Beta adrenergic blockers, specifically bisoprolol, are cardioselective beta-1 antagonists essential in cardiovascular pharmacotherapy and a key subject for B.Pharm students. Mastery of bisoprolol’s mechanism of action, pharmacokinetics, therapeutic uses—hypertension, chronic stable angina and heart failure—adverse effects, contraindications and clinically significant drug interactions is crucial for safe dispensing and patient monitoring. This resource focuses on receptor selectivity, onset and duration of action, metabolism and elimination pathways, monitoring parameters, and comparisons with other beta blockers to deepen understanding. These targeted, exam-oriented MCQs reinforce pharmacodynamics, therapeutic rationale and rational prescribing principles for pharmacy practice. Now let’s test your knowledge with 50 MCQs on this topic.
Q1. Which receptor subtype does bisoprolol primarily block?
- Beta-2 adrenergic receptor
- Alpha-1 adrenergic receptor
- Beta-1 adrenergic receptor
- Muscarinic M2 receptor
Correct Answer: Beta-1 adrenergic receptor
Q2. Bisoprolol is classified as which type of beta blocker?
- Non-selective beta blocker
- Beta-1 selective (cardioselective) blocker
- Beta-2 selective blocker
- Alpha and beta blocker
Correct Answer: Beta-1 selective (cardioselective) blocker
Q3. The primary mechanism by which bisoprolol reduces heart rate is:
- Activation of beta-1 receptors in the sinoatrial node
- Blockade of beta-1 receptors in the sinoatrial and atrioventricular nodes
- Inhibition of calcium channels in the myocardium
- Stimulation of alpha-2 receptors centrally
Correct Answer: Blockade of beta-1 receptors in the sinoatrial and atrioventricular nodes
Q4. Which therapeutic indication is bisoprolol specifically approved for and demonstrates mortality benefit?
- Acute myocardial infarction immediate treatment
- Chronic heart failure with reduced ejection fraction
- Essential tremor
- Hyperthyroidism cure
Correct Answer: Chronic heart failure with reduced ejection fraction
Q5. Compared to nonselective beta blockers, bisoprolol has a lower risk of causing which adverse effect?
- Bradycardia
- Bronchospasm in patients with reactive airway disease
- Cold extremities
- Fatigue
Correct Answer: Bronchospasm in patients with reactive airway disease
Q6. Which statement best describes bisoprolol’s intrinsic sympathomimetic activity (ISA)?
- Bisoprolol has high ISA
- Bisoprolol has moderate ISA
- Bisoprolol has no ISA
- Bisoprolol’s ISA depends on dose
Correct Answer: Bisoprolol has no ISA
Q7. A key pharmacokinetic feature of bisoprolol that supports once-daily dosing is:
- Very short half-life of 2 hours
- Long duration of action due to moderate half-life
- Intravenous-only route of administration
- Extensive first-pass inactivation preventing oral use
Correct Answer: Long duration of action due to moderate half-life
Q8. Which of the following is a common adverse effect of bisoprolol?
- Hyperglycemia leading to diabetes
- Bradycardia and fatigue
- Marked weight gain within days
- Significant ototoxicity
Correct Answer: Bradycardia and fatigue
Q9. Bisoprolol’s selectivity for beta-1 receptors is clinically important because it:
- Eliminates all cardiovascular side effects
- Reduces bronchial beta-2 blockade at low to moderate doses
- Increases risk of peripheral vasoconstriction compared to nonselective agents
- Causes more hypoglycemia in diabetic patients than nonselective blockers
Correct Answer: Reduces bronchial beta-2 blockade at low to moderate doses
Q10. Which condition is a contraindication for initiating bisoprolol therapy?
- Controlled hypertension with resting tachycardia
- Asthma with active bronchospasm
- Stable compensated heart failure under monitoring
- Migraine prophylaxis history
Correct Answer: Asthma with active bronchospasm
Q11. Concerning drug interactions, combining bisoprolol with verapamil can lead to:
- Enhanced bronchodilation
- Exaggerated bradycardia and heart block
- Increased diuresis
- Decreased beta-1 blockade
Correct Answer: Exaggerated bradycardia and heart block
Q12. Which monitoring parameter is most important when a patient starts bisoprolol?
- Serum potassium only
- Heart rate and blood pressure
- Liver enzymes every hour
- Arterial blood gases
Correct Answer: Heart rate and blood pressure
Q13. Bisoprolol’s primary therapeutic effect in angina is due to:
- Vasodilation of coronary arteries through alpha blockade
- Reduction of myocardial oxygen demand by lowering heart rate and contractility
- Increasing myocardial contractility to improve perfusion
- Direct thrombolytic activity
Correct Answer: Reduction of myocardial oxygen demand by lowering heart rate and contractility
Q14. Which pharmacokinetic process significantly influences bisoprolol plasma levels?
- Extensive biliary excretion only
- Combined renal excretion and hepatic metabolism
- Complete metabolism by gut flora only
- No renal involvement at all
Correct Answer: Combined renal excretion and hepatic metabolism
Q15. Regarding membrane-stabilizing (local anesthetic) activity, bisoprolol at therapeutic doses:
- Exhibits strong membrane-stabilizing activity
- Has negligible membrane-stabilizing activity
- Causes local anesthesia when applied topically
- Is primarily used for its membrane effects
Correct Answer: Has negligible membrane-stabilizing activity
Q16. Abrupt withdrawal of bisoprolol may lead to:
- Immediate resolution of bradycardia
- Rebound tachycardia, angina or hypertension
- Permanent immunity to beta blockers
- Improved exercise tolerance overnight
Correct Answer: Rebound tachycardia, angina or hypertension
Q17. In patients with diabetes, beta-1 selective blockers like bisoprolol are preferred because they:
- Completely prevent hypoglycemia
- Mask all signs of hyperglycemia
- Less likely to inhibit hepatic glycogenolysis compared to nonselective agents
- Increase insulin secretion
Correct Answer: Less likely to inhibit hepatic glycogenolysis compared to nonselective agents
Q18. For B.Pharm students, which laboratory parameter should be periodically monitored in patients on bisoprolol for heart failure?
- Thyroid stimulating hormone only
- Renal function and electrolytes
- Serum amylase exclusively
- Complete blood count hourly
Correct Answer: Renal function and electrolytes
Q19. Which statement about bisoprolol’s oral bioavailability is correct?
- It is negligible and requires parenteral administration
- It has good oral bioavailability suitable for once-daily dosing
- It is 100% eliminated by first-pass metabolism
- It cannot be absorbed from the gastrointestinal tract
Correct Answer: It has good oral bioavailability suitable for once-daily dosing
Q20. Which adverse effect is particularly important to counsel elderly patients about when starting bisoprolol?
- Risk of sudden weight loss
- Orthostatic hypotension and dizziness
- Increased appetite
- Rapid improvement in memory
Correct Answer: Orthostatic hypotension and dizziness
Q21. Bisoprolol reduces blood pressure primarily by:
- Increasing cardiac output
- Reducing cardiac output and renin release
- Direct vasodilation via nitric oxide
- Inhibiting ACE enzyme
Correct Answer: Reducing cardiac output and renin release
Q22. Which adverse metabolic effect may occur with prolonged beta-blocker therapy including bisoprolol?
- Persistent hypercalcemia
- Altered lipid profile and potential masking of hypoglycemia symptoms
- Marked hyperthyroidism
- Severe hyperkalemia in all patients
Correct Answer: Altered lipid profile and potential masking of hypoglycemia symptoms
Q23. In which scenario is cautious use of bisoprolol indicated rather than absolute contraindication?
- Second- or third-degree AV block without pacemaker
- Uncontrolled heart failure with cardiogenic shock
- Mild peripheral vascular disease or well-controlled asthma
- Severe bradycardia under 40 bpm
Correct Answer: Mild peripheral vascular disease or well-controlled asthma
Q24. Which of the following is a clinically relevant drug interaction with bisoprolol?
- Co-administration with insulin decreases hypoglycemia risk
- Combined use with calcium channel blockers may potentiate bradycardia
- Concurrent use with NSAIDs markedly increases beta-1 selectivity
- Use with proton pump inhibitors reduces bisoprolol absorption to zero
Correct Answer: Combined use with calcium channel blockers may potentiate bradycardia
Q25. Which formulation and dosing frequency is most commonly used for outpatient bisoprolol therapy?
- Intravenous hourly infusion
- Oral once-daily tablet
- Topical cream applied daily
- Inhaled aerosol twice daily
Correct Answer: Oral once-daily tablet
Q26. Bisoprolol is preferred over nonselective beta blockers in patients with:
- Severe uncontrolled asthma
- Concomitant peripheral vascular disease making beta-2 blockade desirable
- Coexisting diabetes with frequent hypoglycemic episodes
- Acute bronchospasm requiring beta-2 agonists
Correct Answer: Coexisting diabetes with frequent hypoglycemic episodes
Q27. Which sign indicates overdosage or excessive beta blockade by bisoprolol?
- Tachycardia above 120 bpm
- Severe bradycardia and hypotension
- Profound hyperactivity and tremor
- Excessive salivation and lacrimation
Correct Answer: Severe bradycardia and hypotension
Q28. In pharmacology, the term ‘cardioselective’ refers to:
- Drugs that only affect the heart and not blood vessels or lungs at any dose
- Preferential blockade of beta-1 receptors at therapeutic doses
- Activation of cardiac beta receptors exclusively
- Drugs causing selective vasodilation of coronary arteries
Correct Answer: Preferential blockade of beta-1 receptors at therapeutic doses
Q29. Which clinical parameter improvement is expected in heart failure patients treated with bisoprolol long-term?
- Immediate increase in exercise tolerance within hours
- Reduction in hospitalizations and improved survival over months
- Complete cure of heart failure within days
- Worsening of left ventricular function universally
Correct Answer: Reduction in hospitalizations and improved survival over months
Q30. Which patient counseling point is important for bisoprolol users?
- It is safe to stop bisoprolol suddenly if you feel dizzy
- Do not stop bisoprolol abruptly; consult the prescriber for tapering
- Bisoprolol will immediately relieve chest pain like nitroglycerin
- Bisoprolol does not affect exercise tolerance
Correct Answer: Do not stop bisoprolol abruptly; consult the prescriber for tapering
Q31. Which effect on blood lipid profile may be seen with beta blockers including bisoprolol?
- Significant decrease in LDL cholesterol
- Possible modest increase in triglycerides and decrease in HDL
- Immediate reduction of total cholesterol to normal
- No metabolic effects at all
Correct Answer: Possible modest increase in triglycerides and decrease in HDL
Q32. An important consideration when prescribing bisoprolol to a patient on insulin therapy is:
- Bisoprolol enhances recognition of hypoglycemia symptoms
- Beta blockers may mask signs of hypoglycemia such as tachycardia
- Bisoprolol increases insulin clearance, requiring dose reduction
- There are no interactions between beta blockers and insulin
Correct Answer: Beta blockers may mask signs of hypoglycemia such as tachycardia
Q33. Which ECG change may occur with therapeutic or excessive bisoprolol use?
- Development of prominent U waves
- Sinus bradycardia and possible AV block
- Shortened PR interval
- Pathologic Q waves in all leads
Correct Answer: Sinus bradycardia and possible AV block
Q34. Bisoprolol has demonstrated benefit in which type of angina management?
- Variant (Prinzmetal) angina primarily through vasospasm induction
- Chronic stable angina by reducing myocardial oxygen demand
- Angina secondary to anemia because it increases hemoglobin
- Microvascular angina by dissolving microthrombi
Correct Answer: Chronic stable angina by reducing myocardial oxygen demand
Q35. Which patient group requires dose adjustment or careful monitoring when using bisoprolol?
- Young adults with no comorbidities
- Patients with significant renal or hepatic impairment
- Patients with well-controlled hypertension on a single drug
- Individuals receiving only topical dermatologic therapy
Correct Answer: Patients with significant renal or hepatic impairment
Q36. Which laboratory or clinical sign suggests bisoprolol-related bronchospasm in a susceptible patient?
- Wheezing and increased shortness of breath after starting therapy
- Sudden weight gain without edema
- Improved peak flow readings
- Marked increase in exercise tolerance
Correct Answer: Wheezing and increased shortness of breath after starting therapy
Q37. Compared with propranolol, bisoprolol is more likely to:
- Cause bronchospasm at low doses
- Be cardioselective and spare beta-2 receptors at therapeutic doses
- Have higher membrane-stabilizing (anesthetic) effects
- Be preferred for essential tremor
Correct Answer: Be cardioselective and spare beta-2 receptors at therapeutic doses
Q38. Which pharmacodynamic effect contributes to bisoprolol’s antihypertensive action besides reduced cardiac output?
- Increased renin release from the kidney
- Reduced renin release from juxtaglomerular cells
- Activation of sympathetic nervous system centrally
- Direct inhibition of ACE enzyme
Correct Answer: Reduced renin release from juxtaglomerular cells
Q39. Which is the correct counseling regarding driving or operating machinery when starting bisoprolol?
- There are no precautions; proceed as usual
- Be cautious until you know how bisoprolol affects you due to possible dizziness
- Bisoprolol enhances alertness and driving ability
- Driving is permanently prohibited while on bisoprolol
Correct Answer: Be cautious until you know how bisoprolol affects you due to possible dizziness
Q40. Which adverse cardiac effect is least likely with bisoprolol at therapeutic doses?
- Excessive bradycardia
- Worsening heart block in predisposed patients
- Marked QT prolongation leading to torsades de pointes
- Reduced exercise tolerance
Correct Answer: Marked QT prolongation leading to torsades de pointes
Q41. Which pharmacodynamic property distinguishes bisoprolol from beta blockers with high lipophilicity?
- Bisoprolol is highly lipophilic causing central nervous system side effects
- Bisoprolol is relatively less lipophilic leading to fewer CNS adverse effects
- Bisoprolol cannot cross the blood-brain barrier at all
- Bisoprolol causes severe sedation compared to others
Correct Answer: Bisoprolol is relatively less lipophilic leading to fewer CNS adverse effects
Q42. When switching a patient from a nonselective beta blocker to bisoprolol, the pharmacist should consider:
- Immediate one-to-one substitution without monitoring
- Gradual cross-titration and monitoring for withdrawal and bronchospasm
- That bisoprolol will worsen pulmonary function compared to nonselective agents
- No need to inform the prescriber
Correct Answer: Gradual cross-titration and monitoring for withdrawal and bronchospasm
Q43. In overdose management of bisoprolol, which treatment may be indicated?
- Beta-adrenergic agonists, atropine and supportive care
- Immediate high-dose ACE inhibitors
- Triple antithrombotic therapy
- Forced alkalinization of urine only
Correct Answer: Beta-adrenergic agonists, atropine and supportive care
Q44. Which statement about bisoprolol use in pregnancy is most appropriate for counseling?
- Bisoprolol is completely safe and has no fetal effects
- Use only if benefits outweigh risks; monitor mother and fetus closely
- It is a first-line safe agent for all trimesters without caution
- It is guaranteed to prevent preterm labor
Correct Answer: Use only if benefits outweigh risks; monitor mother and fetus closely
Q45. Which clinical scenario would justify choosing bisoprolol over atenolol?
- Need for a very short-acting intravenous beta blocker
- Preference for once-daily dosing with proven mortality benefit in heart failure
- Requirement for strong beta-2 blockade to treat tremor
- Desire for a drug with high membrane-stabilizing activity
Correct Answer: Preference for once-daily dosing with proven mortality benefit in heart failure
Q46. For exam-focused pharmacology, which mechanism best explains bisoprolol’s effect on renin-angiotensin system?
- Stimulation of renin release by beta-1 blockade
- Inhibition of renin release due to beta-1 receptor blockade in juxtaglomerular cells
- Direct inhibition of angiotensin II receptors
- Activation of aldosterone secretion
Correct Answer: Inhibition of renin release due to beta-1 receptor blockade in juxtaglomerular cells
Q47. Which patient report should prompt immediate evaluation when on bisoprolol?
- Mild dry mouth that started weeks ago
- New onset syncope or near-syncope
- Minor seasonal allergies
- Improved sleep quality
Correct Answer: New onset syncope or near-syncope
Q48. Regarding therapeutic monitoring, which vital sign trend indicates the need to adjust bisoprolol dose?
- Resting heart rate persistently below 50 bpm
- Heart rate consistently between 70–80 bpm with controlled BP
- Mild transient fatigue during early therapy
- Stable blood pressure and heart rate for months
Correct Answer: Resting heart rate persistently below 50 bpm
Q49. Which statement about bisoprolol’s impact on exercise physiology is correct?
- Bisoprolol increases maximal heart rate response to exercise
- It blunts heart rate and may reduce peak exercise capacity initially
- It causes immediate improvement in VO2 max
- It selectively increases skeletal muscle blood flow during exercise
Correct Answer: It blunts heart rate and may reduce peak exercise capacity initially
Q50. For a pharmacist preparing patient education materials, which key point about bisoprolol should be emphasized?
- Start and stop the medication based on how you feel each day
- Take consistently at the same time each day and report dizziness, breathlessness or syncope
- There are no side effects to be aware of
- It cures hypertension permanently after one week
Correct Answer: Take consistently at the same time each day and report dizziness, breathlessness or syncope
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.
Mail- Sachin@pharmacyfreak.com