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NBME 18 Answers

nbme18/Block 1/Question#3 (reveal difficulty score)
5 yo boy, history of motion sickness
Antagonist at muscarinic-3 receptors ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags: pharm

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 +4  upvote downvote
submitted by iguzman2(4)

Aren't M1 receptors found in the brain and are responsible for motion sickness?

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m-ice  M1 receptors are for sure the major muscarinic receptor type found in the CNS, but M3 receptors are the muscarinic subtype involved in vomiting controlled by the CNS. This is definitely a random fact, but I think they also wanted you to eliminate all other options. Targeting the sympathetic system (options A and B) won't make a difference. NMDA receptors are a major receptor throughout the CNS, but they're not a target of antihistamines, and neither are serotonin receptors. We know that antihistamines target histamine and muscarinic receptors, but the H2 histamine receptor is responsible for gastrin secretion in the stomach, so the answer must be antagonism of M3 receptors. +8
dorsal_vein  ^ First generation antihistamines definitely antagonize serotonin receptors within the CNS, which can cause weight gain and increase appetite. However, this plays little role in motion sickness. +15
mumenrider4ever  That is confusing because scopolamine (anti-muscarinic used to treat motion sickness) is an M1 receptor antagonist +4
pelparente  So according to amboss scopolamine is a nonspecific antiemetic. I think Sketchy probably just confused everyone. +5
osteopathnproud  I had @m-ice logic down to H2 and M3, then from base knowledge, I was like H2 gastrin secretion or M3 contraction of smooth muscle like bladder... stomach stuff is for me so H2... I do not know how you can get this question without knowing that M3 has to do with motion sickness +
mariame  First generation antihistamine are used for extrapyramidal sx in parkinson, and in elderly they have anticholinergic side effects. So I think you could also use this information to answer the question. It antagonizes H1 receptors and also M receptors. +

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submitted by โˆ—visualninjacontender(18)

pg.4 of the manuscript, bottom right paragraph

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visualninjacontender  "As we know that all mAChR subtypes are expressed in the brain, while only M1, M2, and M5 exist in vestibular ganglia and vestibular end organs in humans [72]. The M1, M3, and M5 are postsynaptic excitatory receptors; M2 and M4 receptors are inhibitory. Furthermore, selective M3 and M5 antagonist zamifenacin was found to be as effective as scopolamine in preventing Motion Sickness. These lines of evidence suggest that scopolamine might exert its antagonistic effect on peripheral M1 and M5 and/or central M1 and M3 mAChR to prevent MS" +

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