Sotalol MCQs With Answer

Sotalol MCQs With Answer

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Sotalol MCQs With Answer — This focused collection of Sotalol MCQs with answers is designed for B.Pharm students to deepen understanding of sotalol — a non-selective beta‑blocker with Class III antiarrhythmic properties. Questions probe mechanism of action (beta‑adrenergic blockade and IKr potassium channel inhibition), pharmacokinetics (renal excretion, minimal metabolism), dosing principles, renal dose adjustment, ECG effects like QT prolongation and torsades, adverse effects, contraindications, monitoring requirements, drug interactions, and stereochemistry. Emphasis is placed on integrating pharmaceutical science with clinical pharmacology, safety considerations, and patient counseling to prepare students for exams and practical dispensing. Now let’s test your knowledge with 30 MCQs on this topic.

Q1. Which electrophysiological action primarily explains sotalol’s Class III antiarrhythmic effect?

  • Blockade of fast sodium channels (INa)
  • Inhibition of L-type calcium channels (ICa,L)
  • Blockade of the rapid component of delayed rectifier potassium current (IKr)
  • Enhancement of inward rectifier potassium current (IK1)

Correct Answer: Blockade of the rapid component of delayed rectifier potassium current (IKr)

Q2. Sotalol is best described pharmacologically as:

  • A selective beta-1 blocker with no effect on potassium channels
  • A non-selective beta-blocker with Class III potassium channel blocking activity
  • A pure Class I antiarrhythmic agent
  • An ACE inhibitor with antiarrhythmic properties

Correct Answer: A non-selective beta-blocker with Class III potassium channel blocking activity

Q3. Which statement about sotalol stereochemistry and activity is correct?

  • The racemate has only beta-blocking activity; neither enantiomer affects potassium currents
  • D‑sotalol provides beta-blockade while L‑sotalol provides Class III effects
  • L‑sotalol is primarily responsible for beta‑adrenergic blockade, while D‑sotalol contributes to Class III action
  • Only the D‑enantiomer is clinically used because it has both beta and potassium channel effects

Correct Answer: L‑sotalol is primarily responsible for beta‑adrenergic blockade, while D‑sotalol contributes to Class III action

Q4. The primary route of elimination for sotalol is:

  • Extensive hepatic metabolism via CYP3A4
  • Renal excretion as unchanged drug
  • Biliary excretion after conjugation
  • Pulmonary elimination through exhalation

Correct Answer: Renal excretion as unchanged drug

Q5. Which clinical monitoring is most important when initiating sotalol therapy?

  • Daily liver function tests for 7 days
  • Inpatient ECG monitoring for QT interval and heart rate
  • Routine chest X‑ray
  • Weekly lipid profile

Correct Answer: Inpatient ECG monitoring for QT interval and heart rate

Q6. A major cardiac adverse effect of sotalol related to its Class III action is:

  • Atrial fibrillation induction
  • Torsades de pointes due to QT prolongation
  • Hypertrophic cardiomyopathy
  • Immediate myocardial infarction

Correct Answer: Torsades de pointes due to QT prolongation

Q7. Which patient condition is a relative contraindication to sotalol because of its beta‑blocking properties?

  • Well-controlled hypothyroidism
  • Bronchial asthma with active bronchospasm
  • Controlled essential hypertension on monotherapy
  • Migraine without aura

Correct Answer: Bronchial asthma with active bronchospasm

Q8. Important laboratory parameters to check before and during sotalol therapy include:

  • Serum creatinine and electrolytes (K+, Mg2+)
  • Bronchodilator levels
  • Serum albumin only
  • Amylase and lipase

Correct Answer: Serum creatinine and electrolytes (K+, Mg2+)

Q9. Which drug interaction is most likely to increase the risk of sotalol‑induced torsades?

  • Co-administration with an ACE inhibitor
  • Co-administration with another QT‑prolonging agent such as a macrolide antibiotic
  • Co-administration with an H2 antagonist
  • Co-administration with oral iron supplements

Correct Answer: Co-administration with another QT‑prolonging agent such as a macrolide antibiotic

Q10. Regarding sotalol pharmacokinetics, which adjustment is most appropriate in renal impairment?

  • No adjustment is needed because sotalol is hepatically cleared
  • Dose reduction or increased dosing interval is required due to reduced renal clearance
  • Switch to intravenous route exclusively
  • Administration with activated charcoal to enhance elimination

Correct Answer: Dose reduction or increased dosing interval is required due to reduced renal clearance

Q11. Which arrhythmia is sotalol commonly indicated to treat?

  • Ventricular fibrillation in cardiac arrest (first-line)
  • Atrial fibrillation and ventricular tachycardia maintenance therapy
  • Sinus tachycardia due to dehydration only
  • Complete heart block as first-line therapy

Correct Answer: Atrial fibrillation and ventricular tachycardia maintenance therapy

Q12. A B.Pharm student is counseling about sotalol: which patient instruction is most important?

  • Stop the drug immediately if you miss a dose
  • Report symptoms of lightheadedness, syncope, palpitations, or shortness of breath and avoid abrupt discontinuation
  • Double the dose next day if a dose is missed
  • Reduce fluid intake to prevent drug interactions

Correct Answer: Report symptoms of lightheadedness, syncope, palpitations, or shortness of breath and avoid abrupt discontinuation

Q13. Why is sotalol initiation often done in a monitored setting?

  • To observe for immediate allergic reactions only
  • To monitor for QT prolongation, bradycardia, and proarrhythmia during early dosing
  • To provide continuous IV infusion during the first week
  • To perform serial liver biopsies

Correct Answer: To monitor for QT prolongation, bradycardia, and proarrhythmia during early dosing

Q14. Which pharmacodynamic effect does sotalol share with selective beta‑1 blockers?

  • Pure vasodilation without heart rate effect
  • Reduction in heart rate and decreased AV nodal conduction
  • Increase in cardiac contractility
  • Direct coronary vasospasm induction

Correct Answer: Reduction in heart rate and decreased AV nodal conduction

Q15. Which electrolyte imbalance increases the risk of sotalol‑associated torsades?

  • Hypercalcemia
  • Hypokalemia
  • Hypermagnesemia
  • Alkalemia with normal potassium

Correct Answer: Hypokalemia

Q16. Regarding drug metabolism, sotalol is characterized by:

  • Extensive first‑pass hepatic metabolism producing active metabolites
  • Minimal hepatic metabolism with most drug excreted unchanged in urine
  • Metabolism exclusively via CYP2D6 polymorphism
  • Inactivation by gastric acid prior to absorption

Correct Answer: Minimal hepatic metabolism with most drug excreted unchanged in urine

Q17. Which ECG parameter is most closely monitored to assess sotalol safety?

  • PR interval only
  • QT/QTc interval
  • QRS axis exclusively
  • ST segment elevation magnitude

Correct Answer: QT/QTc interval

Q18. A common noncardiac adverse effect of sotalol related to beta‑blockade is:

  • Diarrhea and abdominal cramping
  • Bronchospasm and worsening of reactive airway disease
  • Polyuria due to renal diuresis
  • Increased appetite and weight gain

Correct Answer: Bronchospasm and worsening of reactive airway disease

Q19. Which patient scenario requires extra caution or avoidance of sotalol?

  • Patient with well‑controlled type 2 diabetes on metformin
  • Patient with baseline prolonged QTc and electrolyte abnormalities
  • Young patient with isolated premature atrial contractions and normal ECG
  • Patient with seasonal allergic rhinitis

Correct Answer: Patient with baseline prolonged QTc and electrolyte abnormalities

Q20. Sotalol’s effect on AV node conduction is primarily due to:

  • Its potassium channel blockade only
  • Beta‑adrenergic blockade decreasing sympathetic drive to the AV node
  • Direct increase in AV nodal calcium influx
  • Activation of sympathetic beta‑2 receptors at the AV node

Correct Answer: Beta‑adrenergic blockade decreasing sympathetic drive to the AV node

Q21. Which statement about oral versus intravenous sotalol is correct?

  • Sotalol is only available orally and has no IV formulation
  • Both oral and IV formulations exist; IV may be used for acute arrhythmia control with monitoring
  • The IV form is used chronically to avoid renal clearance issues
  • Oral sotalol bypasses first‑pass and reaches higher peak levels than IV

Correct Answer: Both oral and IV formulations exist; IV may be used for acute arrhythmia control with monitoring

Q22. Which pharmacological property distinguishes sotalol from amiodarone?

  • Sotalol has significant iodine content affecting thyroid function
  • Sotalol is renally excreted with minimal metabolism; amiodarone is highly lipophilic and hepatically metabolized with multiple organ toxicities
  • Both drugs are identical in metabolism and adverse effect profiles
  • Amiodarone causes bronchospasm more commonly than sotalol

Correct Answer: Sotalol is renally excreted with minimal metabolism; amiodarone is highly lipophilic and hepatically metabolized with multiple organ toxicities

Q23. When counseling on missed doses of sotalol, the best advice is:

  • Skip the missed dose and resume the regular schedule; do not double the next dose
  • Double the next dose to compensate
  • Stop therapy permanently after one missed dose
  • Take the missed dose together with the next scheduled dose

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

Q24. Which laboratory change might necessitate immediate review or adjustment of sotalol therapy?

  • Serum potassium rising from 4.0 to 4.2 mEq/L
  • Serum creatinine clearance falling substantially, indicating renal impairment
  • Slight increase in fasting glucose from 90 to 95 mg/dL
  • Mild elevation of hemoglobin within normal range

Correct Answer: Serum creatinine clearance falling substantially, indicating renal impairment

Q25. In a drug interaction context, which antihypertensive class combined with sotalol may potentiate bradycardia or AV block?

  • ACE inhibitors
  • Calcium channel blockers that depress AV nodal conduction (e.g., verapamil, diltiazem)
  • Thiazide diuretics
  • Alpha‑1 blockers (e.g., prazosin)

Correct Answer: Calcium channel blockers that depress AV nodal conduction (e.g., verapamil, diltiazem)

Q26. Which pharmacotherapeutic principle explains why elderly patients require careful sotalol dosing?

  • Elderly always have increased hepatic metabolism requiring higher doses
  • Age‑related decline in renal function can increase sotalol exposure and risk of adverse effects
  • Elderly have increased pulmonary clearance of sotalol
  • Sotalol is inactivated by gastric acid which is more abundant in elderly

Correct Answer: Age‑related decline in renal function can increase sotalol exposure and risk of adverse effects

Q27. Which of the following best describes sotalol’s influence on action potential duration?

  • Shortens action potential duration by enhancing repolarizing currents
  • Prolongs action potential duration by inhibiting repolarizing potassium currents
  • No effect on action potential duration; it only affects conduction velocity
  • Causes immediate depolarization block via sodium accumulation

Correct Answer: Prolongs action potential duration by inhibiting repolarizing potassium currents

Q28. For pharmacy students calculating dosing, which factor most directly alters sotalol elimination half‑life?

  • Extent of plasma protein binding changes
  • Renal function (creatinine clearance)
  • Concomitant use of beta‑agonists
  • Gastric pH variations

Correct Answer: Renal function (creatinine clearance)

Q29. Which patient symptom would most likely prompt immediate evaluation for sotalol‑related proarrhythmia?

  • Dry mouth and mild constipation
  • New‑onset syncope or near‑syncope and palpitations
  • Mild headache resolving with acetaminophen
  • Intermittent paresthesia in the fingertips only

Correct Answer: New‑onset syncope or near‑syncope and palpitations

Q30. In terms of counseling and dispensing, which regulatory or safety step is commonly required for sotalol initiation?

  • No baseline tests; dispense as an over‑the‑counter drug
  • Ensure baseline ECG and renal function assessment and consider inpatient initiation for monitoring
  • Require liver biopsy prior to first dose
  • Mandatory genetic testing for CYP450 polymorphisms before dispensing

Correct Answer: Ensure baseline ECG and renal function assessment and consider inpatient initiation for monitoring

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