What are the two major divisions of the nervous system? - Answers Central nervous system (CNS)
and peripheral nervous system (PNS).
What structures make up the CNS? - Answers Brain and spinal cord.
What are the two major functional divisions of the PNS? - Answers Sensory (afferent) and motor
(efferent).
What do afferent neurons do? - Answers Carry sensory input toward the CNS.
What do efferent neurons do? - Answers Carry signals away from the CNS to muscles and organs.
What are the two divisions of the efferent system? - Answers Somatic motor system and autonomic
nervous system.
What does the somatic motor system control? - Answers Conscious voluntary movement.
What does the autonomic nervous system control? - Answers Subconscious involuntary functions like
heart rate and digestion.
What are the main divisions of the autonomic nervous system? - Answers Sympathetic and
parasympathetic systems.
What is the sympathetic nervous system associated with? - Answers Fight-or-flight responses.
What is the parasympathetic nervous system associated with? - Answers Rest-and-digest functions.
What is the outflow of the sympathetic system? - Answers Thoracolumbar outflow.
What is the outflow of the parasympathetic system? - Answers Craniosacral outflow.
Give examples of parasympathetic effects. - Answers Miosis, increased salivation, decreased heart
rate, bronchoconstriction, increased peristalsis, bile release.
Why is understanding autonomic physiology important in pharmacology? - Answers Drugs act by
manipulating autonomic pathways and receptors.
What are the major steps in neurochemical transmission? - Answers Axonal conduction, transmitter
release, receptor interaction, postsynaptic response, and transmitter destruction or dissipation.
What is the key neurotransmitter in the cholinergic nervous system? - Answers Acetylcholine (ACh).
Where is acetylcholine used in the nervous system? - Answers All preganglionic autonomic sites,
postganglionic parasympathetic sites, some sympathetic sites, skeletal muscle, and CNS.
What neurotransmitter is released at most sympathetic neuroeffector junctions? - Answers
Norepinephrine.
What kind of amine is acetylcholine structurally? - Answers A quaternary amine.
Why does ACh not easily cross the blood-brain barrier? - Answers It is positively charged and water-
soluble.
What AChE inhibitor crosses the BBB? - Answers Physostigmine.
What AChE inhibitor does not cross the BBB? - Answers Pyridostigmine.
What important group is NOT present in acetylcholine? - Answers A phosphate group.
What two molecules are used to synthesize ACh? - Answers Choline and acetyl-CoA.
What enzyme synthesizes acetylcholine? - Answers Choline acetyltransferase (ChAT).
What does ChAT do? - Answers Transfers an acetyl group from acetyl-CoA to choline.
What transporter brings choline into the nerve terminal? - Answers CHT1, the high-affinity choline
transporter.
What is the rate-limiting step in ACh production? - Answers Uptake of choline into the nerve
terminal.
What drug blocks high-affinity choline uptake? - Answers Hemicholinium.
How does hemicholinium decrease cholinergic signaling? - Answers It depletes choline uptake,
reducing ACh synthesis.
What transporter packages ACh into vesicles? - Answers VAChT, the vesicular acetylcholine
transporter.
What drug blocks VAChT? - Answers Vesamicol.
What is the effect of blocking VAChT? - Answers Less ACh is packaged and released, so cholinergic
signaling decreases.
What triggers exocytosis of ACh-containing vesicles? - Answers Calcium entry through voltage-gated
calcium channels.
What toxin interferes with ACh release from vesicles? - Answers Botulinum toxin.
What enzyme breaks down ACh in the synapse? - Answers Acetylcholinesterase (AChE).
What are the breakdown products of ACh? - Answers Choline and acetate.
,What are the two major cholinergic receptor types? - Answers Nicotinic and muscarinic receptors.
What type of receptor is the nicotinic receptor? - Answers A ligand-gated ion channel.
What type of receptor is the muscarinic receptor? - Answers A G protein-coupled receptor (GPCR).
How many subunits make up a nicotinic receptor? - Answers Five subunits.
Where is the ACh binding site on the nicotinic receptor? - Answers At the interface between receptor
subunits.
What happens when ACh binds the nicotinic receptor? - Answers A conformational change opens the
ion channel and allows ions to flow.
Why is the closed nicotinic pore not favorable for ion flow? - Answers It is too narrow and lined with
hydrophobic residues.
What structural change opens the nicotinic channel? - Answers Rotation or movement of helices
shifts hydrophobic residues out of the way.
How many transmembrane segments does a muscarinic receptor have? - Answers Seven.
What happens after ACh binds to a muscarinic receptor? - Answers A conformational change
activates intracellular G proteins and downstream signaling.
Where is M1 mainly found and what does it do? - Answers CNS and gastric glands; enhances
cognition and increases gastric acid secretion.
Where is M2 mainly found and what does it do? - Answers Heart and CNS; slows heart rate and
reduces neurotransmitter release.
Where is M3 mainly found and what does it do? - Answers Smooth muscle, glands, and eyes; causes
smooth muscle contraction, gland secretion, and pupillary constriction.
Where is M4 mainly found and what does it do? - Answers CNS; inhibits neurotransmitter release and
modulates CNS signaling.
Where is M5 mainly found and what does it do? - Answers CNS and blood vessels; involved in
dopamine regulation and vasodilation.
Which muscarinic receptor is most associated with slowing heart rate? - Answers M2.
Which muscarinic receptor is most associated with glandular secretion and smooth muscle
contraction? - Answers M3.
What does an agonist do? - Answers Mimics the natural ligand and activates the receptor.
What does an antagonist do? - Answers Blocks receptor activation and prevents the natural ligand
from working.
What is a cholinergic agonist? - Answers A drug that mimics ACh by activating cholinergic receptors.
What are the two broad types of cholinergic agonists? - Answers Direct-acting and indirect-acting
agonists.
How do direct-acting cholinergic agonists work? - Answers They bind directly to cholinergic receptors.
How do indirect-acting cholinergic agonists work? - Answers They inhibit AChE and increase
endogenous ACh.
Why is acetylcholine itself rarely used therapeutically? - Answers It is rapidly degraded by AChE.
What is bethanechol used for? - Answers Urinary retention and ileus.
What receptor type does bethanechol primarily activate? - Answers Muscarinic receptors.
What is pilocarpine used for? - Answers Glaucoma and xerostomia.
What is methacholine used for? - Answers Asthma diagnosis via methacholine challenge.
What effect of methacholine is used diagnostically? - Answers Bronchoconstriction.
What is carbachol used for? - Answers Glaucoma.
Which direct-acting agonists can act at both muscarinic and nicotinic receptors? - Answers
Acetylcholine and carbachol.
What modification makes carbachol and bethanechol more resistant to hydrolysis? - Answers
Carbamoyl substitution.
What does beta-methyl substitution on the ACh skeleton tend to produce? - Answers Selective
muscarinic agonist activity.
What does alpha-methyl substitution on the ACh skeleton tend to produce? - Answers Selective
nicotinic agonist activity.
What happens if both alpha and beta positions are modified in the way shown in the slides? -
Answers Activity can be lost or inactivated.
What is neostigmine used for? - Answers Myasthenia gravis and reversal of neuromuscular blockade.
What is pyridostigmine used for? - Answers Long-term management of myasthenia gravis.
What is donepezil used for? - Answers Alzheimer's disease.
, What is physostigmine used for? - Answers Reversal of anticholinergic toxicity such as atropine
overdose.
Why is physostigmine useful in central anticholinergic toxicity? - Answers It crosses the BBB and
inhibits CNS AChE.
What is edrophonium used for? - Answers Diagnosis of myasthenia gravis.
What is the general effect of reversible AChE inhibitors? - Answers Increase ACh availability at
synapses and NMJs.
What is the key difference between reversible and irreversible cholinesterase inhibitors? - Answers
Reversible inhibitors can dissociate; irreversible ones form tight covalent bonds.
What drug class includes parathion and malathion? - Answers Organophosphates.
How do organophosphates affect AChE? - Answers They irreversibly inhibit it, causing cholinergic
crisis.
What is echothiophate? - Answers An irreversible cholinesterase inhibitor rarely used for glaucoma.
How are cholinergic agonists useful in myasthenia gravis? - Answers They increase ACh action at
NMJs to improve muscle strength.
Which cholinergic agonists are used in glaucoma? - Answers Pilocarpine and carbachol.
Which drug is used for urinary retention and ileus? - Answers Bethanechol.
Which drug is used to reverse non-depolarizing neuromuscular blockade after surgery? - Answers
Neostigmine.
Which test temporarily boosts ACh to diagnose myasthenia gravis? - Answers Edrophonium test.
Which test assesses airway hyperreactivity in asthma? - Answers Methacholine challenge test.
What cardiovascular adverse effects can cholinergic agonists cause? - Answers Bradycardia and
hypotension.
What respiratory adverse effects can cholinergic agonists cause? - Answers Bronchoconstriction and
difficulty breathing.
What GI adverse effects can cholinergic agonists cause? - Answers Nausea, diarrhea, and abdominal
cramps.
What glandular adverse effects can cholinergic agonists cause? - Answers Excess salivation, sweating,
and tearing.
What is the general pattern of cholinergic agonist overdose? - Answers Too much rest-and-digest
activity.
What do muscarinic antagonists do? - Answers Competitively block muscarinic receptors and reduce
parasympathetic activity.
What do nicotinic antagonists do? - Answers Block nicotinic receptors at NMJs or autonomic ganglia.
What effect does muscarinic blockade have on the heart? - Answers Increases heart rate.
What effect does muscarinic blockade have on smooth muscle and glands? - Answers Reduces
smooth muscle contraction and decreases secretions.
What effect does nicotinic blockade at the NMJ have? - Answers Prevents muscle contraction.
What effect does ganglionic nicotinic blockade have? - Answers Inhibits autonomic signaling.
What is atropine used for? - Answers Bradycardia and organophosphate poisoning.
How does atropine help in bradycardia? - Answers Blocks M2 receptors in the heart.
What are ipratropium and tiotropium used for? - Answers COPD and asthma.
What receptor do ipratropium and tiotropium block? - Answers M3 receptors in the airways.
What are oxybutynin and solifenacin used for? - Answers Overactive bladder.
What receptor do oxybutynin and solifenacin block? - Answers M3 receptors in the bladder.
What is scopolamine used for? - Answers Motion sickness.
Where does scopolamine primarily act for motion sickness? - Answers CNS muscarinic receptors.
What are rocuronium and pancuronium used for? - Answers Muscle relaxation during surgery.
What are common muscarinic antagonist adverse effects? - Answers Dry mouth, blurred vision,
constipation, urinary retention, tachycardia, confusion, and sedation.
What are common nicotinic antagonist adverse effects? - Answers Paralysis, respiratory depression,
orthostatic hypotension, and loss of autonomic control.
What memory phrase matches anticholinergic adverse effects? - Answers Can't see, can't spit, can't
sit.
What early observation linked cholinergic signaling to memory? - Answers Drugs like scopolamine
impair memory.