need help with your account or subscription? click here to email us (or see the contact page)
join telegramNEW! discord
jump to exam page:
search for anything ⋅ score predictor (โ€œpredict me!โ€)

Retired NBME 21 Answers

nbme21/Block 1/Question#48 (reveal difficulty score)
A 44-year-old man is admitted to the hospital ...
Increasing cGMP ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags:

 Login (or register) to see more


 +9  upvote downvote
submitted by โˆ—divya(75)
get full access to all contentpick a username

increase in cAMP (Gs) - beta2 - vasodilation

decrease in cAMP (Gi) - alpha2 - vasoconstriction

increase in IP3 DAG (Gq) - alpha1 - vasoconstriction

increase in cGMP - M3 - NO induced vasodilation

get full access to all contentpick a username
cytotoxict  Alpha 2 agonists do not cause vasoconstriction b/c they lead to negative feedback of norepi and thus decrease sympathetic response +1
payingforthisisdumb  FA20 p317 ฮฑ2-agonists increase NO/cGMP and vasodilate +
sarahs  why is decreasing cAMP wrong? +1
hiroshimi  @sarahs: you want to increase cAMP because it would lead to vasodilation and help to decrease his blood pressure. Decreasing cAMP would make his BP worse. +
fatboyslim  alpha2 stimulation causes vasodilation because it is sympatholytic. +

simple rule of thumb is

Calcium --> vasoconstriction (smooth muscle constriction) -- > must be Gq (alpha 1, v1)

rise in cAMP and cGMP both vasodilation (cAMP by inhibiting MLCK, cGMP by activating MLCP) so whoever causes vasodialation must increase either. cGMP is niche (NO, ANP) so most of the time it is rise in cAMP --> must be Gs (beta 2)

only exception is M3 it rises calcium (Gq) but in endothelial cells , not vascular smooth m. cells, so NO produced and causes vasodialation via rise in cGMP (again!)



 +2  upvote downvote
submitted by โˆ—vi_capsule(21)
get full access to all contentpick a username

HTN emergency, Sodium Nitroprusside. Unlike hydralazine a balanced vasodilator (vein = arteriol)

get full access to all contentpick a username
sympathetikey  Well then, I guess we should just forget about our old pals the Alpha-2 agonists. Good call. I didn't even see that this was hypertensive emergency. Dumb on my part. +
zup  so yea clonidine would be used for hypertensive urgency, but this guy is over 180 (210) so they have to use something like hydralazine or nitroprusside both will increase cGMP +
whoissaad  Drugs used to treat HTN emergency: Nitroprusside Labetolol Nicardipine Clevidpine Fenoldapam Clonidine +18
lola915  Hydralazine actually vasodilates arteries>veins and Nitroprusside vasodilates arteries = veins. Both increase cGMP. +12
vi_capsule  SO this site goes after money now! at least my comments aren't scrambled lol +2



Must-See Comments from nbme21

nosancuck on Absorption atelectasis
assoplasty on Free T4
seagull on GM2
lnsetick on Apocrine
niboonsh on NMDA receptors are blocked by Mg2+ at the ...
drdoom on Deletion of a hydrophobic amino acid ...
hayayah on HCO3โˆ’ transported in the plasma
mcl on Aortic
notadoctor on Usual interstitial pneumonitis
madojo on Genital herpes
hungrybox on Obstruction of the bile duct
jambo2222 on Lung
hungrybox on Mismatch repair
hungrybox on Hydrochlorothiazide

search for anything NEW!