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WorksheetsAdrenergic Pharmacology
Total questions: 30
Worksheet time: 15mins
A patient with COPD uses an albuterol inhaler and a fluticasone inhaler “both due now.” Which should be taken first?
Albuterol
Fluticasone
Either order is fine
Use only the steroid now
Which effect signals beta1 receptor stimulation during a dobutamine infusion?
Bronchodilation
Increased heart rate and AV conduction
Peripheral vasoconstriction with mydriasis
Intestinal hypermotility
Which response best matches beta2 activation?
Uterine contraction
Bronchial smooth muscle relaxation
Pupillary constriction
Bladder sphincter contraction
You’re titrating norepinephrine for septic shock. Which observation most directly reflects its primary receptor profile?
Bronchodilation and tachycardia
Marked vasoconstriction with beta1 cardiac stimulation, minimal beta2 effect
Predominant beta2 effect with uterine relaxation
Pure alpha2 autoreceptor activation
Priority assessment during IV epinephrine for anaphylaxis:
Daily weights
Cardiac rhythm and hemodynamics continuously
Oral mucosa for ulcerations
Ankle edema each shift
You suspect IV infiltration during a vasopressor infusion. First nursing action?
Increase the rate to maintain MAP
Continue infusion and elevate limb
Stop infusion and check/secure site
Bolus with normal saline at the site
Teaching a patient with chronic lung disease starting a β2 agonist inhaler. Which instruction aligns with slide guidance?
Restrict fluids to avoid edema
Encourage fluids up to ~3000 mL/day if permitted
Double doses with persistent wheeze
Rinse mouth to prevent thrush only for bronchodilators
A patient self-treats with topical nasal decongestant multiple times daily for 3 weeks. Which issue do you anticipate?
Angioedema
Rebound congestion/ulcerations
Sedation
Hyperkalemia
Which outcomes indicate therapeutic effect of adrenergic cardiovascular support? (Select all that apply.)
Increased urine output
Improved skin color and temperature
Worsening confusion
Decreased edema
Return to normal vital signs
Which finding best signals bronchodilator therapy is working?
More crackles
Improved breath sounds and air exchange with less dyspnea
Lower PaO2
Increased coughing only
Which statement about alpha-1 agonists is most accurate?
Cause vasodilation and miosis
Cause vasoconstriction and can dilate pupils
Slow AV conduction
Strictly presynaptic and inhibitory
Which adverse clinical consequence is unique to nonselective β-blockers in diabetes?
Hyperglycemia from glycogenolysis
Masking of hypoglycemia signs (tremor, tachycardia, nervousness); sweating persists
Severe diarrhea
Rebound hyperkalemia
A patient on propranolol reports dizziness climbing stairs. Teaching point?
Increase intensity to build tolerance
Skip doses before exercise
Report reduced exercise tolerance (dizziness/fainting) to the provider
Double the dose before workouts
You’re reconciling meds for a post-MI patient. Which β-blocker effect is a main reason for use?
Stimulates circulating catecholamine response
Cardioprotective by inhibiting catecholamine stimulation
Increases myocardial oxygen demand
Promotes AV nodal reentry
Which report requires follow-up in a patient newly on a β-blocker?
Mild fatigue first week
Weight gain >2 lb/day or >5 lb/week with ankle edema and SOB
Resting HR 68
Occasional headache
A patient with BPH asks how an α-blocker helps. Best explanation?
Shrinks prostate tissue
Decreases resistance to urinary outflow at prostate/bladder neck
Increases detrusor contraction directly
Inhibits aldosterone
Which statement about adrenergic antagonists is correct?
They mimic SNS activity
They bind adrenergic receptors to block SNS stimulation (sympatholytics)
They only block α receptors
They only block β receptors
A patient on two adrenergic drugs (e.g., oral decongestant + IV vasopressor) shows SBP 198/110 and HR 128. Most likely cause?
Drug tolerance
Additive severe CV effects (tachycardia/hypertension)
Fluid deficit
Beta-blockade
Which PNS receptor location/function pairing is accurate?
Nicotinic—postsynaptic organs only
Nicotinic—ganglia/adrenal medulla/skeletal muscle; Muscarinic—organs (smooth/cardiac/glands)
Muscarinic—NMJ only
Muscarinic—adrenal medulla only
Which muscarinic effect do you anticipate from a cholinergic agonist?
Increased HR and contractility
Lower HR with increased smooth-muscle tone and glandular secretions
Bronchodilation
Pupil dilation
Which clinical use aligns with bethanechol?
Paralytic ileus prophylaxis
Urinary retention—stimulates muscarinic receptors in the bladder
Mydriasis for eye exam
COPD bronchodilation
Anesthesia requests reversal of a nondepolarizing neuromuscular blocker. Which class is appropriate?
Direct muscarinic agonist only
Indirect cholinergics (anticholinesterases; “-stigmine”)
α-blocker
β-blocker
Pre-op orders include atropine. Which intended effect matches its class?
Profuse secretions to protect airway
Decreased oral/respiratory secretions
Severe bradycardia
Miosis
A traveler asks for scopolamine. Best evidence-based indication from your slides?
Migraine prophylaxis
Chronic hypertension
Prevention of motion sickness; some nausea/emesis types
Smoking cessation
Which patient group is most sensitive to anticholinergic adverse effects and needs careful dosing?
Middle-aged athletes
Infants/young children; older adults; people with Down’s syndrome
Only older adult men
Only patients with asthma
Long-term use of anticholinergics has been associated with which risk that should inform deprescribing?
Gastric ulcers
Development of dementia in older adults
Pancreatitis
Polycythemia
Which indications align with anticholinergics according to the deck? Select all that apply.
Anticholinesterase overdose/poisoning
Certain bradycardias
Overactive bladder/urinary antispasmodic therapy
First-line hypertension in pregnancy
A patient with overactive bladder asks about mechanism of oxybutynin.
Directly stimulates nicotinic receptors
Inhibits α1 receptors in prostate
Blocks muscarinic receptors (urinary antispasmodic effect)
Stimulates β2 receptors in detrusor
Which teaching point best prevents medication–medication issues when starting an anticholinergic?
Combine with other anticholinergics to enhance effect.
Be cautious with drugs that have anticholinergic side effects—opposing and additive interactions exist.
Nicotine patches block the drug.
Alpha-blockers cancel anticholinergics.
During a pharmacology review, a student says, “The PNS is basically the same as the SNS.” Best correction?
True; they share receptors
No; PNS (ACh at muscarinic) generally opposes SNS; receptor locations/effects differ
They’re identical at the heart only
They both use NE at effectors
