Cardiovascular Drugs Practice Questions

Q: Which of the following is a Class III antiarrhythmic drug?

Amiodarone. **Explanation:** The classification of antiarrhythmic drugs is based on the **Vaughan-Williams classification**, which categorizes drugs according to their primary mechanism of action on the cardiac action potential. **A. Amiodarone (Correct):** This is a prototypical **Class III** antiarrhythmic. Class III drugs primarily act by **blocking potassium (K+) channels**, which prolongs the duration of the action potential and the effective refractory period (ERP) without significantly affecting the conduction velocity. While Amiodarone also possesses Class I, II, and IV properties, it is categorized as Class III. **B. Phenytoin:** This is a **Class Ib** antiarrhythmic. It blocks sodium (Na+) channels and is specifically used in treating digitalis-induced arrhythmias. **C. Propafenone:** This belongs to **Class Ic**. It is a potent sodium channel blocker that significantly slows conduction velocity (prolonging the QRS complex) with minimal effect on the action potential duration. **D. Pindolol:** This is a **Class II** antiarrhythmic. It is a non-selective beta-blocker with intrinsic sympathomimetic activity (ISA), used to decrease sympathetic stimulation to the heart. **High-Yield NEET-PG Pearls:** * **Class III Mnemonic:** "A Big Dirty Dog Is Scary" (**A**miodarone, **B**retylium, **D**ronedarone, **D**ofetilide, **I**butilide, **S**otalol). * **Amiodarone Side Effects:** Pulmonary fibrosis, thyroid dysfunction (hypo/hyper due to high iodine content), corneal microdeposits, and "blue-gray" skin discoloration. * **ECG Change:** Class III drugs typically cause **QT interval prolongation**, which carries a risk of Torsades de Pointes (though the risk is lower with Amiodarone compared to Sotalol).

Q: Which of the following potassium-sparing diuretics reduces cardiac mortality?

Spironolactone. The correct answer is **Spironolactone**. **1. Why Spironolactone is correct:** Spironolactone is a **Mineralocorticoid Receptor Antagonist (MRA)** [3]. In patients with heart failure, high levels of aldosterone lead to pathological cardiac remodeling, myocardial fibrosis, and collagen deposition. Spironolactone blocks these effects, thereby preventing structural damage to the heart. The landmark **RALES trial** demonstrated that adding spironolactone to standard therapy significantly reduces morbidity and mortality in patients with Heart Failure with reduced Ejection Fraction (HFrEF). Eplerenone, another MRA, shows similar mortality benefits (EMPHASIS-HF trial). Eplerenone is more selective and does not typically cause gynecomastia [1]. **2. Why the other options are incorrect:** * **Amiloride and Triamterene:** These are **epithelial sodium channel (ENaC) blockers** that act directly on the distal tubule [1]. While they are potassium-sparing diuretics, they do not antagonize the aldosterone receptor. Consequently, they do not prevent cardiac fibrosis or remodeling and have **no proven mortality benefit** in heart failure. They are primarily used to counteract potassium loss caused by thiazides or loop diuretics. **3. High-Yield NEET-PG Pearls:** * **Mechanism:** Spironolactone is a competitive antagonist of aldosterone at the late distal tubule and collecting duct [2, 3]. * **Side Effects:** The most characteristic side effect is **gynecomastia** and impotence in men (due to non-specific binding to androgen and progesterone receptors) [1]. Eplerenone is more selective and does not typically cause gynecomastia. * **Contraindication:** Avoid in patients with significant renal impairment or **hyperkalemia** (K+ > 5.0 mEq/L) [2, 3]. * **Drug of Choice:** Spironolactone is the drug of choice for **primary hyperaldosteronism (Conn’s Syndrome)** and edema associated with **liver cirrhosis**.

Q: What is the drug of choice for relieving pain in myocardial infarction?

Morphine. **Explanation:** **Morphine** is the drug of choice for managing the intense chest pain associated with acute myocardial infarction (MI) [2]. Its efficacy is due to a dual mechanism: 1. **Analgesia:** It is a potent opioid agonist that provides rapid relief from severe pain [2]. 2. **Hemodynamic Benefits:** Morphine acts as a **venodilator**, reducing venous return (preload) and decreasing the workload on the heart [3]. It also reduces sympathetic overactivity, which lowers myocardial oxygen demand and alleviates the patient's anxiety/apprehension. **Analysis of Incorrect Options:** * **B. Fortwin (Pentazocine):** This is a partial opioid agonist/antagonist. It is avoided in MI because it can increase systemic and pulmonary arterial pressure and heart rate, thereby **increasing myocardial oxygen demand**, which can worsen the infarct. * **C. Diazepam:** While it is a benzodiazepine used to reduce anxiety, it has no analgesic properties and cannot manage the severe pain of an MI. * **D. NSAIDs:** These are generally **contraindicated** in the acute phase of MI (except for Aspirin). NSAIDs can increase the risk of myocardial rupture, impair infarct healing, and increase the risk of re-infarction and heart failure. **High-Yield Clinical Pearls for NEET-PG:** * **M.O.N.A. Protocol:** The classic mnemonic for initial MI management is **M**orphine, **O**xygen, **N**itroglycerin, and **A**spirin [1]. * **Route:** Morphine should be administered **Intravenously (IV)**. Intramuscular (IM) injections are avoided as they can cause erratic absorption and interfere with CK-MB enzyme levels used for diagnosis. * **Antidote:** In case of morphine-induced respiratory depression, **Naloxone** is the specific antagonist. * **Caution:** Morphine should be used cautiously in **Right Ventricular MI** or inferior wall MI due to the risk of severe hypotension.

Q: Which drug class is contraindicated in pregnancy?

Angiotensin receptor blockers. **Explanation:** **Angiotensin Receptor Blockers (ARBs)**, along with ACE inhibitors and Direct Renin Inhibitors, are strictly **contraindicated in pregnancy (Category D)**. The underlying medical concept is their interference with the fetal Renin-Angiotensin-Aldosterone System (RAAS), which is essential for normal fetal renal development. Exposure, particularly during the second and third trimesters, leads to **fetal renal dysgenesis**, resulting in oligohydramnios. This lack of amniotic fluid causes the **"Potter Sequence"** (pulmonary hypoplasia, cranial malformations, and limb deformities). **Analysis of Incorrect Options:** * **Beta-blockers (B):** Generally considered safe, though they may be associated with fetal bradycardia or Intrauterine Growth Restriction (IUGR). Labetalol is a first-line agent for pregnancy-induced hypertension. * **Calcium Channel Blockers (C):** Nifedipine (long-acting) is frequently used and considered safe for managing hypertension in pregnancy. * **Thiazides (D):** Not typically started *de novo* during pregnancy due to the risk of volume depletion and electrolyte imbalances, but they are not absolute contraindications if the patient was already well-controlled on them prior to conception. **High-Yield Clinical Pearls for NEET-PG:** * **Safe Antihypertensives in Pregnancy:** Remember the mnemonic **"Better Mother Care During Hypertensive"** (Beta-blockers/Labetalol, Methyldopa, CCBs/Nifedipine, Hydralazine). * **Drug of Choice:** **Labetalol** is currently the preferred drug for chronic hypertension in pregnancy; **Methyldopa** is the classic historical answer. * **Hydralazine** is used primarily for hypertensive emergencies in pregnancy (Preeclampsia/Eclampsia). * **Teratogenic effect of ACEi/ARBs:** Hypocalvaria (incomplete ossification of skull bones) is a specific board-favorite association.

Question 1

Which of the following inhaled gases is used to decrease pulmonary artery pressure in adults and infants?

Accepted Answer

Nitric oxide

Answer

Nitrous oxide

Answer

Nitrogen dioxide

Answer

Nitrogen

Question 2

Which of the following is a Class III antiarrhythmic drug?

Accepted Answer

Amiodarone

Answer

Phenytoin

Answer

Propafenone

Answer

Pindolol

Question 3

Which of the following drugs is NOT used for the treatment of hypertensive emergencies?

Accepted Answer

Enalapril

Answer

Phentolamine

Answer

Fenoldopam

Answer

Sodium Nitroprusside

Question 4

Which of the following statements is NOT true regarding sotalol?

Accepted Answer

It is excreted through bile following hepatic metabolism.

Answer

It is a non-selective beta-blocker.

Answer

It prolongs the action potential duration throughout the heart.

Answer

Polymorphic ventricular tachycardia is a common problem.

Question 5

An increase in heart rate and renin release seen in patients of CHF can be overcome by which of the following drugs?

Accepted Answer

Metoprolol

Answer

Minoxidil

Answer

Metolazone

Answer

Milrinone

Question 6

Which of the following potassium-sparing diuretics reduces cardiac mortality?

Accepted Answer

Spironolactone

Answer

Amiloride

Answer

Triamterene

Answer

All the above

Question 7

A 33-year-old patient with a history of asthma is being treated for symptoms of hypertension. Which of the following beta-blockers would be an appropriate therapy for this patient?

Accepted Answer

Metoprolol

Answer

Isoprenaline

Answer

Labetalol

Answer

Propranolol

Question 8

What is the drug of choice for relieving pain in myocardial infarction?

Accepted Answer

Morphine

Answer

Fortwin

Answer

Diazepam

Answer

NSAID

Question 9

Which drug class is contraindicated in pregnancy?

Accepted Answer

Angiotensin receptor blockers

Answer

Beta blockers

Answer

Calcium channel blockers

Answer

Thiazides

Question 10

Which of the following drugs has a favorable effect on lipid metabolism?

Accepted Answer

Clonidine

Answer

Atenolol

Answer

Chlorothiazide

Answer

Torsemide

Cardiovascular Drugs — MCQs

Cardiovascular Drugs — MCQs

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