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Botulinum
30%
43/141
Guanethidine
4%
5/141
Hemicholinium
34%
48/141
Reserpine
15%
21/141
Vesamicol
11%
15/141
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This patient with weakness that is exacerbated by physical activity most likely has myasthenia gravis and was prescribed a long-acting acetylcholinesterase inhibitor. Reuptake of choline products is inhibited by hemicholinium. Cholinergic signaling is terminated through the degradation of acetylcholine by acetylcholinesterase into choline and acetate. The choline is recycled by being transported into the presynaptic neuron via a reuptake choline transporter. The choline can then subsequently be conjugated into acetylcholine. The reuptake choline transporter is inhibited by hemicholinium though this drug is only used in research settings as it is not safe for clinical applications. Incorrect Answers: Answer 1: Botulinum cleaves SNARE proteins within the neuron thereby preventing presynaptic vesicles from releasing acetylcholine but has no effect on choline reuptake. Answer 2: Guanethidine displaces norepinephrine within vesicles in sympathetic neurons but has no effect on cholinergic physiology. Answer 4: Reserpine inhibits the vesicular monoamine transporter thereby preventing the storage of neurotransmitters but has no effect on cholinergic physiology. Answer 5: Vesamicol inhibits the vesicular acetylcholine transporter thereby preventing the storage of acetylcholine but has no effect on choline reuptake. Bullet Summary: Acetylcholine is degraded by acetylcholinesterase in the synapse and the choline product subsequently undergoes reuptake through a hemicholinium-sensitive transporter.
3.2
(6)
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