NURSES REVISION INSTITUTE OF HEALTH SCIENCES
CONTINUOUS ASSESSMENT TEST
PHARMACOLOGY: AUTONOMIC NERVOUS SYSTEM
TIME: 3 HOURS
| For Examiner's Use Only | |||
|---|---|---|---|
| Section | Question | Result | Initials |
| A | MCQs | ||
| Fill in | |||
| B | 31-32 | ||
| C | 33-35 | ||
| Total | |||
IMPORTANT
- Answer all the questions in the provided answer booklet.
- Read the questions carefully and answer only what has been asked.
- This paper has three sections: A, B, and C.
SECTION A: OBJECTIVE QUESTIONS (40 MARKS)
Multiple Choice Questions (Circle the correct answer in your answer booklet) (20 Marks)
The "fight-or-flight" response is mediated by which division of the autonomic nervous system?
Which neurotransmitter is released by all preganglionic autonomic neurons?
A drug described as a "sympathomimetic" would be expected to cause:
The nicotinic receptor found at the skeletal neuromuscular junction is specifically the:
A patient is given a drug that blocks muscarinic receptors. Which of the following effects would you expect to see?
The primary neurotransmitter released by postganglionic sympathetic neurons is:
Stimulation of which adrenergic receptor subtype causes relaxation of bronchial smooth muscle (bronchodilation)?
The "rest-and-digest" functions are the primary responsibility of which system?
A drug classified as a "parasympatholytic" would also be known as a(n):
Which of the following organs receives ONLY sympathetic innervation?
Stimulation of M₂ muscarinic receptors in the heart would cause:
A patient receives an overdose of a sympathomimetic drug like epinephrine. Which of the following signs would be expected?
The receptors located in all autonomic ganglia (both sympathetic and parasympathetic) are:
Which of the following is an effect of the parasympathetic nervous system?
Stimulation of which adrenergic receptor is primarily responsible for increasing heart rate and force of contraction?
The adrenal medulla functions most like a modified:
Stimulation of M₃ muscarinic receptors would lead to all of the following EXCEPT:
A drug that blocks the effects of the sympathetic nervous system is called a:
Activation of α₁ adrenergic receptors on blood vessels causes:
A patient is given Atropine, a parasympatholytic, before surgery. This drug is expected to cause:
Fill in the Blank Spaces (Write the correct answer in your answer booklet) (20 Marks)
21. Drugs that mimic the effects of the parasympathetic nervous system are called .
22. The two main classes of cholinergic receptors are nicotinic and .
23. The "fight or flight" response is primarily driven by the nervous system.
24. The receptor found on all effector organs of the parasympathetic system is the receptor.
25. A drug that blocks adrenergic receptors is known as a(n) .
26. The primary neurotransmitter of the parasympathetic nervous system at the effector organ is .
27. Stimulation of β₂ adrenergic receptors causes relaxation of bronchial and smooth muscle.
28. The two main classes of adrenergic receptors are alpha and .
29. The nicotinic receptor found in autonomic ganglia is the subtype.
30. A drug that mimics the actions of norepinephrine at adrenergic receptors is called a(n) .
SECTION B: SHORT ESSAY QUESTIONS (20 MARKS)
31.
(a) State the two main divisions of the Autonomic Nervous System (ANS). (2 Marks)
(b) For each division, state its general function (e.g., "fight-or-flight") and the primary neurotransmitter it releases at the effector organ. (8 Marks)
32.
(a) Name the two main types of cholinergic receptors. (4 Marks)
(b) Where is each receptor type primarily located in the peripheral nervous system? (6 Marks)
SECTION C: LONG ESSAY QUESTIONS (40 MARKS)
33. Most organs have dual innervation from the ANS, with the two divisions having opposing effects.
(a) Describe the opposing effects of the sympathetic and parasympathetic nervous systems on the following three organs: (i) The heart, (ii) The bronchi, and (iii) The pupil of the eye. (9 Marks)
(b) What is this type of interaction called, where two systems produce opposing physiological outcomes? (3 Marks)
(c) Name one major organ system that receives almost exclusively sympathetic innervation. (4 Marks)
34.
(a) Explain the mechanism by which Salbutamol provides relief during an asthma attack, specifying the receptor and the resulting physiological effect. (6 Marks)
(b) Explain the mechanism by which Propranolol helps manage hypertension, specifying the receptor and physiological effect on the heart. (6 Marks)
(c) Why would it be dangerous to give the non-selective β-blocker Propranolol to the asthmatic patient? (6 Marks)
Question 35. The pharmacology of the parasympathetic nervous system revolves around cholinergic receptors.
(a) Name the three main subtypes of muscarinic receptors (M1, M2, M3) and state a primary location for each. (6 Marks)
(b) A patient is given Atropine, a muscarinic antagonist (parasympatholytic). Describe two expected effects on the body and the receptor subtype responsible for each effect. (6 Marks)
(c) What is the difference between a sympathomimetic drug and a parasympatholytic drug, even though both can cause an increased heart rate? (4 Marks)
END
NURSES REVISION INSTITUTE - MARKING GUIDE
PHARMACOLOGY: AUTONOMIC NERVOUS SYSTEM
Multiple Choice Questions (1 Mark Each)
Fill in the Blank Spaces (2 Marks Each)
Question 31 (10 Marks)
(a) State the two main divisions of the Autonomic Nervous System. (2 Marks)
- Sympathetic Nervous System
- Parasympathetic Nervous System
(b) For each division, state its general function and primary neurotransmitter. (8 Marks)
Sympathetic (4 marks): General function is "fight-or-flight," preparing the body for stress and activity. The primary neurotransmitter at the effector organ is Norepinephrine (noradrenaline).
Parasympathetic (4 marks): General function is "rest-and-digest," conserving energy and overseeing routine functions. The primary neurotransmitter at the effector organ is Acetylcholine.
Question 32 (10 Marks)
(a) Name the two main types of cholinergic receptors. (4 Marks)
- Nicotinic receptors
- Muscarinic receptors
(b) Where is each receptor type primarily located? (6 Marks)
Nicotinic receptors (3 marks): Primarily located in all autonomic ganglia (Nn subtype) and at the skeletal neuromuscular junction (Nm subtype).
Muscarinic receptors (3 marks): Primarily located on all effector organs innervated by postganglionic parasympathetic neurons (e.g., heart, smooth muscle, glands).
Question 33: Dual Innervation. (16 Marks)
(a) Describe the opposing effects on the heart, bronchi, and pupil. (9 Marks)
Heart (3 marks): Sympathetic increases heart rate and contractility. Parasympathetic decreases heart rate.
Bronchi (3 marks): Sympathetic causes bronchodilation (relaxation of smooth muscle). Parasympathetic causes bronchoconstriction (contraction of smooth muscle).
Pupil (3 marks): Sympathetic causes pupillary dilation (mydriasis). Parasympathetic causes pupillary constriction (miosis).
(b) What is this type of interaction called? (3 Marks)
This is called Physiological Antagonism, where two systems produce opposing effects through different receptors and pathways.
(c) Name one organ system with almost exclusively sympathetic innervation. (4 Marks)
Most blood vessels (arterioles and veins) / Adrenal Medulla / Spleen / Piloerector muscles / Sweat glands.
Question 34: Scenario - Adrenergic Drugs. (18 Marks)
(a) Explain the mechanism of Salbutamol in asthma. (6 Marks)
Salbutamol is a selective β₂-agonist. (2 marks) It binds to and stimulates β₂-adrenergic receptors located on the smooth muscle of the bronchi. (2 marks) Activation of these receptors leads to smooth muscle relaxation, resulting in bronchodilation and relief from the asthma attack. (2 marks)
(b) Explain the mechanism of Propranolol in hypertension. (6 Marks)
Propranolol is a β-antagonist (blocker). (2 marks) It blocks β₁-adrenergic receptors in the heart. (2 marks) This prevents the effects of norepinephrine/epinephrine, leading to a decrease in heart rate and force of contraction, which reduces cardiac output and helps lower blood pressure. (2 marks)
(c) Why is it dangerous to give Propranolol to the asthmatic patient? (6 Marks)
Propranolol is a non-selective β-blocker, meaning it blocks both β₁ and β₂ receptors. (3 marks) If given to an asthmatic patient, it will block the β₂ receptors in the bronchi. This would prevent bronchodilation and could lead to severe, life-threatening bronchoconstriction. (3 marks)
Question 35. Cholinergic Pharmacology. (16 Marks)
(a) Name the three main muscarinic subtypes (M1, M2, M3) and a primary location for each. (6 Marks)
- M₁: CNS / GIT (enteric nerves)
- M₂: Heart (cardiac muscle)
- M₃: Exocrine glands / Smooth muscle (e.g., bladder, bronchi)
(b) Describe two expected effects of Atropine and the receptor responsible. (6 Marks)
Effect 1: Tachycardia (increased heart rate). This is due to the blockade of M₂ receptors on the heart, which removes the normal "braking" effect of the parasympathetic system.
Effect 2: Dry mouth / Decreased secretions. This is due to the blockade of M₃ receptors on the salivary and other exocrine glands.
(Other valid answers include pupil dilation/mydriasis, urinary retention, etc.)(c) Differentiate between a sympathomimetic and a parasympatholytic for increasing heart rate. (4 Marks)
A sympathomimetic (e.g., epinephrine) increases heart rate by directly activating β₁ adrenergic receptors on the heart, stimulating it to beat faster ("pressing the accelerator"). (2 marks)
A parasympatholytic (e.g., atropine) increases heart rate by blocking M₂ muscarinic receptors on the heart. This removes the normal inhibitory (slowing) effect of the parasympathetic system, allowing the heart rate to rise ("taking the foot off the brake"). (2 marks)
END OF MARKING GUIDE