Nifedipine MCQs With Answer

Nifedipine MCQs With Answer offer B. Pharm students a focused review of nifedipine — a dihydropyridine calcium channel blocker widely used in hypertension, chronic stable angina and as an off‑label tocolytic. These carefully designed, evidence-based questions emphasize mechanism of action (L‑type Ca2+ channel blockade), pharmacokinetics (CYP3A4 metabolism, first‑pass effect), formulations (immediate‑release vs. sustained‑release), dose-related adverse effects (peripheral edema, reflex tachycardia, gingival hyperplasia), clinically relevant drug interactions (grapefruit, CYP3A4 inhibitors), and monitoring parameters. Answers with concise explanations will strengthen therapeutic reasoning, dispensing considerations, and safe administration practices for clinical and regulatory scenarios. Now let’s test your knowledge with 30 MCQs on this topic.

Q1. Which class of drug does nifedipine belong to?

• Dihydropyridine calcium channel blocker
• Beta-adrenergic blocker
• Angiotensin-converting enzyme inhibitor
• Hydralazine-like vasodilator

Correct Answer: Dihydropyridine calcium channel blocker

Q2. What is the primary molecular target of nifedipine?

• L-type voltage-gated calcium channels in vascular smooth muscle
• Beta-1 adrenergic receptors in cardiac tissue
• ACE enzyme in the renin-angiotensin system
• Sodium channels in myocardial tissue

Correct Answer: L-type voltage-gated calcium channels in vascular smooth muscle

Q3. Which therapeutic indication is nifedipine commonly used for?

• Chronic stable angina and hypertension
• Type 1 diabetes management
• Acute bacterial infections
• Hypothyroidism

Correct Answer: Chronic stable angina and hypertension

Q4. Which pharmacokinetic property is clinically important for nifedipine?

• Extensive hepatic first-pass metabolism via CYP3A4
• Renal elimination unchanged in urine
• Primary metabolism by CYP2D6 with active metabolites
• Negligible plasma protein binding

Correct Answer: Extensive hepatic first-pass metabolism via CYP3A4

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

• Peripheral edema
• Hyperkalemia
• Neutropenia
• Hypoglycemia

Correct Answer: Peripheral edema

Q6. Which formulation-related consideration is important for nifedipine?

• Immediate-release forms can cause rapid blood pressure drop; extended-release is preferred for chronic therapy
• Only injectable forms are clinically effective
• Oral bioavailability exceeds 90% irrespective of formulation
• Transdermal patches are the standard route

Correct Answer: Immediate-release forms can cause rapid blood pressure drop; extended-release is preferred for chronic therapy

Q7. Which drug interaction increases nifedipine plasma concentration significantly?

• Coadministration with ketoconazole (strong CYP3A4 inhibitor)
• Coadministration with rifampin (CYP3A4 inducer)
• Coadministration with metformin (renal excretion competitor)
• Coadministration with furosemide (loop diuretic)

Correct Answer: Coadministration with ketoconazole (strong CYP3A4 inhibitor)

Q8. Nifedipine’s reflex increase in heart rate is primarily due to which mechanism?

• Baroreceptor-mediated sympathetic activation after peripheral vasodilation
• Direct beta-adrenergic stimulation by nifedipine
• Central opioid receptor activation
• Inhibition of sinoatrial node automaticity

Correct Answer: Baroreceptor-mediated sympathetic activation after peripheral vasodilation

Q9. Which adverse effect is specifically associated with long-term calcium channel blocker therapy including nifedipine?

• Gingival hyperplasia
• Ototoxicity
• Pancreatitis
• Aplastic anemia

Correct Answer: Gingival hyperplasia

Q10. Why is sublingual immediate-release nifedipine discouraged for hypertensive emergencies?

• Unpredictable, excessive hypotension and reflex tachycardia with risk of ischemia
• It produces negligible hypotensive effect
• Rapid onset is too slow for emergencies
• Sublingual route causes severe mucosal necrosis

Correct Answer: Unpredictable, excessive hypotension and reflex tachycardia with risk of ischemia

Q11. Which statement about nifedipine metabolism is correct?

• It is mainly metabolized by hepatic CYP3A4 to inactive metabolites
• It undergoes renal acetylation to active metabolites
• It is primarily excreted unchanged in bile
• Metabolism is independent of hepatic enzymes

Correct Answer: It is mainly metabolized by hepatic CYP3A4 to inactive metabolites

Q12. In pregnancy, nifedipine is sometimes used for which indication?

• Tocolysis for preterm labor management
• Treatment of gestational diabetes
• Prevention of hyperemesis gravidarum
• First-line therapy for eclampsia seizures

Correct Answer: Tocolysis for preterm labor management

Q13. What monitoring parameter is most relevant after initiating nifedipine therapy?

• Blood pressure and heart rate
• Serum creatinine clearance weekly
• INR and prothrombin time
• Serum potassium every dose

Correct Answer: Blood pressure and heart rate

Q14. Which patient population needs dose adjustment or caution with nifedipine?

• Patients with severe hepatic impairment
• Patients with controlled hypothyroidism
• Patients with anemia of chronic disease
• Patients using topical corticosteroids

Correct Answer: Patients with severe hepatic impairment

Q15. Which of the following best explains nifedipine’s antihypertensive effect?

• Arteriolar vasodilation reducing systemic vascular resistance
• Venous pooling increasing venous capacitance
• Direct negative inotropic effect reducing stroke volume exclusively
• Renal sodium retention leading to decreased preload

Correct Answer: Arteriolar vasodilation reducing systemic vascular resistance

Q16. Combining nifedipine with which class increases risk of severe hypotension or bradycardia?

• Beta-blockers or other negative chronotropes (use with caution)
• Loop diuretics only
• Thiazide diuretics exclusively
• Statins

Correct Answer: Beta-blockers or other negative chronotropes (use with caution)

Q17. Which formulation of nifedipine provides smoother plasma concentrations and better tolerability for chronic use?

• Sustained-release (extended-release) oral tablets
• Immediate-release sublingual tablets
• Single-dose intramuscular injection
• Topical gel formulation

Correct Answer: Sustained-release (extended-release) oral tablets

Q18. What effect does grapefruit juice have when taken with nifedipine?

• Inhibits intestinal CYP3A4, increasing nifedipine bioavailability and plasma levels
• Accelerates hepatic clearance, reducing drug levels
• Prevents absorption leading to therapeutic failure
• Has no significant interaction

Correct Answer: Inhibits intestinal CYP3A4, increasing nifedipine bioavailability and plasma levels

Q19. Which cardiac effect is least prominent with nifedipine compared to non-dihydropyridine calcium channel blockers?

• Direct AV nodal conduction depression
• Peripheral vasodilation
• Reflex tachycardia
• Reduction in afterload

Correct Answer: Direct AV nodal conduction depression

Q20. Which adverse metabolic effect can occur with nifedipine therapy?

• Exacerbation of gastroesophageal reflux due to smooth muscle relaxation
• Marked hyperglycemia requiring insulin initiation
• Severe hypocalcemia
• Significant hyponatremia

Correct Answer: Exacerbation of gastroesophageal reflux due to smooth muscle relaxation

Q21. Which laboratory test is routinely required specifically because of nifedipine therapy?

• No routine laboratory monitoring is required solely for nifedipine
• Frequent liver function tests weekly
• Serial hemoglobin electrophoresis
• Daily serum magnesium monitoring

Correct Answer: No routine laboratory monitoring is required solely for nifedipine

Q22. A pharmacist counseling a patient on nifedipine should advise which important point?

• Avoid grapefruit or grapefruit juice while taking nifedipine
• Take drug only with dairy products
• Stop therapy abruptly if mild dizziness occurs
• Use sublingual tablets for sudden angina relief routinely

Correct Answer: Avoid grapefruit or grapefruit juice while taking nifedipine

Q23. Which hemodynamic change is expected after nifedipine administration?

• Decreased systemic vascular resistance and possible reflex tachycardia
• Increased preload and decreased afterload exclusively
• Marked increase in central venous pressure
• Complete suppression of sympathetic tone

Correct Answer: Decreased systemic vascular resistance and possible reflex tachycardia

Q24. In a patient taking strong CYP3A4 inducers like rifampin, what happens to nifedipine levels?

• Plasma concentrations decrease, reducing therapeutic effect
• Plasma concentrations increase, causing toxicity
• No change in plasma concentrations
• Drug is converted to a toxic metabolite

Correct Answer: Plasma concentrations decrease, reducing therapeutic effect

Q25. Which cardiovascular condition should prompt caution or avoidance of nifedipine?

• Unstable angina or recent myocardial infarction with hemodynamic instability
• Essential hypertension controlled on monotherapy
• Mild peripheral arterial disease without ischemia
• Well-controlled atrial fibrillation on anticoagulation

Correct Answer: Unstable angina or recent myocardial infarction with hemodynamic instability

Q26. How does nifedipine affect myocardial oxygen demand/supply in angina?

• Reduces afterload and can decrease myocardial oxygen demand; vasodilation may cause coronary steal in some cases
• Directly increases myocardial contractility raising oxygen demand
• Increases heart rate uniformly without affecting oxygen demand
• Causes coronary vasospasm worsening oxygen supply

Correct Answer: Reduces afterload and can decrease myocardial oxygen demand; vasodilation may cause coronary steal in some cases

Q27. Which property of nifedipine contributes to its suitability for once-daily dosing in extended-release form?

• Formulation-controlled sustained-release providing prolonged plasma concentrations
• Extremely long intrinsic half-life without formulation aid
• Renal accumulation that prolongs effect
• Depot formation in adipose tissue only

Correct Answer: Formulation-controlled sustained-release providing prolonged plasma concentrations

Q28. Which adverse event should prompt immediate discontinuation of nifedipine and urgent evaluation?

• Signs of severe hypotension with syncope or chest pain suggesting ischemia
• Mild ankle swelling after two weeks of therapy
• Transient headache after first dose
• Dry mouth without other symptoms

Correct Answer: Signs of severe hypotension with syncope or chest pain suggesting ischemia

Q29. Which statement about nifedipine protein binding and distribution is correct?

• It is highly protein-bound and widely distributed into tissues
• It is minimally protein-bound and confined to plasma
• It crosses the blood-brain barrier extensively causing CNS toxicity
• It is sequestered in bone tissue primarily

Correct Answer: It is highly protein-bound and widely distributed into tissues

Q30. For a patient on chronic nifedipine, which counseling point about adverse effect management is appropriate?

• Elevate legs and monitor sodium intake to help manage peripheral edema
• Double the dose if blood pressure is not controlled within 24 hours
• Discontinue diuretics immediately upon starting nifedipine
• Expect rapid weight loss as a common side effect

Correct Answer: Elevate legs and monitor sodium intake to help manage peripheral edema

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.

Mail- Sachin@pharmacyfreak.com