Calcium channel blockers (CCBs) are a cornerstone of cardiovascular pharmacotherapy, used to manage a variety of conditions including hypertension, angina, and arrhythmias. Their unique mechanisms, divided between the dihydropyridine and non-dihydropyridine classes, result in distinct therapeutic effects and side effect profiles. For PharmD students, a deep understanding of this drug class is essential for optimizing patient care. This quiz will test your knowledge of the pharmacology, therapeutic uses, and clinical considerations of calcium channel blockers.
1. What is the primary mechanism of action for all calcium channel blockers?
- They block sodium channels in the cardiac myocytes.
- They inhibit the influx of calcium into vascular smooth muscle and/or cardiac cells.
- They are agonists at the beta-1 adrenergic receptor.
- They inhibit the enzyme angiotensin-converting enzyme.
Answer: They inhibit the influx of calcium into vascular smooth muscle and/or cardiac cells.
2. Calcium channel blockers are broadly divided into which two major classes?
- Selective and Non-selective
- First-generation and Second-generation
- Dihydropyridines and Non-dihydropyridines
- Oral and Intravenous
Answer: Dihydropyridines and Non-dihydropyridines
3. Which of the following medications is a dihydropyridine (DHP) calcium channel blocker?
- Diltiazem
- Verapamil
- Amlodipine
- Digoxin
Answer: Amlodipine
4. Dihydropyridine CCBs, like amlodipine, are known for their relative selectivity for:
- The AV node.
- The SA node.
- Cardiac muscle.
- Vascular smooth muscle.
Answer: Vascular smooth muscle.
5. The primary therapeutic effect of dihydropyridine CCBs is:
- A decrease in heart rate.
- A decrease in cardiac contractility.
- Vasodilation and a reduction in systemic vascular resistance.
- An increase in the speed of AV nodal conduction.
Answer: Vasodilation and a reduction in systemic vascular resistance.
6. Which of the following medications are non-dihydropyridine (non-DHP) calcium channel blockers?
- Nifedipine and Felodipine
- Amlodipine and Nicardipine
- Verapamil and Diltiazem
- Lisinopril and Losartan
Answer: Verapamil and Diltiazem
7. A key pharmacologic difference of non-dihydropyridine CCBs compared to DHPs is that non-DHPs have significant effects on:
- The renin-angiotensin-aldosterone system.
- The cardiac conduction system (SA and AV nodes) and myocardial contractility.
- The alpha-1 adrenergic receptors.
- The loop of Henle in the kidney.
Answer: The cardiac conduction system (SA and AV nodes) and myocardial contractility.
8. A common and dose-dependent side effect of dihydropyridine CCBs like amlodipine is:
- Persistent dry cough.
- Hyperkalemia.
- Bradycardia.
- Peripheral edema.
Answer: Peripheral edema.
9. The peripheral edema caused by DHP calcium channel blockers is primarily due to:
- An increase in venous pressure.
- Fluid retention caused by renal effects.
- Preferential arteriolar dilation, which increases intracapillary pressure.
- A direct toxic effect on the lymphatic system.
Answer: Preferential arteriolar dilation, which increases intracapillary pressure.
10. Which of the following side effects is most characteristic of verapamil?
- Diarrhea
- Constipation
- Tachycardia
- A metallic taste
Answer: Constipation
11. Due to their effects on the AV node, non-dihydropyridine CCBs are contraindicated in patients with:
- Asthma and COPD.
- Pre-existing second- or third-degree AV block without a pacemaker.
- Gout.
- High cholesterol.
Answer: Pre-existing second- or third-degree AV block without a pacemaker.
12. Combining a non-dihydropyridine CCB with a beta-blocker increases the risk of:
- Severe tachycardia.
- A hypertensive crisis.
- Severe bradycardia and heart block.
- Acute kidney injury.
Answer: Severe bradycardia and heart block.
13. Non-dihydropyridine CCBs are often used in the management of atrial fibrillation for what purpose?
- To convert the patient back to normal sinus rhythm.
- To control the ventricular rate.
- To prevent blood clots.
- To lower cholesterol.
Answer: To control the ventricular rate.
14. Which calcium channel blocker is most likely to cause reflex tachycardia, especially in its immediate-release formulation?
- Verapamil
- Diltiazem
- Amlodipine
- Nifedipine
Answer: Nifedipine
15. Verapamil and diltiazem are moderate inhibitors of which major drug-metabolizing enzyme?
- CYP2D6
- CYP2C19
- CYP3A4
- CYP1A2
Answer: CYP3A4
16. A patient taking simvastatin begins therapy with diltiazem. The pharmacist should be concerned about an interaction that increases the risk of:
- Myopathy and rhabdomyolysis.
- A hypertensive crisis.
- Serotonin syndrome.
- A bleeding event.
Answer: Myopathy and rhabdomyolysis.
17. Due to their negative inotropic effects, which class of CCBs should generally be avoided in patients with heart failure with reduced ejection fraction (HFrEF)?
- Dihydropyridines
- Non-dihydropyridines
- All calcium channel blockers.
- No calcium channel blockers are contraindicated.
Answer: Non-dihydropyridines
18. A patient complains of swollen ankles after starting amlodipine. A pharmacist could counsel them that this is a common side effect and to:
- Stop the medication immediately.
- Double the dose of the medication.
- Discuss it with their doctor, who may consider adding an ACE inhibitor or ARB to help mitigate the edema.
- Wear tighter shoes.
Answer: Discuss it with their doctor, who may consider adding an ACE inhibitor or ARB to help mitigate the edema.
19. Which calcium channel blocker is available as an intravenous infusion and is often used for acute rate control of atrial fibrillation in the hospital setting?
- Amlodipine
- Nifedipine
- Diltiazem
- Felodipine
Answer: Diltiazem
20. A common therapeutic use for all classes of calcium channel blockers is the management of:
- Heart failure.
- Hypertension.
- Gout.
- Diabetes.
Answer: Hypertension.
21. Gingival hyperplasia is a rare but notable side effect associated with which calcium channel blocker?
- Diltiazem
- Verapamil
- Nifedipine
- Amlodipine
Answer: Nifedipine
22. How do calcium channel blockers help to relieve anginal pain?
- They increase myocardial oxygen demand.
- They cause coronary vasodilation, increasing oxygen supply, and they reduce afterload, decreasing oxygen demand.
- They increase heart rate, which improves coronary perfusion.
- They have a direct analgesic effect on the heart.
Answer: They cause coronary vasodilation, increasing oxygen supply, and they reduce afterload, decreasing oxygen demand.
23. A patient taking verapamil complains of a new-onset headache. This is likely due to the drug’s ________ effect.
- Vasodilatory
- Negative inotropic
- Negative chronotropic
- Anti-emetic
Answer: Vasodilatory
24. The influx of calcium into vascular smooth muscle cells is a key step in initiating:
- Muscle relaxation.
- Muscle contraction.
- The cardiac action potential.
- The release of renin.
Answer: Muscle contraction.
25. A key principle of cardiovascular pharmacology is that blocking calcium channels in vascular smooth muscle will lead to:
- Vasoconstriction.
- Vasodilation.
- An increase in blood pressure.
- An increase in afterload.
Answer: Vasodilation.
26. Why are long-acting dihydropyridine CCBs, like amlodipine, generally preferred over short-acting ones, like immediate-release nifedipine, for hypertension?
- They provide smoother blood pressure control and avoid the reflex tachycardia associated with rapid drops in blood pressure.
- They are less expensive.
- They have fewer drug interactions.
- They are more effective at lowering blood pressure.
Answer: They provide smoother blood pressure control and avoid the reflex tachycardia associated with rapid drops in blood pressure.
27. In the cardiac action potential, calcium influx during Phase 2 (the plateau phase) is critical for:
- Initiating the rapid depolarization.
- Triggering the process of excitation-contraction coupling.
- Causing the rapid repolarization of the cell.
- Maintaining the resting membrane potential.
Answer: Triggering the process of excitation-contraction coupling.
28. A patient taking verapamil may have increased levels of digoxin due to:
- Verapamil inhibiting the P-glycoprotein efflux pump, which is responsible for clearing digoxin.
- Verapamil inducing the metabolism of digoxin.
- A direct chemical interaction between the two drugs.
- Verapamil increasing the absorption of digoxin.
Answer: Verapamil inhibiting the P-glycoprotein efflux pump, which is responsible for clearing digoxin.
29. Which of the following is an example of a “third-generation” dihydropyridine CCB that may cause less peripheral edema?
- Nifedipine
- Nicardipine
- Lercanidipine
- Verapamil
Answer: Lercanidipine
30. The “dihydropyridine” name refers to the drug’s:
- Therapeutic use.
- Side effect profile.
- Core chemical structure.
- Brand name.
Answer: Core chemical structure.
31. A pharmacist’s knowledge of __________ is essential for anticipating the drug interactions with verapamil and diltiazem.
- Medicinal chemistry
- Pharmacokinetics, specifically CYP450 metabolism
- Pharmacy law
- Health economics
Answer: Pharmacokinetics, specifically CYP450 metabolism
32. For a patient with Raynaud’s phenomenon, a dihydropyridine CCB is used to:
- Increase the sensation of cold in the extremities.
- Prevent vasospasm in the digits and improve blood flow.
- Treat the underlying autoimmune cause.
- Reduce pain through a central mechanism.
Answer: Prevent vasospasm in the digits and improve blood flow.
33. Which of the following is a primary counseling point for a patient starting any antihypertensive agent, including a CCB?
- To stop the medication if their blood pressure is normal for one day.
- To rise slowly from a seated or lying position to avoid dizziness (orthostatic hypotension).
- To take the medication only when they feel their blood pressure is high.
- To double the dose if they miss a single dose.
Answer: To rise slowly from a seated or lying position to avoid dizziness (orthostatic hypotension).
34. A key difference between the dihydropyridine and non-dihydropyridine binding sites on the L-type calcium channel is that they are:
- Identical.
- Allosterically distinct, meaning they bind to different sites and affect the channel in different ways.
- Only accessible from the inside of the cell.
- Located on different types of calcium channels.
Answer: Allosterically distinct, meaning they bind to different sites and affect the channel in different ways.
35. A pharmacist providing MTM for a patient on amlodipine should screen for which common, dose-related adverse effect?
- Dry cough
- Peripheral edema
- Hyperkalemia
- Angioedema
Answer: Peripheral edema
36. A patient with hypertension and stable angina would be a good candidate for which class of medications?
- Loop diuretics
- Calcium channel blockers
- Statins
- All of the above could be part of a comprehensive regimen, but CCBs are a direct treatment for both conditions.
Answer: All of the above could be part of a comprehensive regimen, but CCBs are a direct treatment for both conditions.
37. The “negative chronotropic” effect of a non-dihydropyridine CCB refers to its ability to:
- Decrease the force of contraction.
- Decrease the heart rate.
- Decrease the speed of conduction.
- Decrease blood pressure.
Answer: Decrease the heart rate.
38. The “negative inotropic” effect refers to the ability to:
- Decrease the force of contraction.
- Decrease the heart rate.
- Decrease the speed of conduction.
- Decrease blood pressure.
Answer: Decrease the force of contraction.
39. In which practice setting would a pharmacist be most likely to manage an IV diltiazem infusion?
- Community pharmacy
- Ambulatory care clinic
- Hospital/Institutional setting
- Mail-order pharmacy
Answer: Hospital/Institutional setting
40. The use of a “loading dose” for an IV CCB is a pharmacokinetic principle used to:
- More rapidly achieve a therapeutic concentration.
- Decrease the risk of side effects.
- Fulfill a billing requirement.
- Allow for once-daily administration.
Answer: More rapidly achieve a therapeutic concentration.
41. The leadership skill of “advocacy” could be used by a pharmacist to:
- Negotiate with an insurance company for coverage of a non-formulary CCB that is clinically necessary for a patient.
- Insist that all patients receive the same CCB.
- Promote the most expensive CCB available.
- Avoid all communication with prescribers.
Answer: Negotiate with an insurance company for coverage of a non-formulary CCB that is clinically necessary for a patient.
42. When forging ahead with new clinical services, an understanding of the financial principles behind medication selection (e.g., using a cost-effective generic CCB) is important for:
- Demonstrating the value and sustainability of the service.
- It is not an important consideration.
- Ensuring only brand-name drugs are used.
- Increasing the overall cost of care.
Answer: Demonstrating the value and sustainability of the service.
43. A key part of the “Business Plan” for a new hypertension management service would involve understanding:
- The market for antihypertensive drugs, including the role of generic CCBs.
- Only the marketing plan.
- Only the financial plan.
- Only the management structure.
Answer: The market for antihypertensive drugs, including the role of generic CCBs.
44. A patient’s adherence to a once-daily CCB like amlodipine is generally ________ than for a drug that needs to be taken multiple times a day.
- Worse
- Better
- The same
- Not a factor in treatment success
Answer: Better
45. Which of the following is a potential “drug-food” interaction with some calcium channel blockers like felodipine?
- High-fat meals
- Dairy products
- Grapefruit juice
- High-protein foods
Answer: Grapefruit juice
46. The use of a “Dashboard Presentation” could be used by a hospital pharmacy leader to:
- Track the appropriate use of IV calcium channel blockers according to institutional guidelines.
- Counsel an individual patient.
- Dispense a prescription.
- Write a new policy.
Answer: Track the appropriate use of IV calcium channel blockers according to institutional guidelines.
47. From a “human factors” perspective, the different brand and generic names for various CCBs can contribute to:
- Look-alike/sound-alike medication errors.
- Improved patient safety.
- A more efficient workflow.
- No impact on the medication use process.
Answer: Look-alike/sound-alike medication errors.
48. An effective “negotiation” with a physician about changing a patient’s CCB would involve:
- Demanding the change be made.
- Providing a clear, evidence-based rationale for the recommended change.
- Stating that the current drug is “bad.”
- Focusing on the cost of the medication only.
Answer: Providing a clear, evidence-based rationale for the recommended change.
49. The development of once-daily, extended-release formulations of CCBs like verapamil and diltiazem was a key advancement in:
- Pharmaceutics to improve patient adherence and provide smoother drug levels.
- Medicinal chemistry.
- Pharmacogenomics.
- Toxicology.
Answer: Pharmaceutics to improve patient adherence and provide smoother drug levels.
50. The ultimate goal of using a calcium channel blocker is to:
- Achieve a specific number on a blood pressure reading.
- Improve a patient’s clinical outcomes and quality of life by managing their cardiovascular condition.
- Use the highest possible dose.
- Ensure the patient remains on the medication for life, regardless of need.
Answer: Improve a patient’s clinical outcomes and quality of life by managing their cardiovascular condition.
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