Cardiovascular Drugs Practice Questions

Q: Ouabain acts by inhibiting which of the following?

Na+/K+ ATPase. **Explanation:** **Mechanism of Action (Why D is correct):** Ouabain is a rapidly acting **cardiac glycoside**, similar to Digoxin. It works by reversibly inhibiting the **Na+/K+ ATPase pump** (specifically the alpha subunit) located on the myocardial sarcolemma. 1. Inhibition of this pump leads to an increase in intracellular **Sodium (Na+)**. 2. This high intracellular Na+ reduces the concentration gradient required for the **Na+/Ca2+ exchanger (NCX)** to function. 3. Consequently, calcium extrusion from the cell is decreased, leading to increased intracellular **Calcium (Ca2+)** levels. 4. This excess calcium is taken up by the Sarcoplasmic Reticulum, resulting in increased calcium release during subsequent depolarizations, leading to a **positive inotropic effect** (increased force of contraction). **Analysis of Incorrect Options:** * **A. Adenyl cyclase:** This enzyme converts ATP to cAMP. Drugs like Beta-agonists (Dobutamine) act via this pathway, not cardiac glycosides. * **B. Calcium channels:** Calcium channel blockers (e.g., Verapamil) inhibit these channels. Ouabain actually increases intracellular calcium indirectly. * **C. H+/K+ ATPase:** This is the "proton pump" found in gastric parietal cells. It is inhibited by Proton Pump Inhibitors (PPIs) like Omeprazole. **NEET-PG High-Yield Pearls:** * **Source:** Ouabain is derived from the seeds of *Strophanthus gratus*. * **Pharmacokinetics:** Unlike Digoxin, Ouabain is highly polar, poorly absorbed orally, and must be given **intravenously**. It has the fastest onset of action among glycosides. * **Vagal Effect:** Like Digoxin, it increases vagal tone, making it useful for rate control in atrial fibrillation (negative dromotropic effect). * **Toxicity:** Hypokalemia predisposes to toxicity because K+ and cardiac glycosides compete for the same binding site on the Na+/K+ ATPase pump.

Q: Prolonged use of hydralazine for the treatment of hypertension is likely to cause:

Lupus erythematosis. **Explanation:** **Hydralazine** is a direct-acting arterial vasodilator used in hypertensive emergencies and chronic heart failure. The correct answer is **Lupus erythematosus**, specifically **Drug-Induced Lupus Erythematosus (DILE)**. 1. **Why D is correct:** Hydralazine is metabolized in the liver via **N-acetylation**. In individuals who are **"slow acetylators"** (genetically deficient in N-acetyltransferase), the drug or its metabolites can accumulate and bind to nuclear proteins. This triggers the formation of antinuclear antibodies (ANA), leading to a clinical syndrome resembling Systemic Lupus Erythematosus (SLE), characterized by arthralgia, fever, and pleuritis. Notably, unlike idiopathic SLE, DILE rarely involves the kidneys or CNS and typically resolves upon drug discontinuation. 2. **Why other options are incorrect:** * **A. Gynaecomastia:** Commonly associated with Spironolactone, Digoxin, Cimetidine, or Ketoconazole ("DISCO" mnemonic), but not Hydralazine. * **B. Thrombocytopenia:** While many drugs cause marrow suppression, it is not a classic or high-yield side effect of Hydralazine. * **C. Hemolytic anemia:** Classically associated with **Methyldopa** (Coombs-positive hemolytic anemia), not Hydralazine. **High-Yield Clinical Pearls for NEET-PG:** * **DILE Markers:** The most specific screening marker for DILE is **Anti-histone antibodies** (positive in >95% of cases). * **Common Culprits of DILE:** Remember the mnemonic **"SHIP"**: **S**ulfonamides/Sulfasalazine, **H**ydralazine, **I**soniazid, and **P**rocainamide (Procainamide has the highest risk). * **Reflex Tachycardia:** Hydralazine causes significant reflex tachycardia and fluid retention; therefore, it is almost always co-administered with a **Beta-blocker** and a **Diuretic**.

Q: Which of the following is NOT an adverse effect of ACE inhibitors?

Ankle edema. **Explanation:** The correct answer is **D. Ankle edema**. ACE inhibitors (ACEIs) prevent the conversion of Angiotensin I to Angiotensin II. While they have several characteristic side effects, **ankle edema** is not one of them. Instead, ankle edema is a classic adverse effect of **Dihydropyridine Calcium Channel Blockers (CCBs)** like Amlodipine, caused by preferential precapillary vasodilation leading to increased hydrostatic pressure. **Why the other options are incorrect:** * **A. Persistent cough:** This is the most common side effect of ACEIs (occurring in 5-20% of patients) [1]. It is caused by the accumulation of **Bradykinin** and **Substance P** in the lungs, which sensitizes cough receptors [1]. * **B. Taste alteration (Dysgeusia):** This is specifically associated with **Captopril**, likely due to the presence of a sulfhydryl group in its chemical structure. * **C. Angioedema:** A rare but life-threatening side effect. It is also mediated by increased levels of **Bradykinin**, leading to rapid swelling of the lips, tongue, and airway. **High-Yield Clinical Pearls for NEET-PG:** * **Mnemonic for ACEI side effects (CAPTOPRIL):** **C**ough, **A**ngioedema, **P**otassium excess (Hyperkalemia), **T**aste changes, **O**rthostatic hypotension, **P**regnancy contraindication (Teratogenic), **R**enal artery stenosis (contraindicated in bilateral), **I**ncreased renin, **L**eukopenia [1], [2]. * **Switching Therapy:** If a patient develops a cough on ACEIs, the next best step is to switch to an **Angiotensin Receptor Blocker (ARB)**, as ARBs do not affect bradykinin metabolism [1]. * **Teratogenicity:** ACEIs are contraindicated in pregnancy because they cause **fetal renal dysgenesis** and skull hypoplasia [2].

Q: All the following agents may be used for the management of hypertensive crisis EXCEPT?

Indapamide. ### Explanation The management of a **hypertensive crisis** (Urgency or Emergency) requires rapidly acting, intravenous medications to achieve controlled reduction of blood pressure. **Why Indapamide is the Correct Answer:** Indapamide is a **thiazide-like diuretic** administered exclusively via the **oral route**. It has a slow onset of action and a prolonged duration, making it suitable for the long-term maintenance treatment of essential hypertension, but entirely **ineffective and inappropriate** for the acute, rapid stabilization required in a hypertensive crisis. **Analysis of Incorrect Options:** * **Furosemide (Option A):** A potent loop diuretic that can be given IV. It is specifically indicated in hypertensive emergencies complicated by **acute heart failure or pulmonary edema** to reduce fluid overload. * **Nitroglycerin (Option B):** A venodilator (and coronary vasodilator) given as a continuous IV infusion. It is the drug of choice for hypertensive crises associated with **acute coronary syndrome (ACS)** or acute heart failure. * **Esmolol (Option D):** An ultra-short-acting, cardioselective **beta-blocker** given IV. Due to its rapid onset and very short half-life (~9 minutes), it is ideal for managing hypertension associated with **aortic dissection** or perioperative settings. **High-Yield Clinical Pearls for NEET-PG:** * **Drug of Choice (DOC):** **Sodium Nitroprusside** was traditionally the DOC, but **Labetalol** or **Nicardipine** are now preferred due to better safety profiles. * **Aortic Dissection:** Use Esmolol or Labetalol (Goal: SBP <120 mmHg within 20 mins). * **Pheochromocytoma:** Use Phentolamine (Alpha-blocker). * **Neurological Crisis:** Avoid rapid BP drops to prevent cerebral ischemia; aim for a 20-25% reduction in the first hour.

Q: The side effect of corneal microdeposits is seen most commonly with which of the following drugs?

Amiodarone. **Explanation:** **Amiodarone** is a Class III antiarrhythmic drug known for its extensive side-effect profile due to its high lipid solubility and long half-life. **Corneal microdeposits** (also known as *vortex keratopathy* or *cornea verticillata*) occur in nearly **90-100% of patients** on long-term amiodarone therapy. These deposits are yellowish-brown, bilateral, and located in the basal epithelium. While they are a hallmark side effect, they are usually asymptomatic and rarely necessitate drug discontinuation. **Analysis of Options:** * **A. Esmolol:** An ultra-short-acting cardioselective Beta-1 blocker used for acute supraventricular arrhythmias. Its primary side effect is hypotension; it has no ocular toxicity. * **C. Adenosine:** A drug of choice for Paroxysmal Supraventricular Tachycardia (PSVT). It has an extremely short half-life (<10 seconds) and causes transient side effects like flushing, chest pain, and dyspnea. * **D. Bretylium:** An older Class III agent used for refractory ventricular fibrillation. Its main side effect is orthostatic hypotension. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism:** Amiodarone blocks K+ channels (primary), but also Na+, Ca2+ channels, and alpha/beta-adrenergic receptors. * **Ocular Effects:** Besides corneal deposits, it can rarely cause **Optic Neuritis**, which requires immediate drug cessation. * **Other Key Side Effects:** * **Pulmonary:** Pulmonary fibrosis (most serious). * **Thyroid:** Hypothyroidism or Hyperthyroidism (due to high iodine content). * **Skin:** Blue-gray skin discoloration (Smurf skin). * **Liver:** Elevated transaminases/Hepatotoxicity. * **Monitoring:** Baseline and periodic Chest X-ray, PFTs, Thyroid Function Tests (TFTs), and LFTs are essential.

Q: What is the drug of choice for pregnancy-induced hypertension?

Alpha-methyldopa. **Explanation:** **Alpha-methyldopa** is the traditional drug of choice for chronic hypertension in pregnancy. It is a centrally acting alpha-2 adrenergic agonist that reduces sympathetic outflow. Its preference in pregnancy stems from its long-standing safety profile and the absence of long-term adverse effects on fetal development or neonatal hemodynamics. **Analysis of Options:** * **Atenolol (Option A):** Beta-blockers, particularly Atenolol, are generally avoided in early pregnancy as they are associated with **fetal growth restriction (IUGR)** and placental complications. * **Nitroprusside (Option B):** It is contraindicated in pregnancy (except in extreme emergencies) due to the risk of **fetal cyanide poisoning**. * **Enalapril (Option C):** ACE inhibitors and ARBs are strictly **contraindicated** in pregnancy. They are teratogenic and can cause fetal renal dysgenesis, oligohydramnios, and skull hypoplasia. **High-Yield Clinical Pearls for NEET-PG:** * **First-line agents:** While Methyldopa is the classic answer, current guidelines (like ACOG) also recommend **Labetalol** (often preferred for its faster onset) and **Nifedipine** (long-acting) as first-line options. * **Acute Hypertensive Crisis in Pregnancy:** The drugs of choice are **IV Labetalol** or **IV Hydralazine**. * **Preeclampsia Prophylaxis:** Low-dose **Aspirin** (started before 16 weeks) is used in high-risk patients. * **Magnesium Sulfate ($MgSO_4$):** This is the drug of choice for preventing and treating seizures in **Eclampsia**, not for blood pressure control.

Question 1

Which one of the following best represents the mechanism of action and electrocardiographic effect of diltiazem?

Accepted Answer

Calcium channel blockade; increased PR interval

Answer

Calcium channel blockade; increased QT interval

Answer

Adrenergic receptor blockade; decreased QT interval

Answer

Potassium channel blockade; increased QRS duration

Question 2

Which potent antiarrhythmic drug has little negative inotropic effect, making it valuable in patients with poor left ventricular function?

Accepted Answer

Digoxin

Answer

Amlodipine

Answer

Bidoprolo

Answer

Amiodarone

Question 3

Ouabain acts by inhibiting which of the following?

Accepted Answer

Na+/K+ ATPase

Answer

Adenyl cyclase

Answer

Calcium channels

Answer

H+/K+ ATPase

Question 4

Prolonged use of hydralazine for the treatment of hypertension is likely to cause:

Accepted Answer

Lupus erythematosis

Answer

Gynaecomastia

Answer

Thrombocytopenia

Answer

Hemolytic anemia

Question 5

Which of the following is NOT an adverse effect of ACE inhibitors?

Accepted Answer

Ankle edema

Answer

Persistent cough

Answer

Taste alteration

Answer

Angioedema

Question 6

Which of the following is a true statement about Endothelin-1, a potent vasoconstrictor?

Accepted Answer

Produced in increased amounts in Pulmonary Arterial Hypertension

Answer

Used in hypertension treatment

Answer

Dilates vascular smooth muscle cells

Answer

Safely indicated in liver injury

Question 7

All the following agents may be used for the management of hypertensive crisis EXCEPT?

Accepted Answer

Indapamide

Answer

Furosemide

Answer

Nitroglycerin

Answer

Esmolol

Question 8

All are true about ranolazine except?

Accepted Answer

It causes hypotension

Answer

It is recommended as first-line treatment for angina

Answer

It improves glycemic control

Answer

It is not indicated for acute attack of angina

Question 9

The side effect of corneal microdeposits is seen most commonly with which of the following drugs?

Accepted Answer

Amiodarone

Answer

Esmolol

Answer

Adenosine

Answer

Bretylium

Question 10

What is the drug of choice for pregnancy-induced hypertension?

Accepted Answer

Alpha-methyldopa

Answer

Atenolol

Answer

Nitroprusside

Answer

Enalapril

Cardiovascular Drugs — MCQs

Cardiovascular Drugs — MCQs

On this page

Practice by Chapter

Want unlimited practice?