Beta adrenergic blockers – Metoprolol MCQs With Answer

Beta adrenergic blockers – Metoprolol MCQs With Answer

Metoprolol is a widely used beta adrenergic blocker with predominant beta-1 selectivity, making it essential learning for B.Pharm students studying cardiovascular pharmacology. This concise introduction covers mechanism of action, pharmacokinetics (CYP2D6 metabolism, bioavailability, half-life), clinical indications (hypertension, angina, heart failure, rate control), common adverse effects (bradycardia, bronchospasm risk, masking hypoglycemia), dosing forms (tartrate vs succinate), and important drug interactions. Understanding these concepts helps students handle prescriptions, counselling, monitoring and safe pharmacotherapy. These MCQs are structured to strengthen understanding of Metoprolol’s pharmacology, therapeutic use, and safe clinical practice. Now let’s test your knowledge with 50 MCQs on this topic.

Q1. Which receptor subtype is Metoprolol primarily selective for?

• Beta-2 adrenergic receptors
• Beta-1 adrenergic receptors
• Alpha-1 adrenergic receptors
• Muscarinic receptors

Correct Answer: Beta-1 adrenergic receptors

Q2. Metoprolol succinate differs from metoprolol tartrate mainly by:

• Being a non-selective beta blocker
• Extended-release formulation for once-daily dosing
• Higher alpha-blocking activity
• Intravenous-only formulation

Correct Answer: Extended-release formulation for once-daily dosing

Q3. The principal mechanism by which metoprolol reduces blood pressure is:

• Vasodilation via nitric oxide release
• Reduction of cardiac output by decreasing heart rate and contractility
• Inhibition of renin release only in the kidney cortex
• Diuretic action increasing urinary sodium excretion

Correct Answer: Reduction of cardiac output by decreasing heart rate and contractility

Q4. Metoprolol is predominantly metabolized by which cytochrome P450 enzyme?

• CYP3A4
• CYP1A2
• CYP2D6
• CYP2C9

Correct Answer: CYP2D6

Q5. A key contraindication to initiating metoprolol therapy is:

• Controlled hypertension
• Second- or third-degree AV block without a pacemaker
• History of migraine headaches
• Hyperthyroidism being treated with methimazole

Correct Answer: Second- or third-degree AV block without a pacemaker

Q6. Which adverse effect is commonly associated with beta-blocker therapy and is clinically important in diabetic patients?

• Hyperkalemia
• Masking signs of hypoglycemia such as tachycardia
• Increased insulin secretion
• Enhanced gluconeogenesis

Correct Answer: Masking signs of hypoglycemia such as tachycardia

Q7. Which statement about metoprolol’s lipid solubility and CNS effects is most accurate?

• Metoprolol is highly lipophilic and commonly causes severe CNS sedation
• Metoprolol is hydrophilic and does not cross the blood–brain barrier
• Metoprolol has moderate lipophilicity and can produce central effects in some patients
• Metoprolol is bound irreversibly in the CNS leading to long-term effects

Correct Answer: Metoprolol has moderate lipophilicity and can produce central effects in some patients

Q8. The bioavailability of oral metoprolol is reduced due to:

• Poor intestinal absorption only
• Extensive first-pass hepatic metabolism
• Rapid renal excretion unchanged
• Inactivation by gastric acid

Correct Answer: Extensive first-pass hepatic metabolism

Q9. Which of the following is an appropriate initial oral dose of metoprolol tartrate for mild hypertension in adults?

• 5 mg once daily
• 50 mg twice daily
• 400 mg once daily
• 1000 mg divided doses

Correct Answer: 50 mg twice daily

Q10. Metoprolol is useful in acute myocardial infarction because it:

• Increases myocardial oxygen demand
• Reduces infarct size and decreases arrhythmic risk by lowering sympathetic drive
• Acts as a thrombolytic agent
• Causes coronary vasospasm to limit bleeding

Correct Answer: Reduces infarct size and decreases arrhythmic risk by lowering sympathetic drive

Q11. Which interaction is clinically significant when metoprolol is combined with verapamil?

• Decreased metoprolol absorption due to chelation
• Potentiation of bradycardia and atrioventricular block
• Complete antagonism of metoprolol’s effect
• Increased renal clearance of verapamil

Correct Answer: Potentiation of bradycardia and atrioventricular block

Q12. Metoprolol’s effect on renin secretion is due to blockade of beta receptors located on:

• Cardiac pacemaker cells only
• Renal juxtaglomerular cells
• Adrenal medulla chromaffin cells
• Pulmonary alveolar cells

Correct Answer: Renal juxtaglomerular cells

Q13. Which condition requires cautious use or avoidance of metoprolol?

• Stable angina
• Asthma with active bronchospasm
• Essential tremor without lung disease
• Hyperlipidemia

Correct Answer: Asthma with active bronchospasm

Q14. Which pharmacodynamic property best describes metoprolol?

• Intrinsic sympathomimetic activity (ISA) positive
• Partial agonist at beta-2 receptors
• Selective beta-1 receptor antagonist (cardioselective)
• Alpha-2 receptor agonist

Correct Answer: Selective beta-1 receptor antagonist (cardioselective)

Q15. How does abrupt withdrawal of metoprolol potentially affect patients with ischemic heart disease?

• Leads to sustained hypotension without symptoms
• May cause rebound tachycardia and angina or myocardial infarction
• Produces immediate tolerance to beta-blockers
• Prevents angina permanently after cessation

Correct Answer: May cause rebound tachycardia and angina or myocardial infarction

Q16. In overdose of metoprolol with severe bradycardia and hypotension, a recommended first-line treatment is:

• High-dose beta agonist such as isoproterenol without monitoring
• Glucagon to increase heart rate and contractility
• Oral atropine only after 24 hours
• Immediate dialysis as primary treatment

Correct Answer: Glucagon to increase heart rate and contractility

Q17. Which laboratory parameter is most useful to monitor for potential adverse effects of metoprolol in heart failure patients?

• Serum potassium only
• Heart rate and blood pressure
• Urinary protein excretion
• Serum amylase

Correct Answer: Heart rate and blood pressure

Q18. Metoprolol’s half-life in healthy adults (immediate release) is approximately:

• 30 minutes
• 3 to 7 hours
• 48 to 72 hours
• One week

Correct Answer: 3 to 7 hours

Q19. Which statement about metoprolol use in pregnancy is most appropriate?

• Completely contraindicated in all trimesters
• Use with caution; benefits must outweigh risks and monitoring is needed
• Guaranteed to cause teratogenicity in the first trimester
• Preferred antihypertensive for pregnancy-induced hypertension without caution

Correct Answer: Use with caution; benefits must outweigh risks and monitoring is needed

Q20. Metoprolol can worsen which of the following metabolic disturbances?

• Hypokalemia
• Masking tachycardia in hypoglycemia and possible dyslipidemia changes
• Hypercalcemia
• Severe lactic acidosis in therapeutic doses

Correct Answer: Masking tachycardia in hypoglycemia and possible dyslipidemia changes

Q21. For heart failure with reduced ejection fraction, which metoprolol formulation is generally recommended?

• Metoprolol tartrate immediate release only
• Metoprolol succinate extended release
• Topical metoprolol gel
• Metoprolol inhalation spray

Correct Answer: Metoprolol succinate extended release

Q22. Which effect best explains metoprolol’s benefit in rate control for atrial fibrillation?

• Direct anticoagulant effect to prevent thromboembolism
• Slowing AV node conduction thereby reducing ventricular rate
• Increasing atrial conduction velocity
• Enhancing pacemaker automaticity in the AV node

Correct Answer: Slowing AV node conduction thereby reducing ventricular rate

Q23. A patient on metoprolol develops worsening peripheral coldness and claudication—this is most likely due to:

• Alpha-adrenergic blockade causing vasodilation
• Increased peripheral sympathetic activity from metoprolol
• Unopposed alpha vasoconstriction in peripheral circulation
• Metoprolol-induced hypervolemia

Correct Answer: Unopposed alpha vasoconstriction in peripheral circulation

Q24. Which drug interaction increases metoprolol plasma levels by inhibiting its metabolism?

• Rifampin
• Fluoxetine
• Carbamazepine
• St. John’s Wort

Correct Answer: Fluoxetine

Q25. The common side effect of metoprolol that may impair patient adherence is:

• Hair loss in all patients
• Fatigue and exercise intolerance
• Permanent hearing loss
• Constant diarrhea

Correct Answer: Fatigue and exercise intolerance

Q26. Metoprolol’s effect on lipid profile may include:

• Marked decrease in LDL and increase in HDL only
• Small increases in triglycerides and small decreases in HDL in some patients
• No metabolic effects at all
• Immediate normalization of dyslipidemia

Correct Answer: Small increases in triglycerides and small decreases in HDL in some patients

Q27. Which monitoring is recommended when initiating metoprolol in an elderly patient?

• Only annual ECG
• Frequent monitoring of heart rate and blood pressure and assessment for orthostatic hypotension
• No monitoring required
• Only serum creatinine measurement

Correct Answer: Frequent monitoring of heart rate and blood pressure and assessment for orthostatic hypotension

Q28. In patients with COPD but without active bronchospasm, metoprolol may be used cautiously because:

• It is a potent beta-2 agonist improving airflow
• Beta-1 selectivity reduces but does not eliminate risk of bronchospasm
• It irreversibly blocks all pulmonary receptors
• It acts as a mucolytic agent

Correct Answer: Beta-1 selectivity reduces but does not eliminate risk of bronchospasm

Q29. Which effect on ECG is expected with therapeutic dosing of metoprolol?

• QT interval prolongation always
• Reduced heart rate (increased RR interval) and possible PR prolongation
• Immediate ST-segment elevation
• Fragmented QRS complexes development

Correct Answer: Reduced heart rate (increased RR interval) and possible PR prolongation

Q30. How should metoprolol be adjusted in patients with severe hepatic impairment?

• No dose adjustment required due to renal elimination
• Lower starting dose and cautious titration because hepatic metabolism is impaired
• Switch to intravenous metoprolol only
• Double the dose to overcome reduced metabolism

Correct Answer: Lower starting dose and cautious titration because hepatic metabolism is impaired

Q31. Which symptom is a sign of excessive beta-blockade requiring dose reduction?

• Persistent tachycardia
• Symptomatic bradycardia or syncope
• Increased appetite
• Excessive hair growth

Correct Answer: Symptomatic bradycardia or syncope

Q32. Which of the following best describes metoprolol’s effect on myocardial oxygen demand?

• Increases oxygen demand by raising contractility
• Decreases oxygen demand by lowering heart rate and contractility
• No effect on oxygen demand
• Causes a paradoxical increase only during exercise

Correct Answer: Decreases oxygen demand by lowering heart rate and contractility

Q33. When switching a patient from metoprolol tartrate to succinate, the pharmacist should counsel that:

• The succinate is immediate release and must be given twice daily
• Succinate formulation provides once-daily extended release with similar total daily dosing
• They are not interchangeable and succinate is ineffective
• Tartrate has longer duration than succinate

Correct Answer: Succinate formulation provides once-daily extended release with similar total daily dosing

Q34. Which adverse effect on sexual function may be reported with metoprolol therapy?

• Increased libido and hypersexuality
• Erectile dysfunction or decreased libido in some patients
• Permanent sterility in both sexes
• Enhanced fertility due to hormonal changes

Correct Answer: Erectile dysfunction or decreased libido in some patients

Q35. Metoprolol reduces mortality in which chronic cardiovascular condition when titrated to target doses?

• COPD exacerbations
• Heart failure with reduced ejection fraction
• Acute bacterial endocarditis
• Hyperthyroidism without other therapy

Correct Answer: Heart failure with reduced ejection fraction

Q36. Which pharmacologic property explains why metoprolol may blunt the therapeutic response to albuterol?

• Metoprolol’s alpha-1 agonism counteracts bronchodilation
• Beta-1 selectivity completely blocks albuterol
• Non-selective beta blockade or residual beta-2 blockade can reduce bronchodilator response
• Metoprolol degrades albuterol in plasma

Correct Answer: Non-selective beta blockade or residual beta-2 blockade can reduce bronchodilator response

Q37. Which class of drugs can potentiate the bradycardic effect of metoprolol when given concomitantly?

• Loop diuretics
• Calcium channel blockers like verapamil and diltiazem
• ACE inhibitors
• HMG-CoA reductase inhibitors

Correct Answer: Calcium channel blockers like verapamil and diltiazem

Q38. Which clinical sign would prompt immediate discontinuation or reduction of metoprolol in a hospitalized patient?

• Resting heart rate of 58 bpm in an asymptomatic patient
• Symptomatic hypotension with systolic BP <90 mmHg and dizziness
• Mild fatigue after exertion
• Occasional dry cough

Correct Answer: Symptomatic hypotension with systolic BP <90 mmHg and dizziness

Q39. In elderly patients, metoprolol dosing should often be:

• Higher due to increased hepatic clearance
• Started at lower doses and titrated slowly
• Never used under any circumstances
• Started intravenously before oral therapy

Correct Answer: Started at lower doses and titrated slowly

Q40. Which of the following best describes metoprolol’s protein binding?

• Highly protein bound (>99%)
• Moderately protein bound (~50%)
• Low protein binding (~10–15%)
• Irreversibly bound to albumin

Correct Answer: Low protein binding (~10–15%)

Q41. A patient taking metoprolol reports vivid dreams and sleep disturbances. This adverse effect is most likely due to:

• Peripheral beta-2 blockade only
• CNS penetration due to metoprolol’s moderate lipophilicity
• Direct serotonergic activity of metoprolol
• Accumulation in adipose tissue permanently

Correct Answer: CNS penetration due to metoprolol’s moderate lipophilicity

Q42. In patients with pheochromocytoma, beta-blockers like metoprolol should be:

• Given before alpha blockade to control tachycardia
• Never used under any conditions
• Used only after adequate alpha blockade to avoid unopposed alpha stimulation
• Used as sole therapy to normalize blood pressure

Correct Answer: Used only after adequate alpha blockade to avoid unopposed alpha stimulation

Q43. Which monitoring parameter can detect early beta-blocker–induced heart block?

• Serum transaminases
• Electrocardiogram (PR interval prolongation)
• Serum lipid panel
• Urine glucose

Correct Answer: Electrocardiogram (PR interval prolongation)

Q44. For perioperative management, abrupt discontinuation of metoprolol is generally:

• Recommended to avoid intraoperative hypotension
• Not recommended because withdrawal can cause tachycardia and ischemia; continue if possible
• Irrelevant since beta-blockers have no perioperative effects
• Mandatory 72 hours before surgery for safety

Correct Answer: Not recommended because withdrawal can cause tachycardia and ischemia; continue if possible

Q45. Which adverse respiratory effect is possible with metoprolol, especially at higher doses?

• Pulmonary fibrosis
• Bronchospasm due to residual beta-2 blockade
• Pulmonary embolism induction
• Increased surfactant production

Correct Answer: Bronchospasm due to residual beta-2 blockade

Q46. Which parameter would NOT be expected to change with metoprolol therapy?

• Resting heart rate decrease
• Fasting blood glucose increase due to catecholamine blockade
• Immediate increase in stroke volume without heart rate change
• Reduction in exercise-induced heart rate

Correct Answer: Immediate increase in stroke volume without heart rate change

Q47. In case of severe bradycardia from metoprolol, which immediate medication can be administered to increase heart rate?

• Oral propranolol
• Intravenous atropine
• Subcutaneous insulin
• Oral diltiazem

Correct Answer: Intravenous atropine

Q48. Which statement about metoprolol dosing in renal impairment is most correct?

• Metoprolol requires major renal dose reduction because it is renally excreted unchanged
• No adjustment is usually required because metoprolol is primarily hepatically metabolized
• Metoprolol is contraindicated in any renal impairment
• Only intranasal dosing should be used in renal disease

Correct Answer: No adjustment is usually required because metoprolol is primarily hepatically metabolized

Q49. Which adverse effect would suggest beta-1 selectivity is being lost at higher doses of metoprolol?

• Worsening glycemic control only
• Development of bronchospasm or wheeze indicating beta-2 blockade
• Improved exercise tolerance
• Reduction in LDL cholesterol

Correct Answer: Development of bronchospasm or wheeze indicating beta-2 blockade

Q50. For educational counseling, which patient instruction is most appropriate when starting metoprolol?

• Stop the drug abruptly if you feel dizzy
• Take the medication at the same time(s) each day, monitor pulse and blood pressure, and report signs of severe bradycardia or hypotension
• Double the dose if you miss a single dose
• Expect immediate relief of chest pain after first dose always

Correct Answer: Take the medication at the same time(s) each day, monitor pulse and blood pressure, and report signs of severe bradycardia or hypotension

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