Nimodipine MCQs With Answer

Nimodipine MCQs With Answer: This concise, exam-focused collection helps B. Pharm students master nimodipine — a lipophilic dihydropyridine calcium channel blocker primarily used to prevent cerebral vasospasm and ischemic deficits following subarachnoid hemorrhage. Questions explore mechanism of action (L‑type Ca2+ channel blockade), clinical indications, recommended dosing regimens, formulation and administration cautions, pharmacokinetics (absorption, low oral bioavailability, high protein binding, hepatic CYP3A4 metabolism, short half‑life), adverse effects (hypotension, hepatic enzyme changes), major drug interactions (grapefruit, CYP3A4 inhibitors/inducers), contraindications and monitoring. Designed to reinforce pharmacology, therapeutics and safe dispensing practices with clinical reasoning for B. Pharm coursework. Now let’s test your knowledge with 30 MCQs on this topic.

Q1. Which class of calcium channel blockers does nimodipine belong to?

• Dihydropyridines
• Phenylalkylamines
• Benzothiazepines
• Non‑selective calcium antagonists

Correct Answer: Dihydropyridines

Q2. What is the primary clinical indication for nimodipine?

• Acute myocardial infarction
• Prevention of cerebral vasospasm after subarachnoid hemorrhage
• Hypertensive emergency
• Stable angina pectoris

Correct Answer: Prevention of cerebral vasospasm after subarachnoid hemorrhage

Q3. Nimodipine exerts its therapeutic effect mainly by blocking which ion channel?

• Voltage‑gated sodium channels
• L‑type voltage‑gated calcium channels
• NMDA receptor channels
• Potassium ATP channels

Correct Answer: L‑type voltage‑gated calcium channels

Q4. Which pharmacokinetic property is characteristic of nimodipine?

• High oral bioavailability (>70%)
• Extensive first‑pass hepatic metabolism with low oral bioavailability
• Primarily renally excreted unchanged
• Long elimination half‑life (>24 hours)

Correct Answer: Extensive first‑pass hepatic metabolism with low oral bioavailability

Q5. Nimodipine is mainly metabolized by which hepatic enzyme system?

• CYP2D6
• CYP1A2
• CYP3A4
• CYP2C19

Correct Answer: CYP3A4

Q6. A commonly recommended oral dosing regimen for nimodipine in subarachnoid hemorrhage is:

• 10 mg once daily for 7 days
• 60 mg every 4 hours for 21 days
• 200 mg twice daily for 14 days
• 5 mg IV bolus every 8 hours

Correct Answer: 60 mg every 4 hours for 21 days

Q7. Which adverse effect is most clinically significant and frequently associated with nimodipine?

• Hyperglycemia
• Hypotension
• Hypokalemia
• Ototoxicity

Correct Answer: Hypotension

Q8. Which of the following is a major drug interaction concern with nimodipine?

• Co‑administration with CYP3A4 inhibitors increases nimodipine levels
• Co‑administration with proton pump inhibitors reduces nimodipine absorption
• NSAIDs significantly increase nimodipine clearance
• Antacids chelate nimodipine and inactivate it

Correct Answer: Co‑administration with CYP3A4 inhibitors increases nimodipine levels

Q9. Grapefruit juice affects nimodipine by:

• Inducing hepatic CYP3A4 to lower nimodipine levels
• Inhibiting intestinal CYP3A4 and increasing nimodipine bioavailability
• Directly binding nimodipine and blocking absorption
• Increasing renal elimination of nimodipine

Correct Answer: Inhibiting intestinal CYP3A4 and increasing nimodipine bioavailability

Q10. Which statement about nimodipine formulation and administration is correct?

• Intravenous administration is the preferred route in SAH
• Oral capsules are the usual formulation; parenteral use is contraindicated
• Nimodipine tablets are designed for sublingual rapid absorption
• It must be given as an inhalation aerosol in critical care

Correct Answer: Oral capsules are the usual formulation; parenteral use is contraindicated

Q11. The volume of distribution and protein binding of nimodipine are best described as:

• Low Vd, low protein binding (10–20%)
• Large Vd, high protein binding (~95%)
• Confined to plasma, negligible tissue distribution
• Restricted to extracellular fluid only

Correct Answer: Large Vd, high protein binding (~95%)

Q12. The elimination half‑life of nimodipine in healthy adults is approximately:

• 1–2 hours
• 8–12 hours
• 24–48 hours
• More than 72 hours

Correct Answer: 1–2 hours

Q13. Which monitoring parameter is most important during nimodipine therapy?

• Blood pressure and heart rate monitoring
• Serum creatine kinase levels weekly
• Fasting blood glucose daily
• Pulmonary function tests monthly

Correct Answer: Blood pressure and heart rate monitoring

Q14. In patients with severe hepatic impairment, nimodipine use requires:

• No dose adjustment is necessary
• Caution and possible dose reduction due to decreased metabolism
• Switch to intravenous nimodipine to bypass liver
• Administration only with enzyme‑inducing drugs

Correct Answer: Caution and possible dose reduction due to decreased metabolism

Q15. Which of the following is a contraindication for nimodipine?

• History of migraine headaches
• Hypotension or systolic blood pressure below acceptable limits
• Mild renal impairment
• Hyperlipidemia

Correct Answer: Hypotension or systolic blood pressure below acceptable limits

Q16. Which co‑administered drug class may produce additive hypotension with nimodipine?

• Beta‑blockers and other antihypertensives
• Loop diuretics only
• Thyroid hormone replacements
• Topical corticosteroids

Correct Answer: Beta‑blockers and other antihypertensives

Q17. Which statement about nimodipine’s selectivity is correct?

• It preferentially relaxes cerebral and peripheral vascular smooth muscle over myocardium
• It selectively blocks cardiac sodium channels only
• It is a selective antagonist at beta‑adrenergic receptors
• It primarily targets skeletal muscle calcium channels

Correct Answer: It preferentially relaxes cerebral and peripheral vascular smooth muscle over myocardium

Q18. Which laboratory abnormality has been reported with nimodipine therapy and should be monitored?

• Elevated liver enzymes (transaminases)
• Marked hyponatremia
• Elevated serum amylase only
• Severe neutrophilia

Correct Answer: Elevated liver enzymes (transaminases)

Q19. Which patient counseling point is appropriate when dispensing nimodipine?

• Avoid grapefruit juice during therapy
• Crush tablets and inject intravenously if swallowing is difficult
• Double the dose if a dose is missed
• Stop therapy suddenly without medical advice

Correct Answer: Avoid grapefruit juice during therapy

Q20. Nimodipine’s role in stroke other than SAH (e.g., ischemic stroke) is:

• Well established as first‑line antiplatelet therapy
• Not routinely recommended for acute ischemic stroke to improve outcome
• Required as part of standard thrombolysis protocols
• Contraindicated in all ischemic cerebrovascular disease

Correct Answer: Not routinely recommended for acute ischemic stroke to improve outcome

Q21. A likely presentation of nimodipine overdose is:

• Severe hypertension and agitation
• Profound hypotension and bradycardia
• Excessive salivation and hyperreflexia
• Acute hemolytic anemia

Correct Answer: Profound hypotension and bradycardia

Q22. Which of the following drugs is likely to decrease nimodipine plasma concentrations?

• Rifampicin (rifampin)
• Ketoconazole
• Clarithromycin
• Grapefruit juice

Correct Answer: Rifampicin (rifampin)

Q23. Concerning storage and dispensing, nimodipine capsules should be:

• Frozen to stabilize the drug
• Stored at room temperature away from light and moisture
• Kept under refrigeration at 2–8°C at all times
• Exposed to direct sunlight before dispensing

Correct Answer: Stored at room temperature away from light and moisture

Q24. Which pharmacodynamic effect explains nimodipine’s benefit in SAH?

• Antiplatelet aggregation preventing clot formation
• Reduction of cerebral arterial vasospasm improving cerebral blood flow
• Direct neuroregeneration of injured neurons
• Increasing intracranial pressure to tamponade bleeding

Correct Answer: Reduction of cerebral arterial vasospasm improving cerebral blood flow

Q25. When administered orally, the time to reach peak plasma concentration (Tmax) for nimodipine is roughly:

• 5–10 minutes
• 30–90 minutes
• 12–24 hours
• 48–72 hours

Correct Answer: 30–90 minutes

Q26. Which pregnancy category has been traditionally assigned to nimodipine by older FDA classification?

• Category A — safe in pregnancy
• Category B — no evidence of risk in humans
• Category C — risk cannot be ruled out; use only if benefits justify risks
• Category X — contraindicated in pregnancy

Correct Answer: Category C — risk cannot be ruled out; use only if benefits justify risks

Q27. Which of the following statements about nimodipine and blood–brain barrier penetration is correct?

• Nimodipine is highly lipophilic and penetrates the CNS, contributing to its cerebral effects
• Nimodipine cannot cross the blood–brain barrier and acts only peripherally
• Nimodipine is hydrophilic and accumulates in cerebrospinal fluid only
• Nimodipine requires intrathecal administration to reach the brain

Correct Answer: Nimodipine is highly lipophilic and penetrates the CNS, contributing to its cerebral effects

Q28. For drug compatibility, co‑prescribing nimodipine with verapamil would most likely cause:

• No interaction and safe co‑administration
• Increased risk of severe hypotension and conduction abnormalities
• Marked increase in nimodipine renal clearance
• Mutual inactivation rendering both drugs ineffective

Correct Answer: Increased risk of severe hypotension and conduction abnormalities

Q29. Which formulation precaution is important when patients have difficulty swallowing nimodipine capsules?

• Crushing an extended‑release nimodipine tablet is recommended for faster action
• Follow manufacturer guidance; avoid IV use and consult for alternative oral administration methods
• Inject capsule contents intramuscularly to ensure absorption
• Mix with alcohol to increase solubility and absorption

Correct Answer: Follow manufacturer guidance; avoid IV use and consult for alternative oral administration methods

Q30. Which teaching point is important regarding missed doses of nimodipine in SAH prophylaxis?

• If one dose is missed, take double the next dose to compensate
• Skip the missed dose and resume the regular schedule; do not double doses
• Discontinue therapy permanently if any dose is missed
• Switch immediately to intravenous nimodipine for missed oral doses

Correct Answer: Skip the missed dose and resume the regular schedule; do not double doses

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