Introduction: Beta adrenergic blockers, especially Propranolol, are essential in B. Pharm pharmacology and therapeutics courses. This concise guide covers mechanism of action, pharmacokinetics, clinical indications, adverse effects, drug interactions, and dosing nuances of non-selective beta-blockers. Propranolol’s lipophilicity, membrane‑stabilizing action, hepatic metabolism, and utility in hypertension, angina, arrhythmias, migraine prophylaxis, thyrotoxicosis, and portal hypertension make it a high-yield topic for exams. Understanding contraindications (eg, asthma, heart block), management of overdose, and key interactions (CYP inhibitors, calcium channel blockers) is crucial for safe use. Now let’s test your knowledge with 50 MCQs on this topic.
Q1. What is the primary pharmacological classification of propranolol?
- Selective β1-adrenergic receptor antagonist
- Non-selective β1 and β2 adrenergic receptor antagonist
- Alpha-1 adrenergic receptor antagonist
- Beta agonist with partial agonist activity
Correct Answer: Non-selective β1 and β2 adrenergic receptor antagonist
Q2. Which property of propranolol explains its central nervous system side effects such as vivid dreams and fatigue?
- High renal excretion
- Low protein binding
- Lipophilicity allowing blood–brain barrier penetration
- Selective β2 blockade
Correct Answer: Lipophilicity allowing blood–brain barrier penetration
Q3. Propranolol is extensively metabolized in the liver leading to which clinical pharmacokinetic consequence?
- Very high and predictable oral bioavailability
- Significant first-pass metabolism with variable oral bioavailability
- Predominantly renal excretion as unchanged drug
- Long half-life requiring once-monthly dosing
Correct Answer: Significant first-pass metabolism with variable oral bioavailability
Q4. Which clinical indication is propranolol commonly used for due to its nonselective beta blockade?
- Asthma exacerbations
- Migraine prophylaxis and performance anxiety
- Severe bradycardia management
- Acute decompensated heart failure with cardiogenic shock
Correct Answer: Migraine prophylaxis and performance anxiety
Q5. Propranolol should be used with caution or avoided in patients with which condition?
- Essential tremor
- Type 2 diabetes without hypoglycemia risk
- Reactive airways disease (asthma)
- Hyperthyroidism symptom control
Correct Answer: Reactive airways disease (asthma)
Q6. Which adverse effect is most directly related to blockade of β1 receptors by propranolol?
- Bronchospasm
- Hypoglycemia unawareness
- Bradycardia and reduced cardiac contractility
- Peripheral vasodilation and flushing
Correct Answer: Bradycardia and reduced cardiac contractility
Q7. In the management of beta-blocker overdose with severe bradycardia and hypotension, which antidote is classically recommended?
- Glucagon
- Flumazenil
- Physostigmine
- Naloxone
Correct Answer: Glucagon
Q8. Propranolol’s membrane-stabilizing (local anesthetic) activity is clinically significant at:
- Therapeutic doses for hypertension
- Very high concentrations not usually reached in standard dosing
- Only when given topically
- Only in combination with ACE inhibitors
Correct Answer: Very high concentrations not usually reached in standard dosing
Q9. Which of the following is a major drug interaction concern with propranolol?
- Combined use with beta-2 agonists increasing bronchodilation
- Concomitant use with verapamil or diltiazem causing additive AV block
- Concurrent use with insulin abolishing hypoglycemic risk
- Co-administration with penicillin reducing propranolol levels
Correct Answer: Concomitant use with verapamil or diltiazem causing additive AV block
Q10. For portal hypertension and prevention of variceal bleeding, propranolol works primarily by:
- Increasing hepatic blood flow
- Reducing portal venous pressure via decreased cardiac output and splanchnic vasoconstriction
- Direct vasodilation of portal vein
- Enhancing clotting factor synthesis in the liver
Correct Answer: Reducing portal venous pressure via decreased cardiac output and splanchnic vasoconstriction
Q11. Which metabolic pathway is most relevant for propranolol clearance?
- Renal tubular secretion predominates
- Extensive hepatic metabolism via cytochrome P450 enzymes
- Hydrolysis by plasma esterases
- Elimination unchanged in bile
Correct Answer: Extensive hepatic metabolism via cytochrome P450 enzymes
Q12. Which statement about propranolol’s effect on blood glucose is correct?
- It causes hyperglycemia by increasing gluconeogenesis
- It masks symptoms of hypoglycemia and can delay recovery from hypoglycemia
- It enhances glycogenolysis during hypoglycemia
- It has no effect on glycemic control
Correct Answer: It masks symptoms of hypoglycemia and can delay recovery from hypoglycemia
Q13. Before performing surgery on a patient on long-term propranolol, which perioperative consideration is important?
- Sudden withdrawal is harmless and recommended
- Continue therapy; abrupt withdrawal may precipitate angina or MI
- Double the dose on the day of surgery to prevent tachycardia
- Switch to an ACE inhibitor immediately before surgery
Correct Answer: Continue therapy; abrupt withdrawal may precipitate angina or MI
Q14. Which of the following is a clinical use unique to propranolol compared to selective β1-blockers?
- Treatment of systolic heart failure
- Migraine prophylaxis and essential tremor due to central penetration
- Preferred agent for exercise-induced bronchospasm
- First-line therapy for Type 1 diabetic hypoglycemia prevention
Correct Answer: Migraine prophylaxis and essential tremor due to central penetration
Q15. In pheochromocytoma management, why should an α-adrenergic blocker be given before propranolol?
- Alpha blockade is unnecessary and may worsen hypertension
- To avoid unopposed alpha-adrenergic vasoconstriction and hypertensive crisis
- Because beta-blockers have no effect on catecholamine symptoms
- To increase catecholamine release before surgery
Correct Answer: To avoid unopposed alpha-adrenergic vasoconstriction and hypertensive crisis
Q16. Which formulation of propranolol is available for acute intravenous use?
- Immediate-release oral tablets only
- Intravenous injectable formulation for emergency use
- Transdermal patch formulation exclusively
- Inhalational aerosol form
Correct Answer: Intravenous injectable formulation for emergency use
Q17. The half-life of immediate-release propranolol is approximately:
- Less than 1 hour
- 3–6 hours
- 24–48 hours
- One week
Correct Answer: 3–6 hours
Q18. Which of the following adverse effects is commonly reported with propranolol due to β2 blockade?
- Hyperreflexia
- Bronchoconstriction and worsening of asthma
- Excessive lacrimation
- Renal stone formation
Correct Answer: Bronchoconstriction and worsening of asthma
Q19. Which patient population requires dose adjustment or caution when using propranolol because of reduced hepatic clearance?
- Young healthy adults
- Patients with hepatic impairment or elderly
- Patients with hyperthyroidism only
- Patients on high-protein diets
Correct Answer: Patients with hepatic impairment or elderly
Q20. Which laboratory parameter is most important to monitor in a patient starting propranolol for hypertension?
- Serum creatinine only
- Heart rate and blood pressure
- Liver biopsy every month
- Serum potassium daily
Correct Answer: Heart rate and blood pressure
Q21. Which effect explains propranolol’s benefit in thyrotoxicosis treatment?
- Direct reduction of thyroid hormone synthesis
- Inhibition of peripheral conversion of T4 to T3 and symptomatic beta blockade
- Stimulating adenylate cyclase in thyroid tissue
- Increasing thyroid hormone clearance by kidneys
Correct Answer: Inhibition of peripheral conversion of T4 to T3 and symptomatic beta blockade
Q22. Which statement is true regarding intrinsic sympathomimetic activity (ISA) and propranolol?
- Propranolol has significant ISA
- Propranolol lacks intrinsic sympathomimetic activity
- ISA increases the risk of bronchospasm with propranolol
- Only ISA drugs cross the blood–brain barrier
Correct Answer: Propranolol lacks intrinsic sympathomimetic activity
Q23. Which symptom of acute propranolol poisoning is least likely?
- Severe bradycardia
- Hypotension and cardiogenic shock
- Profound hyperthermia and rhabdomyolysis as a primary effect
- Hypoglycemia, especially in children
Correct Answer: Profound hyperthermia and rhabdomyolysis as a primary effect
Q24. Which therapy is useful in refractory beta-blocker overdose causing cardiogenic shock when glucagon is insufficient?
- High-dose insulin euglycemia therapy and vasopressors
- Oral beta-agonist therapy only
- Immediate dialysis to remove propranolol
- Acetylcysteine infusion
Correct Answer: High-dose insulin euglycemia therapy and vasopressors
Q25. Which statement best describes propranolol’s effect on lipid metabolism?
- It universally improves HDL and lowers LDL
- Some beta-blockers may adversely affect lipid profile; propranolol can increase triglycerides and decrease HDL modestly
- It has no effect on lipid metabolism
- It causes rapid and sustained weight loss improving lipids
Correct Answer: Some beta-blockers may adversely affect lipid profile; propranolol can increase triglycerides and decrease HDL modestly
Q26. Which of the following is a contraindication to initiating propranolol therapy?
- Well-controlled essential hypertension
- Sinus bradycardia and second- or third-degree heart block without a pacemaker
- Migraine prophylaxis in young adults
- Performance anxiety before public speaking
Correct Answer: Sinus bradycardia and second- or third-degree heart block without a pacemaker
Q27. Which opioid or psychotropic drug interaction is notable with propranolol due to CYP inhibition increasing propranolol levels?
- Co-administration with rifampin increases propranolol levels
- Fluoxetine (a CYP2D6 inhibitor) may increase propranolol plasma concentrations
- St. John’s wort increases propranolol concentrations dramatically
- Aspirin causes inhibition of propranolol metabolism
Correct Answer: Fluoxetine (a CYP2D6 inhibitor) may increase propranolol plasma concentrations
Q28. Which effect on electrocardiogram (ECG) would you expect after propranolol administration?
- Marked prolongation of QT interval universally
- Slowing of AV nodal conduction and potential PR interval prolongation
- Sustained ventricular tachycardia induction
- Immediate development of new Q waves
Correct Answer: Slowing of AV nodal conduction and potential PR interval prolongation
Q29. In elderly patients, propranolol dosage considerations include:
- No adjustment because clearance increases with age
- Start low and titrate slowly due to increased sensitivity and reduced hepatic clearance
- Always avoid propranolol in elderly regardless of indication
- Use only intravenous formulations in elderly
Correct Answer: Start low and titrate slowly due to increased sensitivity and reduced hepatic clearance
Q30. Which of the following best explains why propranolol can worsen peripheral vascular disease symptoms?
- Beta-2 blockade causes cutaneous and peripheral vasoconstriction
- It increases nitric oxide production causing edema
- It causes direct damage to peripheral nerves
- It increases peripheral blood flow excessively
Correct Answer: Beta-2 blockade causes cutaneous and peripheral vasoconstriction
Q31. Which clinical sign suggests an adverse CNS effect of propranolol?
- Persistent cough with yellow sputum
- Depression, vivid dreams, or memory disturbances
- Isolated ankle swelling without other symptoms
- Hyperactivity and insomnia only
Correct Answer: Depression, vivid dreams, or memory disturbances
Q32. For migraine prophylaxis, typical mechanism by which propranolol is effective includes:
- Direct serotonin receptor agonism
- Central and peripheral beta blockade reducing neuronal excitability and vascular reactivity
- Anticholinergic properties reducing GI motility
- Increasing cerebral blood flow by vasodilation
Correct Answer: Central and peripheral beta blockade reducing neuronal excitability and vascular reactivity
Q33. Which statement about propranolol use in pregnancy is correct?
- It is absolutely contraindicated in all trimesters
- Use with caution; may cause fetal growth restriction and neonatal bradycardia/hypoglycemia
- It increases placental thyroid hormone transfer
- It enhances labor and is used to induce delivery
Correct Answer: Use with caution; may cause fetal growth restriction and neonatal bradycardia/hypoglycemia
Q34. Which monitoring parameter is particularly important in diabetic patients on propranolol?
- Serum sodium concentration
- Frequent monitoring for masked hypoglycemia and blood glucose levels
- Immediate renal biopsy
- Daily serum creatine kinase (CK)
Correct Answer: Frequent monitoring for masked hypoglycemia and blood glucose levels
Q35. Compared to atenolol, propranolol is more likely to cause which effect?
- Less CNS penetration
- More central nervous system side effects due to higher lipophilicity
- Greater β1 selectivity
- Renal excretion as unchanged drug predominates
Correct Answer: More central nervous system side effects due to higher lipophilicity
Q36. Which statement about withdrawal from long-term propranolol therapy is true?
- Abrupt withdrawal may precipitate tachycardia, hypertension, and ischemia in susceptible patients
- Immediate cessation is recommended before elective surgery
- No withdrawal phenomena are associated with propranolol
- Withdrawal causes permanent loss of beta receptor function
Correct Answer: Abrupt withdrawal may precipitate tachycardia, hypertension, and ischemia in susceptible patients
Q37. Which of the following best describes propranolol’s effect on exercise tolerance?
- It enhances maximal exercise capacity by increasing heart rate
- It reduces exercise tolerance by limiting heart rate and cardiac output during exertion
- It has no effect on exercise performance
- It causes immediate muscle hypertrophy improving endurance
Correct Answer: It reduces exercise tolerance by limiting heart rate and cardiac output during exertion
Q38. Which lab change might be seen with propranolol therapy?
- Marked increase in hemoglobin
- Small decrease in HDL cholesterol and possible increase in triglycerides
- Rapid rise in serum sodium
- Large elevation of serum alkaline phosphatase consistently
Correct Answer: Small decrease in HDL cholesterol and possible increase in triglycerides
Q39. Propranolol’s effect in controlling supraventricular tachycardia is mainly due to:
- Increasing sinoatrial node automaticity
- Slowing AV nodal conduction and reducing sympathetic tone
- Directly blocking potassium channels causing QT shortening
- Agonism at muscarinic receptors
Correct Answer: Slowing AV nodal conduction and reducing sympathetic tone
Q40. In patients with concomitant COPD and hypertension, which statement about propranolol is most appropriate?
- Propranolol is the drug of choice
- A cardioselective β1 blocker is preferred over propranolol to reduce bronchospasm risk
- Propranolol has no effect on respiratory function
- Combine propranolol with nonselective beta-agonist for safety
Correct Answer: A cardioselective β1 blocker is preferred over propranolol to reduce bronchospasm risk
Q41. Which clinical scenario is a recognized use of propranolol outside cardiovascular disease?
- Treatment of bacterial infections
- Management of essential tremor and performance anxiety
- As an antidepressant monotherapy
- To induce diuresis in nephrotic syndrome
Correct Answer: Management of essential tremor and performance anxiety
Q42. Which statement about dosing frequency for propranolol immediate-release preparations is correct?
- Single daily dosing is sufficient for 24-hour control
- Usually requires multiple daily dosing due to short half-life unless extended-release form is used
- Dosing frequency is irrelevant to plasma concentrations
- Immediate-release tablets are never used clinically
Correct Answer: Usually requires multiple daily dosing due to short half-life unless extended-release form is used
Q43. Which vascular effect is expected acutely after propranolol administration?
- Immediate peripheral vasodilation leading to flushing
- Initial reduction in cardiac output; unopposed α-mediated vasoconstriction may increase peripheral resistance
- Massive histamine release
- Direct stimulation of nitric oxide synthase
Correct Answer: Initial reduction in cardiac output; unopposed α-mediated vasoconstriction may increase peripheral resistance
Q44. When treating performance anxiety with propranolol, the usual approach is:
- Daily high-dose therapy only
- Single low dose taken 30–60 minutes before the event
- Use only topical propranolol spray
- Combine with MAO inhibitors for best effect
Correct Answer: Single low dose taken 30–60 minutes before the event
Q45. Which sign suggests propranolol-induced peripheral vasoconstriction?
- Warm, flushed extremities
- Cold extremities with worsening claudication
- Increased hair growth on hands
- Marked hyperhidrosis of palms
Correct Answer: Cold extremities with worsening claudication
Q46. Which of the following antihypertensive combinations with propranolol requires caution due to risk of additive bradycardia?
- ACE inhibitor
- Calcium channel blockers that act on AV node (verapamil or diltiazem)
- Hydrochlorothiazide diuretic
- Nitrates for angina
Correct Answer: Calcium channel blockers that act on AV node (verapamil or diltiazem)
Q47. How does propranolol affect epinephrine-induced hyperglycemia?
- It enhances epinephrine effects on blood glucose
- It blocks β-mediated glycogenolysis, potentially blunting epinephrine-induced hyperglycemia but masking symptoms
- It potentiates hepatic gluconeogenesis via alpha-2 stimulation
- It abolishes all counterregulatory responses permanently
Correct Answer: It blocks β-mediated glycogenolysis, potentially blunting epinephrine-induced hyperglycemia but masking symptoms
Q48. Which statement best describes propranolol’s use in arrhythmias?
- It is effective for supraventricular tachyarrhythmias by decreasing AV nodal conduction and controlling ventricular rate
- It is the first-line agent for torsades de pointes
- It universally converts atrial fibrillation to sinus rhythm with a single dose
- It has no role in arrhythmia management
Correct Answer: It is effective for supraventricular tachyarrhythmias by decreasing AV nodal conduction and controlling ventricular rate
Q49. Which counseling point is important for a patient starting propranolol?
- Stop the drug abruptly if you feel fatigued
- Avoid sudden discontinuation; monitor pulse and blood pressure and report dizziness or shortness of breath
- It will cause immediate weight loss
- There are no interactions with over-the-counter cold medicines
Correct Answer: Avoid sudden discontinuation; monitor pulse and blood pressure and report dizziness or shortness of breath
Q50. Which characteristic differentiates propranolol from a highly cardioselective β1 blocker?
- Propranolol selectively spares β2 receptors in bronchial smooth muscle
- Propranolol is non-selective, blocking both β1 and β2 receptors and crosses the CNS due to lipophilicity
- Propranolol is excreted unchanged by the kidneys exclusively
- Propranolol acts primarily as an alpha-adrenergic agonist
Correct Answer: Propranolol is non-selective, blocking both β1 and β2 receptors and crosses the CNS due to lipophilicity
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.
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