Drugs for heart failure and hyperlipidemia MCQs With Answer

Introduction: This set of MCQs on “Drugs for Heart Failure and Hyperlipidemia” is designed for M.Pharm students preparing for advanced pharmacology exams and clinical practice. Questions focus on mechanisms of action, pharmacokinetics, therapeutic use, adverse effects, drug interactions and monitoring strategies for contemporary and classical agents used in heart failure and lipid disorders. Emphasis is placed on integrating molecular targets with clinical implications — e.g., neprilysin inhibition, inotropic agents, natriuretic peptides, statin pharmacology, PCSK9 inhibitors and therapies for severe familial dyslipidemias. Use these questions to test conceptual depth, refine decision-making and identify topics needing further study.

Q1. Which of the following best describes the primary mechanism by which sacubitril/valsartan reduces heart failure morbidity?

• Direct beta-1 adrenergic receptor blockade reducing heart rate
• Inhibition of neprilysin increasing natriuretic peptides combined with angiotensin II receptor blockade
• Selective inhibition of phosphodiesterase-5 increasing cGMP in vascular smooth muscle
• Blocking sodium channels in cardiac myocytes to reduce arrhythmias

Correct Answer: Inhibition of neprilysin increasing natriuretic peptides combined with angiotensin II receptor blockade

Q2. Digoxin improves symptoms in heart failure primarily by which combination of actions?

• Inhibition of ACE and reduction of aldosterone
• Inhibition of cardiac Na+/K+-ATPase, increasing intracellular Ca2+ and enhanced vagal tone at the AV node
• Blocking L-type calcium channels to reduce afterload
• Stimulating beta-2 receptors to cause peripheral vasodilation

Correct Answer: Inhibition of cardiac Na+/K+-ATPase, increasing intracellular Ca2+ and enhanced vagal tone at the AV node

Q3. Which heart failure drug is most likely to increase risk of hyperkalemia when combined with spironolactone?

• Hydralazine
• Furosemide
• Lisinopril (an ACE inhibitor)
• Digoxin

Correct Answer: Lisinopril (an ACE inhibitor)

Q4. Ivabradine reduces hospitalization in symptomatic heart failure by selectively inhibiting which cardiac current?

• L-type calcium current (ICa,L)
• Rapid delayed rectifier potassium current (IKr)
• If “funny” pacemaker sodium current in the sinoatrial node
• Transient outward potassium current (Ito)

Correct Answer: If “funny” pacemaker sodium current in the sinoatrial node

Q5. Milrinone improves cardiac output in acute decompensated heart failure primarily by which mechanism?

• Beta-1 receptor agonism increasing contractility without vasodilation
• Inhibition of phosphodiesterase-3 increasing intracellular cAMP in heart and vasculature
• Activation of ATP-sensitive potassium channels causing coronary vasodilation
• Blocking sodium channels to reduce myocardial oxygen demand

Correct Answer: Inhibition of phosphodiesterase-3 increasing intracellular cAMP in heart and vasculature

Q6. Which statement about sacubitril/valsartan and natriuretic peptide biomarkers is correct?

• Sacubitril increases BNP levels but does not affect NT-proBNP concentrations because BNP is degraded by neprilysin whereas NT-proBNP is not
• Sacubitril decreases both BNP and NT-proBNP equally because it blocks their production
• Sacubitril decreases BNP but increases NT-proBNP due to enhanced clearance
• Sacubitril has no effect on natriuretic peptide measurements

Correct Answer: Sacubitril increases BNP levels but does not affect NT-proBNP concentrations because BNP is degraded by neprilysin whereas NT-proBNP is not

Q7. In a patient with advanced systolic heart failure on ACE inhibitor and beta-blocker, which combination has been shown to improve survival particularly in African American patients?

• Hydralazine plus isosorbide dinitrate
• Verapamil plus diltiazem
• Phenylephrine plus digoxin
• Furosemide plus spironolactone only

Correct Answer: Hydralazine plus isosorbide dinitrate

Q8. Which inotrope would you avoid in a patient with significant tachyarrhythmia because it can exacerbate arrhythmias via cAMP-mediated calcium overload?

• Dobutamine
• Levosimendan
• Digoxin
• Ivabradine

Correct Answer: Dobutamine

Q9. Which drug used in heart failure acts as a calcium sensitizer and opens ATP-dependent potassium channels, producing inotropic and vasodilatory effects?

• Milrinone
• Levosimendan
• Digoxin
• Metoprolol

Correct Answer: Levosimendan

Q10. Loop diuretics like furosemide are preferred in acute decompensated heart failure primarily because they:

• Increase aldosterone release and thus retain potassium
• Have potent natriuretic effect by inhibiting Na+-K+-2Cl- transporter in the thick ascending limb
• Directly increase myocardial contractility
• Are positive inotropes through beta-adrenergic stimulation

Correct Answer: Have potent natriuretic effect by inhibiting Na+-K+-2Cl- transporter in the thick ascending limb

Q11. HMG-CoA reductase inhibitors (statins) reduce LDL cholesterol primarily by which mechanism?

• Blocking intestinal cholesterol absorption by inhibiting NPC1L1
• Increasing hepatic LDL receptor expression by inhibiting cholesterol synthesis, thereby enhancing LDL clearance
• Activating lipoprotein lipase to clear chylomicrons
• Directly inhibiting PCSK9 protein to decrease LDL receptor degradation

Correct Answer: Increasing hepatic LDL receptor expression by inhibiting cholesterol synthesis, thereby enhancing LDL clearance

Q12. Which adverse effect profile is most characteristic of statins and requires monitoring during therapy?

• Hepatotoxicity and myopathy with elevated CK
• Severe hypertriglyceridemia and pancreatitis
• Marked bradycardia and AV block
• Excessive hypokalemia and metabolic alkalosis

Correct Answer: Hepatotoxicity and myopathy with elevated CK

Q13. Ezetimibe lowers LDL cholesterol by which specific intestinal mechanism?

• Binding bile acids to prevent micelle formation
• Inhibiting the NPC1L1 cholesterol transporter and reducing enterocyte cholesterol uptake
• Activating hepatic PPAR-alpha to increase LDL receptor expression
• Blocking pancreatic lipase to reduce fat absorption

Correct Answer: Inhibiting the NPC1L1 cholesterol transporter and reducing enterocyte cholesterol uptake

Q14. Which combination is most associated with an increased risk of statin-related myopathy due to CYP3A4-mediated interaction?

• Atorvastatin with clarithromycin
• Pravastatin with rifampin
• Rosuvastatin with bile acid sequestrant
• Fluvastatin with warfarin

Correct Answer: Atorvastatin with clarithromycin

Q15. Fibrates (e.g., fenofibrate) lower triglycerides primarily via which mechanism?

• Inhibition of HMG-CoA reductase
• Activation of PPAR-alpha leading to increased lipoprotein lipase activity and decreased VLDL synthesis
• Inhibition of intestinal cholesterol absorption
• Blocking hepatic PCSK9 synthesis

Correct Answer: Activation of PPAR-alpha leading to increased lipoprotein lipase activity and decreased VLDL synthesis

Q16. Niacin (nicotinic acid) decreases hepatic VLDL and LDL primarily by which action, and what common side effect can be minimized by aspirin pretreatment?

• Inhibits CETP; hepatotoxicity can be minimized by aspirin
• Inhibits hepatic diacylglycerol acyltransferase-2; flushing mediated by prostaglandins can be reduced by aspirin
• Increases bile acid excretion; constipation can be reduced by aspirin
• Stimulates lipoprotein lipase; hyperglycemia can be reduced by aspirin

Correct Answer: Inhibits hepatic diacylglycerol acyltransferase-2; flushing mediated by prostaglandins can be reduced by aspirin

Q17. PCSK9 monoclonal antibodies lower LDL-C by which precise mechanism?

• Increasing hepatic cholesterol synthesis to reduce LDL particle formation
• Binding circulating PCSK9 to prevent LDL receptor degradation and thereby increase LDL clearance
• Blocking intestinal absorption of cholesterol via NPC1L1 inhibition
• Activating CETP to transfer cholesteryl esters into HDL

Correct Answer: Binding circulating PCSK9 to prevent LDL receptor degradation and thereby increase LDL clearance

Q18. Which lipid-lowering agent is most appropriate for homozygous familial hypercholesterolemia and acts by inhibiting microsomal triglyceride transfer protein (MTP)?

• Ezetimibe
• Lomitapide
• Fenofibrate
• Alirocumab

Correct Answer: Lomitapide

Q19. Bile acid sequestrants (e.g., cholestyramine) can reduce LDL but may worsen which lipid parameter and interfere with absorption of which type of substances?

• Reduce triglycerides and enhance vitamin D absorption
• Increase triglycerides and interfere with absorption of fat-soluble vitamins and some drugs
• Decrease HDL and increase water-soluble vitamin absorption
• Increase HDL and improve absorption of oral anticoagulants

Correct Answer: Increase triglycerides and interfere with absorption of fat-soluble vitamins and some drugs

Q20. A patient on high-intensity statin therapy presents with muscle pain and CK elevation. Which is the best initial management step?

• Immediately start fibrate therapy in addition to the statin
• Stop statin temporarily, evaluate CK and renal function, and reassess risk-benefit before rechallenge or switch
• Increase statin dose to overcome tolerance
• Administer digoxin-specific Fab fragments

Correct Answer: Stop statin temporarily, evaluate CK and renal function, and reassess risk-benefit before rechallenge or switch

Download