Autonomic and cardiovascular pharmacology

40 Gulf Prometric Pharmacist (DHA, DOH, MOH, SCFHS, QCHP) practice questions on Autonomic and cardiovascular pharmacology, part of Pharmacology and Medicinal Chemistry. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

1. Question 1 · Medium

   A patient admitted to a Doha hospital stops clonidine abruptly and develops BP 210/120 mmHg, tachycardia, sweating and headache. What is the best explanation?

   1. AExcessive blockade of beta-1 receptors after the withdrawal
   2. BAcute accumulation of bradykinin after the dose was missed
   3. CRebound sympathetic overactivity after abrupt clonidine withdrawal
   4. DDirect renal vasoconstriction caused by the drug's metabolite

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   Answer: C · Rebound sympathetic overactivity after abrupt clonidine withdrawal

   Clonidine stimulates central alpha-2 receptors and lowers sympathetic outflow, so catecholamine release is suppressed during treatment. When it is stopped suddenly, the sympathetic system overshoots and causes rebound hypertension with tachycardia and sweating. The risk is higher with high doses and with concurrent beta-blockers, so clonidine is tapered over several days.

   • A: Beta-blockade would slow the heart rather than cause tachycardia.
   • B: Bradykinin build-up is linked to ACE inhibitors, not clonidine withdrawal.
   • D: Clonidine has no vasoconstrictor metabolite that explains this picture.

   Remember this

   Taper clonidine over 1-2 weeks; abrupt withdrawal causes rebound hypertension.

2. Question 2 · Easy

   Atropine produces which of the following effects?

   1. ABradycardia and salivation
   2. BTachycardia and dry mouth
   3. CIncreased gastric motility
   4. DMiosis and bronchoconstriction

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   Answer: B · Tachycardia and dry mouth

   Atropine is a competitive muscarinic antagonist. Blocking vagal tone on the heart raises the heart rate, and blocking glands reduces saliva and secretions. It also causes mydriasis, urinary retention and reduced gut motility.

   • A: Bradycardia and salivation are cholinergic effects.
   • C: Gut motility falls, not rises, with antimuscarinics.
   • D: Miosis and bronchoconstriction are cholinergic effects.

   Remember this

   Atropine blocks muscarinic receptors, causing tachycardia, dry mouth and mydriasis.

3. Question 3 · Medium

   A patient taking salbutamol inhaler frequently complains of tremor and palpitations. Which laboratory change might also occur?

   1. AHypermagnesaemia
   2. BHyperkalaemia
   3. CHypokalaemia
   4. DHyponatraemia

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   Answer: C · Hypokalaemia

   Beta-2 agonists drive potassium into cells through stimulation of the Na-K ATPase. Large or repeated doses can therefore lower serum potassium, and tremor arises from beta-2 effects in skeletal muscle.

   • A: Magnesium is not raised by beta-2 agonists.
   • B: Potassium falls, not rises, with beta-2 agonists.
   • D: Sodium is not lowered by beta-2 agonists.

   Remember this

   High-dose beta-2 agonists cause tremor, tachycardia and hypokalaemia.

4. Question 4 · Hard

   A patient taking propranolol has anaphylaxis and fails to respond to repeated doses of intramuscular adrenaline. What is the explanation and next treatment?

   1. ABeta-blockade blunts adrenaline's effect; give glucagon
   2. BAntihistamine resistance; stop adrenaline
   3. CAlpha receptor desensitisation; give phenylephrine only
   4. DAdrenaline was inactivated by propranolol; double the dose repeatedly

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   Answer: A · Beta-blockade blunts adrenaline's effect; give glucagon

   A non-selective beta-blocker blocks the beta-1 and beta-2 actions of adrenaline, leaving unopposed alpha effects and refractory bronchospasm and hypotension. Glucagon activates adenylate cyclase through its own receptors and bypasses the block. Fluids and airway care continue.

   • B: Adrenaline remains the key drug and is not stopped.
   • C: Alpha desensitisation is not the mechanism.
   • D: Propranolol does not inactivate adrenaline chemically.

   Remember this

   Anaphylaxis in a beta-blocked patient may need glucagon when adrenaline fails.

5. Question 5 · Medium

   A hypertensive man on amlodipine 10 mg has bilateral ankle swelling with no signs of heart failure. What is the most likely mechanism?

   1. AArteriolar dilation, which raises capillary pressure in the legs
   2. BSodium retention caused by aldosterone excess
   3. CLeft ventricular systolic failure causing venous congestion
   4. DProtein loss from the glomeruli lowering oncotic pressure

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   Answer: A · Arteriolar dilation, which raises capillary pressure in the legs

   Dihydropyridines dilate precapillary arterioles more than veins, so pressure transmitted to the capillary bed rises and fluid moves into the interstitium. The oedema is dose-related, often worse in the evening, and does not respond well to diuretics. Reducing the dose or adding an ACE inhibitor, which dilates the venous side, reduces it.

   • B: Aldosterone excess is not an effect of amlodipine.
   • C: No signs of heart failure are present in the case.
   • D: Amlodipine does not cause protein loss in the urine.

   Remember this

   Amlodipine oedema is a vasodilator effect, not heart failure, and diuretics are of little help.

6. Question 6 · Medium

   A 63-year-old with hypertension has had three attacks of gout. Which drug is most likely to provoke further attacks and should be avoided if possible?

   1. AHydrochlorothiazide
   2. BLosartan
   3. CAmiloride
   4. DSpironolactone

   Answer and explanation in LearnFree account

7. Question 7 · Medium

   A patient develops lip and tongue swelling on lisinopril. What is the correct decision?

   1. AStop the ACE inhibitor and avoid it permanently
   2. BReduce the dose by half and monitor the swelling
   3. CSwitch to a different ACE inhibitor instead
   4. DContinue it and add an antihistamine for the swelling

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8. Question 8 · Hard

   A heart failure patient taking ramipril, spironolactone and a potassium supplement has a serum potassium of 6.6 mmol/L and peaked T waves on the ECG. What is the first treatment?

   1. AOral potassium binder only
   2. BIntravenous calcium gluconate
   3. CFurosemide only
   4. DIntravenous potassium chloride

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9. Question 9 · Hard

   A patient with an undiagnosed phaeochromocytoma is given propranolol alone before surgery and develops a hypertensive crisis. What best explains this?

   1. ABeta-2 vasodilation is blocked, leaving alpha-1 vasoconstriction unopposed
   2. BBeta-1 blockade increases renin secretion
   3. CPropranolol releases catecholamines from the tumour
   4. DPropranolol stimulates alpha-1 receptors directly

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10. Question 10 · Easy

    Which beta-blocker is cardioselective (beta-1 selective)?

    1. APropranolol
    2. BNadolol
    3. CTimolol
    4. DBisoprolol

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11. Question 11 · Medium

    A patient taking bisoprolol is to start verapamil. What is the main risk of combining them?

    1. ASevere bradycardia and heart block
    2. BTachycardia and ventricular arrhythmia
    3. CHyperglycaemia and weight gain
    4. DPulmonary oedema without any conduction change

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12. Question 12 · Medium

    A 58-year-old Emirati man with asthma and newly diagnosed hypertension is prescribed propranolol by another clinic. Which problem is the main reason the pharmacist should intervene?

    1. AStimulation of beta-1 receptors can raise the heart rate
    2. BBlockade of alpha-1 receptors can cause postural hypotension
    3. CBeta-2 blockade in the bronchi can trigger bronchospasm
    4. DBlockade of muscarinic M3 receptors can dry airway secretions

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13. Question 13 · Medium

    A patient is given neostigmine to reverse a non-depolarising neuromuscular block. Why is glycopyrronium given with it?

    1. ATo reverse the nicotinic effects of neostigmine
    2. BTo prolong the duration of neostigmine action
    3. CTo prevent hypoglycaemia during the whole reversal procedure
    4. DTo block the muscarinic effects such as bradycardia and salivation

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14. Question 14 · Easy

    Which antihypertensive drug is contraindicated in pregnancy because of fetal renal damage?

    1. ANifedipine
    2. BLabetalol
    3. CMethyldopa
    4. DLisinopril

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15. Question 15 · Hard

    An 80 kg patient needs a noradrenaline infusion at 0.1 micrograms/kg/min. The syringe contains 4 mg in 50 mL. What infusion rate in mL/h is required?

    1. A12 mL/h
    2. B6 mL/h
    3. C0.1 mL/h
    4. D3 mL/h

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16. Question 16 · Medium

    After the first 1 mg dose of doxazosin for benign prostatic hyperplasia, a man feels faint on standing and nearly collapses. What causes this first-dose effect?

    1. AStimulation of central alpha-2 receptors lowers sympathetic outflow
    2. BBlockade of beta-1 receptors reduces cardiac output
    3. CInhibition of angiotensin-converting enzyme lowers angiotensin II
    4. DAlpha-1 blockade relaxes arteriolar and venous smooth muscle

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17. Question 17 · Hard

    A patient with a phaeochromocytoma is being prepared for surgery. Which drug sequence is correct?

    1. AStart an alpha-blocker first, then add a beta-blocker
    2. BStart a beta-blocker and alpha-blocker together on day one
    3. CGive clonidine and withdraw all other drugs
    4. DStart a beta-blocker alone first

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18. Question 18 · Medium

    A patient with hypertension taking hydrochlorothiazide develops an acute gout flare. Which explanation is correct?

    1. AThiazides reduce renal uric acid excretion and raise serum urate
    2. BThiazides inhibit xanthine oxidase and raise urate
    3. CThiazides lower urate by increasing its excretion
    4. DThiazides increase hepatic purine synthesis and raise urate

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19. Question 19 · Medium

    A patient taking clonidine for hypertension stops it abruptly. Which problem is most likely?

    1. AHyperkalaemia with muscle weakness
    2. BRebound hypertension and tachycardia
    3. CBradycardia without any change in blood pressure
    4. DProfound and prolonged hypotension

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20. Question 20 · Hard

    A man with stable angina took tadalafil 20 mg for erectile dysfunction 24 hours ago and now has chest pain at rest. The ambulance crew considers sublingual glyceryl trinitrate. Which statement is correct?

    1. AIsosorbide dinitrate is safe because it does not raise cGMP
    2. BNitrates are safe because 24 hours is longer than the half-life of the drug
    3. CA half dose of glyceryl trinitrate removes the risk of hypotension
    4. DNitrates should be withheld because tadalafil's effect lasts about 48 hours

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21. Question 21 · Hard

    A woman on digoxin and furosemide has nausea, visual yellow-green halos and K+ 2.9 mmol/L. Why does hypokalaemia worsen digoxin toxicity?

    1. AHypokalaemia increases the volume of distribution of digoxin
    2. BFurosemide displaces digoxin from albumin in the plasma
    3. CLow potassium lets more digoxin bind to Na+/K+-ATPase
    4. DHypokalaemia lowers renal clearance of digoxin to nil

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22. Question 22 · Easy

    Which receptor mediates bronchodilation when salbutamol is inhaled?

    1. AM3 muscarinic receptor
    2. BAlpha-1 adrenoceptor
    3. CBeta-2 adrenoceptor
    4. DBeta-1 adrenoceptor

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23. Question 23 · Medium

    A patient stable on digoxin 250 micrograms daily is started on verapamil for rate control. What effect on digoxin is expected?

    1. ADigoxin levels fall; increase the dose to compensate
    2. BDigoxin is inactivated and the dose should be doubled
    3. CNo change, because they are cleared by different routes
    4. DLevels rise; reduce the dose and monitor

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24. Question 24 · Medium

    A man with type 1 diabetes takes atenolol after a myocardial infarction. During a hypoglycaemic episode at work he notices his shirt is soaked but feels no pounding heartbeat. Why?

    1. AAtenolol raises glucose and so hides the heartbeat
    2. BSweating persists while beta-blockade hides palpitations
    3. CInsulin prevents the cholinergic sweating response
    4. DAtenolol blocks muscarinic receptors in the sweat glands

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25. Question 25 · Medium

    A patient taking amlodipine develops ankle swelling. What is the cause and expected response to furosemide?

    1. ALow albumin caused by the drug
    2. BHeart failure caused by the drug
    3. CArteriolar dilation, so a diuretic will not help
    4. DSodium retention, which a diuretic would then correct

    Answer and explanation in LearnFree account