Understanding drugs used in therapy of shock is essential for B. Pharm students preparing for clinical pharmacology and therapeutics. This introduction outlines shock types (septic, cardiogenic, hypovolemic, distributive, anaphylactic, neurogenic) and core pharmacotherapy: fluid resuscitation, vasopressors, inotropes, vasodilators, and vasopressin analogues. Focus on mechanisms of action, receptor selectivity (alpha, beta, V1, D1), dosing principles, adverse effects, and monitoring parameters (MAP, lactate, urine output) will enhance both exam performance and clinical reasoning. Key agents such as norepinephrine, epinephrine, dopamine, dobutamine, phenylephrine, vasopressin, and milrinone are emphasized for practical use. Now let’s test your knowledge with 30 MCQs on this topic.
Q1. Which drug is the recommended first-line vasopressor for most cases of septic shock?
- Dopamine
- Norepinephrine
- Epinephrine
- Phenylephrine
Correct Answer: Norepinephrine
Q2. At low doses, dopamine was historically believed to produce which primary effect?
- Alpha-1 mediated systemic vasoconstriction
- Beta-1 mediated increased contractility
- Dopamine (D1) receptor-mediated renal vasodilation
- Vasopressin V1 receptor activation
Correct Answer: Dopamine (D1) receptor-mediated renal vasodilation
Q3. What is the drug of choice for immediate management of anaphylactic shock?
- Norepinephrine IV
- Epinephrine IM (or IV in severe cases)
- Diphenhydramine IV
- Hydrocortisone IV
Correct Answer: Epinephrine IM (or IV in severe cases)
Q4. Which vasopressor is a primarily selective alpha-1 agonist used to raise blood pressure without increasing heart rate?
- Norepinephrine
- Phenylephrine
- Epinephrine
- Dobutamine
Correct Answer: Phenylephrine
Q5. Which inotropic agent is primarily a beta-1 agonist used to increase cardiac output in cardiogenic shock?
- Dopamine
- Dobutamine
- Milrinone
- Norepinephrine
Correct Answer: Dobutamine
Q6. Which drug is a phosphodiesterase-3 inhibitor used as an inodilator to increase contractility and reduce afterload?
- Digoxin
- Milrinone
- Levosimendan
- Dobutamine
Correct Answer: Milrinone
Q7. The mechanism by which milrinone improves cardiac output is primarily:
- Alpha-1 agonism increasing afterload
- PDE-3 inhibition increasing intracellular cAMP
- Blocking beta-adrenergic receptors
- Stimulating dopamine receptors
Correct Answer: PDE-3 inhibition increasing intracellular cAMP
Q8. Which vasopressor combines strong alpha-1 vasoconstriction with beta-1 cardiac stimulation and is often first-line in distributive shock?
- Phenylephrine
- Norepinephrine
- Vasopressin
- Dobutamine
Correct Answer: Norepinephrine
Q9. A common adverse effect of high-dose dopamine is:
- Renal vasodilation
- Arrhythmias and tachycardia
- Severe hypotension
- Prolonged QT shortening
Correct Answer: Arrhythmias and tachycardia
Q10. What is the initial fluid of choice for rapid resuscitation in hypovolemic shock?
- Colloids (albumin)
- Crystalloids (e.g., normal saline or lactated Ringer’s)
- Vasopressors without fluids
- Loop diuretics
Correct Answer: Crystalloids (e.g., normal saline or lactated Ringer’s)
Q11. Which agent primarily increases myocardial contractility via beta-1 stimulation and may cause mild vasodilation through beta-2 effects?
- Phenylephrine
- Dobutamine
- Vasopressin
- Digoxin
Correct Answer: Dobutamine
Q12. Norepinephrine has the strongest activity at which receptors?
- Beta-2 only
- Alpha-1 and beta-1 (predominantly alpha-1)
- Dopamine D2 receptors
- V1 vasopressin receptors
Correct Answer: Alpha-1 and beta-1 (predominantly alpha-1)
Q13. Vasopressin acts in vasodilatory shock primarily through activation of which receptor?
- Beta-1 adrenergic receptor
- V2 renal water-retentive receptor
- V1 vascular smooth muscle receptor
- Alpha-2 adrenergic receptor
Correct Answer: V1 vascular smooth muscle receptor
Q14. Before initiating vasopressors in hypovolemic shock, what critical step must be taken?
- Start high-dose vasopressors immediately
- Perform diuretic therapy
- Adequate fluid resuscitation to restore intravascular volume
- Administer beta-blockers
Correct Answer: Adequate fluid resuscitation to restore intravascular volume
Q15. Dobutamine primarily targets which adrenergic receptor to produce positive inotropy?
- Alpha-1 receptor
- Beta-1 receptor
- Beta-2 receptor
- D1 receptor
Correct Answer: Beta-1 receptor
Q16. A notable adverse effect of milrinone therapy is:
- Severe bradycardia without arrhythmias
- Hypotension and risk of ventricular arrhythmias
- Marked peripheral vasoconstriction
- Hyperkalemia
Correct Answer: Hypotension and risk of ventricular arrhythmias
Q17. Which statement about low-dose dopamine is historically claimed in shock management?
- Low-dose dopamine is preferred first-line in septic shock
- Low-dose dopamine selectively increases renal blood flow via D1 receptors
- Low-dose dopamine causes pure alpha-1 vasoconstriction
- Low-dose dopamine antagonizes beta-1 receptors
Correct Answer: Low-dose dopamine selectively increases renal blood flow via D1 receptors
Q18. The vasopressor of choice for neurogenic shock (spinal shock) is typically:
- Norepinephrine
- Dopamine low-dose
- Furosemide
- Isoproterenol
Correct Answer: Norepinephrine
Q19. Epinephrine exhibits predominantly beta-adrenergic effects at low doses and alpha-adrenergic effects at high doses. This pharmacologic property is called:
- Receptor desensitization
- Dose-dependent receptor selectivity
- Inverse agonism
- Competitive antagonism
Correct Answer: Dose-dependent receptor selectivity
Q20. The most useful hemodynamic target to guide vasopressor therapy in shock is:
- Systolic blood pressure
- Heart rate
- Mean arterial pressure (MAP)
- Central venous pressure (CVP) alone
Correct Answer: Mean arterial pressure (MAP)
Q21. Which vasopressor is essentially a pure alpha-1 agonist often used to treat hypotension while minimizing tachycardia?
- Epinephrine
- Phenylephrine
- Dobutamine
- Dopamine
Correct Answer: Phenylephrine
Q22. A major risk associated with high-dose norepinephrine infusion is:
- Renal hyperperfusion
- Peripheral ischemia and tissue necrosis
- Marked hypoglycemia
- Prolonged sedation
Correct Answer: Peripheral ischemia and tissue necrosis
Q23. Dobutamine has which combination of receptor activities?
- Pure alpha-1 agonist
- Beta-1 agonist with some beta-2 agonism and weak alpha effects
- V1 receptor agonist
- D2 receptor antagonist
Correct Answer: Beta-1 agonist with some beta-2 agonism and weak alpha effects
Q24. Which catecholamine is standardly used in cardiac arrest protocols for its potent alpha and beta effects?
- Vasopressin
- Epinephrine
- Phenylephrine
- Milrinone
Correct Answer: Epinephrine
Q25. For short-term inotropic support in acute decompensated heart failure with low cardiac output, which drug is commonly used?
- Milrinone
- Digoxin oral
- Metoprolol IV
- Furosemide alone
Correct Answer: Milrinone
Q26. Vasopressin analogues increase vascular tone by acting on which subtype of vasopressin receptor located on vascular smooth muscle?
- V2 receptor
- V1a receptor
- V3 receptor
- D1 receptor
Correct Answer: V1a receptor
Q27. In the outpatient or early emergency setting for suspected anaphylaxis, the preferred immediate route for epinephrine administration is:
- Intravenous bolus in all cases
- Intramuscular (IM) injection into the lateral thigh
- Oral tablet
- Subcutaneous injection in the arm
Correct Answer: Intramuscular (IM) injection into the lateral thigh
Q28. Which statement best describes how beta-1 stimulation increases cardiac contractility?
- Decreases intracellular calcium via PDE activation
- Increases intracellular cAMP leading to enhanced calcium influx
- Blocks L-type calcium channels
- Activates muscarinic receptors to increase contractility
Correct Answer: Increases intracellular cAMP leading to enhanced calcium influx
Q29. Which adrenergic receptor subtype mediates vasodilation in skeletal muscle vasculature?
- Alpha-1 receptor
- Beta-2 receptor
- V1 receptor
- D2 receptor
Correct Answer: Beta-2 receptor
Q30. The cornerstone of therapy for hemorrhagic hypovolemic shock is:
- High-dose vasopressors without addressing bleeding
- Control of bleeding and restoration of intravascular volume with crystalloids and blood products
- Immediate chronic beta-blocker therapy
- Administration of vasodilators to reduce afterload
Correct Answer: Control of bleeding and restoration of intravascular volume with crystalloids and blood products
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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