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Decreased cyclic adenosine monophosphate production
16%
22/141
Decreased inositol phosphate production
45%
63/141
Increased cyclic adenosine monophosphate production
14%
20/141
Increased diacylglycerol production
6%
8/141
Increased inositol phosphate production
9%
13/141
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This patient who presents with urinary hesitancy, nocturia, and dribbling most likely has benign prostatic hyperplasia, which in combination with hypertension can be treated with prazosin. This drug is an alpha-1-adrenergic inhibitor that decreases inositol phosphate production. G-protein coupled receptors (GPCR) are cell surface receptors that serve as common mechanisms for intercellular signaling. Ligands bind to GPCRs and induce conformational changes that activate attached second messenger pathways. There are 3 common pathways used: Gq, Gs, and Gi. The Gq pathway activates phospholipase C to increase the production of inositol phosphate (IP3) and diacylglycerol. These products then activate protein kinase C and lead to downstream changes. Important receptors that use this pathway include alpha-1-adrenergic receptors, M3 muscarinic receptors, H1 histamine receptors, and V1 vasopressin receptors. Illustration A shows the second messenger pathways downstream of Gs, Gi, and Gq receptors. As depicted, Gq activates phospholipase C to produce inositol phosphate and diacylglycerol. Incorrect Answers: Answer 1: Decreased cyclic adenosine monophosphate production would occur with drugs that inhibit the Gs second messenger pathway. This pathway is used by beta-adrenergic receptors as well as D1 dopamine receptors. Answer 3: Increased cyclic adenosine monophosphate production would occur with drugs that inhibit the Gi second messenger pathway. This pathway is used by alpha-2-adrenergic receptors, M2 muscarinic receptors, and D2 dopamine receptors. Answers 4-5: Increased diacylglycerol production and increased inositol phosphate production would occur with drugs that activate the Gq second messenger pathway. An example of an alpha-1-adrenergic pathway agonist is phenylephrine. Bullet Summary: The Gq second messenger pathway activates phospholipase C to increase the production of inositol phosphate and diacylglycerol.
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