Antianginal drugs MCQs With Answer

Antianginal drugs MCQs With Answer provide B.Pharm students a focused review of pharmacology, mechanisms, and clinical applications for angina pectoris. This set emphasizes key drug classes—nitrates, beta‑blockers, calcium channel blockers, ranolazine, ivabradine—and covers pharmacokinetics, adverse effects, drug interactions, contraindications, and nitrate tolerance. Questions are designed to deepen understanding of mechanism of action, hemodynamic effects, therapeutic choices for stable and variant angina, and safe prescribing principles. Ideal for exam prep and clinical reasoning, these MCQs reinforce critical concepts needed for therapeutics and pharmacy practice. Now let’s test your knowledge with 30 MCQs on this topic.

Q1. Which mechanism primarily explains how nitrates relieve angina?

• Blockade of beta-adrenergic receptors
• Direct myocardial calcium channel blockade
• Metabolic inhibition of fatty acid oxidation
• Release of nitric oxide leading to vascular smooth muscle relaxation

Correct Answer: Release of nitric oxide leading to vascular smooth muscle relaxation

Q2. Which drug class reduces myocardial oxygen demand mainly by decreasing heart rate and contractility?

• Nitrates
• Beta-blockers
• Calcium channel blockers (dihydropyridine)
• Nicotinic acid

Correct Answer: Beta-blockers

Q3. Which calcium channel blocker is preferred for angina due to potent negative inotropic effect and heart rate reduction?

• Amlodipine
• Nifedipine
• Verapamil
• Nicardipine

Correct Answer: Verapamil

Q4. Which antianginal drug is contraindicated with sildenafil due to risk of severe hypotension?

• Isosorbide mononitrate
• Metoprolol
• Amlodipine
• Ranolazine

Correct Answer: Isosorbide mononitrate

Q5. What is the primary clinical use of ivabradine in angina management?

• Coronary vasodilation in Prinzmetal angina
• Reduction of heart rate by inhibiting If current in SA node
• Direct positive inotropic support
• Potent venodilation via nitric oxide donation

Correct Answer: Reduction of heart rate by inhibiting If current in SA node

Q6. Which adverse effect is most characteristically associated with nitrates?

• Bradycardia
• Headache and flushing
• Constipation
• Hyperglycemia

Correct Answer: Headache and flushing

Q7. Ranolazine primarily exerts its antianginal effect by inhibiting which current?

• Peak sodium current (INa)
• Late inward sodium current (INaL)
• Transient outward potassium current
• Funny current (If)

Correct Answer: Late inward sodium current (INaL)

Q8. Which condition is an indication for using calcium channel blockers in angina?

• Bradycardia with AV block
• Prinzmetal (variant) angina due to coronary spasm
• Uncompensated heart failure with reduced ejection fraction
• Acute decompensated heart failure requiring positive inotropes

Correct Answer: Prinzmetal (variant) angina due to coronary spasm

Q9. Tolerance to nitrates can be minimized clinically by which strategy?

• Increasing dose continuously
• Using a nightly nitrate-free interval
• Combining nitrates with PDE5 inhibitors
• Administering with beta-blockers only

Correct Answer: Using a nightly nitrate-free interval

Q10. Which beta-blocker property is most desirable in a patient with angina and asthma?

• Nonselective beta blockade
• High intrinsic sympathomimetic activity
• Cardioselective beta-1 blockade
• High lipid solubility

Correct Answer: Cardioselective beta-1 blockade

Q11. Which statement about nitrates’ hemodynamic effects is correct?

• They primarily increase afterload by arterial constriction
• They predominantly cause venodilation, reducing preload
• They increase heart rate by direct sympathetic stimulation only
• They inhibit platelet aggregation as their main action

Correct Answer: They predominantly cause venodilation, reducing preload

Q12. Which laboratory or ECG effect is associated with ranolazine use and requires monitoring?

• Prolongation of QT interval
• Elevation of liver enzymes in all patients
• Marked hypokalemia
• Widening of QRS duration exclusively

Correct Answer: Prolongation of QT interval

Q13. Which antianginal drug class can worsen heart failure due to negative inotropic effects?

• Dihydropyridine calcium channel blockers
• Nitrates
• Non-dihydropyridine calcium channel blockers (verapamil, diltiazem)
• Ivabradine

Correct Answer: Non-dihydropyridine calcium channel blockers (verapamil, diltiazem)

Q14. Which enzyme system metabolizes many nitrates and influences their bioavailability?

• CYP3A4
• Nitric oxide synthase
• Glutathione S-transferase
• High-capacity aldehyde dehydrogenase (ALDH2)

Correct Answer: High-capacity aldehyde dehydrogenase (ALDH2)

Q15. In acute angina attack, the fastest onset route for nitroglycerin is:

• Oral tablet
• Transdermal patch
• Sublingual tablet/spray
• Intravenous infusion only

Correct Answer: Sublingual tablet/spray

Q16. Which combination is generally avoided due to additive bradycardia and heart block risk?

• Beta-blocker plus nitrate
• Verapamil plus beta-blocker
• Amlodipine plus nitrate
• Ranolazine plus statin

Correct Answer: Verapamil plus beta-blocker

Q17. Nicorandil has a dual mechanism combining nitrate-like action with opening of which channels?

• Voltage-gated sodium channels
• ATP-sensitive potassium channels
• Calcium-activated potassium channels
• Hyperpolarization-activated cyclic nucleotide-gated channels

Correct Answer: ATP-sensitive potassium channels

Q18. Which antianginal agent is beneficial in patients with chronic angina who remain symptomatic despite other therapies and acts without affecting heart rate or blood pressure significantly?

• Ivabradine
• Ranolazine
• Nitrate patch
• Propranolol

Correct Answer: Ranolazine

Q19. Which drug lowers myocardial oxygen demand primarily by vasodilation of veins rather than arteries?

• Nifedipine
• Isosorbide dinitrate
• Amlodipine
• Ranolazine

Correct Answer: Isosorbide dinitrate

Q20. Which sign suggests nitrates are producing excessive hemodynamic effect during therapy?

• Improved exercise tolerance
• Severe orthostatic hypotension and syncope
• Mild headache relieved by acetaminophen
• Decreased anginal episodes

Correct Answer: Severe orthostatic hypotension and syncope

Q21. Which antianginal drug can cause constipation as a notable adverse effect?

• Verapamil
• Amlodipine
• Metoprolol
• Isosorbide mononitrate

Correct Answer: Verapamil

Q22. For a patient with exertional angina and hypertension, which initial combination is often effective?

• Beta-blocker plus nitrate-free patch
• Beta-blocker plus calcium channel blocker (dihydropyridine)
• Ranolazine plus PDE5 inhibitor
• Nitrate plus hydralazine

Correct Answer: Beta-blocker plus calcium channel blocker (dihydropyridine)

Q23. Which lab monitoring is especially relevant for ranolazine due to interaction with CYP3A4 inhibitors?

• Serum creatinine only
• Serum potassium and ECG for QT prolongation
• Complete blood count weekly
• Liver biopsy

Correct Answer: Serum potassium and ECG for QT prolongation

Q24. Which statement about sublingual nitroglycerin use is correct?

• It should be swallowed for best effect
• It can be repeated every 5 minutes up to three doses for chest pain
• It is ineffective for angina relief
• It has a long duration of action exceeding 12 hours

Correct Answer: It can be repeated every 5 minutes up to three doses for chest pain

Q25. Which antianginal approach is appropriate for microvascular angina (cardiac syndrome X)?

• High-dose nitrates only
• Beta-blockers, calcium channel blockers, and metabolic agents like ranolazine
• Immediate coronary angioplasty in all cases
• Systemic vasoconstrictors

Correct Answer: Beta-blockers, calcium channel blockers, and metabolic agents like ranolazine

Q26. Which pharmacokinetic property is important when choosing between short-acting and long-acting nitrates?

• First-pass hepatic metabolism and tolerance development
• Renal excretion unchanged only
• Poor oral absorption universally
• Lack of any metabolism in humans

Correct Answer: First-pass hepatic metabolism and tolerance development

Q27. Which antianginal drug improves exercise tolerance by selectively reducing heart rate without affecting inotropy?

• Propranolol
• Ivabradine
• Verapamil
• Isosorbide mononitrate

Correct Answer: Ivabradine

Q28. Which adverse effect is commonly associated with dihydropyridine calcium channel blockers?

• Bradycardia and AV block
• Peripheral edema and reflex tachycardia
• Severe constipation in most patients
• Bronchospasm

Correct Answer: Peripheral edema and reflex tachycardia

Q29. In a patient with hypertrophic obstructive cardiomyopathy and angina, which therapy is often beneficial?

• High-dose dihydropyridine CCBs
• Beta-blockers to reduce LV outflow gradient
• Nitrates to increase preload dramatically
• Immediate use of PDE5 inhibitors

Correct Answer: Beta-blockers to reduce LV outflow gradient

Q30. Which interaction increases risk of hypotension when combined with nitrates?

• Concurrent use of ACE inhibitors at low dose only
• Combination with phosphodiesterase-5 inhibitors like sildenafil
• Use with aspirin
• Use with statins

Correct Answer: Combination with phosphodiesterase-5 inhibitors like sildenafil

Download