Beta adrenergic blockers – Metibranolol MCQs With Answer

Beta adrenergic blockers are a core topic in B.Pharm pharmacology, and Metibranolol exemplifies how beta-blockers modulate cardiovascular physiology. This concise introduction covers mechanism of action, therapeutic uses, adverse effects, pharmacokinetic considerations and clinical monitoring relevant to students. Key keywords included here—Beta adrenergic blockers, Metibranolol, beta-blockers, adrenergic receptors, pharmacology, B.Pharm, cardiovascular, mechanism of action, adverse effects, drug interactions—will help you learn and revise efficiently. These points prepare you for exam-style questions and clinical reasoning about drug choice, contraindications and patient counseling. Now let’s test your knowledge with 50 MCQs on this topic.

Q1. Which of the following best describes the primary mechanism of action of Metibranolol?

• Activation of beta-adrenergic receptors to increase cAMP
• Competitive antagonism of beta-adrenergic receptors reducing cAMP
• Irreversible blockade of muscarinic receptors
• Stimulation of alpha-2 receptors in the CNS

Correct Answer: Competitive antagonism of beta-adrenergic receptors reducing cAMP

Q2. Beta-1 adrenergic receptors are primarily located in which organ system?

• Bronchial smooth muscle
• Heart (cardiac tissue)
• Vascular endothelial cells
• Adipose tissue

Correct Answer: Heart (cardiac tissue)

Q3. Blockade of beta-1 receptors by Metibranolol will most directly cause which effect?

• Increased heart rate
• Decreased myocardial contractility
• Bronchodilation
• Increased renin release

Correct Answer: Decreased myocardial contractility

Q4. Non-selective beta-blockers differ from cardioselective agents because they block which additional receptor?

• Beta-3 receptor
• Beta-2 receptor
• Muscarinic M2 receptor
• Alpha-1 receptor

Correct Answer: Beta-2 receptor

Q5. Which clinical indication is commonly treated with beta-adrenergic blockers like Metibranolol?

• Acute bacterial infection
• Hypertension and chronic stable angina
• Hyperkalemia
• Hypothyroidism

Correct Answer: Hypertension and chronic stable angina

Q6. Which adverse effect is particularly important to monitor in asthmatic patients receiving Metibranolol?

• Urinary retention
• Bronchospasm due to beta-2 blockade
• Excessive salivation
• Insomnia

Correct Answer: Bronchospasm due to beta-2 blockade

Q7. How can beta-blockers mask a common symptom of hypoglycemia in diabetic patients?

• They increase insulin secretion masking symptoms
• They prevent sweating while increasing tachycardia
• They blunt sympathetic symptoms like tachycardia and tremor
• They prolong glucose absorption in the gut

Correct Answer: They blunt sympathetic symptoms like tachycardia and tremor

Q8. Which pharmacokinetic property increases central nervous system penetration of a beta-blocker?

• High water solubility
• Low protein binding
• High lipid solubility
• Renal excretion without metabolism

Correct Answer: High lipid solubility

Q9. Abrupt withdrawal of Metibranolol may lead to which complication?

• Rebound hypertension and tachycardia
• Permanent hyperthyroidism
• Severe hypokalemia
• Renal failure

Correct Answer: Rebound hypertension and tachycardia

Q10. Which of the following interactions is clinically important with beta-blockers like Metibranolol?

• Potentiation of bradycardia when combined with non-dihydropyridine calcium channel blockers
• Reduced anticoagulant effect with warfarin
• Increased risk of serotonin syndrome with SSRIs
• Complete inactivation by antacids

Correct Answer: Potentiation of bradycardia when combined with non-dihydropyridine calcium channel blockers

Q11. Which electrophysiological effect is expected with beta-1 blockade by Metibranolol?

• Shortened AV node conduction time
• Prolongation of PR interval due to slowed AV conduction
• Increased pacemaker automaticity
• Development of early afterdepolarizations

Correct Answer: Prolongation of PR interval due to slowed AV conduction

Q12. For migraine prophylaxis, beta-blockers are used because they:

• Directly constrict cerebral vessels causing relief
• Stabilize vascular tone and reduce sympathetic overactivity
• Increase serotonin synthesis in the brain
• Act as NMDA receptor antagonists

Correct Answer: Stabilize vascular tone and reduce sympathetic overactivity

Q13. Which laboratory or clinical monitoring is important when initiating Metibranolol therapy?

• Baseline and periodic blood glucose only
• Heart rate and blood pressure monitoring
• Regular EEG monitoring
• Serum magnesium concentration weekly

Correct Answer: Heart rate and blood pressure monitoring

Q14. Which statement about intrinsic sympathomimetic activity (ISA) is correct?

• Beta-blockers with ISA fully block beta receptors at all doses
• Beta-blockers with ISA partially activate beta receptors while blocking excessive stimulation
• ISA increases bronchoconstriction risk
• All beta-blockers have ISA

Correct Answer: Beta-blockers with ISA partially activate beta receptors while blocking excessive stimulation

Q15. Which effect on renal function is produced by beta-blockade in the short term?

• Increased renin release
• Decreased renin release leading to reduced angiotensin II formation
• Direct diuretic effect in the nephron
• Increased glomerular filtration rate

Correct Answer: Decreased renin release leading to reduced angiotensin II formation

Q16. Which of the following patient conditions is a relative contraindication to non-selective beta-blocker therapy?

• Stable angina
• Asthma or reactive airways disease
• Essential tremor
• Migraine prophylaxis

Correct Answer: Asthma or reactive airways disease

Q17. Topical ophthalmic beta-blockers reduce intraocular pressure primarily by:

• Increasing aqueous humor production
• Decreasing aqueous humor production by ciliary epithelium
• Enhancing trabecular outflow exclusively
• Causing miosis which lowers pressure

Correct Answer: Decreasing aqueous humor production by ciliary epithelium

Q18. Which property of a beta-blocker would make it preferable in patients with PTSD or anxiety symptoms?

• High beta-2 selectivity
• High lipid solubility enabling CNS penetration
• Predominant alpha-blocking activity
• Long-acting diuretic effect

Correct Answer: High lipid solubility enabling CNS penetration

Q19. A patient on Metibranolol develops severe bradycardia. Which pharmacologic agent can be used as an antidote in acute settings?

• Atropine to increase heart rate
• Propanolol to further decrease heart rate
• Furosemide to reduce preload
• Insulin to increase sympathetic tone

Correct Answer: Atropine to increase heart rate

Q20. Which statement about beta-blocker dosing in elderly patients is appropriate?

• Use higher starting doses due to tolerance
• Start with lower doses and titrate slowly while monitoring
• No dose adjustment is ever needed with age
• Avoid monitoring once therapy is established

Correct Answer: Start with lower doses and titrate slowly while monitoring

Q21. Which symptom is a common central nervous system side effect of lipophilic beta-blockers?

• Constipation
• Depression, vivid dreams or fatigue
• Excessive lacrimation
• Hyperreflexia

Correct Answer: Depression, vivid dreams or fatigue

Q22. Which pharmacodynamic effect contributes to the antihypertensive action of beta-blockers?

• Direct vasodilation via nitric oxide release
• Reduction of cardiac output and renin secretion
• Increase in plasma volume
• Activation of sympathetic nervous system

Correct Answer: Reduction of cardiac output and renin secretion

Q23. In a patient with concurrent heart failure, how are beta-blockers like Metibranolol used clinically?

• Contraindicated in all forms of heart failure
• Initiated carefully at low doses and titrated as tolerated to improve survival
• Used only as a single bolus dose during exacerbations
• Given in high doses initially to suppress symptoms rapidly

Correct Answer: Initiated carefully at low doses and titrated as tolerated to improve survival

Q24. Which ECG change might indicate excessive beta-blockade?

• Short QT interval
• Sinus bradycardia and possible AV block
• Widened QRS due to sodium channel blockade
• Peaked T waves from hyperkalemia

Correct Answer: Sinus bradycardia and possible AV block

Q25. Which mechanism explains why beta-blockers can help in thyrotoxic symptoms?

• They increase peripheral conversion of T4 to T3
• They block sympathetic-mediated symptoms like tachycardia and tremor
• They stimulate thyroid hormone synthesis
• They enhance iodine uptake by the thyroid

Correct Answer: They block sympathetic-mediated symptoms like tachycardia and tremor

Q26. Which characteristic of Metibranolol would most likely increase its oral bioavailability?

• Extensive first-pass hepatic metabolism
• High stability to gut and hepatic enzymes
• Very low lipid solubility preventing absorption
• Large molecular size preventing membrane passage

Correct Answer: High stability to gut and hepatic enzymes

Q27. Which hemodynamic response is expected during acute beta-blocker administration?

• Immediate increase in cardiac output
• Reduction in heart rate and myocardial oxygen demand
• Marked vasoconstriction due to alpha stimulation
• Immediate diuresis and natriuresis

Correct Answer: Reduction in heart rate and myocardial oxygen demand

Q28. Which beta-blocker property is important when treating patients with diabetes who experience hypoglycemia?

• Non-selectivity is preferred to mask symptoms
• Cardioselectivity is preferred to minimize masking of hypoglycemia
• High alpha activity reduces hypoglycemia risk
• Use of long-acting formulations eliminates risk

Correct Answer: Cardioselectivity is preferred to minimize masking of hypoglycemia

Q29. Which of the following is a typical pharmacological effect of beta-2 receptor blockade?

• Bronchodilation
• Bronchoconstriction and potential worsening of airflow
• Increased hepatic glycogenolysis
• Enhanced insulin secretion

Correct Answer: Bronchoconstriction and potential worsening of airflow

Q30. Which statement about beta-blocker metabolism and drug interactions is accurate?

• All beta-blockers are excreted unchanged in urine and have no interactions
• Some beta-blockers are metabolized by hepatic CYP enzymes and may interact with CYP inhibitors or inducers
• Beta-blockers are activated by grapefruit juice
• Concomitant digoxin eliminates the need for monitoring

Correct Answer: Some beta-blockers are metabolized by hepatic CYP enzymes and may interact with CYP inhibitors or inducers

Q31. Which clinical scenario is an appropriate indication for intravenous beta-blocker administration?

• Acute decompensated heart failure with cardiogenic shock
• Atrial fibrillation with rapid ventricular response requiring rate control
• Asymptomatic mild hypertension in outpatient setting
• Acute bronchospasm in severe asthma

Correct Answer: Atrial fibrillation with rapid ventricular response requiring rate control

Q32. Which adverse effect on lipid profile can be associated with some non-selective beta-blockers?

• Increase in HDL and decrease in LDL universally
• Potential increase in triglycerides and decrease in HDL
• Marked reduction in all lipids to dangerously low levels
• No effect on lipid metabolism at all

Correct Answer: Potential increase in triglycerides and decrease in HDL

Q33. Which statement is true about beta-blocker use in pregnancy?

• All beta-blockers are absolutely contraindicated in pregnancy
• Risks and benefits must be weighed; some beta-blockers may be used with caution under supervision
• They always cause teratogenic malformations in the first trimester
• They enhance fetal growth and are recommended routinely

Correct Answer: Risks and benefits must be weighed; some beta-blockers may be used with caution under supervision

Q34. Which autonomic reflex is blunted by chronic beta-blocker therapy?

• Baroreceptor-mediated reflex tachycardia
• Pupillary constriction in response to light
• Salivation increase after sour taste
• Reflex hyperglycemia from epinephrine

Correct Answer: Baroreceptor-mediated reflex tachycardia

Q35. In pharmacology exams, Metibranolol is most likely classified under which drug category?

• Calcium channel blockers
• Beta adrenergic blockers (beta-blockers)
• ACE inhibitors
• Diuretics

Correct Answer: Beta adrenergic blockers (beta-blockers)

Q36. Which symptom should be included in patient counseling when starting Metibranolol?

• Expect immediate resolution of all symptoms within minutes
• Report dizziness, slow pulse, breathlessness or syncope; do not stop drug abruptly
• There are no side effects to worry about
• Only take the drug once and no follow-up needed

Correct Answer: Report dizziness, slow pulse, breathlessness or syncope; do not stop drug abruptly

Q37. Which laboratory measurement is most helpful to evaluate an adverse metabolic effect of beta-blockers?

• Serum calcium concentration
• Lipid profile including triglycerides and HDL
• Serum amylase for pancreatitis
• Urine ketones routinely

Correct Answer: Lipid profile including triglycerides and HDL

Q38. Which pharmacologic class, when combined with beta-blockers, increases the risk of severe bradycardia and heart block?

• Loop diuretics
• Non-dihydropyridine calcium channel blockers (verapamil, diltiazem)
• ACE inhibitors
• HMG-CoA reductase inhibitors

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

Q39. Which clinical benefit of beta-blockers has been demonstrated in post-myocardial infarction care?

• No impact on mortality but increase in recurrent MI
• Reduction in mortality and arrhythmic deaths when used appropriately
• Causing immediate myocardial tissue regeneration
• Complete reversal of coronary atherosclerosis

Correct Answer: Reduction in mortality and arrhythmic deaths when used appropriately

Q40. Which pharmacologic descriptor best fits a drug that blocks beta receptors but also has weak vasodilating alpha-blocking effects?

• Pure beta-1 selective antagonist
• Mixed alpha and beta antagonist with vasodilatory properties
• Selective beta-2 agonist
• Direct renin inhibitor

Correct Answer: Mixed alpha and beta antagonist with vasodilatory properties

Q41. Which sign is a likely peripheral vascular adverse effect of beta-blockers?

• Warm and flushed extremities
• Cold extremities and worsening intermittent claudication in some patients
• Marked peripheral edema only due to sodium retention
• Rapid hair growth on the limbs

Correct Answer: Cold extremities and worsening intermittent claudication in some patients

Q42. Which pharmacological approach reduces the risk of bronchospasm in patients needing beta-blocker therapy?

• Choose a non-selective beta-blocker
• Use a cardioselective (beta-1 selective) agent at the lowest effective dose
• Combine with a beta-2 agonist chronically without respiratory monitoring
• Avoid all cardiovascular therapy

Correct Answer: Use a cardioselective (beta-1 selective) agent at the lowest effective dose

Q43. Which adverse endocrine effect may be seen with non-selective beta-blockers?

• Excessive insulin secretion leading to hyperglycemia
• Masking of adrenergic symptoms of hypoglycemia and inhibition of glycogenolysis
• Complete cure of diabetes mellitus
• Increased thyroid hormone synthesis

Correct Answer: Masking of adrenergic symptoms of hypoglycemia and inhibition of glycogenolysis

Q44. Which statement about topical (ophthalmic) beta-blockers is correct?

• They have no systemic absorption and therefore no systemic effects
• They can have systemic beta-blocking effects and should be used cautiously in patients with respiratory disease
• They always cause permanent vision loss
• They stimulate aqueous humor production

Correct Answer: They can have systemic beta-blocking effects and should be used cautiously in patients with respiratory disease

Q45. In the context of drug design, why might a medicinal chemist modify a beta-blocker to be more hydrophilic?

• To increase CNS side effects
• To reduce CNS penetration and central adverse effects
• To make the drug taste better
• To guarantee complete renal excretion unchanged

Correct Answer: To reduce CNS penetration and central adverse effects

Q46. Which symptom suggests excessive beta-blockade in a patient receiving Metibranolol?

• Resting tachycardia above 110 bpm
• Marked fatigue, dizziness, syncope, or resting pulse below target
• Excessive sweating and hyperactivity
• Severe constipation only

Correct Answer: Marked fatigue, dizziness, syncope, or resting pulse below target

Q47. Which pharmacologic test would demonstrate beta-adrenergic blockade pharmacodynamically?

• Increased response to isoproterenol challenge
• Reduced heart rate response to isoproterenol or exercise
• Immediate bronchodilation with histamine inhalation
• Increased renin release after beta-blocker dosing

Correct Answer: Reduced heart rate response to isoproterenol or exercise

Q48. Which population requires extra caution when prescribing Metibranolol due to altered pharmacokinetics?

• Young healthy adults with normal hepatic function
• Patients with significant hepatic impairment affecting metabolism
• Individuals with robust renal function only
• Patients on no concurrent medications

Correct Answer: Patients with significant hepatic impairment affecting metabolism

Q49. Which of the following is a true educational point about long-term management with beta-blockers?

• Therapy can be stopped abruptly once symptoms improve
• Long-term therapy may require dose adjustments and periodic monitoring of heart rate, blood pressure and side effects
• No follow-up is needed after the first prescription
• They cure the underlying cardiovascular disease permanently

Correct Answer: Long-term therapy may require dose adjustments and periodic monitoring of heart rate, blood pressure and side effects

Q50. Which exam-focused statement best summarizes Metibranolol and related beta-blockers for B.Pharm students?

• They are primarily diuretics acting on the renal tubule
• They are beta adrenergic blockers that reduce sympathetic cardiac stimulation, have diverse clinical uses, notable adverse effects, and important drug interactions to monitor
• They universally increase sympathetic tone and heart rate
• They have no role in modern cardiovascular therapy

Correct Answer: They are beta adrenergic blockers that reduce sympathetic cardiac stimulation, have diverse clinical uses, notable adverse effects, and important drug interactions to monitor

G S Sachin

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