Beta adrenergic blockers – Atenolol MCQs With Answer

Introduction:

A concise, exam-focused guide to beta adrenergic blockers—specifically Atenolol—designed for B.Pharm students. This introduction covers key concepts in pharmacology such as mechanism of action, beta1 selectivity, pharmacokinetics, therapeutic uses in hypertension, angina and arrhythmias, adverse effects, contraindications and important drug interactions. Questions emphasize clinical application, dosing considerations, and differentiation from other beta-blockers (propranolol, metoprolol). These Atenolol MCQs with answers will reinforce understanding of cardioselective beta-blockers, renal elimination, lack of intrinsic sympathomimetic activity, and monitoring parameters relevant to pharmacy practice. Now let’s test your knowledge with 50 MCQs on this topic.

Q1. Which receptor subtype does atenolol primarily block?

• Beta2-adrenergic receptor
• Alpha1-adrenergic receptor
• Beta1-adrenergic receptor
• Muscarinic receptor

Correct Answer: Beta1-adrenergic receptor

Q2. Atenolol is best described as which of the following?

• Non-selective beta blocker with high lipophilicity
• Cardioselective (beta1) blocker with low lipophilicity
• Beta2 agonist
• Alpha2 agonist

Correct Answer: Cardioselective (beta1) blocker with low lipophilicity

Q3. Which pharmacokinetic property is characteristic of atenolol?

• Extensive hepatic metabolism by CYP3A4
• Primarily renal excretion unchanged
• High first-pass metabolism to active metabolites
• Excreted mainly in bile

Correct Answer: Primarily renal excretion unchanged

Q4. The principal antihypertensive mechanism of atenolol is:

• Direct vasodilation of arterioles
• Reduction of cardiac output via decreased heart rate and contractility
• Diuretic-induced volume loss
• Central alpha2 agonism reducing sympathetic outflow

Correct Answer: Reduction of cardiac output via decreased heart rate and contractility

Q5. Which adverse effect is most commonly associated with atenolol?

• Excessive cough
• Bronchospasm in high doses, especially in reactive airways
• Ototoxicity
• Photosensitivity

Correct Answer: Bronchospasm in high doses, especially in reactive airways

Q6. Atenolol differs from propranolol primarily because atenolol:

• Is non-selective and highly lipophilic
• Has intrinsic sympathomimetic activity
• Is more beta1-selective and less likely to cross the blood–brain barrier
• Is primarily metabolized to an active metabolite

Correct Answer: Is more beta1-selective and less likely to cross the blood–brain barrier

Q7. Which clinical indication is atenolol commonly used for?

• Acute anaphylaxis
• Chronic stable angina and hypertension
• Acute asthma exacerbation
• Hypotension due to shock

Correct Answer: Chronic stable angina and hypertension

Q8. Atenolol’s elimination half-life in healthy adults is approximately:

• 30 minutes
• 1–2 hours
• 6–7 hours
• 24–48 hours

Correct Answer: 6–7 hours

Q9. Which statement about atenolol and intrinsic sympathomimetic activity (ISA) is correct?

• Atenolol has significant ISA
• Atenolol has no ISA
• Atenolol’s ISA is greater than pindolol
• ISA is irrelevant to beta-blocker pharmacology

Correct Answer: Atenolol has no ISA

Q10. In patients with renal impairment, atenolol dosing should be:

• Increased due to increased clearance
• Unchanged because it is metabolized hepatically
• Reduced or interval extended due to renal excretion
• Replaced with a higher dose of propranolol

Correct Answer: Reduced or interval extended due to renal excretion

Q11. Which of the following is a major pharmacodynamic effect of atenolol on the kidney?

• Increase in renin release
• Decrease in renin release via beta1 blockade
• Direct inhibition of ACE enzyme
• Stimulation of aldosterone secretion

Correct Answer: Decrease in renin release via beta1 blockade

Q12. Atenolol is less likely to cause central nervous system side effects because it is:

• Highly lipophilic and crosses the BBB easily
• Hydrophilic and poorly crosses the BBB
• A prodrug activated in brain tissue
• Primarily metabolized to central active metabolites

Correct Answer: Hydrophilic and poorly crosses the BBB

Q13. The recommended usual oral dose range of atenolol for hypertension is:

• 0.25–1 mg daily
• 25–100 mg once daily
• 200–400 mg twice daily
• 500–1000 mg once weekly

Correct Answer: 25–100 mg once daily

Q14. Which drug interaction is clinically significant with atenolol?

• Concurrent use with verapamil may increase risk of bradycardia and AV block
• Atenolol increases the metabolism of theophylline via CYP1A2
• Atenolol induces CYP3A4 lowering statin levels
• Atenolol has no known interactions with calcium channel blockers

Correct Answer: Concurrent use with verapamil may increase risk of bradycardia and AV block

Q15. Which monitoring parameter is most important when initiating atenolol therapy?

• Liver function tests weekly
• Heart rate and blood pressure
• Serum potassium daily
• Pulmonary function only in all patients

Correct Answer: Heart rate and blood pressure

Q16. Atenolol’s effect on lipid profile is generally:

• Marked improvement in HDL and triglycerides
• No effect or slight adverse changes in lipid profile
• Severe increase in LDL causing hypercholesterolemia
• Complete normalization of cholesterol

Correct Answer: No effect or slight adverse changes in lipid profile

Q17. Which of the following patients is least appropriate for atenolol therapy?

• Patient with stable angina and hypertension
• Patient with asthma and active bronchospasm
• Patient with prior myocardial infarction
• Patient with essential tremor

Correct Answer: Patient with asthma and active bronchospasm

Q18. Withdrawal of atenolol should be managed by:

• Sudden discontinuation to avoid side effects
• Tapering gradually to avoid rebound tachycardia and angina
• Doubling the dose for two days before stopping
• Switching abruptly to an alpha blocker

Correct Answer: Tapering gradually to avoid rebound tachycardia and angina

Q19. Atenolol is classified pharmacologically as a:

• Calcium channel blocker
• Selective beta1-adrenergic antagonist
• ACE inhibitor
• Direct renin inhibitor

Correct Answer: Selective beta1-adrenergic antagonist

Q20. Which adverse metabolic effect is a concern with beta-blockers like atenolol?

• Masking signs of hypoglycemia in diabetic patients
• Causing hyperthyroidism
• Inducing acute pancreatitis
• Persistent hyperkalemia

Correct Answer: Masking signs of hypoglycemia in diabetic patients

Q21. In acute myocardial infarction, atenolol benefit is primarily by:

• Increasing myocardial oxygen demand
• Reducing heart rate and myocardial oxygen consumption
• Direct thrombolysis of coronary thrombus
• Vasoconstriction of coronary arteries

Correct Answer: Reducing heart rate and myocardial oxygen consumption

Q22. Compared with propranolol, atenolol has a lower risk of which side effect?

• Bronchospasm at high doses
• Central nervous system depression (sleep disturbances, vivid dreams)
• Bradycardia
• Hypotension

Correct Answer: Central nervous system depression (sleep disturbances, vivid dreams)

Q23. Atenolol’s oral bioavailability is approximately:

• 5%
• 50%
• 95%
• 100%

Correct Answer: 50%

Q24. Which of the following is TRUE about atenolol and pregnancy?

• Atenolol is absolutely safe throughout pregnancy
• Atenolol may cause fetal growth restriction and should be used cautiously
• Atenolol is indicated as first-line therapy for eclampsia
• Atenolol is only given as an injection during pregnancy

Correct Answer: Atenolol may cause fetal growth restriction and should be used cautiously

Q25. An advantage of atenolol in elderly patients is:

• Extensive CNS penetration reduces peripheral effects
• Hydrophilicity lowers central adverse effects
• It enhances reflex tachycardia
• It causes strong diuresis

Correct Answer: Hydrophilicity lowers central adverse effects

Q26. Which statement about dosing frequency of atenolol is correct?

• Atenolol must be given hourly due to short action
• Atenolol is commonly administered once daily for chronic therapy
• Atenolol requires continuous IV infusion for hypertension control
• Atenolol is effective only when given at bedtime

Correct Answer: Atenolol is commonly administered once daily for chronic therapy

Q27. Which ECG change is most likely with atenolol overdose?

• Sinus tachycardia
• Bradycardia and possible AV block
• Peaked T waves from hyperkalemia only
• Widened QRS due to sodium channel blockade

Correct Answer: Bradycardia and possible AV block

Q28. Which laboratory test is most likely to be affected by atenolol?

• Marked increase in ALT/AST
• Significant changes in renal clearance markers in renal impairment
• Immediate severe leukopenia
• Sustained hypercalcemia

Correct Answer: Significant changes in renal clearance markers in renal impairment

Q29. Atenolol’s therapeutic effect on heart rate is primarily due to blockade of:

• Beta2 receptors in vascular smooth muscle
• Beta1 receptors in the sinoatrial node
• M-cholinergic receptors in AV node
• Alpha1 receptors in adrenal medulla

Correct Answer: Beta1 receptors in the sinoatrial node

Q30. Which patient history would prompt caution before prescribing atenolol?

• History of controlled hypertension on ACE inhibitor
• Well-controlled hypothyroidism on levothyroxine
• Severe peripheral arterial disease with intermittent claudication
• Myopia corrected with glasses

Correct Answer: Severe peripheral arterial disease with intermittent claudication

Q31. Atenolol effect on exercise tolerance is usually due to:

• Increased cardiac contractility during exertion
• Reduced maximal heart rate and decreased exercise tolerance
• Enhanced peripheral oxygen delivery
• Improved anaerobic threshold by increasing lactate clearance

Correct Answer: Reduced maximal heart rate and decreased exercise tolerance

Q32. Which adverse sexual side effect can beta-blockers like atenolol cause?

• Improved libido
• Erectile dysfunction and decreased libido
• Increased fertility in males
• Hypersexuality

Correct Answer: Erectile dysfunction and decreased libido

Q33. For a patient with combined hypertension and benign essential tremor, atenolol is:

• Contraindicated because it worsens tremor
• Potentially beneficial due to beta-blocker tremor suppression
• Ineffective for both conditions
• Only useful if combined with high-dose diuretics

Correct Answer: Potentially beneficial due to beta-blocker tremor suppression

Q34. A pharmacology student asks why atenolol may be preferred in patients with depression; the correct rationale is:

• Atenolol centrally stimulates mood-enhancing neurotransmitters
• Lower CNS penetration reduces depressive side effects compared with lipophilic beta-blockers
• Atenolol acts as an antidepressant via serotonin reuptake inhibition
• Atenolol has no cardiovascular effects in depressed patients

Correct Answer: Lower CNS penetration reduces depressive side effects compared with lipophilic beta-blockers

Q35. Which formulation of atenolol is most commonly used clinically?

• Intravenous continuous infusion only
• Oral tablets for once-daily dosing
• Topical ophthalmic drops
• Subcutaneous depot injection

Correct Answer: Oral tablets for once-daily dosing

Q36. Which of the following is NOT a therapeutic use of atenolol?

• Hypertension management
• Prophylaxis of migraine (select cases)
• Treatment of acute severe asthma exacerbation
• Management of stable angina

Correct Answer: Treatment of acute severe asthma exacerbation

Q37. Beta-blocker plus insulin use requires caution because atenolol can:

• Enhance peripheral signs of hypoglycemia like tremor
• Mask sympathetic warning signs of hypoglycemia such as tachycardia
• Directly raise blood glucose levels
• Prevent insulin from entering cells

Correct Answer: Mask sympathetic warning signs of hypoglycemia such as tachycardia

Q38. Which statement about atenolol and heart failure is most accurate?

• Atenolol is contraindicated in all heart failure patients
• Some beta-blockers improve mortality in chronic heart failure; atenolol may be used cautiously
• Atenolol acutely increases contractility and is first-line in decompensated heart failure
• Atenolol causes immediate worsening of all heart functions

Correct Answer: Some beta-blockers improve mortality in chronic heart failure; atenolol may be used cautiously

Q39. Which physical sign indicates excessive beta-blockade from atenolol?

• Tachycardia and hyperreflexia
• Bradycardia and cool extremities
• Hypertension and diaphoresis
• Flushing and hyperthermia

Correct Answer: Bradycardia and cool extremities

Q40. Structurally, atenolol belongs to which chemical class commonly seen in beta-blockers?

• Sulfonylureas
• Aryloxypropanolamine derivatives
• Benzodiazepines
• Statin lactones

Correct Answer: Aryloxypropanolamine derivatives

Q41. Which of the following is a key counseling point for patients starting atenolol?

• Stop the drug abruptly when feeling better
• Avoid sudden discontinuation; report dizziness or lightheadedness
• Double dose if a dose is missed
• Consume large amounts of grapefruit to enhance efficacy

Correct Answer: Avoid sudden discontinuation; report dizziness or lightheadedness

Q42. In toxicity, a primary treatment option for atenolol overdose is:

• Administration of beta-agonists such as isoproterenol or glucagon
• Immediate dialysis only
• High-dose aspirin
• Activation of CYP enzymes to speed metabolism

Correct Answer: Administration of beta-agonists such as isoproterenol or glucagon

Q43. Atenolol has less risk of which effect compared to lipophilic beta-blockers?

• Peripheral vasoconstriction
• CNS-related adverse effects like vivid dreams and depression
• Bradycardia
• Masking signs of hypoglycemia

Correct Answer: CNS-related adverse effects like vivid dreams and depression

Q44. Which statement about atenolol’s effect on exercise ECG testing is correct?

• Atenolol increases maximal exercise heart rate making tests easier
• Atenolol reduces exercise-induced tachycardia and may blunt ischemic signs
• Atenolol has no effect on exercise ECG
• Atenolol causes false-positive ST-elevations only

Correct Answer: Atenolol reduces exercise-induced tachycardia and may blunt ischemic signs

Q45. Which population requires dose adjustment of atenolol most commonly?

• Patients with severe hepatic impairment only
• Patients with renal impairment due to renal excretion
• Healthy young adults with no comorbidities
• Patients taking topical beta-blocker eye drops

Correct Answer: Patients with renal impairment due to renal excretion

Q46. How does atenolol reduce myocardial oxygen demand?

• By increasing preload and afterload
• By decreasing heart rate, contractility, and blood pressure
• By direct vasodilation of coronary arteries only
• By enhancing catecholamine release

Correct Answer: By decreasing heart rate, contractility, and blood pressure

Q47. Which adverse effect is a dermatologic reaction reported with beta-blockers including atenolol?

• Fixed drug eruption causing mucosal necrosis
• Cold, clammy extremities and sometimes rash
• Severe exfoliative dermatitis in all users
• Petechial hemorrhages universally

Correct Answer: Cold, clammy extremities and sometimes rash

Q48. Compared to atenolol, which beta-blocker is more likely to be preferred when central nervous system penetration is desired?

• Propranolol because it is highly lipophilic
• Hydrophilic labetalol
• Atenolol already has highest CNS penetration
• All beta-blockers have identical CNS penetration

Correct Answer: Propranolol because it is highly lipophilic

Q49. A pharmacokinetic advantage of atenolol in elderly with poor hepatic function is:

• Complete hepatic metabolism prevents accumulation
• Renal elimination avoids dependence on hepatic clearance
• Atenolol is inactivated by age-related enzymes increasing potency
• It is converted to active metabolites by diseased liver

Correct Answer: Renal elimination avoids dependence on hepatic clearance

Q50. Which exam-focused statement best summarizes atenolol?

• Atenolol is a non-selective, lipophilic beta-blocker with ISA
• Atenolol is a cardioselective, hydrophilic beta1 antagonist used in hypertension and angina
• Atenolol is an alpha-blocker used primarily for BPH
• Atenolol is a diuretic with beta-adrenergic activity

Correct Answer: Atenolol is a cardioselective, hydrophilic beta1 antagonist used in hypertension and angina

G S Sachin

I am a Registered Pharmacist under the Pharmacy Act, 1948, and the founder of PharmacyFreak.com. I hold a Bachelor of Pharmacy degree from Rungta College of Pharmaceutical Science and Research. With a strong academic foundation and practical knowledge, I am committed to providing accurate, easy-to-understand content to support pharmacy students and professionals. My aim is to make complex pharmaceutical concepts accessible and useful for real-world application.

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