1. A patient with COPD is taking an orally inhaled muscarinic receptor-blocking drug to maintain bronchodilation. The drug is most likely ipratropium. 2. A 2-year-old child is suspected of antimuscarinic drug overdose. Probable signs include increased heart rate, dilated pupils, and dry mouth. 3. Physostigmine is the antidote for antimuscarinic poisoning like atropine. Neostigmine is not suitable because it cannot overcome the adverse effects in the brain and central nervous system.

1. 1
A patient with chronic obstructive pulmonary disease (COPD, e.g.,
emphysema) is receiving an orally inhaled muscarinic receptor-blocking
drug to maintain bronchodilation. Which of the following drug is this
patient most likely taking?
A. Albuterol
B. Diphenhydramine
C. Ipratropium
D. Pancuronium
E. Pilocarpine

2. 2
A 2-year-old child has been admitted to the emergency department.
Antimuscarinic drug overdose is suspected. Probable signs of atropine
overdose include which one of the following?
(A) Gastrointestinal smooth muscle cramping
(B) Increased heart rate
(C) Increased gastric secretion
(D) Pupillary constriction
(E) Urinary frequency

3. 3
Physostigmine is the antidote for poisoning with antimuscarinic drugs
(e.g., atropine). Another AChE inhibitor, neostigmine, is not suitable. That
is because neostigmine cannot overcome the adverse effects of the
antimuscarinic drug in or on which of the following?
A. Central nervous system (e.g., the brain)
B. Exocrine glands
C. Heart
D. Skeletal muscle
E. Smooth muscle

4. 4
Which of the following is an expected effect of a therapeutic dose of
an antimuscarinic drug?
A. Decreased cAMP (cyclic adenosine monophosphate) in cardiac muscle
B. Decreased DAG (diacylglycerol) in salivary gland tissue
C. Increased IP3 (inositol trisphosphate) in intestinal smooth muscle
D. Increased potassium efflux from smooth muscle
E. Increased sodium influx into the skeletal muscle end plate

5. 5
A 75-year-old man who was a smoker is diagnosed with chronic
obstructive pulmonary disease and suffers from occasional
bronchospasm. Which of the following would be effective in treating
him?
A. Ipratropium aerosol.
B. Scopolamine patches.
C. Oxygen.
D. Nicotine.

6. 6
Urination in the human subject is decreased by
A. muscarinic agonists
B. muscarinic antagonists
C. AChase inhibitors
D. Nicotinic agonists
E. Spider venom

7. 7
The prolonged apnea sometimes seen in patients who have undergone an operation
in which succinylcholine was used as a muscle relaxant has been shown to be due to:
A. Urinary atony.
B. Depressed levels of plasma cholinesterase.
C. A mutation in acetylcholinesterase.
D. A mutation in the nicotinic receptor at the neuromuscular junction.
E. Weak histamine-releasing action.

8. 8
A 50-year-old male farm worker is brought to the emergency room. He was found
confused in the orchard and since then has lost consciousness. His heart rate is 45, and his
blood pressure is 80/40 mm Hg. He is sweating and salivating profusely. Which of the
following treatments is indicated?
A. Physostigmine.
B. Norepinephrine.
C. Trimethaphan.
D. Atropine.
E. Edrophonium.

9. 9
Which one of the following can be blocked by atropine?
A. Decreased blood pressure caused by hexamethonium
B. Increased blood pressure caused by nicotine
C. Increased skeletal muscle strength caused by neostigmine
D. Tachycardia caused by exercise
E. Tachycardia caused by infusion of acetylcholine

10. 10
Which of the following is the most dangerous effect of belladonna alkaloids in
infants and toddlers?
A. Dehydration
B. Hallucinations
C. Hypertension
D. Hyperthermia
E. Intraventricular heart block