Cardiovascular pharmacology: diuretics and antihypertensives MCQs With Answer

Cardiovascular pharmacology: diuretics and antihypertensives MCQs With Answer

Introduction: This quiz set is designed for M.Pharm students preparing for Advanced Pharmacology-I examinations. It focuses on diuretics and antihypertensive drug classes, mechanisms of action, therapeutic uses, adverse effects, drug interactions, and clinical considerations such as pregnancy, renal impairment and diuretic resistance. Questions emphasize mechanistic understanding and clinically relevant pharmacology rather than rote memorization, helping students integrate basic science with therapeutic decision-making. Each multiple-choice item includes four options and a clearly identified correct answer to support focused revision and self-assessment.

Q1. Which molecular target is primarily inhibited by loop diuretics in the nephron?

• Na+/K+/2Cl− cotransporter in the thick ascending limb of Henle
• Na+/Cl− cotransporter in the distal convoluted tubule
• Epithelial sodium channel (ENaC) in the collecting duct
• Carbonic anhydrase in the proximal tubule

Correct Answer: Na+/K+/2Cl− cotransporter in the thick ascending limb of Henle

Q2. Thiazide diuretics lower blood pressure partly by which renal mechanism?

• Inhibition of Na+/K+/2Cl− cotransporter
• Inhibition of Na+/Cl− cotransporter (NCC) in the distal convoluted tubule
• Blocking aldosterone receptors in the collecting duct
• Increasing osmolarity of tubular fluid in proximal tubule

Correct Answer: Inhibition of Na+/Cl− cotransporter (NCC) in the distal convoluted tubule

Q3. Which diuretic is most likely to cause a hyperchloremic metabolic acidosis due to proximal tubular bicarbonate loss?

• Acetazolamide (carbonic anhydrase inhibitor)
• Furosemide (loop diuretic)
• Hydrochlorothiazide (thiazide diuretic)
• Spironolactone (aldosterone antagonist)

Correct Answer: Acetazolamide (carbonic anhydrase inhibitor)

Q4. Which potassium‑sparing diuretic acts as a competitive antagonist at the mineralocorticoid (aldosterone) receptor?

• Amiloride — blocks ENaC channels
• Spironolactone — aldosterone receptor antagonist in the collecting duct
• Hydrochlorothiazide — inhibits NCC
• Furosemide — inhibits Na+/K+/2Cl− cotransporter

Correct Answer: Spironolactone — aldosterone receptor antagonist in the collecting duct

Q5. Which agent is an osmotic diuretic used to reduce intracranial pressure by increasing tubular fluid osmolarity?

• Mannitol
• Acetazolamide
• Spironolactone
• Hydrochlorothiazide

Correct Answer: Mannitol

Q6. Which diuretic class commonly precipitates acute gout by reducing uric acid excretion?

• Thiazide diuretics (e.g., hydrochlorothiazide)
• Potassium‑sparing diuretics (e.g., amiloride)
• Carbonic anhydrase inhibitors (e.g., acetazolamide)
• Osmotic diuretics (e.g., mannitol)

Correct Answer: Thiazide diuretics (e.g., hydrochlorothiazide)

Q7. The persistent dry cough seen with ACE inhibitors is primarily due to accumulation of which mediator?

• Bradykinin
• Angiotensin II
• Renin
• Endothelin

Correct Answer: Bradykinin

Q8. Which antihypertensive drug class is contraindicated in pregnancy because of fetal renal damage and oligohydramnios?

• ACE inhibitors (e.g., enalapril)
• Beta blockers (e.g., metoprolol)
• Calcium channel blockers (e.g., nifedipine)
• Centrally acting alpha‑2 agonists (e.g., clonidine)

Correct Answer: ACE inhibitors (e.g., enalapril)

Q9. Which beta‑blocker possesses intrinsic sympathomimetic activity (ISA), producing less resting bradycardia?

• Pindolol
• Propranolol
• Atenolol
• Metoprolol

Correct Answer: Pindolol

Q10. Angiotensin II receptor blockers (ARBs) lower blood pressure by which direct mechanism?

• Selective blockade of AT1 receptors, preventing angiotensin II effects
• Inhibition of angiotensin‑converting enzyme to reduce angiotensin II synthesis
• Stimulation of bradykinin breakdown
• Direct renin inhibition at the juxtaglomerular apparatus

Correct Answer: Selective blockade of AT1 receptors, preventing angiotensin II effects

Q11. Which calcium channel blocker is most associated with negative inotropic and strong atrioventricular nodal blocking effects?

• Verapamil — potent negative inotrope and AV nodal blocker
• Amlodipine — mainly vascular smooth muscle vasodilator
• Nifedipine — primarily peripheral vasodilator with minimal AV nodal effect
• Nicardipine — selective renal vasodilator

Correct Answer: Verapamil — potent negative inotrope and AV nodal blocker

Q12. For an acute hypertensive emergency requiring rapid IV blood pressure control with predictable short‑term titration, which agent is commonly used but requires cyanide toxicity monitoring with prolonged use?

• Sodium nitroprusside
• Labetalol
• Hydralazine
• Oral captopril

Correct Answer: Sodium nitroprusside

Q13. Gynecomastia and menstrual irregularities seen with spironolactone are due to which off‑target effect?

• Antagonism of androgen and progesterone receptors
• Excessive inhibition of carbonic anhydrase
• Direct estrogen receptor agonism
• Exacerbation of aldosterone secretion

Correct Answer: Antagonism of androgen and progesterone receptors

Q14. Which diuretic class produces the greatest potassium wasting and predisposes patients to hypokalemia?

• Loop diuretics (e.g., furosemide)
• Potassium‑sparing diuretics (e.g., spironolactone)
• Carbonic anhydrase inhibitors (e.g., acetazolamide)
• Osmotic diuretics (e.g., mannitol)

Correct Answer: Loop diuretics (e.g., furosemide)

Q15. Which class of commonly used drugs can blunt the natriuretic and antihypertensive effects of ACE inhibitors and some diuretics by inhibiting renal prostaglandin synthesis?

• Nonsteroidal anti‑inflammatory drugs (NSAIDs)
• Calcium channel blockers
• Statins
• SSRIs

Correct Answer: Nonsteroidal anti‑inflammatory drugs (NSAIDs)

Q16. In patients with diabetic nephropathy and hypertension, which antihypertensive class slows progression of proteinuria and kidney disease?

• ACE inhibitors (e.g., lisinopril)
• Loop diuretics (e.g., furosemide)
• Thiazide diuretics (e.g., hydrochlorothiazide)
• Alpha‑1 blockers (e.g., prazosin)

Correct Answer: ACE inhibitors (e.g., lisinopril)

Q17. Which antihypertensive is a direct renin inhibitor that blocks conversion of angiotensinogen to angiotensin I?

• Aliskiren
• Captopril
• Losartan
• Eplerenone

Correct Answer: Aliskiren

Q18. Which diuretic decreases urinary calcium excretion and is useful in patients with idiopathic hypercalciuria or recurrent calcium kidney stones?

• Thiazide diuretics (e.g., hydrochlorothiazide)
• Loop diuretics (e.g., furosemide)
• Carbonic anhydrase inhibitors (e.g., acetazolamide)
• Potassium‑sparing diuretics (e.g., spironolactone)

Correct Answer: Thiazide diuretics (e.g., hydrochlorothiazide)

Q19. Which antihypertensive intervention commonly causes reflex tachycardia, especially when used in short‑acting form?

• Short‑acting dihydropyridine calcium channel blockers (e.g., immediate‑release nifedipine)
• ACE inhibitors (e.g., enalapril)
• Beta blockers (e.g., propranolol)
• Clonidine (central alpha‑2 agonist)

Correct Answer: Short‑acting dihydropyridine calcium channel blockers (e.g., immediate‑release nifedipine)

Q20. A major mechanism underlying diuretic resistance in advanced heart failure is:

• Neurohormonal activation (RAAS) with increased distal sodium reabsorption and renal hypoperfusion
• Enhanced glomerular filtration increasing diuretic delivery to the tubule
• Loss of collecting duct sodium transporters due to medication downregulation
• Excessive dietary potassium intake

Correct Answer: Neurohormonal activation (RAAS) with increased distal sodium reabsorption and renal hypoperfusion

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