A 66-year-old female with a long history of heavy smoking presents to her doctor with complaints of shortness of breath and chronic coughing that has been present for about 2 years and has been worsening in frequency. The doctor decides to prescribe a bronchodilator agent that has minimal cardiac side effects, since the patient also has an extensive cardiac history. Which medication did the doctor likely prescribe?

Correct Answer: D

Rationale: The correct answer is D: Ipratropium. Ipratropium is an anticholinergic bronchodilator that has minimal cardiac side effects. It is commonly used to treat chronic obstructive pulmonary disease (COPD) and asthma. In this case, the patient's history of heavy smoking, shortness of breath, and chronic coughing suggests a respiratory condition like COPD. Albuterol (choice A) is a short-acting beta-agonist bronchodilator that can have cardiac side effects such as palpitations and increased heart rate. Prazosin (choice B) is an alpha-blocker used for hypertension and has no bronchodilator effects. Atenolol (choice C) is a beta-blocker used for hypertension and can worsen bronchospasm in patients with respiratory conditions. Therefore, the doctor likely prescribed Ipratropium to address the patient's respiratory symptoms while minimizing cardiac side effects.

Correct Answer: A

Rationale: The correct answer is A: Amphetamine. Amphetamine is a central nervous system stimulant that helps manage narcolepsy symptoms by promoting wakefulness. It increases levels of neurotransmitters like dopamine and norepinephrine, enhancing alertness. Adrenaline (B), Isoprenaline (C), and Salbutamol (D) are not typically used to treat narcolepsy as they do not directly target the underlying cause of excessive daytime sleepiness. Adrenaline and Isoprenaline are more commonly used for acute situations like anaphylaxis or cardiac arrest. Salbutamol is a bronchodilator used for conditions like asthma.

Correct Answer: D

Rationale: The correct answer is D. Bethanechol is a parasympathomimetic drug that primarily acts on muscarinic receptors in the bladder and gastrointestinal tract, causing increased smooth muscle contraction and promoting urination and improved GI motility. It does not affect intraocular pressure. A, B, and C are incorrect: A: Methacholine - acts as a muscarinic agonist causing bronchoconstriction, not vasodilation. B: Neostigmine - inhibits acetylcholinesterase leading to increased acetylcholine levels, enhancing neuromuscular transmission, not directly stimulating skeletal muscles. C: Pilocarpine - acts on muscarinic receptors in the eye, causing miosis and increased aqueous humor outflow, not increased sweat secretion.

Correct Answer: D

Rationale: The correct answer is D: Guanethidine. Guanethidine is a quaternary amine, which prevents it from passing the blood-brain barrier due to its charge. The blood-brain barrier is selective and only allows certain molecules to pass through. In contrast, choices A, B, and C (Ephedrine, Propranolol, Clonidine) are all capable of crossing the blood-brain barrier to some extent due to their chemical properties. Ephedrine is a weak base, Propranolol is lipophilic, and Clonidine is relatively small in size, allowing them to penetrate the blood-brain barrier.

Correct Answer: D

Rationale: The correct answer is D: Blood pressure. Ganglion blockers, similar to atropine, block the transmission of nerve impulses at ganglia. Ganglion blockers affect the eye, gastrointestinal tract, and urinary bladder by inhibiting parasympathetic activity. However, ganglion blockers do not have a significant direct effect on blood pressure regulation. Blood pressure is primarily regulated by the autonomic nervous system through the actions of the sympathetic and parasympathetic systems, not solely at ganglia. Therefore, the correct answer is D because ganglion blockers do not directly influence blood pressure regulation.