Barkley Pharmacology Practice ACTUAL
EXAM ALL QUESTIONS AND ANSWERS
ALREADY GRADED A+. 100% VERIFIED
SOLUTIONS | UPDATED PER LATEST
GUIDELINES | GRADED A+
Section 1: Autonomic Nervous System Pharmacology (Questions 1-15)
Question 1
The neurotransmitter released by postganglionic parasympathetic nerve fibers is:
A. Norepinephrine
B. Acetylcholine
C. Dopamine
D. Epinephrine
Correct Answer: B
Rationale: Acetylcholine is the neurotransmitter released by all preganglionic autonomic fibers
(both sympathetic and parasympathetic) and by postganglionic parasympathetic fibers.
Norepinephrine is released by postganglionic sympathetic fibers (except sweat glands) .
Question 2
Pilocarpine is a direct-acting cholinergic agonist used to treat:
A. Glaucoma
B. Myasthenia gravis
C. Urinary retention
D. Hypertension
Correct Answer: A
,Rationale: Pilocarpine is a direct muscarinic agonist that causes miosis and reduces intraocular
pressure, making it effective for glaucoma. Bethanechol is used for urinary retention, and
pyridostigmine is used for myasthenia gravis .
Question 3
Which of the following is an adverse effect of cholinergic agonists?
A. Diarrhea, bradycardia, miosis
B. Dry mouth, tachycardia, mydriasis
C. Constipation, blurred vision, urinary retention
D. Hypertension, bronchodilation
Correct Answer: A
Rationale: Cholinergic agonists stimulate the parasympathetic nervous system, causing SLUDGE
syndrome (Salivation, Lacrimation, Urination, Defecation, Gastrointestinal distress, Emesis).
They also cause bradycardia and miosis (pupil constriction) .
Question 4
Atropine is classified as a(n):
A. Cholinergic agonist
B. Anticholinergic (muscarinic antagonist)
C. Adrenergic agonist
D. Beta-blocker
Correct Answer: B
Rationale: Atropine is a competitive muscarinic receptor antagonist (anticholinergic) that blocks
the effects of acetylcholine at muscarinic receptors. It is used for bradycardia, as an antidote for
organophosphate poisoning, and preoperatively to reduce secretions .
Question 5
A patient on pyridostigmine for myasthenia gravis reports increased muscle weakness, difficulty
swallowing, and excessive salivation. These symptoms suggest:
A. Therapeutic response
B. Cholinergic crisis (overdose)
C. Myasthenic crisis (underdose)
D. Allergic reaction
,Correct Answer: B
Rationale: Cholinergic crisis results from excessive acetylcholinesterase inhibition, causing
overstimulation of nicotinic and muscarinic receptors. Symptoms include muscle weakness
(depolarizing blockade), salivation, diarrhea, and bradycardia. This is distinguished from
myasthenic crisis by the presence of muscarinic excess symptoms .
Question 6
Bethanechol (Urecholine) is used to treat:
A. Urinary retention (non-obstructive)
B. Glaucoma
C. Myasthenia gravis
D. Hypertension
Correct Answer: A
Rationale: Bethanechol is a direct-acting cholinergic agonist that stimulates bladder detrusor
muscle contraction, promoting voiding. It is used for non-obstructive urinary retention. It is not
used for glaucoma (pilocarpine is used for that) .
Question 7
A patient taking an alpha-1 blocker (e.g., doxazosin) for hypertension should be advised to:
A. Rise slowly from sitting to prevent orthostatic hypotension
B. Monitor for constipation
C. Take with food
D. Expect bradycardia
Correct Answer: A
Rationale: Alpha-1 blockers cause vasodilation and can lead to orthostatic hypotension,
especially with the first dose. Patients should be instructed to rise slowly from sitting or lying
positions. Doxazosin is used for hypertension and BPH .
Question 8
Tamsulosin (Flomax) is an:
A. Alpha-1 selective antagonist (relaxes smooth muscle in prostate and bladder neck)
B. Beta-blocker
, C. Alpha-2 agonist
D. Alpha-1 agonist
Correct Answer: A
Rationale: Tamsulosin is a selective alpha-1A antagonist that relaxes smooth muscle in the
prostate and bladder neck, improving urinary flow in BPH. It has minimal effect on blood
pressure compared to non-selective alpha blockers .
Question 9
Which of the following is a non-selective beta-blocker that also blocks alpha-1 receptors?
A. Atenolol
B. Carvedilol
C. Esmolol
D. Bisoprolol
Correct Answer: B
Rationale: Carvedilol is a non-selective beta-blocker (beta-1 and beta-2) with additional alpha-1
blocking activity. This combination provides vasodilation and is beneficial in heart failure.
Atenolol, esmolol, and bisoprolol are beta-1 selective .
Question 10
A patient receiving pyridostigmine for myasthenia gravis experiences increased salivation and
diarrhea. What is the most appropriate intervention?
A. Administer atropine
B. Increase pyridostigmine dose
C. Administer neostigmine
D. Discontinue all medications
Correct Answer: A
Rationale: Pyridostigmine is an acetylcholinesterase inhibitor. Atropine (muscarinic antagonist)
can be administered to block peripheral muscarinic effects (salivation, diarrhea, bradycardia)
while allowing nicotinic effects (muscle strength) to continue .
Question 11
A patient on donepezil for Alzheimer's disease should be monitored for:
EXAM ALL QUESTIONS AND ANSWERS
ALREADY GRADED A+. 100% VERIFIED
SOLUTIONS | UPDATED PER LATEST
GUIDELINES | GRADED A+
Section 1: Autonomic Nervous System Pharmacology (Questions 1-15)
Question 1
The neurotransmitter released by postganglionic parasympathetic nerve fibers is:
A. Norepinephrine
B. Acetylcholine
C. Dopamine
D. Epinephrine
Correct Answer: B
Rationale: Acetylcholine is the neurotransmitter released by all preganglionic autonomic fibers
(both sympathetic and parasympathetic) and by postganglionic parasympathetic fibers.
Norepinephrine is released by postganglionic sympathetic fibers (except sweat glands) .
Question 2
Pilocarpine is a direct-acting cholinergic agonist used to treat:
A. Glaucoma
B. Myasthenia gravis
C. Urinary retention
D. Hypertension
Correct Answer: A
,Rationale: Pilocarpine is a direct muscarinic agonist that causes miosis and reduces intraocular
pressure, making it effective for glaucoma. Bethanechol is used for urinary retention, and
pyridostigmine is used for myasthenia gravis .
Question 3
Which of the following is an adverse effect of cholinergic agonists?
A. Diarrhea, bradycardia, miosis
B. Dry mouth, tachycardia, mydriasis
C. Constipation, blurred vision, urinary retention
D. Hypertension, bronchodilation
Correct Answer: A
Rationale: Cholinergic agonists stimulate the parasympathetic nervous system, causing SLUDGE
syndrome (Salivation, Lacrimation, Urination, Defecation, Gastrointestinal distress, Emesis).
They also cause bradycardia and miosis (pupil constriction) .
Question 4
Atropine is classified as a(n):
A. Cholinergic agonist
B. Anticholinergic (muscarinic antagonist)
C. Adrenergic agonist
D. Beta-blocker
Correct Answer: B
Rationale: Atropine is a competitive muscarinic receptor antagonist (anticholinergic) that blocks
the effects of acetylcholine at muscarinic receptors. It is used for bradycardia, as an antidote for
organophosphate poisoning, and preoperatively to reduce secretions .
Question 5
A patient on pyridostigmine for myasthenia gravis reports increased muscle weakness, difficulty
swallowing, and excessive salivation. These symptoms suggest:
A. Therapeutic response
B. Cholinergic crisis (overdose)
C. Myasthenic crisis (underdose)
D. Allergic reaction
,Correct Answer: B
Rationale: Cholinergic crisis results from excessive acetylcholinesterase inhibition, causing
overstimulation of nicotinic and muscarinic receptors. Symptoms include muscle weakness
(depolarizing blockade), salivation, diarrhea, and bradycardia. This is distinguished from
myasthenic crisis by the presence of muscarinic excess symptoms .
Question 6
Bethanechol (Urecholine) is used to treat:
A. Urinary retention (non-obstructive)
B. Glaucoma
C. Myasthenia gravis
D. Hypertension
Correct Answer: A
Rationale: Bethanechol is a direct-acting cholinergic agonist that stimulates bladder detrusor
muscle contraction, promoting voiding. It is used for non-obstructive urinary retention. It is not
used for glaucoma (pilocarpine is used for that) .
Question 7
A patient taking an alpha-1 blocker (e.g., doxazosin) for hypertension should be advised to:
A. Rise slowly from sitting to prevent orthostatic hypotension
B. Monitor for constipation
C. Take with food
D. Expect bradycardia
Correct Answer: A
Rationale: Alpha-1 blockers cause vasodilation and can lead to orthostatic hypotension,
especially with the first dose. Patients should be instructed to rise slowly from sitting or lying
positions. Doxazosin is used for hypertension and BPH .
Question 8
Tamsulosin (Flomax) is an:
A. Alpha-1 selective antagonist (relaxes smooth muscle in prostate and bladder neck)
B. Beta-blocker
, C. Alpha-2 agonist
D. Alpha-1 agonist
Correct Answer: A
Rationale: Tamsulosin is a selective alpha-1A antagonist that relaxes smooth muscle in the
prostate and bladder neck, improving urinary flow in BPH. It has minimal effect on blood
pressure compared to non-selective alpha blockers .
Question 9
Which of the following is a non-selective beta-blocker that also blocks alpha-1 receptors?
A. Atenolol
B. Carvedilol
C. Esmolol
D. Bisoprolol
Correct Answer: B
Rationale: Carvedilol is a non-selective beta-blocker (beta-1 and beta-2) with additional alpha-1
blocking activity. This combination provides vasodilation and is beneficial in heart failure.
Atenolol, esmolol, and bisoprolol are beta-1 selective .
Question 10
A patient receiving pyridostigmine for myasthenia gravis experiences increased salivation and
diarrhea. What is the most appropriate intervention?
A. Administer atropine
B. Increase pyridostigmine dose
C. Administer neostigmine
D. Discontinue all medications
Correct Answer: A
Rationale: Pyridostigmine is an acetylcholinesterase inhibitor. Atropine (muscarinic antagonist)
can be administered to block peripheral muscarinic effects (salivation, diarrhea, bradycardia)
while allowing nicotinic effects (muscle strength) to continue .
Question 11
A patient on donepezil for Alzheimer's disease should be monitored for:
