CCMP 2020 Batch – Mission 100% Regular Hard Work, Dedication, Study with No Stress.

20 MCQs in one Set. No Negative Marking. Time allowed 30 minutes.

CCMP Study Group @ RCSM GMC Kolhapur
MCQS in Autonomic Nervous System_Answers 03
01. Acetylcholine is not used commercially because:
(a) Long duration of action
(b) Costly
(c) Rapidly destroyed in the body
(d) Crosses blood brain barrier
01. Ans. (c) Rapidly destroyed in the body

02. Which one of the following acts commonly both on parasympathetic and sympathetic division?
(a) Atropine
(b) Pilocarpine
(c) Acetylcholine
(d) Adrenaline
02. Ans. (c) Acetylcholine (Ref: KDT 6/e p91)

03. The short acting anticholinesterase drug is:

(a) Edrophonium
(b) Demecarium
(c) Dyflos
(d) Ectothiophate
03. Ans. (a) Edrophonium (Ref: KDT 6/e p101)

04. Anticholineesterase with effect on CNS is:

(a) Neostigmine
(b) Pyridostigmine
(c) Physostigmine
(d) Edrophonium
04. Ans. (c) Physostigmine (Ref: KDT 6/e p101)

05. Which of the following anticholinesterase is derived from natural source?

(a) Physostigmine
(b) Neostigmine
(c) Pyridostigmine
(d) Tacrine
05. Ans. (a) Physostigmine (Ref: KDT 6/e p102)

06. The a2 agonist used in glaucoma is:

(a) Guanacare
(b) Guanabenz
(c) Brimonidine
(d) Tizanidine
06. Ans. (c) Brimonidine (Ref: KDT 6/e p146)

07. Blood brain barrier is crossed by:

(a) Physostigmine
(b) Neostigmine
(c) Acarbose
(d) All
07. Ans. (a) Physostigmine (Ref: KDT 6/e p101)

08. Which antiglaucoma drug can be used in an asthmatic patient?

(a) Timolol
(b) Betaxolol
(c) Propanolol
(d) All
08. Ans. (b) Betaxolol (Ref: KDT 6/e p145)

09. Cholinesterase activators are useful for treatment of which poisoning?

(a) Paraquat
(b) Parathion
(c) Carbamates
(d) Organochlorocompounds
09. Ans. (b) Parathion (Ref: KDT 6/e p105)

10. Neostigmine used in treatment of myasthenia gravis acts by:

(a) Increasing the number of receptors for acetylcholine
(b) Increasing synthesis of acetylcholine
(c) Decreasing breakdown of acetylcholine
(d) Increasing actylcholine degradation
10. Ans. (c) Decreasing breakdown of acetylcholine (Ref: KDT 6/e p101)

11. Which of the following drug binds only with the anionic site of cholinesterase?
(a) Physostigmine
(b) Neostigmine
(c) Edrophonium
(d) Pyridostigmine
11. Ans. (c) Edrophonium (Ref: KDT 6/e p105)
Physostigmine, neostigmine and pyridostigmine are carbamates by chemical nature, they bind to both
esteritic as well as anionic site whereas edrophonium is an alcohol and binds to anionic site only.

12. Which among the following is contraindicated in a myasthenic patient?

(a) Aminoglycosides
(b) Sulphonamides
(c) Penicillin
(d) All
12. Ans. (a) Aminoglycosides (Ref: KDT 6/e p722)
Aminoglycosides can result in neuromuscular blockade that can aggravate myasthenia gravis.

13. Neostigmine is not able to cross blood brain barrier because of its:
(a) Primary structure
(b) Secondary structrure
(c) Tertiary structure
(d) Quarternary structure
13. Ans. (d) Quarternary structure (Ref: KDT 6/e p101)
Quarternary ammonium compounds are water soluble and thus cannot cross blood brain barrier.
Neostigmine is a quarternary derivative whereas physostigmine is a tertiary amine.

14. Besides stimulation of M3 receptors located on endothelial cells, the main mechanism of vasodilatory
actions of acetylcholine includes which of the following?
(a) Decrease in endothelin by acetylcholine released from cholinergic nerves in blood vessels
(b) Inhibition of norepinephrine release from adrenergic nerve endings
(c) Stimulation of vascular smooth muscle cells
(d) Effects on autoregulation particularly in coronary vascular beds.
14. Ans. (b) Inhibition of nor-epinephrine release from adrenergic nerve endings (Ref: KDT 6/e p96)
• Most of the blood vessels contain cholinergic M3 receptors but no parasympathetic nerve supply.
• Exogenously administered ACh can stimulate M3 receptors and result in vasodilation.
• Stimulation of M3 receptors increases the production of NO (endothelium derived relaxing factor; EDRF)
that causes smooth muscle relaxation resulting in vasodilation.
• Vasodilation also may arise indirectly due to inhibition of NA release from nerve endings by ACh.
• If endothelium is damaged, ACh can stimulate receptors on vascular smooth muscle cells resulting in
vasoconstriction.

15. True statement about pralidoxime is:

(a) Signs of atropinization occur more slowly when pralidoxime is used as compared to
the use of atropine alone
(b) It can be used for chlorinated pesticides
(c) It should not used for nerve gases used in chemical warfare
(d) Therapy with pralidoxime should ideally be monitored by measuring blood
cholinesterase concentration
15. Ans. (d) Therapy with pralidoxime should ideally be monitored by measuring blood cholinesterase levels.
(Ref: KDT 6/e p105)
• Pralidoxime is ACh esterase reactivator used for organophosphate poisoning.
• Blood cholinesterase levels can be used to monitor therapy, however RBC cholinesterase levels better
reflect ACh esterase activity than serum or plasma levels because with chronic exposure to
organophosphates, serum levels may return to normal but RBC levels remain depressed.
• Chlorinated pesticides like DDT are CNS stimulants and their overdose is treated by diazepam like drugs.
Pralidoxime has no role in their treatment.
• Nerve gases used in warfare act by inhibiting acetyl cholinesterase. Atropine and oximes are used for their
treatment.
• When atropine and pralidoxime are used together, the signs of atropinization may occur earlier than might
be expected when atropine is used alone.

16. Which drug is not used now in Alzheimer’s disease?

(a) Tacrine
(b) Galantamine
(c) Donepezil
(d) Rivastigmine
16. Ans. (a) Tacrine (Ref: KDT 6/e p104, 472, 473)
Because of hepatotoxicity, and requirement of frequent dosing, tacrine is less often used than other agents.

17. Organophosphates bind to:

(a) Anionic site of AChEs
(b) Esteratic site of AChEs
(c) ACh
(d) None
17. Ans. (b) Esteratic site of AChEs (Ref: KDT 6/e p99-100)
• The active region of Acetylcholinesterase (AChE) has two sites i.e. an anionic site and an esteratic site.
Anticholinesterase poisoning like Organophosphate compounds binds to esteratic site of AChE.
18. Drug used in ameliorative test for myasthenia gravis is:
(a) Physostigmine
(b) Edrophonium
(c) Tacrine
(d) Pyridostigmine
18. Ans. (b) Edrophonium (Ref: KDT 6/e p104)
• Drug used in ameliorative test (tensilon test) for myasthenia gravis is edrophonium. It is a cholinergic drug
and can be used for diagnosis of myasthenia gravis because of its short duration of action (10 – 30 min.)

19. Atropine is useful in organophosphate poisoning because it:

(a) Reactivates acetylcholinesterase
(b) Competes with acetylcholine release
(c) Binds with both nicotinic and muscarinic acetylcholine receptors
(d) Is a competitive antagonist of acetylcholine
19. Ans. (d) Is a competitive antagonist of acetylcholine (Ref: KDT 6/e p106)
Atropine acts as an antagonist at muscarinic receptors. It has no activity on nicotinic receptors and do not
interfere with the release of ACh.

20. 2-PAM (Pralidoxime) is useful in treatment of:

(a) Paracetamol overdose
(b) DDT Poisoning
(c) Malathion Poisoning
(d) Lead Poisoning
20. Ans. (c) Malathion Poisoning (Ref: KDT 6/e p105)
• Pralidoxime is cholinesterase reactivator useful for organophosphate (malathion, parathion) poisoning.