Amlodipine MCQs With Answer

Amlodipine MCQs With Answer

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Amlodipine MCQs With Answer
Amlodipine is a widely prescribed dihydropyridine calcium channel blocker used in hypertension and angina. This concise, student-focused introduction emphasizes pharmacology, mechanism of action, pharmacokinetics (absorption, long half-life), dosing, adverse effects such as peripheral edema, and clinically important drug interactions involving CYP3A4. B. Pharm students should master therapeutic indications, monitoring parameters, contraindications, and management of overdose. These MCQs are designed to deepen understanding of receptor selectivity, vascular effects, formulation considerations, and evidence-based prescribing principles, helping bridge theory and clinical application. Now let’s test your knowledge with 30 MCQs on this topic.

Q1. What is the primary mechanism of action of amlodipine?

  • Inhibition of beta-1 adrenergic receptors in the heart
  • Blockade of L-type voltage-gated calcium channels in vascular smooth muscle
  • Stimulation of alpha-2 adrenergic receptors reducing sympathetic outflow
  • Inhibition of angiotensin-converting enzyme (ACE)

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

Q2. Amlodipine belongs to which class of calcium channel blockers?

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

Correct Answer: Dihydropyridines

Q3. Which pharmacokinetic property best describes amlodipine?

  • Very short half-life requiring multiple daily dosing
  • Long elimination half-life allowing once-daily dosing
  • Extensive renal excretion of unchanged drug
  • Poor oral bioavailability necessitating intravenous use

Correct Answer: Long elimination half-life allowing once-daily dosing

Q4. The usual initial adult oral dose of amlodipine for hypertension is:

  • 0.5 mg once daily
  • 5 mg once daily
  • 40 mg once daily
  • 100 mg once daily

Correct Answer: 5 mg once daily

Q5. Which adverse effect is most characteristically associated with amlodipine?

  • Dry cough
  • Peripheral edema
  • Hyperkalemia
  • Bronchospasm

Correct Answer: Peripheral edema

Q6. Peripheral edema with amlodipine is primarily due to:

  • Renal sodium retention mediated by aldosterone
  • Venous dilation increasing venous capacitance
  • Preferential precapillary arteriolar dilation increasing capillary hydrostatic pressure
  • Lymphatic obstruction caused by drug metabolites

Correct Answer: Preferential precapillary arteriolar dilation increasing capillary hydrostatic pressure

Q7. Amlodipine is primarily metabolized by which enzyme system?

  • CYP2D6
  • CYP3A4
  • Monoamine oxidase
  • Glucuronosyltransferase only

Correct Answer: CYP3A4

Q8. Co-administration of amlodipine with which drug class may increase its plasma levels via CYP3A4 inhibition?

  • Macrolide antibiotics (e.g., clarithromycin)
  • Rifamycins (e.g., rifampin)
  • Ritonavir when used as an inducer
  • Bulk-forming laxatives

Correct Answer: Macrolide antibiotics (e.g., clarithromycin)

Q9. Which statement about amlodipine’s effect on heart rate and conduction is true?

  • It significantly slows AV nodal conduction causing heart block
  • It causes marked bradycardia in most patients
  • It has minimal direct effects on heart rate and conduction compared with non-dihydropyridines
  • It produces strong negative inotropy leading to heart failure in all patients

Correct Answer: It has minimal direct effects on heart rate and conduction compared with non-dihydropyridines

Q10. In which clinical condition should amlodipine be used with caution?

  • Mild stable hypertension without symptoms
  • Severe aortic stenosis
  • Essential tremor
  • Seasonal allergic rhinitis

Correct Answer: Severe aortic stenosis

Q11. The recommended adjustment for amlodipine in hepatic impairment is:

  • No adjustment needed regardless of severity
  • Increase dose due to increased clearance
  • Use lower initial doses and titrate cautiously
  • Switch to intravenous amlodipine

Correct Answer: Use lower initial doses and titrate cautiously

Q12. Which formulation aspect is true for amlodipine?

  • It is commonly available as a sustained-release once-daily oral tablet
  • It is only available as an intravenous infusion
  • It must be given sublingually for effect
  • It is formulated exclusively as a transdermal patch

Correct Answer: It is commonly available as a sustained-release once-daily oral tablet

Q13. Amlodipine’s antihypertensive effect is mainly due to:

  • Reduction in cardiac contractility only
  • Arteriolar vasodilation reducing systemic vascular resistance
  • Decreased blood volume via diuresis
  • Central sympathetic blockade

Correct Answer: Arteriolar vasodilation reducing systemic vascular resistance

Q14. Which of the following is an appropriate combination therapy with amlodipine for hypertension?

  • Amlodipine plus a beta-1 selective blocker increases peripheral edema
  • Amlodipine plus an ACE inhibitor often reduces peripheral edema and provides additive BP control
  • Amlodipine plus a non-dihydropyridine CCB is always recommended for hypertension
  • Amlodipine plus high-dose NSAIDs consistently lowers BP further

Correct Answer: Amlodipine plus an ACE inhibitor often reduces peripheral edema and provides additive BP control

Q15. Which monitoring parameter is most important after initiating amlodipine therapy?

  • Serum potassium every week
  • Blood pressure and signs of peripheral edema
  • Serum digoxin levels
  • Pulmonary function tests

Correct Answer: Blood pressure and signs of peripheral edema

Q16. The onset of antihypertensive action of oral amlodipine is typically:

  • Within 5–15 minutes
  • Within 6–12 hours with peak effect in 6–12 hours and gradual onset
  • After 7–10 days only
  • Immediate and short-lived, requiring multiple daily dosing

Correct Answer: Within 6–12 hours with peak effect in 6–12 hours and gradual onset

Q17. Amlodipine overdose management may include which immediate intervention?

  • Intravenous diuretics as first-line
  • Administration of intravenous calcium (e.g., calcium gluconate) and supportive measures
  • Immediate dialysis to remove drug
  • High-dose beta-agonists to reverse blockade

Correct Answer: Administration of intravenous calcium (e.g., calcium gluconate) and supportive measures

Q18. Which patient population often requires a lower starting dose of amlodipine?

  • Young healthy adults
  • Patients with hepatic impairment or elderly patients
  • Patients with hyperthyroidism
  • Patients with chronic anemia

Correct Answer: Patients with hepatic impairment or elderly patients

Q19. Amlodipine’s bioavailability is influenced primarily by:

  • First-pass hepatic metabolism by CYP3A4
  • Extensive renal excretion of unchanged drug
  • Inactivation by gastric acid alone
  • Rapid degradation in the intestine by brush-border enzymes

Correct Answer: First-pass hepatic metabolism by CYP3A4

Q20. Which cardiovascular condition is an approved indication for amlodipine?

  • Acute myocardial infarction as first-line thrombolytic
  • Chronic stable angina and hypertension
  • Severe bradyarrhythmias requiring pacemaker
  • Hypertrophic obstructive cardiomyopathy first-line therapy

Correct Answer: Chronic stable angina and hypertension

Q21. Which symptom would most likely suggest an amlodipine adverse reaction rather than disease progression?

  • Gradual improvement in exercise tolerance
  • New-onset bilateral ankle swelling after starting therapy
  • Steady reduction in blood pressure readings
  • Resolution of chest pain

Correct Answer: New-onset bilateral ankle swelling after starting therapy

Q22. Which statement about amlodipine use in pregnancy is correct?

  • Extensive controlled human studies show no risk; universally recommended
  • Data are limited; benefits must outweigh potential risks and use is considered cautiously
  • It is strictly contraindicated in all trimesters
  • It is the preferred antihypertensive for preeclampsia emergencies

Correct Answer: Data are limited; benefits must outweigh potential risks and use is considered cautiously

Q23. Grapefruit juice can affect amlodipine exposure by:

  • Inducing CYP3A4 and reducing drug levels
  • Inhibiting intestinal CYP3A4 and potentially increasing drug levels
  • Binding drug in the gut and decreasing absorption
  • No known effect on amlodipine metabolism

Correct Answer: Inhibiting intestinal CYP3A4 and potentially increasing drug levels

Q24. How does amlodipine compare to short-acting dihydropyridines regarding reflex tachycardia?

  • Amlodipine causes more pronounced reflex tachycardia than short-acting agents
  • Amlodipine, due to slow onset and long action, generally causes less reflex tachycardia
  • Both cause identical degrees of reflex tachycardia
  • Amlodipine completely abolishes reflex tachycardia

Correct Answer: Amlodipine, due to slow onset and long action, generally causes less reflex tachycardia

Q25. Which laboratory test is most directly useful to assess amlodipine toxicity?

  • Serum amlodipine concentration in routine clinical settings
  • Electrocardiogram and hemodynamic monitoring
  • Serum creatine kinase (CK) levels
  • Pulmonary function tests

Correct Answer: Electrocardiogram and hemodynamic monitoring

Q26. Which co-morbidity may be improved by amlodipine therapy besides hypertension?

  • Stable angina due to coronary vasodilation
  • Acute decompensated heart failure as first-line therapy
  • Asthma control via bronchodilation
  • Type 1 diabetes by improving insulin secretion

Correct Answer: Stable angina due to coronary vasodilation

Q27. The major route of elimination for amlodipine and its metabolites is:

  • Renal excretion of inactive metabolites
  • Biliary excretion of unchanged drug only
  • Exhalation via the lungs
  • Sweat and salivary glands primarily

Correct Answer: Renal excretion of inactive metabolites

Q28. Which drug interaction could reduce the antihypertensive effect of amlodipine?

  • Co-administration with CYP3A4 inducers like rifampin
  • Concurrent use of clarithromycin increasing levels
  • Combination with ACE inhibitors enhancing effect
  • Use with nitrates causing synergistic vasodilation

Correct Answer: Co-administration with CYP3A4 inducers like rifampin

Q29. Which description best fits amlodipine’s effect on myocardial oxygen demand?

  • Increases afterload and worsens myocardial ischemia
  • Reduces afterload and may decrease myocardial oxygen demand, helpful in angina
  • Directly increases heart rate causing higher oxygen demand
  • Has no effect on vascular resistance or myocardial demand

Correct Answer: Reduces afterload and may decrease myocardial oxygen demand, helpful in angina

Q30. When counseling a patient starting amlodipine, which advice is most appropriate?

  • Expect rapid symptom relief within minutes and take extra doses if needed
  • Take once daily, monitor blood pressure, and report persistent swelling or dizziness
  • Avoid all fruits and vegetables while on therapy
  • Stop therapy abruptly if blood pressure seems low without consulting a clinician

Correct Answer: Take once daily, monitor blood pressure, and report persistent swelling or dizziness

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