Cardiovascular Drugs Practice Questions

Q: Which of the following anti-hypertensive drugs is/are best avoided during pregnancy ?

Angiotensin converting enzyme inhibitors. ***Angiotensin converting enzyme inhibitors*** - **ACE inhibitors** are contraindicated in pregnancy due to their association with **fetal renal abnormalities**, **oligohydramnios**, and **fetal death**. - They can cause severe **birth defects** and are categorized as pregnancy category D drugs, meaning there is positive evidence of human fetal risk. *Nifedipine* - **Nifedipine**, a dihydropyridine calcium channel blocker, is considered a **safe** and effective antihypertensive in pregnancy. - It is frequently used for managing **hypertension** and **preterm labor** in pregnant women. *Methyldopa* - **Methyldopa** is often considered the **first-line drug** for chronic hypertension in pregnancy due to its established safety profile for both mother and fetus. - It has a long history of use and is one of the most studied antihypertensives in pregnancy. *Labetalol* - **Labetalol**, a combined alpha and beta-blocker, is also considered a **safe** and effective option for managing hypertension in pregnancy. - It is often used for **gestational hypertension** and **preeclampsia** and has a good fetal safety record.

Q: Match the following antiarrhythmic drugs with their mechanism of action: | Mechanism of action | Drug | | :-- | :-- | | 1. Na+ channel blocker | A. Quinidine | | 2. K+ channel blocker | B. Digoxin | | 3. Na+K+ ATPase inhibitor | C. Esmolol | | 4. Beta-blocker | D. Ibutilide |

1-A, 2-D, 3-B, 4-C. ***1-A, 2-D, 3-B, 4-C*** - **Quinidine** is a Class IA antiarrhythmic drug that primarily blocks **sodium channels**, prolonging the action potential duration and refractoriness. - **Ibutilide** is a Class III antiarrhythmic drug that blocks **potassium channels**, leading to delayed repolarization and increased effective refractory period. - **Digoxin** inhibits the **Na+/K+ ATPase pump**, increasing intracellular calcium and affecting AV nodal conduction. - **Esmolol** is a **beta-blocker** (Class II antiarrhythmic) that reduces heart rate and contractility by blocking β1-adrenergic receptors. *1-A, 2-C, 3-D, 4-B* - This option incorrectly matches **Esmolol** (a beta-blocker) with **K+ channel blocker** and **Ibutilide** (K+ channel blocker) with **Na+K+ ATPase inhibitor**. - It also incorrectly matches **Digoxin** (Na+K+ ATPase inhibitor) with **beta-blocker**. *1-D, 2-C, 3-A, 4-B* - This option incorrectly matches **Ibutilide** (K+ channel blocker) with **Na+ channel blocker** and incorrectly matches **Quinidine** (Na+ channel blocker) with **Na+K+ ATPase inhibitor**. - It also incorrectly matches **Digoxin** (Na+K+ ATPase inhibitor) with **beta-blocker**. *1-D, 2-B, 3-A, 4-C* - This option incorrectly matches **Ibutilide** (K+ channel blocker) with **Na+ channel blocker** and **Digoxin** (Na+K+ ATPase inhibitor) with **K+ channel blocker**. - It also incorrectly matches **Quinidine** (Na+ channel blocker) with **Na+K+ ATPase inhibitor**.

Q: Identify the correct match, regarding the drug and its adverse effect.

Verapamil - constipation. ***Verapamil - Constipation*** - **Verapamil**, a **non-dihydropyridine calcium channel blocker**, frequently causes constipation due to its effect on smooth muscle in the gastrointestinal tract, leading to **decreased intestinal motility**. - This adverse effect is common and often dose-dependent, making it a significant consideration in patient management. *Aliskiren - hypokalemia* - **Aliskiren**, a **direct renin inhibitor**, can cause **hyperkalemia** by reducing angiotensin II levels, which normally stimulate aldosterone secretion. - It does not typically cause hypokalemia; rather, potassium-sparing effects are often observed. *Hydralazine - heart failure* - **Hydralazine** is a **vasodilator** used to treat hypertension and **heart failure** with reduced ejection fraction by reducing afterload. - It does not cause heart failure; instead, it is often prescribed to improve cardiac function in patients with heart failure. *Atenolol - hemolytic anemia* - **Atenolol** is a **beta-blocker** primarily used for hypertension, angina, and arrhythmias. - **Hemolytic anemia** is a rare adverse effect associated with certain drugs, but it is not a known or common side effect of atenolol.

Q: A patient who is on treatment for hyperlipidemia develops gallstones. What is the mechanism of action of the causative drug that was given to this patient?

Activates PPAR alpha. ***Activates PPAR alpha*** * Activation of **PPAR alpha (Peroxisome Proliferator-Activated Receptor alpha)** by fibrates can lead to increased cholesterol secretion into bile [1]. * This increased biliary cholesterol saturation predisposes patients to **cholesterol gallstone** formation. *Decreases VLDL* * While fibrates do decrease **VLDL (Very Low-Density Lipoprotein)** production, this specific action is not the primary mechanism by which they cause gallstones [1]. * The reduction in VLDL is beneficial for triglyceride lowering, but the gallstone risk relates to cholesterol metabolism. *Binds to deoxycholic acid* * This mechanism is characteristic of **bile acid sequestrants** like cholestyramine, which bind to bile acids in the gut to prevent their reabsorption. * Bile acid sequestrants are not typically associated with an increased risk of gallstones; in fact, they can sometimes be used to reduce gallstones in specific contexts. *Inhibits HMG CoA reductase* * This is the mechanism of action for **statins**, which are highly effective in lowering LDL cholesterol by inhibiting the rate-limiting enzyme in cholesterol synthesis [2]. * Statins are not generally associated with an increased risk of gallstones; some studies even suggest a potential protective effect [3].

Q: Preferred drug for the treatment of ventricular tachycardia is

Lignocaine. ***Lignocaine*** *(Historical Answer for FMGE-2019)* - **Lignocaine** (also known as **lidocaine**) is a **Class IB antiarrhythmic** drug that was historically the preferred treatment for **ventricular tachycardia (VT)**, especially in patients with **ischemic heart disease**. - It works by **blocking sodium channels** in the heart, specifically targeting depolarized or partially depolarized cells, which helps to stabilize the ventricular rhythm. - **⚠️ IMPORTANT UPDATE:** Current guidelines (AHA/ACC 2015 onwards) now recommend **amiodarone as the first-line antiarrhythmic** for hemodynamically stable VT, with lignocaine as a **second-line alternative**. This question reflects the teaching prevalent at the time of FMGE-2019. *Digoxin* - **Digoxin** is a **cardiac glycoside** primarily used for **atrial fibrillation** with rapid ventricular response and **heart failure**. - It is **not the preferred drug** for ventricular tachycardia and can even precipitate arrhythmias in some cases. *Propranolol* - **Propranolol** is a **beta-blocker** (Class II antiarrhythmic) typically used to treat **supraventricular tachycardias**, **hypertension**, and **angina**. - While beta-blockers can have some role in preventing recurrent VT, they are **not the first-line treatment** for acute VT. *Diltiazem* - **Diltiazem** is a **calcium channel blocker** (Class IV antiarrhythmic) primarily used for **supraventricular tachycardias** and to control ventricular rate in **atrial fibrillation**. - It is **not effective** for ventricular tachycardia and may worsen the condition in some cases.

Q: Atorvastatin is used as an anti-dyslipidemic drug. These drugs inhibit their target enzyme by:-

Competitive inhibition. ***Competitive inhibition*** - Atorvastatin is a **statin**, which acts as a **competitive inhibitor** of **HMG-CoA reductase**, the rate-limiting enzyme in cholesterol synthesis. - It competes with the natural substrate, HMG-CoA, for binding to the **active site of the enzyme**, thereby reducing cholesterol production. *Uncompetitive* - **Uncompetitive inhibitors** bind only to the **enzyme-substrate complex**, not to the free enzyme. - This type of inhibition is characterized by a decrease in both **apparent Vmax** and **apparent Km**. *Noncompetitive inhibition* - **Noncompetitive inhibitors** bind to an allosteric site on the enzyme, distinct from the active site, and can bind to either the **free enzyme or the enzyme-substrate complex**. - This leads to a decrease in the **apparent Vmax** but does not affect Km. *Irreversible inhibition* - **Irreversible inhibitors** form a **strong covalent bond** with the enzyme, permanently inactivating it. - Statins do not form covalent bonds with HMG-CoA reductase; their inhibition is **reversible** upon drug discontinuation.

Q: Which of the following drug causes postural hypotension commonly?

Alpha blocker. ***Alpha blocker*** - **Alpha-1 adrenergic blockers** cause common postural hypotension by blocking **alpha-1 receptors** on vascular smooth muscle, leading to vasodilation and reduced peripheral vascular resistance. - This vasodilation, especially in the upright position, can cause blood to pool in the lower extremities, decreasing venous return to the heart and thus lowering blood pressure. *Angiotensin receptor blockers* - These drugs block the effects of **angiotensin II**, leading to vasodilation and decreased aldosterone secretion, typically causing a more gradual and less pronounced drop in blood pressure. - While they can cause hypotension, **postural hypotension** is less common and usually less severe compared to alpha blockers due to their different mechanism of action and less abrupt vasodilation. *Beta blocker* - **Beta-blockers** primarily reduce heart rate and myocardial contractility, thereby decreasing cardiac output, which can contribute to generalized hypotension. - They do not directly cause significant **vasodilation** in the same manner as alpha-blockers, making postural hypotension less common unless there are other contributing factors. *ACE inhibitor* - **ACE inhibitors** prevent the conversion of angiotensin I to **angiotensin II**, leading to vasodilation and reduced aldosterone. - They can cause hypotension, especially with the first dose or in volume-depleted patients, but **postural hypotension** is typically less frequent and severe than with alpha-blockers.

Q: The drug that causes fall in elderly patients with postural hypotension is:-

Prazosin. ***Prazosin*** - **Alpha-1 adrenergic blocker** used to treat hypertension and benign prostatic hyperplasia (BPH) - Commonly causes **orthostatic hypotension (postural hypotension)** as a side effect by blocking alpha-1 receptors on vascular smooth muscle, preventing compensatory vasoconstriction upon standing - Leads to **dizziness, lightheadedness, and falls**, especially in elderly patients who have reduced baroreceptor sensitivity - **First-dose phenomenon** is particularly notable, with marked hypotension after the initial dose *Acarbose* - Alpha-glucosidase inhibitor used to treat type 2 diabetes by reducing carbohydrate absorption in the intestine - Primary side effects are **gastrointestinal** (flatulence, diarrhea, abdominal discomfort) - Does not affect blood pressure or cause postural hypotension *Nor-adrenaline (Norepinephrine)* - **Vasopressor** and sympathomimetic agent that causes vasoconstriction through alpha-adrenergic receptor stimulation - **Increases blood pressure** and is used to treat severe hypotension in critical care settings - Would not cause falls due to postural hypotension; rather, it counteracts hypotension *Metformin* - **Biguanide** oral hypoglycemic agent for type 2 diabetes that primarily decreases hepatic glucose production and increases insulin sensitivity - Main side effects include gastrointestinal disturbances and rare lactic acidosis - Not associated with postural hypotension or increased risk of falls

Question 1

Which one of the following responses to intravenous adenosine is correctly matched?

Accepted Answer

Atrio-ventricular nodal reentrant tachycardia - Termination and complete recovery

Answer

Atrial flutter - Termination and complete recovery

Answer

Ventricular tachycardia - Termination and complete recovery

Answer

Atrial fibrillation - Termination

Question 2

Which of the following anti-hypertensive drugs is/are best avoided during pregnancy ?

Accepted Answer

Angiotensin converting enzyme inhibitors

Answer

Nifedipine

Answer

Methyldopa

Answer

Labetalol

Question 3

Match the following antiarrhythmic drugs with their mechanism of action:

Accepted Answer

1-A, 2-D, 3-B, 4-C

Answer

1-D, 2-B, 3-A, 4-C

Answer

1-A, 2-C, 3-D, 4-B

Answer

1-D, 2-C, 3-A, 4-B

Question 4

Identify the correct match, regarding the drug and its adverse effect.

Accepted Answer

Verapamil - constipation

Answer

Aliskiren - hypokalemia

Answer

Hydralazine - heart failure

Answer

Atenolol - hemolytic anemia

Question 5

A patient who is on treatment for hyperlipidemia develops gallstones. What is the mechanism of action of the causative drug that was given to this patient?

Accepted Answer

Activates PPAR alpha

Answer

Binds to deoxycholic acid

Answer

Decreases VLDL

Answer

Inhibits HMG CoA reductase

Question 6

Which among the following is the false statement regarding statins?

Accepted Answer

They can be given with verapamil and other enzyme inhibitors

Answer

These drugs should not be stopped even in severe conditions like injury, surgery etc.

Answer

Although HMG-CoA reductase inhibitors substantially reduce the risk of cardiovascular events, there is mild increase in lipoprotein a (Lpa) levels.

Answer

With the long term use, there is slight increase in the incidence of type 2 diabetes mellitus.

Question 7

Preferred drug for the treatment of ventricular tachycardia is

Accepted Answer

Lignocaine

Answer

Digoxin

Answer

Propranolol

Answer

Diltiazem

Question 8

Atorvastatin is used as an anti-dyslipidemic drug. These drugs inhibit their target enzyme by:-

Accepted Answer

Competitive inhibition

Answer

Noncompetitive inhibition

Answer

Irreversible inhibition

Answer

Uncompetitive inhibition

Question 9

Which of the following drug causes postural hypotension commonly?

Accepted Answer

Alpha blocker

Answer

Angiotensin receptor blockers

Answer

Beta blocker

Answer

ACE inhibitor

Question 10

The drug that causes fall in elderly patients with postural hypotension is:-

Accepted Answer

Prazosin

Answer

Acarbose

Answer

Nor-adrenaline

Answer

Metformin

Cardiovascular Drugs — MCQs

Cardiovascular Drugs — MCQs

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