Cardiovascular

System
 Image-based Questions

Cardiovascular System
1. A patient was prescribed an antiarrhythmic drug which 3. A 25-year-old patient presents to the emergency with
caused pigmentation as seen in the picture. Which of the palpitation and shortness of breath. An ECG was advised,
following drugs might have done it? which gave the following finding. Which of the following
is to be done immediately?

a. IV adenosine
b. IV Procainamide
a. Lidocaine b. Amiodarone c. Carotid sinus massage
c. Procainamide d. Bretylium d. IV Verapamil

2. A patient of COPD presents to the emergency with recent 4. The apparatus in the X-ray given below is the first line
onset of palpitation. The ECG revealed findings given treatment option in all of the following except:
below. Which of the following is drug of choice for chronic
therapy?

a. Congenital long QT syndrome

b. Ventricular fibrillation
a. Amiodarone b. Flecainide c. Ventricular tachycardia Image-based Questions
c. Digoxin d. Propranolol d. Atrial fibrillation

161
 5. Which of the following is the first drug of choice for 7. Which of the following drug is contraindicated in a
Conceptual Review of Pharmacology

treatment of the condition given in the picture? patient with the given angiogram?

a. Chlorthalidone b. Metoprolol
a. ACEI b. Beta blockers
c. Captopril d. Enalapril
c. Spironolactone d. Ivabradine

6. The plant in the picture is a source of: 8. Which of the following drug could have precipitated the
condition in the angiography?

a. Digoxin b. Atropine a. CCB b. Beta blockers

c. Reserpine d. Physostigmine c. ACEI d. Nitroglycerine
Image-based Questions

162
 9. A patient presented with a 2 hours history of pain in his 11. A patient 65-year-old presented with chest pain and the

Cardiovascular System
chest and the ECG had findings given below. Which of the following ECG was recorded. Which of the following is not
following is the treatment of choice? to be done?

a. PCI
b. Thrombolysis
c. LMWH
a. PCI b. Thrombolysis d. Aspirin
c. NTG d. IV beta blocker

10. Which of the following antiarrhythmic can cause the

ocular changes in the picture?

a. Procainamide b. Verapamil
c. Amiodarone d. Dronedarone

Image-based Questions

163
 Answers with Explanations to Image-based Questions
Conceptual Review of Pharmacology

1. Ans. (b)  Amiodarone 7. Ans. (c)  Captopril

(Ref: Braunwald’s Cardiology 9th E/P723) (Ref: Goodman Gilman 12th E/P778)
ˆˆ Blue gray pigmentation, as seen in the picture is ˆˆ The given angiogram depicts a case of bilateral renal
characteristic of amiodarone, which is also known as artery stenosis․
ceruloderma. ˆˆ RAS inhibitors are absolutely contraindicated in a

2. Ans. (a)  Amiodarone patient of bilateral renal artery stenosis, as they can
precipitate renal failure.
(Ref: CMDT 2015/P390)
ˆˆ Sawtooth pattern in leads II, III and AVF and association 8. Ans. (b)  Beta blockers
of COPD confirms the diagnosis of atrial flutter. For (Ref: CMDT 2016/P363)
chronic atrial flutter and to maintain sinus rhythm,
amiodarone is the drug of choice. ˆˆ This is a case of vasospastic angina precipitated by beta
blockers.
3. Ans. (c)  Carotid sinus massage ˆˆ Beta blockers block beta-2 mediated vasodilation and
(Ref: CMDT 2015/P381) cause unopposed alpha-1 receptor mediated vasocon-
striction.
ˆˆ Narrow complex tachycardia with absent P waves
ˆˆ Thus beta blockers are contraindicated in variant angina
at a young age is suggestive of PSVT. The first line of
management is vagal maneuvers like carotid sinus as it can be worsened.
massage. If the patient does not respond, then IV
9. Ans. (a)  PCI
adenosine is given.
(Ref: Harrison 19th E/P1604)
4. Ans. (d)  Atrial fibrillation
ˆˆ This is a case of STEMI and since the patient has
(Ref: Goodman Gilman 12th E/P824) presented before 12 hours, reperfusion should be
ˆˆ The patient has been implanted an ICD (Implanted performed at the earliest.
cardiovert defibrillator) device, which is used for long- ˆˆ PCI is more preferred as compared to thrombolysis for
term management to prevent reperfusion.
ˆˆ Congenital long QT syndrome
Answers with Explanations to Image-based Questions

ˆˆ Ventricular tachycardia associated with MI 10. Ans. (c)  Amiodarone

ˆˆ Ventricular fibrillation
(Ref: Goodman Gilman 12th E/P829)
5. Ans. (a)  ACEI ˆˆ The streaks of deposits in cornea in a concentric circle
(Ref: Goodman and Gilman 12th E/P 798) is called as whorl like deposits, seen with amiodarone.
ˆˆ It is seen in almost 100% patients with six months of drug
ˆˆ The given X-ray depicts, CHF with left ventricular
hypertrophy. exposure.
ˆˆ The first drug of choice to decrease mortality is ACEI/
11. Ans. (b)  Thrombolysis
ARB.
(Ref: CMDT 2016/P364)
6. Ans. (a)  Digoxin
ˆˆ ST segment depression in the precordial leads and min-
(Ref: Goodman and Gilman 12th E/P 801) imal STE in avR. This is a case of NSTEMI.
ˆˆ The plant in the picture is Digitalis lanata or white ˆˆ Incase of NSTEMI thrombolysis is absolutely contrain-
foxglove, which is the source for digoxin. dicated.

164
   Annexures

Cardiovascular System
Drugs of Choice Hypertension with comorbidities
Angina •• Acute attack (All types DM
of angina) – Sublingual CKD
ACEI/ARB
Nitroglycerine Scleroderma
•• Long-term prophylaxis Nephrotic syndrome
in stable angina – Beta Angina
blockers Previous MI
Hyperthyroidism
Aortic dissection Labetalol Migraine
Anxiety with somatic Beta blockers
manifestations
Atrial Fibrillation and flutter •• Acute Attack – IV Ibutilide
Essential tremor
•• Rhythm control –
Atrial fibrillation and flutter
Amiodarone
Preoperative hypertension
•• Rate control – Beta blockers
Osteoporosis Thiazides
Novel Oral anticoagulants Raynaud’s disease
Anticoagulation in Atrial
•• Dabigatran Cyclosporine induced CCB
fibrillation
•• Apixaban hypertension
BPH
α1 blockers
Acute CHF •• First drug of choice – Dyslipidemia
Furosemide Hypertensive Emergency I/V Nicardipine
•• Inotrope of choice –
Dobutamine Hypertensive Urgency Clonidine

Chronic CHF ACEIs/ARBs Hypertensive emergency with Captopril

scleroderma

•• Hypertriglyceridemia
•• Chylomicronemia Syndrome PSVT •• Treatment – I/V Adenosine
•• Fibrates SVT •• Prophylaxis – Verapamil or
•• Type III
hyperlipoproteinemia Beta blockers

Hypercholesterolemia •• Statins Shock •• Anaphylactic – Epinephrine

•• Pregnancy and Children – •• Cardiogenic –
Bile Acid Sequestrants Norepinephrine or
Dopamine
•• Septic – Norepinephrine
Hypertension •• First line drugs •• Vasodilatory –
 ACE inhibitors or ARB Norepinephrine
 CCB
 Thiazides
•• Resistant hypertension SVT •• Treatment and prophylaxis –
 Aldosterone antagonists
Verapamil > Beta blockers
•• Associated CHF – Digoxin

Hypertension in age groups •• Elderly–CCB

Annexures

•• Young–ACEIs/ARBs Torsades de pointes Magnesium sulfate

165
 Ventricular extrasystole Beta Blockers Ventricular Tachycardia in MI Lidocaine
Conceptual Review of Pharmacology

(Symptomatic) and digitalis toxicity

Ventricular Fibrillation Amiodarone WPW Syndrome IV procainamide

New Drugs
Drug Mechanism of action Use
Ivabradine Inhibits current in SA node that decreases its Decrease in oxygen demand is beneficial in
automaticity and myocardial oxygen consumption •• Angina
•• CHF
Cangrelor P2Y12 platelet receptor inhibitor that blocks ADP- Antiaggregant
induced platelet activation and aggregation.
Vorapaxar Protease-activated receptor-1 (PAR-1) antagonist, Antiaggregant
which inhibits thrombin-induced and thrombin
receptor agonist peptide (TRAP)-induced platelet
aggregation
Riociguat Soluble guanylate cyclase stimulator, which Pulmonary artery hypertension
increases cyc GMP and causes vasodilation
Mipomersen sodium Inhibits ApoB-100 protein and decreases LDL Homozygous familial hypercholesterolemia
production
Macitentan Endothelin receptor antagonist Pulmonary artery hypertension
Lomitapide Microsomal triglyceride transport protein (MTP) Homozygous familial hypercholesterolemia
inhibitor
Icosapent Decreases VLDL synthesis and secretion Hypertriglyceridemia
Sacubitril Inhibits Neutral endopeptidase Chronic CHF along with ARBs
Omapatrilat Vasopeptidase Inhibitor Chronic CHF
Evolocumab Anti PCSK-9 Ab Hyperlipidemia
Annexures

166
   Multiple Choice Questions

Cardiovascular System
ANTIARRHYTHMICS 9. All of the following drugs can cause whorl like corneal
deposits except?  (AIIMS May 2015)
1. The drug preferred in a patient with ischemic heart a. Aminodarone  b. Chloroquine
disease with VT (Recent Question 2019) c. Indomethacin d. Chlorpromazine
a. Lignocaine b. Diltiazem 10. All are toxicities seen with amiodarone therapy except:
c. Propranolol d. Adenosine (AIIMS May 2009)
2. QT prolongation is caused by: (Recent Question 2017) a. Pulmonary fibrosis b. Corneal microdeposits
a. Quinidine b. Omeprazole c. Cirrhosis of liver d. Productive cough
c. Lidocaine d. Penicillin 11. Which of the following anti-arrhythmic agents does not
3. Which of the following is treatment of choice for the belong to class Ic? (AIIMS Nov 2006)
condition given in ECG (SVT) in a one year old child? a. Tocainide b. Encainide
 (Recent Question Dec 2016) c. Flecainide d. Propafenone
12. Which of the following drugs is not used in the treatment
of torsades de pointes?  (Recent Question 2016)
a. Isoproterenol b. Propanolol
c. Magnesium d. Amiodarone
13. Which of the following drugs is used for termination
as well as prophylaxis of paroxysmal supraventricular
tachycardia?
(Recent Question 2016)
a. Digoxin b. Verapamil
c. Propanolol d. Quinine
14. Patient on verapamil should not be given beta blocker
as
a. Fast adenosine (Recent Question 2016)
b. Slow adenosine a. Conduction block b. Bronchospasm
c. Synchronized cardioversion c. Neurogenic shock d. Anaphylaxis
d. Procainamide 15. Digitalis produces which of the following changes in
4. Which of the following is used for treatment of 2 year old ECG? 
baby with supraventicular tachycardia?  a. Tall T waves  (Recent Question 2016)
 (Recent Question Dec 2016) b. ST segment elevation
a. Adenosine b. Verapamil  c. Prolonged QT interval
c. IV Nicardipine d. Synchronized DC d. Prolonged PR interval
5. Quinidine toxicity cause (Recent Question Dec 2016) 16. All of the following are used in atrial arrhythmias
a. Torsades de pointes except:
b. Brugada syndrome  (Recent Question 2016)

Multiple Choice Questions

c. QT prolongation a. Digoxin b. Verapamil
d. Ventricular arrhythmias c. Quinidine d. Lignocaine
6. Side effects of amiodarone are all except:- 17. All the following statements regarding adenosine are
(Recent Question Dec 2016) true except: (Recent Question 2016)
a. Pulmonary fibrosis b. Hepatotoxicity a. Dipyridamole potentiates its action
c. Hypothyroidism d. Nephrotoxicity b. Used to produce controlled hypotension
7. Which of the following ion causes delayed after c. Administered by slow IV injection
depolarization?  (Recent Question Dec 2016) d. Administered by rapid IV injection
a. Calcium b. Sodium 18. Adverse effects of quinidine are all except?
c. Potassium d. Magnesium a. SLE (Recent Question 2016)
8. Digitalis causes all except (Recent Question Dec 2016) b. Diarrhea
a. Heart block b. PSVT c. Bradycardia
c. Bradycardia d. Atrial flutter d. Torsades de pointes
167
 19. The antiarrythmic drug which causes myocardial 32. Dofetilide is which class of antirrhythmic drug?
depression is? (Recent Question 2016) (Recent Question 2016)
Conceptual Review of Pharmacology

a. Sotalol b. Quinine a. Class 1 b. Class 2

c. Amiodarone d. None of these c. Class 3 d. Class 4
20. Beta blockers are antiarrhythmic agents of type? 33. Procainamide is a class___antiarrhythmic drug
(Recent Question 2016) (Recent Question 2016)
a. I b. II a. I b. II
c. III d. IV c. III d. IV
21. Amiodarone does not cause? (Recent Question 2016) 34. Drug resembling thyroid hormone
a. Irreversible microdeposits on the cornea (Recent Question 2016)
b. Hypothyroidism a. Amiodarone b. Captopril
c. Photosensitization c. Lithium d. Losartan
d. Pulmonary fibrosis 35. Drug used in teminating SVT (Recent Question 2016)
22. Which drug can cause thyroid dysfunction? a. Diltiazem b. Amlodipine
(Recent Question 2016) c. Vasopressin d. Verapamil
a. Amiodarone b. Ampicillin 36. All of the following anti-arrhythmic drug are from class
c. Ibutillide d. Acyclovir Ic EXCEPT: (Recent Question 2016)
23. Drug of choice for supraventricular tachycardia is a. Encainide b. Hecainide
(Recent Question 2016) c. Tocainide d. Propafenone
a. Verapamil b. Diltiazem 37. Drug not causing edema (AIIMS Nov 2014)
c. Digoxin d. Phenytoin a. NSAID b. Digoxin
24. Which of the following drugs can cause torsades’de c. Estrogen d. Cyclosporine
pointes? (Recent Question 2016) 38. Digoxintoxicity is enhanced by all of the following
a. Quinidine b. Lignocaine except: (AIIMS May 2010, AIIMS May 2009, Nov 2008;
c. Esmolol d. Flecainide Recent Question 2008)
25. Not an adverse effect of chronic amiodarone therapy a. Hyperkalemia b. Hypercalcemia
a. Pulmonary fibrosis  (Recent Question 2016) c. Hypomagnesemia d. Renal failure
b. Hypothyroideism 39. Digoxin action is not affected in: (AIIMS May 2007)
c. Hyperthyroidism a. Hepatic disease b. Electrolyte disturbances
d. Systemic lupus erythematosus c. Renal failure d. MI
26. Digoxin is not indicated in (Recent Question 2016) 40. BNP is degraded by: (AIIMS May 2007)
a. Atrial flutter b. Atrial fibrillation a. Neutral endopeptidase b. Elastase
c. High output failure d. PSVT c. Omapatrilat d. ACE
27. Racemic mixture of two enantiomers with different 41. Which of the following conditions increases the risk of
pharmacokinetic and pharmacodynamics properties is digoxintoxicity? (Recent Question 2016)
seen in (Recent Question 2016) a. Administration of quinidine
a. Dilantin b. Digoxin b. Hyperkalemia
c. Verapamil d. Octerotide c. Hypermagnesemia d. Hypocalcemia
28. The antiarrhythmic drug of choice in most of the cases of 42. Which of the following is not given in acute severe
acute paroxysmal supraventricular tachycardia is digitalis toxicity? (Recent Question 2016)
(Recent Question 2016)
a. Potassium b. Digibind
a. Adenosine b. Amiodarone
c. Lignocaine d. None of these
Multiple Choice Questions

c. Propranolol d. Quinidine
43. Which of the following is a monovalent cation that can
29. Which of the following has the maximum half-life?
reverse a digitalis induded arrhythmia?
(Recent Question 2016)
a. Adenosine b. Amiodarone (Recent Question 2016)
c. Esomolol d. Lidocaine a. Digibind antibodies b. Lignocaine
c. Magnesium d. Potassium
30. Which of the following antiarrhythmic drugs can
decrease the slope of phase 0 and prolong the action 44. Digitalis produces which of the following changes in
potential duration? (Recent Question 2016) ECG? (Recent Question 2016)
a. Lignocaine b. Propranolol a. Tall T waves b. ST segment elevation
c. Quinidine d. Adenosine c. Prolonged QT interval d. Prolonged PR interval
31. The drug of choice for rapid correction of PSVT in known 45. Mechanism of action of levosimendan is:
asthmatic is  (Recent Question 2016) (Recent Question 2016)
a. Adenosine b. Esmolol a. Inoconstrictor b. Potassium channel opener
c. Neostigmine d. Verapamil c. Sodium channel opener d. Beta blocker
168
 46. Half-life of digoxin is: (Recent Question 2016) 59. Drugs causing aferload reduction is:

Cardiovascular System
a. 12 hours b. 24 hours (Recent Question 2016)
c. 36 hours d. 48 hours a. Digoxin b. Captopril
47. Most effective method of treatment of digitalis toxicity c. Dobutamine d. Frusemide
is? (Recent Question 2016) 60. Drug of choice in LVH: (Recent Question 2016)
a. Hemodialysis b. Cardioversion a. ACE inhibitors
c. Digoxin antibody d. Atropine b. Beta blockers
48. Drug used in remodeling of heart in congestive cardiac c. Calcium channel blockers
failure are all except: (Recent Question 2016) d. Sodium channel blockers
a. Beta blocker b. ACE inhibitor 61. Drug used in heart failure: (Recent Question 2016)
c. Digoxin d. Aldosterone antagonist a. Celiprolol b. Carteolol
c. Carvediol d. All of the above
49. Which among the following is the best inotrope drug for
use in right heart failure? (Recent Question 2016) 62. Mechanism of action of digoxin in CHF is:
a. Dobutamine b. Digoxin (Recent Question 2016)
c. Dopamine d. Milrinone a. Prolonged systole b. Shortened diastole
c. Increased HR d. Decreased HR
50. All of the following drugs are used for the treatment of
congestive heart failure except: (Recent Question 2016) 63. Digoxin increases refractoriness at:
a. Nitroglycerine b. Spironolactone (Recent Question 2016)
c. Nesiritide d. Trimetazidine a. SA node b. AV node
c. Ventricular cells d. Atrial cells
51. All of the following statements about nesiritide are true
except: (Recent Question 2016)
a. It is a BNP analogue HYPERTENSION, ANGINA AND MI
b. It can be used in decompensated CHF
c. It can be administered orally 64. For a patient of hypertension on metoprolol, verapamil
d. It causes loss of Na+ in the urine was given; this will result in (AIIMS Nov 2018)
a. Atrial fibrillation
52. The most important channel of elimination of digoxin b. Bradycardia with AV block
is: (Recent Question 2016) c. Torsades de pointes
a. Glomerular filtration b. Tubular secretion d. Tachycardia
c. Hepatic metabolism d. Excretion in bile
65. Nitroprusside active metabolite act by (AIIMS Nov 2018)
53. Which of the following drugs can prolong survival in a. Phosphokinase 1,2 b. Guanylyl cyclase
patients with CHF? (Recent Question 2016) c. Phospholipase A d. Phospholipase B
a. Furosemide b. Inamrinone
66. Primary action of nitrates in a patient of angina is
c. Losartan d. Digoxin
(AIIMS Nov 2018)
54. The diuretic of choice for rapid relief of congestive a. Coronary vasodilation b. Decreases preload
symptoms in a patient of CHF is: (Recent Question 2016) c. Decreases afterload d. Decreases heart rate
a. Hydrochlorothiazide b. Furosemide
67. A patient having prinzmetal angina is started with
c. Metolazone d. Amiloride
isosorbide mononitrate. Patient got symptomatic relief
55. All are useful for long-term treatment of congestive from angina. what is the mechanism of action of nitrate?
heart failure except: (Recent Question 2016)  (AIIMS Nov 2017)
a. Digoxin b. Ramipril a. Endothelium independent coronary vasodilation
c. Dobutamine d. Spironolactone b. Reduced cardiac contractility
c. Increased left ventricular end diastolic volume
Multiple Choice Questions
56. The drug not useful in congestive heart failure is:
(Recent Question 2016) d. Decreased diastolic perfusion pressure
a. Adrenaline b. Digoxin 68. Which of the following drug is not used in pregnancy
c. Hydrochlorothiazide d. Enalapril induced hypertension? (Recent Question 2017)
57. Digibind is used to: (Recent Question 2016) a. Atenolol b. Labetalol
a. Potentiate the action of digoxin c. Hydralazine d. Methyldopa
b. Decrease the metabolism of digoxin 69. ARB inhibitor with additional PPAR-γ agonist activity is
c. Treat digoxintoxicity  (AIIMS May 2016)
d. Rapidly digitalize the patient a. Losartan b. Candisartan
58. Digitalis toxicity can cause: (Recent Question 2016) c. Telmesartan d. Eprosartan
a. Hyperkalemia 70. Which of the following antihypertensive drug causes
b. Nausea nasal congestion?  (Recent Question Dec 2016)
c. Arrhythmias a. Ace inhibitor b. Beta blockers
d. All of the above c. ARB d. CCB
169
 71. Which of the following ARB is thromboxane A2 inhibitor 83. Hypertension is not seen with: (AIIMS May 2007)
with PPAR gamma stimulating property?  a. Cyclosporine
Conceptual Review of Pharmacology

 (Recent Question Dec 2016) b. NSAIDs

a. Telmisartan b. Losartan c. Erythropoietin
c. Candesartan d. Olmesartan d. L-dopa
72. Not centrally acting antihypertensive are 84. Renin is secreted from: (AIIMS May 2007)
(Recent Question Dec 2016) a. Juxtaglomerular apparatus
a. Methyl dope b. Clonidine b. PCT
c. Minoxidil d. Guanabenz c. DCT
73. Which of the following drug is contraindicated in a case d. Collecting ducts
of B/L renal artery stenosis  (Recent Question Dec 2016) 85. Maximum incidence of impotence is seen with the
a. Methyldopa b. Enalapril following antihypertensive agent: (AIIMS May 2007)
c. Hydralazine d. Dopamine a. CCBs b. Beta blockers
74. Drug of choice for hypertension in eclampsia is:- c. ARBs d. ACE inhibitors
(Recent Question Dec 2016) 86. The most significant adverse effect of ACE inhibition is:
a. MgSo4 b. Labetalol (AIIMS May 2006)
c. Nifedipine d. Hydralazine a. Hypotension b. Hypertension
75. Which of the following is drug of choice for pregnancy- c. Hypocalcemia d. Hypercalcemia
induced hypertension? (AIIMS Nov 2015) 87. Preload of heart reduced by: (Recent Question 2018)
a. Atenolol b. α-methyl dopa a. CCB b. Minoxidil
c. Enalapril d. Nitroprusside c. Hydralazine d. Nitroglycerine
76. A 60-year-old man, chest pain since one day, with the 88. Drug of choice for ventricular arrhythmias due to myo-
following ECG. Which of the following drugs should not cardial infarction (MI) is  (Recent Question 2016)
be used?  (AIIMS Nov 2015) a. Quinidine b. Amiodarone
a. Aspirin b. Thrombolytics c. Xylocaine d. Diphenylhydantoin
c. Morphine d. Statins
89. Ranolazine is a (Recent Question 2016)
77. Which of the following antihypertensive is absolutely a. Vasodilator b. Antianginal
contraindicated in pregnancy? (AIIMS May 2015) c. Antihypertensive d. Antiarrhythmic
a. Enalapril b. Methyldopa
c. Nifedipine d. Labetalol 90. ACE inhibitors should not be used with
(Recent Question 2016)
78. Diuretic which can be given in mild to moderate hyper- a. Amiloride b. Calcium channel blockers
tension (AIIMS May 2015)
c. Chlorthalidone d. Spironolactone
a. Loop diuretics b. Osmotic diuretics
c. Thiazide diuretics 91. Antihypertensive drug contraindicated in pregnancy is
d. Potassium sparing diuretics a. Enalapril (Recent Question 2016)
b. Cardio selective beta blockers
79. All of the following drugs can worsen angina except:
c. Methyl dopa
(AIIMS May 2011)
d. Hydralazine
a. Dipyridamole b. Oxyphedrine
c. Thyroxine d. Sumatriptan 92. Which of the following drug decreases plasma rennin
activity? (Recent Question 2016)
80. Which of the following statements regarding ACE
a. Enalapril b. Nifedipine
inhibitors is true? (AIIMS May 2008, 2011, Nov 2008)
c. Hydralazine d. Clonidine
a. These inhibit the conversion of angiotensinogen to an-
Multiple Choice Questions

giotensin-1 93. ACE inhibitors cause (Recent Question 2016)

b. Omission of prior diuretic dose decreases the risk of a. Hyperkalemia b. Hypokalemia
postural hypotension c. Hypocalcemia d. Hypernatremia
c. Lisinopril is shorter acting than enalapril 94. False about diazoxide is (Recent Question 2016)
d. These are contraindicated in diabetic patients a. It acts by causing prolonged opening of ATP depended
81. Nitrates are used for all of the following conditions K+ channels in beta cells
except? (AIIMS Nov 2009) b. It can cause severe hypoglycemia
a. Congestive heart failure b. Cyanide poisoning c. It can be used to treat patients with insulinoma
c. Esophageal spasm d. Renal colic d. It is used as an antihypertensive agent
82. A man presents with chest pain. ECG shows ST segment 95. Which of the following drugs is best for reducing
depression in leads V1-V4. Which of the following should proteinuria in a diabetic patient?
not be given? (AIIMS May 2008) (Recent Question 2016)
a. Beta blocker b. Thrombolytic a. Metoprolol b. Perindopril
c. Morphine d. Aspirin c. Chlorthiazide d. Clonidine
170
 96. Alpha methyldopa is primarily used for: 108. Nitroglycerine can be administered by all of the following

Cardiovascular System
(Recent Question 2016) routes except (Recent Question 2016)
a. Pregnancy induced hypertension  a. Oral b. Sublingual
b. endovascular hypertension c. Intramuscular d. Intravenous
c. First line agent in hypertension 109. The antihypertensive agent that should be avoided in
d. Refractory hypertension young females and is used topically to treat alopecia is
97. Which of the following ACE inhibitor is not a prodrug? (Recent Question 2016)
a. Fosinopril (Recent Question 2016) a. Hydralazine b. Prazosin
b. Enalapril c. Minoxidil d. Indapamide
c. Ramipril 110. Which antihypertensive is a prodrug and is converted to
d. Lisinopril its active form in brain? (Recent Question 2016)
98. Nitroglycerine causes all except (Recent Question 2016) a. Clonidine b. Methyl dopa
a. Hypotension and bradycardia c. Minoxidil d. Nitroprusside
b. Methemoglobinemia 111. Which of these anti-hypertensives do not have any
c. Hypotension and tachycardia central action? (Recent Question 2016)
d. Vasodilation a. Propranolol b. Methyldopa
99. Angiotensin II causes all except: (Recent Question 2016) c. Clonidine d. Prazosin
a. Stimulates release of ADH 112. When treating hypertension chronically, orthostatic hy-
b. Increases thirst potension is maximum with (Recent Question 2016)
c. Vasodilation a. Clonidine b. Guanethidine
d. Stimulates aldosterone release c. Prazosin d. Propranolol
100. Calcium channel blocking agents of use in the treatment 113. Which of the following drugs is used in severe
of hypertension include: (Recent Question 2016) hypertension emergencies, is very short acting and must
a. Prazosin b. Lidoflazine be given by i.v. infusion? (Recent Question 2016)
c. Captopril d. Nifedipine a. Diazoxide b. Hydralazine
101. All are true regarding losartan except c. Labetolol d. Nitroprusside
a. It is a competitive angiotensin receptor antagonist 114. Longest acting nitroglycerine preparation is
b. It has a long acting metabolite (Recent Question 2016) a. Glyceryltrinitrate  (Recent Question 2016)
c. Associated with negligible cough b. Amyl nitrite
d. Causes hyperuricemia c. Pentaerythritol tetranitrate
102. Coronary steal phenomenon is seen with: d. Isosorbidedinitrate
(Recent Question 2016) 115. A drug lacking vasodilatory properties that is effective in
a. Dipyridamole b. Diltiazem angina is (Recent Question 2016)
c. Propranolol d. Verapamil a. Isosorbidedinitrate b. Metoprolol
103. Which of the following is not given alone in a patient of c. Nifedipine d. Verapamil
pheochromocytoma? (Recent Question 2016) 116. Which of the following antihypertensive drug does not
a. Atenolol b. Prazosin alter serum glucose and lipid levels?
c. Nitroprusside d. Metyrosine (Recent Question 2016)
104. Not an adverse effect of ACE inhibitors: a. Propranolol b. Prazosin
(Recent Question 2016) c. Clonidine d. Thiazide diuretics
a. Cough b. Hypokalemia 117. Drug not useful in hypertensive emergency is
c. Angioneurotic edema d. Skin rash  (Recent Question 2016)
105. An elderly hypertensive has diabetes mellitus and a. IV hydralazine b. Indapamide 

Multiple Choice Questions

bilateral renal artery stenosis. The best management is c. Sublingual nifedipine d. Sodium nitroprusside
(Recent Question 2016) 118. Nimodipine is used in
a. Enalapril b. Verapamil a. Subarachnoid hemorrhage  (Recent Question 2016)
c. Beta blockers d. Thiazides b. Intracerebral hemorrhage
106. Postural hypotension is the common side effect of c. Extradural hemorrhage
(Recent Question 2016) d. Subdrual hemorrhage
a. ACE inhibitors b. Alpha receptor blockers 119. Calcium channel blockers are used in all except
c. Arteriolar dilators d. Selective b1 blockers (Recent Question 2016)
107. Nitroglycerine exerts beneficial effects in classical a. Angina b. Arrhythmia
angina pectoris primarily by (Recent Question 2016) c. Congestive heart failure d. Hypertension
a. Increase intotal coronary blood flow 120. Sodium-nitroprusside act by activation of
b. Redistribution of coronary blood flow (Recent Question 2016)
c. Reduction of cardiac preload a. Guanylatecyclase b. K+ channels
d. Reduction of cardiac afterload c. Ca++ channels d. Cyclic AMP
171
 121. Drug not to be given in ischemic heart disease is 135. Most common side effect of ARB (Recent Question 2016)
(Recent Question 2016) a. Hypotension b. Hypokalemia
Conceptual Review of Pharmacology

a. Atenolol b. ACE inhibitor c. Edema d. Cough

c. Isoproterenol d. Streptokinase 136. Cerebro protective calcium-channel blocker
122. Cough is an adverse reaction seen with intake of (Recent Question 2016)
(Recent Question 2016) a. Nifedipine b. Amlodipine
a. Thiazide b. Nifedipine c. Enalapril d. Nimodipine
c. Enalapril d. Prazosin 137. Most commonly used drug in hypertensive emergencies
123. An antihypertensive drug that causes positive coomb’s (Recent Question 2016)
test is (Recent Question 2016) a. Clonidine b. Nifedipine
a. Methyl dopa b. Clonidine c. Sodium nitroprusside d. α-methyl dopa
c. Hydralazine d. Sodium–nitropruside
138. Drug of choice for hypertension with angina pectoris
124. Potassium channel opener with anti-anginal activity is (Recent Question 2016)
a. Nicorandil b. Dipyridamole a. Atenolol b. ACE inhibitors
c. Trimetazidine d. Oxyphedrine c. Verapamil d. Nitrates
125. Amy nitrite in used by which route? 139. ACE inhibitor not to be given along with
(Recent Question 2016) (Recent Question 2016)
a. Oral b. Inhalation a. Amiloride b. Xipamide
c. IV d. IM c. Hydrochlorothiazide d. Chlorthalidone
126. ACE inhibitors are contraindicated in 140. Enalapril is a/an (Recent Question 2016)
a. Diabetes mellitus  (Recent Question 2016) a. Angiotensin receptor blocker
b. Hypertension in old age groups b. Angiotensin converting enzyme inhibitor
c. Scleroderma
c. Renin inhibitor
d. Bilateral renal artery stenosis
d. Calcium channel blocker
127. All of the following are vasodilators except
141. Most common side effect of calcium channel blocker is
(Recent Question 2016)
(Recent Question 2016)
a. Methyl dopa b. Nitroprusside
a. Headache b. Constipation
c. Hydralazine d. Diazoxide
c. Diarrhea d. Muscle cramps
128. Cough and angioedema in a patient receiving ACE
142. Adverse effect of angiotensin receptor blocker
inhibitors is due to (Recent Question 2016)
(Recent Question 2016)
a. Bradykinin b. Renin
a. Postural hypotension b. Urticaria
c. Angiotensin-II d. All
c. Bronchospasm d. Hypokalemia
129. Enalapril increases the levels of (Recent Question 2016)
a. Bradykynin b. Interferon 143. Drug of choice for intermittent claudication
c. PAF d. TNF a. Atropine b. Paracetamol
c. Pentoxiphlline d. Phenytoin
130. Treatment of choice in hypertension with diabetes
mellitus is (Recent Question 2016) 144. SLE like reaction is caused by? (Recent Question 2016)
a. B-Blockers b. Thiazides a. Hydralazine b. Rifampicin
c. ACE inhibitors d. Calcium channel blockers c. Paracetamol d. Furozemide
131. Which of the following antihypertensives causes 145. Anti-hypertensive drug contraindicated in pregnancy
sedation (Recent Question 2016) is? (Recent Question 2016)
a. Clonidine b. Hydralazine a. Enalapril
b. Cardio selective beta blockers
Multiple Choice Questions

c. Losartan d. Amlodipine
c. Methyldopa
132. Antidote for calcium channel blockers overdose
d. Hydralazine
(Recent Question 2016)
a. Atropine b. Calcium gluconate 146. Adverse effects of losartan are all except:
c. Adrenaline d. Digoxin (Recent Question 2016)
a. Angioedema b. Cough
133. Drug of choice for prinzmetal angina is
(Recent Question 2016) c. Hyperkalemia d. Headache
a. Nifedipine b. Propranolol 147. Which drug may aggravate renovascular hypertension?
c. CCB d. GTN (Recent Question 2016)
134. In variant angina calcium channel blockers act by a. ACE inhibitors b. Beta blockers
a. Reducing coronary spasm  (Recent Question 2016) c. Calcium channel blockers d. Thiazide diuretics
b. Increasing myocardial oxygen demand 148. Drug not given sublingually is: (Recent Question 2016)
c. Colonary vasoconstriction a. Isosorbidedinitrate b. Buprenorphine
d. All of the above c. Ergotamine tartrate d. Isosorbide-5-mononitrate
172
149. Drug not used in prinzmetal angina is? 159. Nicotinic acid (Recent Question 2016)

Cardiovascular System
(Recent Question 2016) a. Increases HDL
a. Propranolol b. Verapamil b. Increased triglyceride synthesis
c. Nitrites d. Isosorbide dinitrate c. Type II hyperlipoproteinemia
150. The anti-hypertensive agent which decreases libido is? d. Decreased hydrolysis of VLDL
(Recent Question 2016) 160. Drug that decreasesLpA in blood
a. Methyl dopa b. Captopril (Recent Question 2016)
c. Diazoxide d. Hydralazine a. Statin b. Nicotinic acid
151. The antihypertensive which causes decreased libido and c. Ezetimibe d. CETP inhibitors
impotence is? (Recent Question 2016) 161. Mechanism of action of fibrates in treatment of hyper-
a. Atenolol b. Enalapril lipidemia is (Recent Question 2016)
c. Prazosin d. Diltiazem a. Activator of lipoprotein lipase
152. Ivabradine is indicated in the management of: b. PPAR alpha agonist
(Recent Question 2016) c. Decreased synthesis of VLDL
a. Congestive heart failure b. Angina pectoris d. Inhibitor of CETP
c. Cardiomyopathy d. Irritable bowel syndrome 162. Mechanism of action of cholestyramine is
a. Bind to bile acid  (Recent Question 2016)
HYPOLIPIDEMICS b. Decrease HMG-COA
c. Increase excretion of cholesterol
153. A patient of CAD with history of MI 2 months back, d. Decrease utilization of cholesterol
diabetes mellitus with LDL 126, HDL 32 and triglycerides 163. Drug that inhibits absorption of Cholesterol from
236. What should be given: (AIIMS May 2017) intestine (Recent Question 2016)
a. Atorvastatin 80 mg a. Resins b. Ezetimibe
b. Rosuvastatin 10 mg c. Niacin d. Orlistat
c. Fenofibrate 164. Which of the following is not a direct acting antiplatelet
d. Fenofibrate and Rosuvastatin agent? (Recent Question 2016)
154. Niacin is dangerous in diabetes mellitus because: a. Aspirin b. Colpidogrel
a. It causes insulin resistance (Recent Question 2017) c. Atorvastatin d. Alteplase
b. It causes sudden hypoglycemia 165. Competitive inhibition of rate limiting step in cholesterol
c. It decreases glucagon secretion synthesis is by (Recent Question 2016)
d. It decreases effect of other OHA a. Bile acid sequestrants b. Fibric acid derivatives
155. Dyslipedemic drug used in hyperurecemia and acute c. Statins d. Nicotinic acid
gout is (Recent Question Dec 2016) 166. Mechanism of action of lovastatin is by
a. Niacin b. Fenofibrate (Recent Question 2016)
c. Cholestyramine d. Statins a. Competitive inhibition of rate limiting step in choles-
156. True about fibrates is all except: (AIIMS Nov 2007) terol synthesis
a. Drug of choice for type III hyperlipoproteinemia and b. Bile acid sequestration
hypertriglyceridemia c. Activate lipoprotein lipase
b. Activates PPAR to stimulate LPL d. Inhibits lipolysis and triglyceride
c. Absorbed good on empty stomach and absorption is 167. Mechanism of action of statins is
delayed by fatty meals (Recent Question 2016)
d. Side effects are rash, urticarial, myalgia and impotence a. Inhibition of HMG-CoA synthase

Multiple Choice Questions

157. All of the following are true regarding HMG-CoA b. Stimulation of HMG-CoA reductase
reductase inhibitors except (AIIMS May 2002) c. Indirect increase of LDL receptors synthesis
a. CNS accumulation of simvastatin and lovastatin is high d. Inhibition of intestinal cholesterol absorption
and less for pravastatin and fluvastatin 168. Mechanism of action of ezithimibe
b. Simvastatin is rapidly and pravastatin is least (Recent Question 2016)
metabolized a. Inhibit cholesterol absorption
c. Bioavailability is minimally modified when pravastatin b. Inhibit release of triglycerides in LDL
is taken with food c. Inhibit HMG CoA reductase
d. Fibrinogen levels are increased by pravastatin d. Inhibit HMG CoA synthase
158. Hypolipidemic drugs act on all except 169. The vitamin which in large doses decreases the
a. HMG Co A reductase  (Recent Question 2016) triglycerides and cholesterol levels
b. Lipoprotein lipase (Recent Question 2016)
c. Acyl CoA, cholesterol acyl transferase 1 a. Vitamin B12 b. Nicotinic acid
d. Peripheral decarboxylase c. Vitamin B1 d. Retinol
173
 170. Appropriate drug for a patient with high LDL level is 182. Which of the following is/are not calcium-channel
(Recent Question 2016) blocking agent(s): (PGI May 2012)
Conceptual Review of Pharmacology

a. Atorvastatin b. Rosuvastatin a. Verapamil b. Propranolol

c. Fenofibrate d. Nicotinic acid c. Carvedilol d. Nicardipine
171. Statins are used in ___type of dyslipidemia e. Nebivolol
(Recent Question 2016) 183. Rebound hypertension is seen with: (PGI June 2009)
a. II b. III a. Amlodipine b. Methyldopa
c. IV d. I c. Clonidine d. Na nitroprusside
172. Mechanism of action of clofibrate  e. Atenolol
(Recent Question 2016) 184. Beta Blockers used in CHF are: (PGI Nov 2008)
a. Inhibit HMGCoAreductase a. Propranolol b. Bisoprolol
b. Inhibit HMGCoA synthase c. Carvedilol d. Nebivolol
c. Inhibit absorption if cholesterol e. Pindolol
d. Stimulates lipoprotein lipase 185. Vasodilators are: (PGI Nov 2007)
173. First dose syncope occurs with which of the following a. NO b. CO2
drug(s): (PGI May 2018) c. Minoxidil d. ACE inhibitor
a. ACE inhibitor b. CCB 186. Digoxin is used in A/E: (PGI Nov 2007)
c. Alpha blockers d. Beta blockers a. Decompensated heart failure
e. Thiazide diuretics b. HOCM
174. Drugs used in monomorphic ventricular tachycardia in c. Supraventicular tachycardia
hemodynamically stable patient: (PGI Nov 2017) d. Myocarditis
a. Amiodarone b. Propranolol 187. ECG changes in digitalis toxicity are A/E:
c. Lignocaine d. Diltiazem
(PGI Nov 2007)
e. Procainamide
a. T wave inversion
175. Among ACE inhibitors, which of the following is/are b. Diminished T wave amplitude
prodrug(s): (PGI May 2017) c. Conduction block
a. Perindopril b. Captopril d. ST depression in proximal part
c. Lisinopril d. Ramipril
188. Side effects of directly acting vasodilators are:
e. Enalapril
(PGI June 2007)
176. Drug(s) causing QT interval prolongation: a. Hypertrichosis b. Hypotension
(PGI May 2017)
189. Drugs used in CHF: (PGI June 2007)
a. Amiodarone b. Cisapride
a. Nesiritide b. Digoxin
c. Calcium gluconate d. Magnesium therapy
c. Spironolactone d. Losartan
e. Ketoconazole
190. Drugs of choice in lignocaine toxicity: (PGI June 2007)
177. Drug that can potentiate Torsades de pointes:
a. Bretylium b. Amiodarone
a. Amiodarone b. Sotalol (PGI Nov 2016)
c. Chlorpromazine d. Cisapride c. Isoprenaline d. Beta blocker
e. Aspirin 191. After inadvertent inj. of Bretylium, TOC is:
178. Drugs which can be used in gestational hypertension: (PGI June 2007)
 (PGI Nov 2016) a. Bretylium b. Propranolol
a. Metoprolol b. Labetalol c. Norepinephrine d. Lignocaine
c. Methyldopa d. Sustained release nifedipine 192. Drugs which cause fetal renal anomalies:
(PGI Nov 2006)
Multiple Choice Questions

e. Losartan
179. Peripheral neuropathy is/are caused by: (PGI Nov 2014) a. Enalapril
a. Vincristine b. Sulfonamide b. Frusemide
c. Amiodarone d. Paclitaxel c. Angiotensin receptor blocker
d. Amlodipine
180. Drug that increases QT interval: (PGI May 2012)
e. Phenytoin
a. Haloperidol b. Fexofenadine
c. Amiodarone d. Ebastine 193. Mg++ administered in: (PGI June 2006)
e. Sotatol a. Eclampsia b. Cardiac arrhythmia
181. MOA of Verapamil is: (PGI May 2012) c. Seizure d. Tetani
a. Inhibition of Ca+2 channel 194. Digoxintoxicity aggravated in: (PGI June 2006)
b. Inhibition of Na+ channel a. Hypokalemia
c. Inhibition of K+ channel b. Hyperkalemia
d. Block membrane repolarisation c. hypercalcemia
e. Membrane stabilisation d. Hypermagnesemia
174
 195. Action of Angiotensin II (PGI June 2005) 204. A patient is brought to the emergency department

Cardiovascular System
a. Systemic vasconstriction with severe bradycardia, drowsiness, feeble pulse, and
b. Systemic vasodilatation very low blood pressure. The patient was found to have
c. Renal vasodilatation consumed unknown quantity of his anti-hypertensive
d. Re-absorbtion of Na in proximal renal tubule medication. Which of the following cannot be the
e. Water reabsorbtion medication?  (JIPMER 2016)
196. A hypertensive patient with BP 160/90 mm of Hg a. Clonidine b. Hydralazine
presents with increased level of Lipoprotein a. c. Reserpine d. Digoxin
Which Hypolipidemic drug will you prescribe? 205. Which of the following drug has least value in heart
(JIPMER May 2018) failure?  (JIPMER 2014)
a. Fenofibrate b. Pitavastatin a. Antiplatelet agents b. Beta blockers
c. Niacin d. Ezetimibe c. Diuretics d. ACE inhibitors
197. A 60 years old hypertensive patient is on lithium for 206. Which is not a pleiotropic effect of statins? 
treatment of BPD. What is the antihypertensive of (JIPMER 2014)
choice: (JIPMER 2017) a. Reduce LDL cholesterol
a. Ramipril b. Improve endothelial stability
b. Amlodipine c. Anti inflammatory/anti oxidant
c. Atenolol d. Reduce plaque rupture
d. Chlorthiazide 207. Antiarrhythmic drug causing hypothyroidism is: 
198. Which of the following statement is true regarding a. Lidocaine (JIPMER 2014)
b. Propanolol
Sacubitril? (JIPMER 2017) c. Amiodarone d. Procainamide
a. Used with ARB for treatment of CHF 208. Which is not side effect of aminodarone? 
b. BNP inhibitor (JIPMER 2012)
c. ACE inhibitor a. Pulmonary fibrosis b Torsades de pointes
d. Decreases BNP c. Atrial fibrillation d Bradycardia
199. Which of the following is a PCSK-9 inhibitor? 209. Which of the following is a direct rennin inhibitor?
 (JIPMER 2017) a. Aliskiren b. Losartan (JIPMER 2012)
a. Evolocumab b. Bordalumab c. Perindopril d. Vernakalant
c. Ramucirumab d. Bolosozumab
210. Which of the following is a calcium sensitizing agent?
200. Which statin is given to an 8 years old child with  (JIPMER 2012)
heterozygous familial hypercholesterolemia? a. Levosimendan b. Cinacalcet
(JIPMER, 2016/2014) c. Alendronate d. Teriparatide
a. Simvastain b. Pravastain
c. Atorvastain d. Lovastatin 211. Drug contraindicated in severe hypertriglyceridemia is:
(JIPMER 2010)
201. A 50 years old man was recently diagnosed to be having a. Fibrates b. Simvastatin
coronary artery disease. There was no added risk factors c. Niacin d. Cholestyramine
except for a LDL value of 150-165mgs/dL. The single
drug most appropriate for initial therapy is  (JIPMER 212. ACE inhibitors are contraindicated in all the following
2016) except:  (JIPMER 2008)
a. Gemfibrozil a. Bilateral renal artery stenosis
b. Nicotinic acid b. Elderly hypertensive
c. Bile acid binding resins c. Diabetic microalbuminuria
d. Statins (Any) d. Severe renal failure

Multiple Choice Questions

202. A 49-year-old male is diagnosed with hypertension. He 213. Calcium channel blocker which is usually used in
is a known asthmatic. His creatinine and potassium subarachnoid hemorrhage is:  (JIPMER 2007)
are both slightly elevated. Which of the following drugs a. Nimodipine b. Diltiazem
would be appropriate in his case?  (JIPMER 2016) c. Verapamil d. Flunarizine
a. Amlodipine b. Spironolactone 214. Which is a characteristic adverse effect of chronic
c. Propranolol d. Hydrochlorthiazide amiodarone therapy?  (JIPMER 2007)
203. A 59 years old female patient taking medications for a. Corneal deposition
hypertension and congestive cardiac failure. She b. Cataract
suddenly develops skin rashes along with swelling c. Glaucoma
of tongue, lips as well as eyes, causing her breathing d. Retinal pigmentation
difficulty. Which one of the following medications is the 215. Drug used in the treatment of Congestive Heart Failure
reason for the untoward effects?  (JIPMER 2016) is (NIMHANS 2013)
a. Propranolol b. Hydrochlorthiazide a. ACE inhibitor b. Beta blocker
c. Captopril d. Clonidine c. Art blocker d. All of the above
175
 216. Verapamil belongs to which Class of Anti Arrhythmic
Drugs?  (NIMHANS 2013)
CHF
Conceptual Review of Pharmacology

a. I
218. A 40-year-old man presents with NYHA 3 class, dyspnea,
b. II
creatinine of 2.5 mg%, potassium level of 4.5 mEq/L.
c. III
Drug contraindicated is: (AIIMS May 2017)
d. IV
a. Carvedilol b. Spironolactone
217. All of the following are side effects of Hydralazine except c. Enalapril d. Digoxin
 (NIMHANS 2007)
219. What is the mechanism of action of sacubitril?
a. Lupus syndrome
a. ACE inhibitor (Recent Question 2017)
b. Rheumatoid arthritis b. Neutral endopeptidase inhibitor
c. Postural hypotension c. Endothelin antagonist
d. Teratogenicity d. Angiotensin receptor blocker

Practice Questions & Answers from 220 to 264 are given at the end of the chapter.

Answers with Explanations to Multiple Choice Questions

1. Ans (a)  Lignocaine 5. Ans. (d)  Ventricular arrhythmia

(Ref: Goodman Gilman 13th E/P555) (Ref: Goodman Gilman 12th E/P844)
ˆˆ Lidocaine is the drug of choice for treatment of ˆˆ Quinidine toxicity can present as ventricular tachycardia.
ˆˆ QT prolongation and torsades with quinidine can be
ventricular tachycardia caused by myocardial infarction
seen even at normal doses.
and digoxintoxicity.
6. Ans. (b)  Hepatotoxicity
2. Ans. (a)  Quinidine
(Ref: Goodman Gilman 12th E/P834)
(Ref: Goodman Gilman 12th E/P821)
7. Ans. (a)  Calcium
Drugs Causing QT Prolongation
Answers with Explanations to Multiple Choice Questions

ˆˆ Antiarrhythmics: Class Ia (Quinidine) and Class III (Ref: Goodman Gilman 12th E/P803-04)
ˆˆ Cisapride
Cellular effect of digoxin
ˆˆ Antipsychotics: Ziprasidone, Sertindol, Quitiapine,
ˆˆ In a myocardial cell, digitalis act by inhibiting
Haloperidol etc.
phosphorylated Na/K ATPase pump, whose function
ˆˆ Antidepressants: Tricyclic antidepressants like
is to reverse the effect of depolarization by pumping
amitryptilline, SSRI like flluoxetine sodium out and potassium in. Thus when this effect
ˆˆ Antibiotics: Fluoroquinolones, Erythromycin is inhibited, there is intracellular accumulation of
ˆˆ Antihistaminics: Astemizole, Terfenadine sodium and extracellular potassium, and thus the side
ˆˆ Antifungals: Ketoconazole effect hyperkalemia. Potassium which accumulates
ˆˆ Antimalarials: Chloroquine, Quinine, Halofentrine extracellularly, dephosphorylates Na/K ATPase pump
ˆˆ Antivirals: Amantidine and hence limits digitalis action. Thus in case of
hypokalemia digitalis toxicity can be seen.
3. Ans. (a)  Fast adenosine ˆˆ Intracellular sodium stimulates the Na/Ca exchanger
pump, which extrudes sodium out and pumps calcium
(Ref: Nelson 19th E/P1614) in, which is further stored in the sarcoplasmic reticulum.
ˆˆ The ECG is characteristic of SVT. Now when an action potential strikes the myocardial
ˆˆ The first thing to be done in infant is place ice bag cell, a huge amount of calcium is released from the
over the face and placing the face in ice water for older sarcoplasmic reticulum giving a strong positive inotropic
children. If it fails then pharmacotherapy is used. effect.
ˆˆ The drug of choice for SVT in children is adenosine by ˆˆ The persistently high level of calcium in myocardial

rapid IV administration. cells can generate small depolarization just after or in

between repolarization and is known as delayed after
ˆˆ Verapamil is contraindicated in children less than 1 year.
depolarization (DAD). Further it can take shape of a
4. Ans. (a)  Adenosine complete action potential i.e. a cardiac contraction
triggered by calcium alone (usually by Na in myocardial
(Ref: Nelson 19th E/P1613) cells) and is known as an extra systole. If it’s repetitive
176
 bigeminy can be seen, which is the most common Treatment of Long QT Syndrome or Torsades de
Pointes

Cardiovascular System
digitalis induced arrhythmia. Ventricular tachycardia
can follow, which is self-sustained (by myocardial cell)
and bidirectional and finally can precipitate fibrillation.

8. Ans. (d)  Atrial flutter

(Ref: Goodman Gilman 12th E/P803-04)

9. Ans. (c)  Indomethacin

(Ref: Copeland and Afshari’s principles and practice of
cornea)
ˆˆ Whorl like corneal deposits can be seen with drugs like
ƒƒ Chloroquine
ƒƒ Amiodarone
13. Ans. (b)  Verapamil
ƒƒ Chlorpromazine
ƒƒ Vandetanib (Ref: Goodman Gilman 12th E/P830)
ƒƒ Indomethacin ˆˆ Verapamil is the drug of choice for prophylaxis of PSVT.
ˆˆ Adenosine is the drug of choice for treatment of PSVT.
ˆˆ Indomethacin being the least common cause in the
options is the best answer. As it causes bronchoconstriction, in patients of COPD
and bronchial asthma, verapamil becomes the drug of
10. Ans. (d)  Productive cough choice for treatment of PSVT.

(Ref: Goodman Gilman 12th E/P837) 14. Ans. (a)  Conduction block

Side effects of Amiodarone (Ref: Goodman Gilman 12th E/P831)

ˆˆ Both beta blockers and non-dihydropyridine CCBs i.e.
Mnemonics diltiazem and verapamil block conduction at AV node
and hence they have similar antiarrhythmic uses.
Side effects of Amiodarone ˆˆ However due to risk of severe conduction block IV
Potassium : Pulmonary fibrosis verapamil should never be given with IV beta blocker.

Answers with Explanations to Multiple Choice Questions

Channel : Corneal microdeposits
Blocker : Blue colored skin 15. Ans. (d)  Prolonged PR interval
Makes : Myocarditis (Ref: Goodman Gilman 12th E/P838)
Liver : Liver toxicity
ˆˆ The characteristic ECG change seen with digitalis is PR
Nerve : Neuropathy
And : Alpha receptor block causes hypotension prolongation due to AV block.
ˆˆ ST segment depression can be seen due to alteration in
Skin : Photosensitivity
Toxic : Thyroid (Hypothyroidism > Hyperthyroidism) ventricular repolarization.

16. Ans. (d)  Lignocaine

11. Ans. (a)  Tocainide (Ref: Goodman Gilman 12th E/P830)
(Ref: Goodman Gilman 12th E/P829) ˆˆ Lignocaine is not effective in atrial arrhythmia, as it
Class I antiarrhythmics blocks sodium channel in a closed state.
ˆˆ In atrium the action potential is short and the sodium
Ia Ib Ic channels are in closed state for a very short period of
time.
Procainamide Lidocaine Flecainide
Quinidine Mexiletine Propafenone 17. Ans. (c)  Administered by slow IV injection
Disopyramide Phenytoin Moricizine
(Ref: Goodman Gilman 12th E/P834)
Tocainide
ˆˆ Adenosine is an endogenous nucleoside that is readily
taken up by cells and immediately metabolized by
12. Ans. (d)  Amiodarone adenosine deaminase. Hence it has a very short half-
life of around 1–5 seconds and a bolus of 6-12 mg by
(Ref: CMDT 2015/P394) rapid IV route is required for clinical effect, as slow
Amiodarone being a class III drug itself causes torsades administration will result in complete uptake of drug by
and hence should be avoided. cells without any effect on heart.
177
 ˆˆ Dipyridamole is an adenosine reuptake inhibitor and hypothyroidism. However if it is given to patients living
hence to prevent toxicity dose of adenosine should be in endemic iodine deficiency region, the iodine is taken
Conceptual Review of Pharmacology

decreased by 50%. up by thyroid and accelerated production of thyroid

ˆˆ Adenosine is used for maintaining controlled hormones causes hyperthyroidism.
hypotension in surgeries and for diagnosis of coronary ˆˆ Since most patients live in euthyroid region, hypo­
artery disease. thyroidism is more common than hyperthyroidism.

18. Ans. (c)  Brdaycardia 23. Ans. (a)  Verapamil

(Ref: Goodman Gilman 12th E/P834) (Ref: Goodman Gilman 12th E/P830)

Side effects of Quinidine ˆˆ Verapamil is the drug of choice for treatment and
prophylaxis of SVT and for prophylaxis of PSVT.
ˆˆ Most common side effect seen is diarrhea, whereas
ˆˆ IN case PSVT is associated with bronchial asthma or
most specific side effect is cinnchonism, which is dose
COPD verapamil is drug of choice for treatment of PSVT.
dependent as it improves with decrease in dose.
ˆˆ High doses of quinidine can precipitate ventricular 24. Ans. (a)  Quinidine
tachycardia. Hypotension can be seen due to alpha
receptor blockade. (Ref: Goodman Gilman 12th E/P844)
ˆˆ Unlike other drugs of this class, quinidine can causes QT
Antiarrhythmics Causing Torsades
prolongation even at therapeutic and subtherapeutic
ˆˆ Class Ia
doses.
ˆˆ Class III
19. Ans. (c)  Amiodarone
25. Ans. (d)  Systemic lupus erythematosus
(Ref: Goodman Gilman 12th E/P837)
(Ref: Goodman Gilman 12th E/P834)
ˆˆ Apart from blocking potassium channels, amiodarone
also blocks sodium channels (in closed state), beta and 26. Ans. (c)  High output failure
alpha receptors and calcium channels.
ˆˆ This is responsible of myocardial depression, which is (Ref: Goodman Gilman 12th E/P838)
usually seen with IV administration. ˆˆ The use of digoxin as an antiarrhythmic drug is because
Answers with Explanations to Multiple Choice Questions

of its vagomimetic action, which decreases SA node

20. Ans. (b)  II automaticity, shortens atrial APD and blocks conduction
(Ref: Goodman Gilman 12th E/P829) at AV node.
ˆˆ Hence the use is limited as an adjunct for ventricular
Vaughan William’s classification of antiarrhythmic drugs
rate control in patients with atrial fibrillation and flutter.
Class I Class II Class III Class IV ˆˆ Though not routinely indicated in PSVT, digoxin by
blocking AV node can be helpful.
Sodium Beta blockers Potassium Calcium
ˆˆ Since it is a positive inotrope, it has no role in high output
channel channel channel
blockers blockers blockers cardiac failure.

27. Ans. (c)  Verapamil

21. Ans. (a)  Irreversible microdeposits on cornea
(Ref: Goodman Gilman 12th E/P831)
(Ref: Goodman Gilman 12th E/P837)
ˆˆ All calcium channel blockers are racemic mixture of
ˆˆ Whorl like corneal microdeposits (corneal verticillata) enantiomers, except nifedipine and diltiazem.
associated with amiodarone are usually asymptomatic ˆˆ L-verapamil is more potent and undergoes more
and reversible on dose decrease or discontinuation of first pass metabolism than D-verapamil. Hence IV
drug.
verapamil delivers a higher amount of L-verapamil, that
ˆˆ The incidence is around 100% after six months of drug
significantly increases chances of toxicity.
use.

22. Ans. (a)  Amiodarone 28. Ans. (a)  Adenosine

(Ref: Goodman Gilman 12th E/P837) (Ref: Goodman Gilman 12th E/P834)
ˆˆ Amiodarone being an analog of thyroid hormone, has ˆˆ Adenosine is the drug of choice for treatment of PSVT.
iodine which can cause thyroid related disorders. ˆˆ Asit causes bronchoconstriction, in patients of COPD
ˆˆ If it is given to patients living in euthyroid region, and bronchial asthma, verapamil becomes the drug of
iodine inhibits release of thyroid hormones and causes choice for treatment of PSVT.
178
29. Ans. (b)  Amiodarone ˆˆ NSAID decrease Pg synthesis and hence inhibit Pg

Cardiovascular System
induced Cl loss and block of Vasopressin, which results
(Ref: Goodman Gilman 12th E/P837) in fluid retention and edema.
ˆˆ Cyclosporine can cause nephrotoxicity, which leads to
Pharmacokinetics of Amiodarone
retention of solute and water followed by edema.
ˆˆ The average half-life of amiodarone is around 53 days
and hence is the longest acting antiarrhythmic. 38. Ans. (a)  Hyperkalemia
ˆˆ It has high lipid solubility, which is responsible for its
high volume of distribution (5000 liters) and hence (Ref: Goodman and Gilman 12th E/P 803)
a loading dose of 800-1600 mg/day is given for many Digitalis toxicity can be precipitated by
weeks to achieve steady state concentration. For same ˆˆ Renal failure
reason its concentration is 20 times more in heart and ˆˆ Myocardial ischemia
300 times more in fat as compared to plasma. ˆˆ Hypokalemia
ˆˆ Hypercalcemia
30. Ans. (c)  Quinidine ˆˆ Hypomagnesemia
(Ref: Goodman Gilman 12th E/P844) ˆˆ Drugs
ƒƒ Diuretics
ˆˆ Quinidine being a class Ia drug blocks both sodium and
ƒƒ Quinidine
potassium channel.
ƒƒ Verapamil
ˆˆ Hence it can decrease slope of phase 0 as well as prolong
ƒƒ Flecainide
the action potential duration.
ƒƒ Propafenone
31. Ans. (d)  Verapamil ƒƒ Amiodarone

(Ref: Goodman Gilman 12th E/P831) 39. Ans. (a)  Hepatic disease
(Ref: Goodman and Gilman 12th E/P 803)
32. Ans. (c)  Class 3
(Ref: Goodman Gilman 12th E/P829) 40. Ans. (a)  Neutral endopeptidase
(Ref: Goodman and Gilman 12th E/P 696)
33. Ans. (a)  I
ˆˆ BNP is metabolized by neutral endopeptidase.
(Ref: Goodman Gilman 12th E/P829) ˆˆ Omapatrilat is a vasopeptidase inhibitor that inhibits

Answers with Explanations to Multiple Choice Questions

both ACE and neutral endopeptidase.
34. Ans. (a)  Amiodarone
(Ref: Goodman Gilman 12th E/P834) 41. Ans. (a)  Administration of quinidine
ˆˆ Amiodarone is an analog of thyroid hormone and it has (Ref: Goodman and Gilman 12th E/P 803)
iodine which can cause thyroid related disorders.
ˆˆ If it is given to patients living in euthyroid region, iodine 42. Ans. (a)  Potassium
inhibits release of thyroid hormones and causes hypo-
thyroidism. However if it is given to patients living in en- (Ref: Goodman and Gilman 12th E/P 804)
demic iodine deficiency region, the iodine is taken up by
thyroid and accelerated production of thyroid hormones Treatment of Digitalis Toxicity
causes hyperthyroidism. ˆˆ Lidocaine is the drug of choice for digitalis induced ven-
ˆˆ Since most patients live in euthyroid region, hypothy- tricular tachyarrhythmias. Other alternatives are phe-
roidism is more common than hyperthyroidism. nytoin and MgSO4.
ˆˆ Digiband is an anti-digoxin antibody reserved for
35. Ans. (d)  Verapamil treatment of life threatening arrhythmias induced by
(Ref: Goodman Gilman 12th E/P831) digoxin.
ˆˆ Potassium can be given for benign arrhythmias like atri-
36. Ans. (c)  Tocainide al, AV junctional and ventricular ectopic rhythms, even if
serum potassium levels are normal. Potassium dephos-
(Ref: Goodman Gilman 12th E/P829) phorylates Na/K ATPase and limits digitalis action. Po-
tassium is contraindicated in case of AV block, as it can
37. Ans. (b)  Digoxin
be worsened.
(Ref: Goodman and Gilman 12th E/P 803-04) ˆˆ Cardioversion can be problematic as it can itself induce

ˆˆ Digoxin doesn’t cause edema, rather is used for arrhythmia in digitalis toxicity.
treatment of cardiogenic edema.
43. Ans. (d)  Potassium
ˆˆ Estrogen stimulates endothelial NO production, which
causes vasodilation and edema. (Ref: Goodman and Gilman 12th E/P 804)
179
 44. Ans. (d)  Prolonged PR interval 50. Ans. (d)  Trimetazidine
Conceptual Review of Pharmacology

(Ref: Goodman and Gilman 12th E/P 804) (Ref: Goodman and Gilman 12th E/P 791)
ECG Changes with Digoxin
51. Ans. (c)  It can be administered orally
ECG changes Cause
PR prolongation Refractoriness at AV node (Ref: Goodman and Gilman 12th E/P 696)
QT shortening Shortening of action potential ˆˆ Nesiritide is a BNP analogue that has a short half-
duration life, as it is rapidly metabolized by an enzyme neutral
T wave inversion Accelerated repolarization of endopeptidase. Since it is a peptide it is given by IV
ST segment depression inner layers of myocardium route for treatment of pulmonary edema associated
with acute CHF to patients who are still symptomatic
45. Ans. (b)  Potassium channel opener with diuretics and nitrates.
(Ref: Harrison 19th E/P1510) ˆˆ It causes vasodilatation along with natriuresis and
ˆˆ Levosimendan apart from blocking PDE-3, also produces diuresis.
inotropic effect and vasodilatation by sensitizing
myocardium to calcium ions and opening potassium 52. Ans. (a)  Glomerular filtration
channels respectively. (Ref: Goodman and Gilman 12th E/P 803)
ˆˆ Though not approved by FDA, it is approved by many
ˆˆ The primary rout of excretion of digoxin is renal in un-
countries for treatment of acute CHF not responding to
other inotropes. changed form.
ˆˆ Thus renal failure can precipitate digitalis toxicity.
46. Ans. (c)  36 hours
53. Ans. (c)  Losartan
(Ref: Goodman and Gilman 12th E/P 803)
ˆˆ Digoxin has a half-life of 36-48 hours. Though both are (Ref: Goodman and Gilman 12th E/P 791)
in options, 36 is a better answer as it is mostly lower in
the limit for young patients with normal renal functions. 54. Ans. (b)  Furosemide

47. Ans. (c)  Digoxin antibody (Ref: Goodman and Gilman 12th E/P 790)
ˆˆ Loop diuretics are the first line drug for treatment of
(Ref: Goodman and Gilman 12th E/P 804)
Answers with Explanations to Multiple Choice Questions

pulmonary edema, due to their high ceiling effect and

ˆˆ Digiband, an anti-digoxin antibody is the most effective
ability to rapidly control volume overload.
drug and hence reserved for treatment of life threatening
ˆˆ Thiazides are less effective but can be combined to loops
arrhythmias induced by digoxin.
in case of inadequate response.
ˆˆ The dose of digiband is calculated based on the total
ˆˆ Potassium sparing diuretics are combined to combat
digoxin dose administered.
hypokalemia and refractory edema.
48. Ans. (c)  Digoxin
55. Ans. (c)  Dobutamine
(Ref: Goodman and Gilman 12th E/P 791)
(Ref: Goodman and Gilman 12th E/P 791)
Drugs inhibiting cardiac remodeling and delaying
mortality in CHF ˆˆ Dobutamine is the inotrope of choice for acute CHF, but
not used for long-term management.
Mnemonics ˆˆ Drugs decreasing cardiac remodelling like ACEI/ARB,
beta blockers, spironolactone, ivabridine and IDN +
SHIBA
Hydralazine is used on long-term basis to decrease
S : Spironolactone
mortality.When these drugs are ineffective the patient is
H : Hydralazine + IDN
I : Ivabridine then maintained on digoxin.
B : Beta blockers
56. Ans. (a)  Adrenaline
A : ACEI/ARB
(Ref: Goodman and Gilman 12th E/P 791)

49. Ans. (d)  Milrinone

57. Ans. (c)  Treat digoxintoxicity
(Ref: Goodman and Gilman 12th E/P 805)
(Ref: Goodman and Gilman 12th E/P 804)
ˆˆ In right sided heart failure milrinone has positive
inotropic effect, as well as it decreases systemic 58. Ans. (d)  All of the above
congestion by venodilation.
ˆˆ Hence it is the inotrope of choice. (Ref: Goodman and Gilman 12th E/P 804)
180
 Side effects of Digitalis 65. Ans. (b)  Guanylyl cyclase

Cardiovascular System
ˆˆ GIT upset (nausea, vomiting and diarrhea) – It is the (Ref: Goodman Gilman 13th E/P520)
earliest and most common side effect associated.
ˆˆ Sodium nitroprusside is metabolized into nitric oxide,
ˆˆ Arrhythmias – Ventricular bigeminy is most common
which activates guanylyl cyclase and increases cyclic
and atrial tachycardia with variable AV block is most GMP.
specific arrhythmia. ˆˆ Cyclic GMP activates protein kinase G which dephos-
ˆˆ Xanthopsia (yellow vision) phorylates MLCP (Myosin Light Chain Phosphorylase)
ˆˆ Gynecomastia and relaxes the smooth muscles of blood vessels.
ˆˆ Hallucinations ˆˆ Other drugs acting by similar mechanism are nitrates,
hydralazine, riociguat and cinaciguat.
ˆˆ Hyperkalemia.
ˆˆ Nitrates and hydralazine are also metabolized into nitric
oxide and then they act by same mechanism.
59. Ans. (b)  Captopril
ˆˆ Riociguat and cinaciguat are direct stimulators of
(Ref: Goodman and Gilman 12th E/P 798) guanylyl cyclase.
ˆˆ Captopril is an ACE inhibitor that is a mixed dilator and
66. Ans. (b)  Decreases preload
hence decreases both preload and after load.
(Ref: Goodman Gilman 13th E/P493)
60. Ans. (a)  ACE inhibitors ˆˆ Dilatation of coronary arteries increases coronary blood
(Ref: Goodman and Gilman 12th E/P 797) flow and dilation of systemic veins decrease the preload
on heart.
ˆˆ Incase of LVH seen after CHF, the first class of drug ˆˆ A decrease in cardiac preload significantly decreases
started are ACEI or ARB to decrease mortality by the wall tension and oxygen demand of myocardium is
inhibiting cardiac mortality. the most important mechanism for beneficial effect in
ˆˆ After ACEI/ARB, beta blockers are started. classical angina as well as chronic CHF.
ˆˆ Coronary vasodilation is the most important mechanism
61. Ans. (c)  Carvedilol in variant angina.
(Ref: Goodman and Gilman 12th E/P 801) 67. Ans. (a)  Endothelium independent coronary vasodilation
Beta Blockers Used in CHF to Decrease (Ref: Goodman Gilman 12th E/P749)

Answers with Explanations to Multiple Choice Questions

Mortality ˆˆ In Prinz metal angina which is caused by contraction
ˆˆ Carvedilol – Maximum decrease in mortality of coronary artery; endothelium independent coronary
ˆˆ Metoprolol (long acting formulation) vasodilation is primary mechanism.
ˆˆ In case of stable angina the primary mechanism is a
ˆˆ Bisoprolol
decrease in preload, which decreases cardiac contraction
62. Ans. (d)  Decreased HR and oxygen demand; hence in this case answer would
have been b.
(Ref: Goodman and Gilman 12th E/P 804)
ˆˆ Digoxin is a positive inotropic drug and hence increases 68. Ans. (a)  Atenolol
the force of contraction thereby shortening systole, (Ref: CMDT 2018/P826)
which increases the duration of diastole and filling
ˆˆ Three drugs commonly used in pregnancy induced
period.
hypertension are
ˆˆ Becauseof vagomimetic and sympatholytic effect the ƒƒ Methyldopa
HR decreases. ƒƒ Labetalol
ƒƒ Nifedipine
63. Ans. (b)  AV node ˆˆ Hydralazine is used for treatment of hypertensive
emergency in pregnancy.
(Ref: Goodman and Gilman 12th E/P 804)
ˆˆ Atenolol is avoided in pregnancy due to concerns about
fetal growth retardation.
64. Ans. (b)  Bradycardia with AV block
(Ref: Goodman Gilman 13th E/P214) 69. Ans. (c)  Telmesartan

ˆˆ Beta blockers and calcium channel blockers like (Ref: Michael Schupp, Jürgen, JankeRonald, Clasen.
verapamil block both SA and AV node. Thus if both are Angiotensin Type 1
combined, it will result in bradycardia and AV block. Receptor Blockers Induce Peroxisome Proliferator–Activated
ˆˆ This is the reason why beta blockers should not be Receptor-Activity.
combined with verapamil. Circulation 2004;109: 2054-2057.)
181
 ˆˆ Some ARBs can stimulate PPAR-γ receptors and increase 78. Ans. (c)  Thiazide diuretics
insulin sensitivity.
Conceptual Review of Pharmacology

ˆˆ This effect with ARBs is directly proportional to their (Ref: Goodman Gilman 12th E/P770)
ˆˆ Thiazides are used for mild to moderate hypertension.
lipid solubility, and based upon it their order PPAR-γ
agonist activity is telmisartan > Irbesartan > Losartan. ˆˆ Loops are indicated in hypertensive emergency with

ˆˆ ACE inhibitors also increase insulin sensitivity but via

renal failure.
bradykinin pathway. ˆˆ Potassium sparing diuretics are used to prevent hypo­
kalemia. Spironolactone is drug of choice in resistant
70. Ans. (b)  Beta blockers hypertension.

(Ref: CMDT 2017/P449) 79. Ans. (b)  Oxyphedrine

Bradykinin increased by ACE inhibitors can cause nasal
(Ref: Goodman Gilman 12th E/P770)
congestion and rhinitis.
ˆˆ Oxyphedrine causes coronary vasodilation along with
71. Ans. (b)  Losartan positive inotropic effect without an increase in oxygen
demand or worsening of angina.
(Ref: Goodman Gilman 12th E/P791) ˆˆ Dipyridamole can cause coronary steal phenomenon
and worsen angina.
72. Ans. (c)  Minoxidil ˆˆ Thyroxine can increase the oxygen demand and
(Ref: Goodman Gilman 12th E/P733) sumatriptan can cause coronary vasoconstriction.

80. Ans. (b)  Omission of prior diuretic dose decrease the

73. Ans. (b)  Enalapril
risk of postural hypotension
(Ref: Goodman Gilman 12th E/P736)
(Ref: Goodman and Gilman 12th E/P 736)
ˆˆ ACEIs can cause hypotension which can be augmented
74. Ans. (b)  Labetalol
by diuretics and if not given the chances of hypotension
(Ref: Goodman Gilman 12th E/P801) are lesser.
ˆˆ According to current OBG guidelines the drug of choice ˆˆ They inhibit conversion of AT-I to AT-II.
for hypertension in pregnancy is labetalol. ˆˆ Enalapril has a half-life of 1.3 hours, but its active
metabolite enalaprilat has a half-life of 11 hours because
Answers with Explanations to Multiple Choice Questions

75. Ans. (b)  α-methyl dopa of higher affinity for ACE that causes slow dissociation.
Lisinopril is an analog of enalaprilat and hence has a
(Ref: Goodman Gilman 12th E/P773) longer half-life of 12 hours as compared to enalapril.
ˆˆ According to older guidelines α-methyl dopa is the drug ˆˆ ACEIs are the drug of choice for treatment of DM with
of choice for pregnancy induced hypertension. hypertension, where they delay the progression of ne-
ˆˆ In newer OBG guidelines, oral labetalol is the drug phropathy as well as retinopathy.
of choice for pregnancy induced hypertension and
IV labetalol is the drug of choice for hypertensive 81. Ans. (d)  Renal colic
emergency in pregnancy. (Ref: Goodman Gilman 12th E/P753-54)
Uses of Nitrates
76. Ans. (b)  Thrombolytics
ˆˆ Angina
(Ref: CMDT 2016/P370) ˆˆ MI
ˆˆ This is a case of acute myocardial infarction with ST ˆˆ Esophageal and biliary spasm
elevation in the ECG. ˆˆ Cyanide toxicity (Nitrites preferred)
ˆˆ For such a case thrombolysis or PCI is indicated within ˆˆ CHF (IDN + Hydralazine)
12 hours of symptom onset. In this case since it has been
one day, thrombolysis is contraindicated. 82. Ans. (b)  Thrombolytic

77. Ans. (a)  Enalapril (Ref: CMDT 2016/P364)

ˆˆ In case of NSTEMI and unstable angina thrombolysis is
(Ref: Goodman and Gilman 12th E/P 736) absolutely contraindicated.
ˆˆ RAS inhibitors like ACEIs, ARBs and DRIs are absolutely
83. Ans. (d)  L-dopa
contraindicated in pregnancy.
ˆˆ The teratogenic effects seen are (Ref: Goodman Gilman 12th E/P616)
1st trimester: CVS and CNS defects ˆˆ Levodopa in periphery is metabolized to dopamine,
2nd and 3rd trimester: Renal defects which causes orthostatic hypotension.
182
 ˆˆ NSAIDS can decrease prostaglandin synthesis and cause 90. Ans. (a)  Amiloride, (d) Spironolactone

Cardiovascular System
hypertension.
ˆˆ Erythropoetin increases blood viscousity and cause hy- (Ref: Goodman Gilman 12th E/P736)
pertension. ˆˆ Potassium sparing diuretics are contraindicated with
ˆˆ Cyclosporine also causes hypertension, though ACEIs due to risk of hyperkalemia. In the options both
mechanism is not clear. amiloride and spironolactone are potassium sparing
diretics.
84. Ans. (a)  Juxtaglomerulus apparatus
91. Ans. (a)  Enalapril
(Ref: Goodman and Gilman 12th E/P 722, 724)
(Ref: Goodman Gilman 12th E/P736)
85. Ans. (b)  Beta blockers
92. Ans. (d)  Clonidine
(Ref: KDT 7th E/P563)
(Ref: Goodman Gilman 12th E/P736)
86. Ans. (a)  Hypotension Factors and drugs affecting renin
(Ref: Goodman and Gilman 12th E/P 736) Renin increased Renin decreased
ATP Prostaglandins
Mnemonics Adenosine Loop diuretics
Side effects of ACEIs – ACE INH NSAIDS Beta blockers
A : Angioedema ACEIs/ARBs/DRIs Central sympatholytics
C : Cough (e.g. clonidine)
E : Electrolyte imbalance (Hyperkalemia)
I : Itch caused by rash
93. Ans. (a)  Hyperkalemia
N : Neutropenia
H : Hypotension (Ref: Goodman Gilman 12th E/P736)

94. Ans. (b)  It can cause severe hypoglycemia

87. Ans. (d)  Nitroglycerine
(Ref: Goodman Gilman 12th E/P783,1248)

Answers with Explanations to Multiple Choice Questions

(Ref: Goodman Gilman 13th E/P491)
ˆˆ Diazoxide is a potassium channel opener that inhibits
Arterial dilators: Vasodilators: Mixed dilators: insulin release and is drug of choice for treatment of
Decrease afterload Decrease Decrease both insulinoma. Since it decreases insulin release it can
preload preload and cause hyperglycemia.
afterload ˆˆ By opening of potassium channels in blood vessels it can
cause vasodilatation and was earlier used for treatment
Calcium channel Nitrates Nitroprusside
of hypertensive emergency.
blockers
Minoxidil ACE Inhibitors
95. Ans. (b)  Perindopril
Hydralazine ARBs
Fenoldopam DRIs (Ref: Goodman Gilman 12th E/P735)
Diazoxide Alpha blockers
ˆˆ ACEIs decrease proteinuria and the progression of
nephropathy and retinopathy associated with DM.
88. Ans. (c)  Xylocaine
96. Ans. (a)  Pregnancy induced hypertension
(Ref: CMDT 2016 E/P375)
ˆˆ Earlierlidocaine was prophylactically given to prevent (Ref: Goodman Gilman 12th E/P773)
ventricular arrhythmia in a patient of MI. But now
prophylactic use has been discontinued due to no 97. Ans. (d)  Lisinopril
reduction in mortality. (Ref: Goodman Gilman 12th E/P736)
ˆˆ Currently to all patients of ventricular arrhythmia in
ˆˆ All ACEIs are prodrugs except captopril and lisinopril.
MI, lidocaine is only given for treatment and is the
drug of choice. Other alternatives are amiodarone and
98. Ans. (c)  Hypotension and tachycardia
procainamide.
(Ref: Goodman Gilman 12th E/P749)
89. Ans. (b)  Antianginal
ˆˆ Hypotension and bradycardia can be seen with sublingual
Ref: (Goodman Gilman 12th E/P752) nitroglycerine due to activation of Bezold-Jarisch reflex.
183
 ˆˆ Vasodilatation decreases preload on the heart. Methe- 106. Ans. (b)  Alpha receptor blocker
moglobinemia can also be seen.
Conceptual Review of Pharmacology

(Ref: Goodman Gilman 12th E/P772)

ˆˆ Tachycardia due to vasodilatation can be seen only a
high doses of nitrates. ˆˆ Alpha blockers can cause postural hypotension in
around 50% patients.
99. Ans. (c)  Vasodilation ˆˆ ACE inhibitors can also cause postural hypotension but
incidence is lesser than alpha blockers.
(Ref: Goodman Gilman 12th E/P728)
ˆˆ Beta blockers don’t cause postural hypotension.
Effects of Angiotensin II ˆˆ Arterial dilators don’t cause postural hypotension as
ˆˆ Vasoconstriction venodilation is essential for postural hypotension.
ˆˆ Constriction of afferent and efferent arterioles of glomerulus
ˆˆ Increase in release of aldosterone, vasopressin and cat- 107. Ans. (a)  Increase intotal coronary blood flow
echolamines
(Ref: Goodman Gilman 12th E/P749)
ˆˆ Thirst
ˆˆ Anorexia ˆˆ In classical angina the main mechanism of benefit is
venodilatation, that decreases the preload and oxygen
100. Ans. (d)  Nifedipine demand by the myocardium.
ˆˆ In variant angina the main mechanism is coronary va-
(Ref: Goodman Gilman 12th E/P777)
sodilatation.
101. Ans. (d)  Causes hyperuricemia
108. Ans. (c)  Intramuscular
(Ref: Goodman Gilman 12th E/P736)
ˆˆ Losartan is a competitive inhibitor of angiotensin
(Ref: Goodman Gilman 12th E/P753)
receptors AT1>AT2.
Routes of Administration for Nitroglycerine
ˆˆ It is metabolized into an active metabolite called as EXP
3174. Losartan has a half-life of 2.5 hours, whereas EXP ˆˆ Sublingual
3174 has a half-life of 9 hours. ˆˆ Oral (Sustained release preparation)
ˆˆ Cough and angioedema are rarely seen with ARBs. ˆˆ Transdermal
ˆˆ Losartan has a uricosuric effect and causes hypouricemia. ˆˆ Buccal spray
ˆˆ Intravenous
102. Ans. (a)  Dipyridamole
Answers with Explanations to Multiple Choice Questions

109. Ans. (c)  Minoxidil

(Ref: KDT 7th E/P553)
ˆˆ Dipyridamoledilates the blood vessels in non-ischemic (Ref: Goodman Gilman 12th E/P781)
area and diverts the blood from ischemic area known as ˆˆ Minoxidil can cause hirsutism and hence is not used in
coronary steal phenomenon. females.
ˆˆ Topical minoxidil is used for treatment of androgenic
103. Ans. (a)  Atenolol
alopecia.
(Ref: Goodman Gilman 12th E/P772)
ˆˆ Beta blockers are given only after alpha blockers in 110. Ans. (b)  Methyl dopa
pheochromocytoma. (Ref: Goodman Gilman 12th E/P773)
ˆˆ If alone beta blocker is given then inhibition of beta-2
ˆˆ Methyl dopa is a prodrug converted into alpha methyl
mediated vasodilatation can cause unopposed alpha-1
norepinephrine in CNS.
mediaded vasoconstriction and worsen pheochromocy-
toma.
111. Ans. (d)  Prazosin
104. Ans. (b)  Hypokalemia (Ref: Goodman Gilman 12th E/P773)
(Ref: Goodman Gilman 12th E/P736) ˆˆ Prazosin causes vasodilatation by blocking alpha 1
receptors in the peripheral blood vessels.
105. Ans. (b)  Verapamil
112. Ans. (b)  Guanethidine
(Ref: Goodman Gilman 12th E/P736)
(Ref: Goodman Gilman 12th E/P775)
ˆˆ Enalapril cannot be used as ACEIs are contraindicated in
bilateral renal artery stenosis. ˆˆ Guanethidine and guanadrel can cause postural
ˆˆ Beta blockers and thiazides are contraindicated in DM, hypotension due to sympathetic blockade even on
as betablockers can cause hypoglycemic unawareness chronic use.
and thiazides cause hyperglycemia. ˆˆ Alpha-1 blockers like prazosin and ACEIs cause postural
ˆˆ Hence verapamil is the best drug in the options for the hypotension only during initial doses.
patients. ˆˆ Beta blockers don’t cause postural hypotension.
184
113. Ans. (d)  Nitroprusside ˆˆ Isoproteronol in ischemic heart disease can increase

Cardiovascular System
oxygen demand by increasing force and rate of heart
(Ref: Goodman Gilman 12th E/P783) contraction. Hence it should be avoided.
ˆˆ Nitroprusside is a very short and fast acting drug as
the effect is seen within 30 seconds and terminates 3 122. Ans. (c)  Enalapril
minutes after infusion is stopped. (Ref: Goodman Gilman 12th E/P736)
114. Ans. (c)  Pentaerythritol tetranitrate 123. Ans. (a)  Methyl dopa
(Ref: KDT 7th E/P544) (Ref: Goodman Gilman 12th E/P773)

115. Ans. (b)  Metoprolol 124. Ans. (a)  Nicorandil

(Ref: Goodman Gilman 12th E/P761) (Ref: Harrison 19th E/P1590)
ˆˆ Beta blockers are not effective in angina because of vaso-
125. Ans. (b)  Inhalation
dilatation, rather decrease oxygen demand on long-term
use and decrease mortality. (Ref: Katzung 11th E/P195)
ˆˆ Amyl nitrite can be given by inhalational route for an
116. Ans. (b)  Prazosin acute attack of angina. Because of pungent odor it is not
(Ref: Goodman Gilman 12th E/P773) used nowadays.
ˆˆ Sodium nitrite is used for treatment of cyanide toxicity.
ˆˆ Alpha-1 antagonist like prazosin have favourable effect
on lipid profile i.e. increase HDL and decrease LDL. 126. Ans. (d)  Bilateral renal artery stenosis
They don’t have any effect on blood glucose level.
(Ref: Goodman Gilman 12th E/P736)
117. Ans. (b)  Indipamide, (c) Sublingual nifedipine Absolute contraindications of ACEIs
ˆˆ Bilateral renal artery stenosis
(Ref: KDT 7th E/P573)
ˆˆ Single kidney with renal artery stenosis
ˆˆ Indipamide is used for treatment of mild to moderate ˆˆ Pregnancy
hypertension but not hypertensive emergency. ˆˆ Along with Potassium sparing diuretics
ˆˆ Sublingual nifedipine is used for treatment of
hypertensive urgency but not emergency. 127. Ans. (a)  Methyl dopa

Answers with Explanations to Multiple Choice Questions

118. Ans. (a)  Subarachnoid hemorrhage (Ref: Goodman Gilman 12th E/P773)

(Ref: Goodman Gilman 12th E/P758) 128. Ans. (a)  Bradykinin

(Ref: Goodman Gilman 12th E/P735)
119. Ans. (c)  Congestive heart failure
ˆˆ Cough and angioedema caused by ACEIs is primarily
(Ref: Goodman Gilman 12th E/P758-760) due to bradykinin. Other contributing factors are
ˆˆ CCB are used for long-term prevention of angina. substance P and prostaglandins.
Verapamil and diltiazem can be used as monotherapyin
129. Ans. (a)  Bradykinin
stable angina, whereas DHPs are always used with beta
blockers to prevent reflex tachycardia. DHPs are also (Ref: Goodman Gilman 12th E/P735)
used in variant angina and are drugs of choice. ˆˆ Bradykinin is metabolized by kininase which is similar
ˆˆ Vaerapamil>Diltiazem is used in PSVT and SVT. to ACE and hence ACEIs also inhibit kininase and
ˆˆ DHPs are commonly used first line drugs in hypertension. metabolism of bradykinin.
120. Ans. (a)  Guanylatecyclase 130. Ans. (c)  ACE inhibitors
(Ref: Goodman Gilman 12th E/P782) (Ref: Goodman Gilman 12th E/P735)
ˆˆ Vasodilators stimulating guanylatecyclase by increasing
ˆˆ ACEIs are drug of choice for treatment of hypertension
NO are nitrates, nitroprusside and hydralazine.
associated with DM and CKD.
ˆˆ Direct stimulators of guanylatecyclase are recent drugs
like riociguat and cinaciguat.
131. Ans. (a)  Clonidine
121. Ans. (c)  Isoproterenol (Ref: Goodman Gilman 12th E/P774)
(Ref: Goodman Gilman 12th E/P760) ˆˆ Clonidine is a central sympatholytic that decreases NE
ˆˆ Beta blockers and ACEIs are used in MI to decrease release.
mortality. ˆˆ NE being a CNS stimulant, its decrease can result in
ˆˆ Streptokinase is used for thrombolysis in STEMI. sedation.
185
 132. Ans. (b)  Calcium gluconate 139. Ans. (a)  Amiloride
Conceptual Review of Pharmacology

(Ref: Goodman Gilman 12th E/P759) (Ref: Goodman Gilman 12th E/P736)

133. Ans. (d)  GTN 140. Ans. (b)  Angiotensin converting enzyme inhibitor
(Ref: CMDT 2016/P363) (Ref: Goodman Gilman 12th E/P736)
ˆˆ Drug of choice for an acute attack of Prinzmetal
angina is nitroglycerine. 141. Ans. (a)  Headache
ˆˆ Long acting nitrates and DHPs can be used for pro-
phylaxis. (Ref: Goodman Gilman 12th E/P759)

134. Ans. (a)  Reducing coronary spasm 142. Ans. (a)  Postural hypotension
(Ref: CMDT 2016/P363) (Ref: Goodman Gilman 12th E/P739)

135. Ans. (a)  Hypotension 143. Ans. (c)  Pentoxifylline

(Ref: Goodman Gilman 12th E/P736) (Ref: Goodman Gilman 12th E/P764)
ˆˆ Hypotension with ARBs is much more common than
Drugs used in peripheral vascular disease
cough and angioedema, which are rarely seen as
compared to ACEIs. Drugs Mechanism of action
Pentoxifylline Rheological drug that acts by
136. Ans. (d)  Nimodipine increasing deformability of RBCs
(Ref: Goodman Gilman 12th E/P758) Cilostazole PDE-3 inhibitor

137. Ans. (c)  Sodium nitroprusside 144. Ans. (a)  Hydralazine

(Ref: Goodman Gilman 12th E/P782) (Ref: Goodman Gilman 12th E/P780)
ˆˆ In the given options only nitroprusside by IV route is
used in hypertensive emergency. 145. Ans. (a)  Enalapril
ˆˆ Clonidine and nifedipine are used in hypertensive (Ref: Goodman Gilman 12th E/P736)
Answers with Explanations to Multiple Choice Questions

urgency but not emergency.

ˆˆ α-methyl dopa is primarily used in pregnancy induced 146. Ans. (d)  Headache
hypertension.
(Ref: Goodman Gilman 12th E/P739)
138. Ans. (a)  Atenolol
147. Ans. (a)  ACE inhibitors
(Ref: Goodman Gilman 12th E/P772)
(Ref: Goodman Gilman 12th E/P736)
Drug of Choice for Hypertension Associated
with Comorbidities ˆˆ ACE inhibitors can worsen kidney function in
renovascular hypertension by dilating the efferent
Associated comorbidity with hypertension Drugs preferred arterioles, that can cause a decrease in filtration pressure
DM ACEI/ARB in glomerulus.
CKD
Scleroderma 148. Ans. (d)  Isosorbide-5-mononitrate
Nephrotic syndrome (Ref: Goodman Gilman 12th E/P751)
Angina Beta blockers
ˆˆ Isosorbide-5 mononitrate has lesser first pass
Previous MI
metabolism and hence given by oral route.
Hyperthyroidism
ˆˆ IDN and NTG can be given by sublingual route.
Migraine
Anxiety with somatic manifestations 149. Ans. (a)  Propranolol
Essential tremor
Atrial fibrillation and flutter (Ref: Goodman Gilman 12th E/P761)
Preoperative hypertension
Osteoporosis Thiazides 150. Ans. (a)  Methyl dopa
Raynaud’s disease CCB (Ref: Goodman Gilman 12th E/P774)
Cyclosporine induced hypertension
BPH α1 blockers Antihypertensive Drugs Causing ED are
Dyslipidemia ˆˆ Beta blockers (Maxiumum)
186
 ˆˆ Thiazides 158. Ans. (d)  Peripheral decarboxylase

Cardiovascular System
ˆˆ Methyl dopa
(Ref: Goodman Gilman 12th E/P893-903)
151. Ans. (a)  Atenolol
Hypolipidemics Mechanism of Action
(Ref: Goodman Gilman 12th E/P772)
Drugs Mechanism of action
152. Ans. (a)  Congestive heart failure, (b) Angina pectoris
Statins Inhibit HMG-CoA reductase
(Ref: CMDT 2016/P358) Bile acid Deplete bile acid and result in decrease in
ˆˆ Ivabridine was first approved for treatment of angina. binding resins cholesterol and triglycerides
ˆˆ Recently in 2014 it has also been approved for CHF to Fibrates Stimulate PPAR alpha and increase LPL
decrease mortality. synthesis
ˆˆ So when the MCQ was asked, angina was the answer but
Niacin Inhibits hormone sensitive lipase
now both a and b are correct options.
Ezetimibe Inhibits NPC1L1 protein in small intestine
153. Ans. (b)  Atorvastatin 80 mg and inhibits cholesterol absorption

(Ref: CMDT 2017/P1263-64) Lomitapide Inhibits MTP

ˆˆ There is history of MI and hence in this case there is Icosapent Inhibits VLDL synthesis/secretion by liver
clinical atherosclerotic disease and hence high intensity Meopmersen Inhibits Apo-B100 synthesis
statin therapy is indicated. sodium
ˆˆ Among given options atorvastatin 80 mg is high intensity Evolocumab Anti PCSK-9 antibody
statin therapy.
Avasimibe Acyl CoA Cholesterol Acyl Transferase
ˆˆ Note: Moderate intensity statin can be used if patient is
(ACAT) inhibitor
above 75 years of age.
ˆˆ Hypertriglyceridemia above 150 association with CAD is
not defined. Triglycerides above 500 is treated to prevent 159. Ans. (a)  Increases HDL
pancreatitis. (Ref: Goodman Gilman 12th E/P900)
154. Ans. (a)  It causes insulin resistance
160. Ans. (b)  Nicotinic acid

Answers with Explanations to Multiple Choice Questions

(Ref: Goodman Gilman 12th E/P900)
(Ref: Goodman Gilman 12th E/P900)
ˆˆ Niacin causes insulin resistance and hence causes
severe hyperglycemia in patients of diabetes mellitus. 161. Ans. (b)  PPAR alpha agonist
ˆˆ Hence it should be avoided in patients of diabetes
mellitus. (Ref: Goodman Gilman 12th E/P901)

155. Ans. (b)  Fenofibrate 162. Ans. (a)  Bind to bile acid
(Ref: Goodman Gilman 12th E/P902) (Ref: Goodman Gilman 12th E/P898)

156. Ans. (c) Absorbed good on empty stomach and 163. Ans. (b)  Ezetimibe
absorption is delayed by fatty meals
(Ref: Goodman Gilman 12th E/P903)
(Ref: Goodman Gilman 12th E/P902)
ˆˆ Fibrates are better absorbed with food and lesser on 164. Ans. (c)  Atorvastatin
empty stomach.
(Ref: Goodman Gilman 12th E/P895)
ˆˆ They activate PPAR alpha and increase LPL synthesis.
ˆˆ Rash, urticarial, myalgia, impotence, alopecia, headache, ˆˆ Atorvastatin is primarily hypolipidemic associated with
anemia can be associated. pleiotropic effects, out of which one is antiaggregant
effect.
157. Ans. (d)  Fibrinogen levels are decreased by pravastatin
165. Ans. (c)  Statins
(Ref: 9KDT 7th E/P637)
(Ref: Goodman Gilman 12th E/894)
ˆˆ Simvastatin and lovastatin are lipid soluble drugs and
hence CNS accumulation is higher. The inverse is correct
166. Ans. (a)  Competitive inhibition of rate limiting step in
for pravastatin and fluvastatin.
cholesterol synthesis
ˆˆ Fibrinogen levels are decreased by pravastatin and not
increased. (Ref: Goodman Gilman 12th E/894)
187
 167. Ans. (c)  Indirect increase of LDL receptors synthesis ˆˆ Cisapride
ˆˆ Antipsychotics: Ziprasidone, Sertindole, Quitiapine,
Conceptual Review of Pharmacology

(Ref: Goodman Gilman 12th E/894) Haloperidol etc.

ˆˆ Statinsby inhibiting cholesterol synthesis, increase ˆˆ Antidepressants: Tricyclic antidepressants like
LDL receptor gene transcription. amitriptyline, SSRI like flluoxetine
ˆˆ More LDL receptors clear LDL from plasma to extract ˆˆ Antibiotics: Fluoroquinolones, Erythromycin
cholesterol. ˆˆ Antihistaminics: Astemizole, Terfenadine
ˆˆ Antifungals: Ketoconazole
168. Ans. (a)  Inhibit cholesterol absorption
ˆˆ Antimalarials: Chloroquine, Quinine, Halofantrine
(Ref: Goodman Gilman 12th E/903) ˆˆ Antivirals: Amantadine

169. Ans. (b)  Nicotinic acid 177. Ans. (a)  Amiodarone, (b) Sotalol, (c) Chlorpromazine,
(d) Cisapride
(Ref: Goodman Gilman 12th E/900)
(Ref: Goodman Gilman 12th E/P821)
170. Ans. (b)  Rosuvastatin
178. Ans. (b)  Labetalol, (c) Methyldopa (d) Sustained release
(Ref: Goodman Gilman 12th E/897)
nifedipine
ˆˆ The most effective LDL decreasing drugs are statins.
ˆˆ Rosuvastatin is more potent and longer acting than (Ref: CMDT 2018/P826)
atorvastatin and hence is a better answer. Three drugs commonly used in gestational hypertension
are
171. Ans. (a)  II
ˆˆ Methyldopa
(Ref: Rang and Dale 8th E/P287) ˆˆ Labetalol
ˆˆ Nifedipine
172. Ans. (d)  Stimulates lipoprotein lipase
179. Ans. (a)  Vincristine, (c) Amiodarone, (d) Paclitaxel
(Ref: Goodman Gilman 12th E/902)
(Ref: Goodman Gilman 12th E/P834, 1707)
173. Ans. (a)  ACE inhibitor and (c) Alpha blockers
180. Ans. (a)  Haloperidol, (c) Amiodarone, (d) Ebastine,
Answers with Explanations to Multiple Choice Questions

(Ref: Goodman Gilman 13th E/P209)

(e) Sotalol
ˆˆ Firstdose syncope and postural hypotension is seen
with drugs that can cause venodilation. (Ref: Harrison 19th E/P1496)
ˆˆ Drugs causing venodilation are nitrates, ACE inhibitors, Drugs that can Prolong QT Interval
alpha blockers and nitroprusside.
ˆˆ Antiarrhythmics

174. Ans. (a)  Amiodarone, (c) Propranolol, (e) Procainamide ƒƒ Class Ia

ƒƒ Class III
(Ref: Braunwald’s Cardiology /P801) ˆˆ Antimicrobials
ˆˆ In an acute attack of monomorphic ventricular ƒƒ Macrolides
tachycardia with stable hemodynamics the drugs that ƒƒ Fluoroquinolones
can be used are ƒƒ Cotrimoxazole
ƒƒ Amiodarone: Drug of choice
ƒƒ Ketoconazole and itraconazole
ƒƒ Lidocaine
ƒƒ Amantadine
ƒƒ Procainamide
ƒƒ Chloroquine
ˆˆ In hemodynamically unstable patients with
ƒƒ Clindamycin
hypotension, shock, angina or CHF these drugs are not
preferred and rather DC cardioversion is preferred. ˆˆ Pentamidine
ˆˆ Antihistaminics
175. Ans. (a)  Perindopril, (d) Ramipril, (e) Enalapril ƒƒ Terfenadine
ƒƒ Astemisole
(Ref: Goodman Gilman 12th E/P731)
ƒƒ Diphenhydramine

176. Ans. (a)  Amiodarone, (b) Cisapride, (e) Ketoconazole ƒƒ Hydroxyzine

ƒƒ Ebastine
(Ref: Goodman Gilman 12th E/P821) ˆˆ Antipsychotics
Drugs Causing QT Prolongation ƒƒ Typical – Haloperidol, Phenothiazines
ˆˆ Antiarrhythmics: Class Ia and Class III (Amiodarone) ƒƒ Atypical – Ziprasidone, sertindol and quitiapine
188
 ˆˆ TCA 190. Ans. (c)  Isoprenaline

Cardiovascular System
ˆˆ Cisapride
ˆˆ Methadone
(Ref: Paul Barsh’s Clinical Anesthesia/P545)
ˆˆ Fluoxetine ˆˆ Thecardiosuppressive effects of lignocaine toxicity like
bradycardia and hypotension can be reversed by cate-
181. Ans. (a)  Inhibition of calcium channel cholamines like isoprenaline. 
(Ref: Goodman Gilman 12th E/P831) 191. Ans. (c)  Norepinephrine

182. Ans. (b)  Propranolo, (c) Carvedilol, (e) Nebivolol (Ref: Peter Bryson’s comprehensive review of toxicology/P238)
ˆˆ Hypotension due to NE depletion is the most common
(Ref: Goodman Gilman 12th E/P758) side effect of bretylium, which can be treated by
norepinephrine.
183. Ans. (b)  Methyl dopa, (c) Clonidine, (e) Atenolol
192. Ans. (a)  Enalapril, (c) Angiotensin receptor blockers
(Ref: KDT 7th E/P564,65,66)
Antihpertensives causing rebound hypertension (Ref: Goodman Gilman 12th E/P736)
ˆˆ Clonidine
ˆˆ Beta blockers (On sudden withdrawal) 193. All
ˆˆ Methyl dopa (Mild)
(Ref: Goodman Gilman 12th E/P 842, 1847)
184. Ans. (b)  Bisoprolol, (c) Carvedilol
194. Ans. (a)  Hypokalemia, (c) Hypercalcemia
(Ref: Goodman Gilman 12th E/P801)
(Ref: Goodman Gilman 12th E/P 802-4)
Beta blockers with proven benefit in CHF are Digitalis toxicity can be precipitated by
ˆˆ Metoprolol ˆˆ Myocardial ischemia
ˆˆ Carvedilol ˆˆ Hypokalemia
ˆˆ Bisoprolol ˆˆ Hypercalcemia
ˆˆ Hypomagnesemia.
185. Ans. (a)  NO, (b) CO2, (c) Minoxidil, (d) ACE inhibitor
(Ref: Goodman Gilman 12th E/P735,747,781) 195. Ans. (b)  Systemic vasodilation, (c) Renal vasodilation,
(d) Reabsorption of Na in proximal tubules, (e) Water

Answers with Explanations to Multiple Choice Questions

186. Ans. (b)  HOCM, (d) Myocarditis reabsorption.

(Ref: Goodman Gilman 12th E/P803)

196. Ans. (c)  Niacin
ˆˆ Digoxin by increasing the force of contraction increases
left outflow tract obstruction in HOCM and hence is (Ref: Goodman Gilman 13th E/P613)
contraindicated. ˆˆ Niacin is the only hypolipidemic which can significantly
ˆˆ It has no role in myocarditis. decrease lipoprotein a levels. Hence is the answer in this
question.
187. Ans. None
197. Ans. (b)  Amlodipine
(Ref: Goodman Gilman 12th E/P 804)
(Ref: Goodman Gilman 12th E/P446)
ECG Changes with Digoxin
ˆˆ In old age hypertension (> 55 years age) the preferred
ECG changes Cause first line drugs are calcium channel blockers and
PR prolongation Refractoriness at AV node thiazides. Since thiazides can cause lithium toxicity
by decreasing renal clearance, it is not advised in this
QT shortening Shortening of action potential situation. Hence the best drug in this case is calcium
duration channel blocker amlodipine.
T wave inversion Accelerated repolarization of ˆˆ Drugs that can precipitate lithium toxicity are
ST segment depression inner layers of myocardium ƒƒ Diuretics: Thiazides > Potassium sparing diuretics
ƒƒ ACE Inhibitors: Maximum with renally cleared drug
like lisinopril
188. Ans. (a)  Hypertrichosis, (b) Hypotension
ƒƒ NSAIDS: Maximum with indomethacin
(Ref: Goodman Gilman 12th E/P 781) Note: Loop diuretics does not affect lithium clearance and
osmotic diuretics increases lithium clearance.
189. Ans. (a)  Nesiritide, (b) Digoxin, (c) Spironolactone,
(d) Losartan 198. Ans. (a)  Used with ARB for treatment of CHF
(Ref: Goodman Gilman 12th E/P 804) (Ref: CMDT 2018/P414)
189
 Sacubitril Drugs Inhibiting Cardiac Remodelling and
Delaying Mortality in Chronic CHF:
Conceptual Review of Pharmacology

ˆˆ It is a neutral endopeptidase (neprilysin) inhibitor

that increases the endogenous BNP and hence causes
vasodilatation along with natriuresis and diuresis.
ˆˆ It is approved by FDA in 2015 along with valsartan for
Mnemonics
use in chronic CHF to decrease mortality. SHIBA
S : Spironolactone
199. Ans. (a)  Evolocumab H : Hydralazine + IDN
I : Ivabridine
(Ref: CMDT 2018/P1276) B : Beta blockers
A : ACEI/ARB
PCSK-9 Inhibitors
ˆˆ Evolocumab
ˆˆ Alirocumab 206. Ans. (a)  Reduce LDL cholesterol
ˆˆ Bococizumab
(Ref: Goodman Gilman 12th E/P894)
200. Ans. (b)  Pravastatin The non hypolipidemic activities of statins called as
(Ref: Goodman Gilman 12th E/P894) pleiotropic effects are
ˆˆ Antiaggregant
ˆˆ All statins are contraindicated in children less than 8
ˆˆ Anticoagulant
years.
ˆˆ Anti-inflammatory (decreases CRP)
ˆˆ Only pravastatin is contraindicated in children less than
ˆˆ Vasodilatory (increases endothelial NO release)
10 years and hence can be used in a 8 year old child.
ˆˆ Atherosclerotic plaque stabilizing effect.
201. Ans. (d)  Statins (Any)
207. Ans. (c)  Amiodarone
(Ref: Goodman Gilman 12th E/P1246)
(Ref: Goodman Gilman 12th E/P837)
202. Ans. (d)  Hydrochlorthiazide
208. Ans. (c)  Atrial fibrillation
(Ref: Goodman Gilman 12th E/P688)
ˆˆ Propranolol cannot be used in this case as the patient (Ref: Goodman Gilman 12th E/P837)
has bronchial asthma and spironolactone cannot be ˆˆ Amiodarone increases cell refractoriness and hence is
Answers with Explanations to Multiple Choice Questions

used as there is hyperkalemia. rather used for rhythm control in atrial fibrillation.
ˆˆ Both amlodipine and hydrochlorthiazide can be ˆˆ It never causes atrial fibrillation.
used, but the latter is more preferred as it can cause
hypokalemia and blunt the hyperkalemia. 209. Ans. (a)  Aliskiren

203. Ans. (c)  Captopril (Ref: Goodman Gilman 12th E/P745)

(Ref: Goodman Gilman 12th E/P736) 210. Ans. (a)  Levosimendan

204. Ans. (b)  Hydralazine (Ref: Harrison 19th E/P1510)

(Ref: Goodman Gilman 12th E/P780) Mechanism of Action of Levosimendan

ˆˆ Hydralazine being an arterial dilator will cause reflex ˆˆ PDE-3 Inhibition
tachycardia and hence it is not a possibility here. ˆˆ Opens potassium channel
ˆˆ Clonidine being a central sympatholytic can cause
ˆˆ Sensitizes myocardial cells to calcium
bradycardia and so is the case with reserpine which
decreases NE synthesis. 211. Ans. (d)  Cholestyramine
ˆˆ Digoxin can also cause given symptoms as it has
parasympatholytic effect. (Ref: Goodman Gilman 12th E/P899)
ˆˆ Bile acid binding resins like cholestyramine can increase
205. Ans. (a)  Antiplatelet agents
triglycerides and hence are contraindicated in patients
(Ref: Goodman Gilman 12th E/P791) of hypertriglyceridemia.

190
212. Ans. (c)  Diabetic microalbuminuria 218. Ans. (b)  Spironolactone

Cardiovascular System
(Ref: Goodman Gilman 12th E/P (Ref: ACC/AHA guidelines 2017)
ˆˆ According to recent ACC/AHA guidelines aldosterone
213. Ans. (a)  Nimodipine antagonists can be used in patients only if
(Ref: Goodman Gilman 12th E/P758) ƒƒ GFR is > 30 mL/min
ƒƒ Serum creatinine is < 2.5 mg/dL
214. Ans. (a)  Corneal deposits ƒƒ Serum potassium is < 5 mEq/L
ˆˆ Since in this case serum creatinine is 2.5,
(Ref: Goodman Gilman 12th E/P837) spironolactone can not be used.

215. Ans. (d)  All of the above 219. Ans. (b)  Neutral endopeptidase inhibitor
(Ref: Goodman Gilman 12th E/P791) (Ref: CMDT 2018/P414)
Scubitril is a neutral endopeptidase or neprylisin inhibitor
216. Ans. (d)  Class IV
approved for treatment of chronic CHF in combination with
(Ref: Goodman Gilman 12th E/P829) angiotensin receptor blocker like valsartan.

217. Ans. (c)  Postural hypotension

(Ref: Goodman Gilman 12th E/P780)

Answers with Explanations to Multiple Choice Questions

191
   Practice Questions
Conceptual Review of Pharmacology

220. Lidocaine dose should be decreased in a patient with all ˆˆ Class Ia increases conduction at AV node due to
except parasympatholytic effect and hence shortens PR interval.
a. Shock ˆˆ Class Ib has no effect on conduction at AV node and PR
b. Liver failure interval.
c. Concomitant beta-blocker use 224. Which of the following is the most preferred class for
d. MI treatment of idiopathic ventricular tachycardia?
a. Class I b. Class II
Ans. (d)  MI c. Class III d. Class IV
(Ref: Goodman Gilman 12th E/P842)
Ans. (b)  Class II
Lidocaine dose should be decreased with
ˆˆ Heart failure: As volume of distribution decreases. (Ref: Harrison 19th E/P1496)
ˆˆ Liver failure ˆˆ Class II or beta blockers are the first line drugs for
ˆˆ Concomitant cispride or beta-blocker therapy idiopathic VT.
ˆˆ Prolonged infusions ˆˆ Class IV or CCB are the second line drugs.
Lidocaine dose should be increased in 225. A patient of atrial fibrillation was to be given a drug to
ˆˆ MI: As lidocaine binds to beta-1 acidic glycoprotein, control ventricular rate. Which of the following is the most
which is increased in MI. The free drug decreases and preferred drug?
hence for the same clinical effect dose needs to be a. Beta blocker b. Amiodarone
increased. c. Adenosine d. MgSO4
221. A maximum decrease in Vmax is caused by:
a. Procainamide b. Amiodarone Ans. (a)  Beta blocker
c. Lidocaine d. Flecainide (Ref: Harrison 19th E/P1496)
Ans. (d)  Flecainide 226. Pulmonary fibrosis associated with amiodarone is due to
depletion of
(Ref: Goodman Gilman 12th E/P829)
a. Macrophages b. Type I pneumocytes
ˆˆ Sincethe recovery from block is delayed maximum i.e. c. Type II pneumocytes d. Lymphocytes
>10 sec by Class Ia antiarrhythmic, they have maximum
delaying effect on Vmax or the rate of rise of action Ans. (c)  Type II pneumocytes
potential.
(Ref: Goodman Gilman 12th E/P837)
222. Which of the following is the most preferred drug for treatment
of atrial fibrillation associated with WPW syndrome? 227. Corneal vertcillata is associated with
a. Ibutilide b. Amiodarone a. Chloroquine b. Ethambutol
c. Lidocaine d. Procainamide c. Amiodarone d. Vigabatrin

Ans. (d)  Procainamide Ans. (c)  Amiodarone

(Ref: Goodman Gilman 12th E/P829)
(Ref: Goodman Gilman 12th E/P824)
ˆˆ The drug preferred for atrial fibrillation with functional 228. Which of the following is the drug of choice for digitalis
re-entry is ibutilide, but if its associated with anatomical induced atrial arrhythmia?
re-entry as in case of WPW syndrome, then procainamide a. Lidocaine b. Verapamil
c. Amiodarone d. Phenytoin
Practice Questions

is preferred which blocks conduction in the accessory

pathway.
Ans. (d)  Phenytoin
223. Which of the following drug increases PR interval?
a. Lidocaine b. Procainamide (Ref: Braunwald’s cardiology 9th E/P728)
c. Flecainide d. Quinidine 229. Dronedarone is better than amiodarone in that
a. It has more efficacy b. It has more potency
Ans. (c)  Flecainide
c. It has less toxicity d. It is cheaper
(Ref: Goodman Gilman 12th E/P828)
Ans. (c)  It has less toxicity
ˆˆ Among sodium channel blockers, only class Ic blocks
conduction at AV node and hence prolongs PR interval. (Ref: Goodman Gilma 12th E/P839)
192
 ˆˆ Dronedarone does not have iodine and hence is devoid Ans. (b)  Lean body mass

Cardiovascular System
of iodine related toxicities seen with amiodarone.
ˆˆ However it is less efficacious than amiodarone. (Ref: Goodman and Gilman 12th E/P 803)
230. Which of the following is more potent? ˆˆ Digoxin is highly distributed in the skeletal muscles
a. L-Verapamil b. D-Verapamil (high volume of distribution), and hence a loading dose
c. L-Diltiazem d. D-Diltiazem is given according to the lean body mass.
235. TDM is done to maintain the plasma digoxin level below
Ans. (a)  L-Verapamil a. 3 ng/mL b. 2 ng/mL
(Ref: Goodman Gilman 12th E/P831) c. 1 ng/mL d. 0.5 ng/mL
ˆˆ All CCB are racemic mixtures of L and D isomers except
Ans. (c)  1 ng/mL
diltiazem and nifedipine.
ˆˆ Verapamil is more potent than diltiazem and L isomer of (Ref: Goodman and Gilman 12th E/P 803)
verapamil is more potent than D isomer. ˆˆ Digoxin has a low therapeutic index. Hence TDM is
ˆˆ However L-isomer undergoes more significant first pass done to keep the plasma concentration below 1 ng/mL
metabolism than D isomer. to prevent toxicity.
231. All of the following drugs can increase digitalis toxicity 236. Nesiritide is eliminated by following mechanisms except
except a. Liver b. Kidney
a. Quinidine b. Verapamil c. Neutral endopeptidase d. NPR-C
c. Chlorthiazide d. Enalapril
Ans. (a)  Liver
Ans. (d)  Enalapril
(Ref: Goodman and Gilman 12th E/P 696)
(Ref: Goodman and Gilman 12th E/P 803)
Three mechanisms of nesiritide elimination are:
ˆˆ Drugs increasing digitalis toxicity are:
ˆˆ Neutral endopeptidase
ƒƒ Diuretics
ˆˆ NPR-C
ƒƒ Quinidine
ˆˆ Kidney
ƒƒ Verapamil
ƒƒ Flecainide 237. Ularitide is an analog of:
ƒƒ Propafenone a. ANP b. BNP
ƒƒ Amiodarone c. Urodilantin d. Uricase
ˆˆ As potassium limits the action of digitalis, hyperkalemia
Ans. (c)  Urodilantin
as associated with ACEI can prevent digitalis toxicity.
232. The dose of digibind in digoxintoxicity is calculated based (Ref: Goodman and Gilman 12th E/P 696)
on digoxin’s 238. Carperitide is an analog of:
a. Loading dose b. Maintenance dose a. ANP b. BNP
c. Total dose d. Last dose
c. Urodilantin d. Caspase
Ans. (c)  Total dose
Ans. (a)  ANP
(Ref: Goodman and Gilman 12th E/P 804)
(Ref: Goodman and Gilman 12th E/P 696)
ˆˆ Digibind, an anti-digoxin antibody is the most effective
drug and hence reserved for treatment of life threatening 239. Omapatrilat is an inhibitor of:
arrhythmias induced by digoxin. a. ACE
ˆˆ The dose of digibind is calculated based on the total b. Neutral endopeptidase
digoxin dose administered. c. Vasopeptidase
d. All of the above
233. All of the following are used in digitalis induced arrhythmia
except Ans. (d)  All of the above
Practice Questions
a. Dialysis b. Digibind
c. MgSO4 d. Phenytoin (Ref: Goodman and Gilman 12th E/P 932)
ˆˆ Omapatrilat is a vasopeptidase inhibitor, which inhibits
Ans. (a)  Dialysis ACE as well as neutral endopeptidase.
(Ref: Goodman and Gilman 12th E/P 804) 240. The dose of beta blocker is uptitrated in CHF every:
ˆˆ Dialysis is not effective for treatment of digoxin induced a. 1 week b. 2 weeks
arrhythmia, as it has a high volume of distribution. c. 3 weeks d. 4 weeks
234. Loading dose of digoxin is calculated based on:
Ans. (b)  2 weeks
a. Total body mass b. Lean body mass
c. Adipose tissue mass d. None (Ref: Goodman and Gilman 12th E/P 800)
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 241. All of the following are indicated for treatment of CHF except: 249. Angioedema caused by ACEI can be worsened by:
a. Propranolol b. Carvedilol a. Diuretics b. Lithium
Conceptual Review of Pharmacology

c. Metoprolol d. Bisoprolol c. Glitazones d. Digoxin

Ans. (a)  Propranolol Ans. (c)  Glitazones

(Ref: Goodman and Gilman 12th E/P 800) (Ref: Braunwald’s cardiology/P967)
242. The class of drug with maximum mortality benefit in CHF is: 250. ACEI with triphasic elimination is:
a. ACEI b. Beta blocker a. Enalapril b. Captopril
c. Spironolactone d. Digoxin c. Lisinopril d. Ramipril

Ans. (b)  Beta blocker Ans. (d)  Ramipril

(Ref: Goodman and Gilman 12th E/P 800) (Ref: Goodman and Gilman 12th E/P 733)
243. The first ARB to be used clinically was: 251. Which of the following beta blockers can be used, when beta
a. Valsartan b. Losartan blockade is contraindicated?
c. Telmisartan d. Candesartan a. Labetalol b. Carvedilol
c. Esmolol d. Propranolol
Ans. (b)  Losartan
Ans. (c)  Esmolol
(Ref: Goodman and Gilman 12th E/P 736)
(Ref: Harrison 19th E/P1589)
244. Which of the following is not a prodrug:
ˆˆ Esmolol is shortest acting beta blocker which is given by
a. Enalapril b. Candesartan
c. Olmesartan d. Lisinopril continuous IV infusion.
ˆˆ Because of its rapid offset of action it is preferred in case
Ans. (d)  Lisinopril beta blockade is contraindicated as the side effects of
cardiosuppression will be short lived.
(Ref: Goodman and Gilman 12th E/P 738)
252. Antiaggregant of choice in myocardial infarction:
ˆˆ All ACEIs are prodrugs except captopril and lisinopril. a. Clopidogrel b. Aspirin
ˆˆ Only candesartan and olmesartan are ARBs which are c. Prasugrel d. Ticagrelor
prodrugs.
245. Which of the following ARB is not taken with food? Ans. (b)  Aspirin
a. Valsartan b. Telmisartan (Ref: Harrison 19th E/P1606)
c. Candesartan d. Olmesartan
ˆˆ Antiaggregant of choice in MI is aspirin.
Ans. (a)  Valsartan ˆˆ Two drug therapy i.e. aspirin plus a P2Y12 inhibitor is
preferred in patients with stent placement.
(Ref: Goodman and Gilman 12th E/P 738)
253. All of the following drugs decrease mortality in a patient of
246. ARB with antiaggregant effect is: MI except:
a. Telmisartan b. Losartan a. CCB b. ACEI
c. Valsartan d. Candesartan c. Beta blockers d. Aspirin

Ans. (b)  Losartan Ans. (a)  CCB

(Ref: Goodman and Gilman 12th E/P 738) (Ref: Harrison 19th E/P1607)
247. ACEI used for diagnosis of renovascular hypertension Drugs decreasing mortality in MI
before renal angiography is: ˆˆ Aspirin
a. Captopril b. Lisinopril ˆˆ ACEI/ARB
ˆˆ Beta blockers
c. Fosinopril d. Ramipril
Practice Questions

ˆˆ Aldosterone antagonist
Ans. (a) Captopril 254. Which of the following drug decreases mortality in a patient
of angina?
(Ref: KDT 7th E/P505)
a. ACEI
248. Which of the following is shortest acting ACEI? b. Nitrates
a. Enalapril b. Captopril c. Beta blockers
c. Lisinopril d. Fosinopril d. Ranolazine

Ans. (b)  Captopril Ans. (c)  Beta blockers

(Ref: Goodman and Gilman 12th E/P 732) (Ref: Harrison 19th E/P1588)
194
255. Which of the following is the drug of choice to decrease pain 260. Which of the following fibrates increases the risk of statin
of angina? induced myopathy?

Cardiovascular System
a. NTG b. Morphine a. Clofibrate b. Fenofibrate
c. Pethidine d. Beta blockers c. Bizafibrate d. Gemfibrozil

Ans. (a)  NTG Ans. (d)  Gemfibrozil

(Ref: CMDT 2016/P373) (Ref: Goodman Gilman 12th E/P903)
Drugs used to decrease pain of MI ˆˆ Among fibrates the risk of myopathy with statins is
ˆˆ S/L NTG – First drug of choice increased maximum by gemfibrozil as it not only inhibits
ˆˆ IV opioids (Morphine > Pethidine) glucunoridation of statins but also hepatic uptake by
ˆˆ IV Beta blockers inhibiting OATP1B1.
256. Which of the following is the drug of choice for an acute ˆˆ Fibrate with least effect on glucunoridation and statin
attack of angina? induced myopathy is fenofibrate.
a. NTG b. IDN 261. Which of the following fibrate does not cause myopathy?
c. IMN d. CCB a. Gemfibrozil b. Clofibrate
c. Bizafibrate d. Fenofibrate
Ans. (a)  NTG
Ans. (c)  Bizafibrate
(Ref: CMDT 2016/P357)
(Ref: Goodman Gilman 12th E/P900)
257. Which of the following cannot be used as monotherapy in
angina? 262. A patient on statins should be routinely screened for
a. Verapamil b. Nifedipine a. Myopathy b. Hepatotoxicity
c. Ranolazine d. Metoprolol c. Nephrotoxicity d. Agranulocytosis

Ans. (b)  Nifedipine Ans. (b)  Hepatotoxicity

(Ref: CMDT 2016/P357) (Ref: Goodman Gilman 12th E/P896)
ˆˆ DHPs cannot be used as monotherapy in angina due to ˆˆ A patient on statins should be routinely monitored ALT/
reflex tachycardia that can increase oxygen demand of AST because of hepatotoxicity.
myocardium and worsen angina. ˆˆ CKmonitoring for myopathy is not done as myopathy
ˆˆ They are always used with beta blockers. can be delayed for years.
258. A maximum decrease in LDL is caused by: 263. Statins are derived from:
a. Simvastatin b. Rosuvastatin a. Bacteria b. Fungus
c. Pitavastatin d. Fluvastatin c. Plant d. Animal

Ans. (b)  Rosuvastatin Ans. (b)  Fungus

(Ref: CMDT 2016/P1246) (Ref: Goodman Gilman 12th E/P893)
259. Which of the following is preferred for treatment of niacin ˆˆ Thefirst statin lovastatin was derived from fungus,
induced flushing? Aspergillus terrus.
a. Indomethacin b. Aspirin 264. Intestinal cholesterol absorption is inhibited by:
c. Cortisol d. Dexamethasone a. Cholestyramine b. Bizafibrate
c. Lomitapide d. Ezitimibe
Ans. (b)  Aspirin
Ans. (d)  Ezitimibe
(Ref: Goodman Gilman 12th E/P900)
ˆˆ Flushingcaused by niacin is due to prostaglandins, (Ref: Goodman Gilman 12th E/P903)
which can be prevented by NSAIDs. The preferred
Practice Questions
NSAID is aspirin.

195