agents?

a) Xylometazoline

b) Terbutaline

c) Phenylephrine

d) Norepinephrine

056. Indicate the long-acting topical decongestant agents:

a) Epinephrine

b) Norepinephrine

c) Phenylephrine

d) Xylometazoline

057. Which of the following topical decongestant agents is an alfa2-selective agonist?

a) Phenylephrine

b) Xylometazoline

c) Ephedrine

d) Epinephrine

058. Indicate the sympathomimetic, which may be useful in the emergency management of cardiac arrest:

a) Methoxamine

b) Phenylephrine

c) Epinephrine

d) Xylometazoline

059. Which of the following sympathomimetics is used in the therapy of bronchial asthma?

a) Formoterol

b) Norepinephrine

c) Methoxamine

d) Dobutamine

060. Indicate the agent of choice in the emergency therapy of anaphylactic shock:

a) Methoxamine

b) Terbutaline

c) Norepinephrine

d) Epinephrine

061. Which of the following sympathomimetics is an effective mydriatic? a) Salmeterol

b) Phenylephrine

c) Dobutamine

d) Norepinephrine

062. The adverse effects of sympathomimetics include all of the following EXCEPT:

a) Drug-induced parkinsonism

b) Cerebral hemorrhage or pulmonary edema

c) Myocardial infarction

d) Ventricular arrhythmias

PART V Adrenoreceptor antagonist drugs

001. Which of the following drugs is a nonselective alfa receptor antagonist?

a) Prazosin

b) Phentolamine

c) Metoprolol

d) Reserpine

002. Indicate the alfa1-selective antagonist:

a) Phentolamine

b) Dihydroergotamine

c) Prazosin

d) Labetalol

003. Which of the following agents is an alfa2–selective antagonist?

a) Yohimbine

b) Tamsulosin

c) Tolazoline

d) Prazosin

004. Indicate the irreversible alfa receptor antagonist:

a) Tolazoline

b) Labetalol

c) Prazosin

d) Phenoxybenzamine

005. Which of the following drugs is an nonselective beta receptor antagonist?

a) Metoprolol

b) Atenolol

c) Propranolol

d) Acebutolol

006. Indicate the beta1-selective antagonist:

a) Propranolol

b) Metoprolol

c) Carvedilol

d) Sotalol

007. Which of the following agents is a beta2–selective antagonist?

a) Tolazolin

b) Pindolol

c) Ergotamin

d) Butoxamine

008. Indicate the beta adrenoreceptor antagonist, which has partial beta–agonist activity:

a) Propranolol

b) Metoprolol

c) Pindolol

d) Betaxolol

009. Which of the following drugs is a reversible nonselective alfa, beta antagonist?

a) Labetalol

b) Phentolamine

c) Metoprolol

d) Propranolol

010. Indicate the indirect-acting adrenoreceptor blocking drug:

a) Tolazoline

b) Reserpine

c) Carvedilol

d) Prazosin

011. The principal mechanism of action of adrenoreceptor antagonists is:

a) Reversible or irreversible interaction with adrenoreceptors

b) Depletion of the storage of catecholamines

c) Blockade of the amine reuptake pumps

d) Nonselective MAO inhibition

012. Characteristics of alfa-receptor antagonists include all of the following EXCEPT:

a) They cause a fall in peripheral resistance and blood pressure

b) They cause epinephrine reversal (convert a pressor response to a depressor response)

c) Bronchospasm

d) They may cause postural hypotension and reflex tachycardia

013. Which of the following drugs is an imidazoline derivative and a potent competitive antagonist at both alfa1 and alfa2 receptors?

a) Prazosin

b) Labetalol

c) Phenoxybenzamine

d) Phentolamine

014. Characteristics of phentolamine include all of the following EXCEPT:

a) Reduction in peripheral resistance

b) Stimulation of responses to serotonin

c) Tachycardia

d) Stimulation of muscarinic, H1 and H2 histamine receptors

015. The principal mechanism of phentolamine-induced tachycardia is:

a) Antagonism of presynaptic alfa2 receptors enhances norepinephrine release, which causes cardiac stimulation via unblocked beta receptors

b) Baroreflex mechanism

c) Direct effect on the heart by stimulation of beta1 receptors

d) Inhibition of transmitter reuptake at noradrenergic synapses

016. Nonselective alfa-receptor antagonists are most useful in the treatment of:

a) Asthma

b) Cardiac arrhythmias

c) Pheochromocytoma

d) Chronic hypertension

017. The main reason for using alfa-receptor antagonists in the management of pheochromocytoma is:

a) Inhibition of the release of epinephrine from the adrenal medulla

b) Blockade of alfa2 receptors on vascular smooth muscle results in epinephrine stimulation of unblocked alfa2 receptors

c) Direct interaction with and inhibition of beta2 adrenoreceptors

d) Antagonism to the release of renin

018. Which of the following drugs is useful in the treatment of pheochromocytoma?

a) Phenylephrine

b) Propranolol

c) Phentolamine

d) Epinephrine

019. Indicate adrenoreceptor antagonist agents, which are used for the management of pheochromocytoma:

a) Selective beta2-receptor antagonists

b) Nonselective beta-receptor antagonists

c) Indirect-acting adrenoreceptor antagonist drugs

d) Αlfa-receptor antagonists

020. The principal adverse effects of phentolamine include all of the following EXCEPT:

a) Diarrhea

b) Bradycardia

c) Arrhythmias

d) Myocardial ischemia

021. Indicate the reversible nonselective alfa-receptor antagonist, which is an ergot derivative:

a) Ergotamine

b) Prazosin

c) Phenoxybenzamine

d) Carvedilol

022. Indicate an alfa-receptor antagonist, which binds covalently to alfa receptors, causing irreversible blockade of long duration (14-48 hours or longer):

a) Phentolamine

b) Phenoxybenzamine

c) Ergotamine

d) Prazosin

023. Compared with phentolamine, prazosin has all of the following features EXCEPT:

a) Irreversible blockade of alfa receptors

b) Highly selective for alfa1 receptors

c) The relative absence of tachycardia

d) Persistent block of alfa1 receptors

024. Which of the following statements is not correct?

a) There are at least three subtypes of alfa1 receptors, designated alfa1a, alfa1b and alfa1d

b) ALFA1a subtype mediates prostate smooth muscle contraction

c) ALFA1b subtype mediates vascular smooth muscle contraction

d) ALFA1a subtype mediates both vascular and prostate smooth muscle contraction

025. Indicate an alfa1 adrenoreceptor antagonist, which has great selectivity for alfa1a subtype:

a) Prazosin

b) Tamsulosin

c) Phenoxybenzamine

d) Phentolamine

026. Subtype-selective alfa1 receptor antagonists such as tamsulosin, terazosin, alfusosin are efficacious in:

a) Hyperthyroidism

b) Cardiac arrhythmias

c) Benign prostatic hyperplasia (BPH)

d) Asthma

027. Indicate an alfa receptor antagonist, which is an efficacious drug in the treatment of mild to moderate systemic hypertension:

a) Phentolamine

b) Tolazoline

c) Ergotamine

d) Prazosin

028. Which of the following alfa receptor antagonists is useful in reversing the intense local vasoconstriction caused by inadvertent infiltration of norepinephrine into subcutaneous tissue during intravenous administration?

a) Propranolol

b) Phentolamine

c) Tamsulosin

d) Ergotamine

029. Beta-blocking drugs-induced chronically lower blood pressure may be associated with theirs effects on:

a) The heart

b) The blood vessels

c) The renin-angiotensin system

d) All of the above

030. Characteristics of beta-blocking agents include all of the following EXCEPT:

a) They occupy beta receptors and competitively reduce receptor occupancy by catecholamines or other beta agonists

b) They do not cause hypotension in individuals with normal blood pressure

c) They induce depression and depleted stores of catecholamines

d) They can cause blockade in the atrioventricular node

031. Beta-receptor antagonists have all of the following cardiovascular effects EXCEPT:

a) The negative inotropic and chronotropic effects

b) Acute effects of these drugs include a fall in peripheral resistance c) Vasoconstriction

d) Reduction of the release of renin

032. Beta-blocking agents have all of the following effects except:

a) Increase plasma concentrations of HDL and decrease of VLDL

b) Bronchoconstriction

c) Decrease of aqueous humor prodaction

d) “membrane-stabilizing” action

033. Beta-receptor antagonists cause:

a) Stimulation of lipolysis

b) Stimulation of gluconeogenesis

c) Inhibition of glycogenolysis

d) Stimulation of insulin secretion

034. Propranolol has all of the following cardiovascular effects EXCEPT:

a) It decreases cardiac work and oxygen demand

b) It reduces blood flow to the brain

c) It inhibits the renin secretion

d) It increases the atrioventricular nodal refractory period

035. Propranolol-induced adverse effects include all of the following EXCEPT:

a) Bronchoconstriction

b) “supersensitivity” of beta-adrenergic receptors (rapid withdrawal)

c) Hyperglycemia

d) Sedation, sleep disturbances, depression and sexual dysfunction

036. Propranolol is used in the treatment all of the following diseases EXCEPT:

a) Cardiovascular diseases

b) Hyperthyroidism

c) Migraine headache

d) Bronchial asthma

037. Metoprolol and atenolol:

a) Are members of the beta1-selective group

b) Are nonselective beta antagonists

c) Have intrinsic sympathomimetic activity

d) Have an anesthetic action

038. Which of the following beta receptor antagonists is preferable in patients with asthma, diabetes or peripheral vascular diseases?

a) Propranolol

b) Metoprolol

c) Nadolol

d) Timolol

039. Indicate a beta receptor antagonist, which has very long duration of action:

a) Metoprolol

b) Propranolol

c) Nadolol

d) Pindolol

040. Indicate a beta1-selective receptor antagonist, which has very long duration of action:

a) Betaxolol

b) Sotalol

c) Nadolol

d) Metoprolol

041. Which of the following drugs is a nonselective beta-blocker without intrinsic sympathomimetic or local anesthetic activity and used for the treatment of life-threatening ventricular arrhythmias?

a) Propranolol

b) Oxprenolol

c) Sotalol

d) Atenolol

042. Indicate a beta receptor antagonist with intrinsic sympathomimetic activity:

a) Propranolol

b) Oxprenolol

c) Metoprolol

d) Carvedilol

043. Pindolol, oxprenolol have all of the following properties EXCEPT:

a) They are nonselective beta antagonists

b) They have no partial agonist activity

c) They are less likely to cause bradycardia and abnormalities in plasma lipids

d) They are effective in hypertension and angina

044. Which of the following drugs has both alfa1-selective and beta-blocking effects?

a) Labetalol

b) Betaxolol

c) Propranolol

d) Timolol

045. Characteristics of carvedilol include all of the following EXCEPT:

a) It is a beta1-selective antagonist

b) It has both alfa1-selective and beta-blocking effects

c) It attenuates oxygen free radical-initiated lipid peroxidation

d) It inhibits vascular smooth muscle mitogenesis

046. Indicate the adrenoreceptor antagonist drug, which is a rauwolfia alkaloid:

a) Prazosin

b) Propranolol

c) Reserpine

d) Phentolamine

047. Characteristics of reserpine include all of the following EXCEPT:

a) It inhibits the uptake of norepinephrine into vesicles and MAO

b) It decreases cardiac output, peripheral resistance and inhibits pressor reflexes

c) It may cause a transient sympathomimetic effect

d) It depletes stores of catecholamines and serotonin in the brain

048. Indicate a beta-blocker, which is particularly efficacious in thyroid storm:

a) Pindolol

b) Sotalol

c) Phentolamine

d) Propranolol

049. Beta-receptor blocking drugs are used in the treatment all of the following diseases EXCEPT:

a) Hypertension, ischemic heart disease, cardiac arrhythmias

b) Glaucoma

c) Pheochromocytoma

d) Hyperthyroidism

050. Beta-blocker-induced adverse effects include all of the following EXCEPT:

a) Bronchoconstriction

b) Depression of myocardial contractility and excitability

c) “supersensitivity” of beta-receptors associated with rapid withdrawal of drugs

d) Hyperglycemia