Enalapril MCQs With Answer

Enalapril MCQs With Answer

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Enalapril MCQs With Answer is a focused review designed for B.Pharm students to master essential pharmacology of enalapril. These MCQs cover mechanism of action, pharmacokinetics, prodrug activation to enalaprilat, dosing, therapeutic uses (hypertension, heart failure, diabetic nephropathy), adverse effects (cough, hyperkalemia, angioedema), contraindications (pregnancy, bilateral renal artery stenosis), drug interactions (NSAIDs, potassium-sparing diuretics, lithium), monitoring (renal function, electrolytes), and formulation differences. Questions emphasize clinically relevant details, calculation-based dosing adjustments, and rational prescribing. This resource strengthens understanding of ACE inhibitor pharmacology, safety considerations, and lab monitoring. Answers include brief explanations and references to dosing guidelines to aid exam preparation. Now let’s test your knowledge with 30 MCQs on this topic.

Q1. Which statement best describes the primary mechanism of action of enalapril?

  • Selective blockade of angiotensin II type 1 (AT1) receptors
  • Inhibition of angiotensin-converting enzyme (ACE) reducing angiotensin II formation
  • Direct vasodilation by nitric oxide donation
  • Inhibition of renin release from the kidney

Correct Answer: Inhibition of angiotensin-converting enzyme (ACE) reducing angiotensin II formation

Q2. Enalapril is administered as a prodrug. Which active metabolite is responsible for its therapeutic effects?

  • Enalaprilat
  • Lisinopril
  • Captopril
  • Ramiprilat

Correct Answer: Enalaprilat

Q3. Which pharmacokinetic property is TRUE for oral enalapril?

  • It has very high oral bioavailability (>90%)
  • It is rapidly converted to enalaprilat primarily in the liver
  • It is eliminated mainly via pulmonary exhalation
  • It is administered only by intravenous route

Correct Answer: It is rapidly converted to enalaprilat primarily in the liver

Q4. Which adverse effect is most characteristically associated with ACE inhibitors like enalapril?

  • Orthostatic hypotension with reflex tachycardia
  • Persistent dry cough due to increased bradykinin
  • Severe sedation and respiratory depression
  • Hyperglycemia and weight gain

Correct Answer: Persistent dry cough due to increased bradykinin

Q5. Enalapril is contraindicated in which of the following conditions?

  • Pregnancy, especially second and third trimesters
  • Type 2 diabetes mellitus without complications
  • Controlled hypothyroidism
  • Essential tremor

Correct Answer: Pregnancy, especially second and third trimesters

Q6. A key laboratory parameter to monitor in patients on enalapril is:

  • Serum amylase
  • Serum potassium and creatinine
  • Fasting blood glucose
  • Serum bilirubin

Correct Answer: Serum potassium and creatinine

Q7. Which drug interaction with enalapril can increase the risk of hyperkalemia?

  • Loop diuretics like furosemide
  • Potassium-sparing diuretics like spironolactone
  • Nicotinic acid
  • Metformin

Correct Answer: Potassium-sparing diuretics like spironolactone

Q8. The most appropriate initial antihypertensive use for enalapril is:

  • First-line monotherapy for essential hypertension in many patients
  • Only used after failure of beta-blockers and diuretics
  • Contraindicated in all elderly patients
  • Effective only when combined with nitrates

Correct Answer: First-line monotherapy for essential hypertension in many patients

Q9. Which of the following is a hemodynamic effect of enalapril?

  • Increased systemic vascular resistance
  • Vasodilation leading to decreased afterload
  • Direct increase in myocardial contractility
  • Marked reflex sympathetic activation

Correct Answer: Vasodilation leading to decreased afterload

Q10. In patients with bilateral renal artery stenosis, ACE inhibitors like enalapril are likely to cause:

  • Improved renal perfusion and increased GFR
  • Acute renal failure due to reduced angiotensin II–mediated efferent arteriolar constriction
  • No effect on renal function
  • Profound hypokalemia

Correct Answer: Acute renal failure due to reduced angiotensin II–mediated efferent arteriolar constriction

Q11. Which adverse reaction is an emergency and has been reported with ACE inhibitors including enalapril?

  • Angioedema involving face and airway
  • Mild transient headache
  • Dry skin rash without swelling
  • Temporary hair loss

Correct Answer: Angioedema involving face and airway

Q12. Which parameter typically increases after starting enalapril therapy and should be reassessed within 1–2 weeks?

  • Serum sodium
  • Serum creatinine
  • Platelet count
  • Serum albumin

Correct Answer: Serum creatinine

Q13. Enalapril dosing must be adjusted in which patient population?

  • Patients with severe renal impairment
  • Patients with active peptic ulcer disease
  • Patients with controlled glaucoma
  • Young healthy adults with normal renal function

Correct Answer: Patients with severe renal impairment

Q14. Which statement about enalapril pharmacokinetics is CORRECT?

  • Enalapril has a very short half-life and requires continuous infusion
  • Oral enalapril is absorbed and then hydrolyzed to active enalaprilat
  • Enalapril is metabolized to enalaprilat exclusively in the kidney
  • Enalapril is not protein bound and rapidly removed by dialysis

Correct Answer: Oral enalapril is absorbed and then hydrolyzed to active enalaprilat

Q15. Which clinical use of enalapril is supported by evidence?

  • Treatment of bacterial infections
  • Management of congestive heart failure to reduce morbidity
  • First-line therapy for acute anaphylaxis
  • Primary treatment for acute ischemic stroke

Correct Answer: Management of congestive heart failure to reduce morbidity

Q16. Which of the following laboratory changes may occur with enalapril therapy?

  • Hyponatremia due to ADH stimulation
  • Hyperkalemia from decreased aldosterone secretion
  • Marked rise in hemoglobin levels
  • Severe hypocalcemia

Correct Answer: Hyperkalemia from decreased aldosterone secretion

Q17. Concomitant use of NSAIDs with enalapril may cause:

  • Enhanced antihypertensive effect without risks
  • Reduced antihypertensive effect and increased risk of renal impairment
  • Marked hypokalemia
  • No clinically relevant interaction

Correct Answer: Reduced antihypertensive effect and increased risk of renal impairment

Q18. Which formulation of enalapril can be given intravenously in emergent situations?

  • Enalapril tablets
  • Enalaprilat (IV active form)
  • Enalapril suspension for oral use only
  • Enalapril transdermal patch

Correct Answer: Enalaprilat (IV active form)

Q19. Which structural/chemical characteristic applies to enalapril?

  • It is a sulfhydryl-containing ACE inhibitor
  • It is an ester prodrug converted to an active dicarboxylate (enalaprilat)
  • It is a peptide analogue with direct renin inhibition
  • It is a beta-lactam antibiotic

Correct Answer: It is an ester prodrug converted to an active dicarboxylate (enalaprilat)

Q20. A B.Pharm student is asked why ACE inhibitors cause cough. The best explanation is:

  • ACE inhibitors increase prostaglandin synthesis in the lungs
  • ACE inhibitors increase bradykinin levels which stimulate cough reflex
  • ACE inhibitors cause bronchial infection leading to cough
  • ACE inhibitors block histamine receptors causing cough

Correct Answer: ACE inhibitors increase bradykinin levels which stimulate cough reflex

Q21. Which monitoring schedule is most appropriate after initiating enalapril in a patient with normal baseline renal function?

  • No monitoring required
  • Check serum creatinine and potassium within 1–2 weeks of start
  • Check liver function tests daily
  • Perform weekly ECGs indefinitely

Correct Answer: Check serum creatinine and potassium within 1–2 weeks of start

Q22. Enalapril’s antihypertensive effect is mainly due to:

  • Decreased peripheral vascular resistance
  • Significant increase in cardiac output via positive inotropy
  • Direct CNS sympathetic blockade
  • Activation of alpha-adrenergic receptors

Correct Answer: Decreased peripheral vascular resistance

Q23. Which patient scenario requires caution or dose reduction of enalapril?

  • Young athlete with normal renal function
  • Patient with creatinine clearance of 25 mL/min
  • Patient on long-term stable low-dose aspirin
  • Patient taking topical antifungal cream

Correct Answer: Patient with creatinine clearance of 25 mL/min

Q24. Which adverse effect would most likely prompt immediate drug discontinuation and emergency care?

  • Mild dizziness on standing
  • Worsening facial swelling and difficulty breathing
  • Transient taste disturbance
  • Occasional headache

Correct Answer: Worsening facial swelling and difficulty breathing

Q25. In diabetic patients, ACE inhibitors like enalapril are particularly useful because they:

  • Reduce progression of diabetic nephropathy by reducing intraglomerular pressure
  • Increase insulin secretion from pancreatic beta cells
  • Act as hypoglycemic agents
  • Prevent diabetic neuropathy directly

Correct Answer: Reduce progression of diabetic nephropathy by reducing intraglomerular pressure

Q26. Which is TRUE about switching from another ACE inhibitor to enalapril?

  • It is never possible due to cross-reactivity
  • Dosing should be converted based on potency; monitor BP and renal function
  • No monitoring is needed after switching
  • Enalapril cannot be combined with previous ACE inhibitor

Correct Answer: Dosing should be converted based on potency; monitor BP and renal function

Q27. Which population has a known increased risk of ACE inhibitor–induced angioedema?

  • Patients of African descent
  • Adolescent males exclusively
  • Patients with chronic obstructive pulmonary disease only
  • All children under 12 years

Correct Answer: Patients of African descent

Q28. Which co-prescribed drug requires careful monitoring or avoidance with enalapril because of lithium toxicity risk?

  • Digoxin
  • Spironolactone
  • Thiazide diuretics
  • Lithium

Correct Answer: Lithium

Q29. For an adult starting enalapril for hypertension, a common starting oral dose is:

  • 0.5 mg once daily
  • 2.5–5 mg once daily
  • 100 mg once daily
  • Intramuscular injection only

Correct Answer: 2.5–5 mg once daily

Q30. Which statement about enalapril and pregnancy is CORRECT?

  • It is safe during all trimesters
  • It is contraindicated due to risk of fetal renal failure and death
  • It is recommended to treat preeclampsia during pregnancy
  • No specific advice is needed for conception planning

Correct Answer: It is contraindicated due to risk of fetal renal failure and death

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