MEDSCI303 | MEDSCI303 Pharmacy Exam 2
Version 3 | Questions with Correct Answers and
Expert Explanation for Each Question | Rajiv
Gandhi University of Health Sciences
1. A 65-year-old patient with a history of asthma is diagnosed with hypertension.
Which of the following beta-blockers is most likely to cause a severe bronchospasm in
this patient?
A. Metoprolol
B. Atenolol
C. Esmolol
D. Propranolol
Correct Answer: D
Expert Explanation: Propranolol is a non-selective beta-adrenergic antagonist that
blocks both beta-1 and beta-2 receptors. In patients with reactive airway diseases
like asthma, blocking beta-2 receptors leads to unopposed bronchoconstriction. This
can trigger life-threatening respiratory distress or an asthma exacerbation.
Cardioselective agents like metoprolol are generally preferred if a beta-blocker is
absolutely necessary. Pharmacists must always screen for respiratory history before
dispensing non-selective beta-antagonists.
,2. In the management of symptomatic bradycardia, Atropine is administered to
increase heart rate. What is the primary mechanism of action for this effect?
A. Stimulation of beta-1 adrenergic receptors
B. Activation of nicotinic receptors at the NMJ
C. Inhibition of acetylcholinesterase
D. Competitive antagonism of muscarinic M2 receptors
Correct Answer: D
Expert Explanation: Atropine acts as a competitive antagonist at muscarinic
acetylcholine receptors, specifically the M2 subtype in the heart. By blocking the
parasympathetic input from the vagus nerve, it effectively increases the firing rate of
the sinoatrial node. This results in a positive chronotropic effect which resolves
bradyarrhythmias. It is important to note that very low doses may paradoxically
slow the heart rate due to central actions. Monitoring for anticholinergic side effects
like dry mouth and blurred vision is essential during treatment.
3. A patient experiencing anaphylactic shock is treated with Epinephrine. Which
adrenergic receptor activation is primarily responsible for reducing mucosal edema
and upper airway obstruction?
A. Beta-1
B. Alpha-1
,C. Beta-2
D. Dopaminergic-1
Correct Answer: B
Expert Explanation: Epinephrine is the first-line treatment for anaphylaxis due to
its multi-receptor activity. The stimulation of alpha-1 receptors causes
vasoconstriction, which significantly reduces mucosal edema in the airway.
Simultaneously, beta-2 stimulation provides necessary bronchodilation to improve
airflow. Beta-1 stimulation increases cardiac output to counteract hypotension
associated with distributive shock. Understanding these distinct receptor roles is
vital for emergency pharmacological intervention.
4. Which of the following medications is a direct-acting cholinergic agonist used to
reduce intraocular pressure in patients with open-angle glaucoma?
A. Physostigmine
B. Pilocarpine
C. Scopolamine
D. Ipratropium
Correct Answer: B
, Expert Explanation: Pilocarpine is a direct-acting muscarinic agonist that causes
contraction of the ciliary muscle. This action facilitates the outflow of aqueous
humor through the canal of Schlemm, thereby reducing intraocular pressure. It also
causes miosis by stimulating the pupillary constrictor muscle. Unlike physostigmine,
which is an acetylcholinesterase inhibitor, pilocarpine acts directly on the receptors.
Patients should be warned about potential systemic cholinergic side effects and
difficulty with night vision.
5. A diabetic patient is prescribed Propranolol for migraine prophylaxis. What critical
safety concern should the pharmacist discuss regarding glycemic control?
A. It masks the sympathetic symptoms of hypoglycemia
B. Propranolol may cause severe hyperglycemia
C. It increases the renal clearance of insulin
D. Propranolol promotes glycogen synthesis in the liver
Correct Answer: A
Expert Explanation: Non-selective beta-blockers like propranolol can mask the
early warning signs of hypoglycemia, such as tachycardia and tremors. These
symptoms are mediated by the sympathetic nervous system and serve as vital alerts
for the patient. However, sweating (diaphoresis) is mediated by cholinergic fibers
and is usually not suppressed by beta-blockers. Furthermore, propranolol can
Version 3 | Questions with Correct Answers and
Expert Explanation for Each Question | Rajiv
Gandhi University of Health Sciences
1. A 65-year-old patient with a history of asthma is diagnosed with hypertension.
Which of the following beta-blockers is most likely to cause a severe bronchospasm in
this patient?
A. Metoprolol
B. Atenolol
C. Esmolol
D. Propranolol
Correct Answer: D
Expert Explanation: Propranolol is a non-selective beta-adrenergic antagonist that
blocks both beta-1 and beta-2 receptors. In patients with reactive airway diseases
like asthma, blocking beta-2 receptors leads to unopposed bronchoconstriction. This
can trigger life-threatening respiratory distress or an asthma exacerbation.
Cardioselective agents like metoprolol are generally preferred if a beta-blocker is
absolutely necessary. Pharmacists must always screen for respiratory history before
dispensing non-selective beta-antagonists.
,2. In the management of symptomatic bradycardia, Atropine is administered to
increase heart rate. What is the primary mechanism of action for this effect?
A. Stimulation of beta-1 adrenergic receptors
B. Activation of nicotinic receptors at the NMJ
C. Inhibition of acetylcholinesterase
D. Competitive antagonism of muscarinic M2 receptors
Correct Answer: D
Expert Explanation: Atropine acts as a competitive antagonist at muscarinic
acetylcholine receptors, specifically the M2 subtype in the heart. By blocking the
parasympathetic input from the vagus nerve, it effectively increases the firing rate of
the sinoatrial node. This results in a positive chronotropic effect which resolves
bradyarrhythmias. It is important to note that very low doses may paradoxically
slow the heart rate due to central actions. Monitoring for anticholinergic side effects
like dry mouth and blurred vision is essential during treatment.
3. A patient experiencing anaphylactic shock is treated with Epinephrine. Which
adrenergic receptor activation is primarily responsible for reducing mucosal edema
and upper airway obstruction?
A. Beta-1
B. Alpha-1
,C. Beta-2
D. Dopaminergic-1
Correct Answer: B
Expert Explanation: Epinephrine is the first-line treatment for anaphylaxis due to
its multi-receptor activity. The stimulation of alpha-1 receptors causes
vasoconstriction, which significantly reduces mucosal edema in the airway.
Simultaneously, beta-2 stimulation provides necessary bronchodilation to improve
airflow. Beta-1 stimulation increases cardiac output to counteract hypotension
associated with distributive shock. Understanding these distinct receptor roles is
vital for emergency pharmacological intervention.
4. Which of the following medications is a direct-acting cholinergic agonist used to
reduce intraocular pressure in patients with open-angle glaucoma?
A. Physostigmine
B. Pilocarpine
C. Scopolamine
D. Ipratropium
Correct Answer: B
, Expert Explanation: Pilocarpine is a direct-acting muscarinic agonist that causes
contraction of the ciliary muscle. This action facilitates the outflow of aqueous
humor through the canal of Schlemm, thereby reducing intraocular pressure. It also
causes miosis by stimulating the pupillary constrictor muscle. Unlike physostigmine,
which is an acetylcholinesterase inhibitor, pilocarpine acts directly on the receptors.
Patients should be warned about potential systemic cholinergic side effects and
difficulty with night vision.
5. A diabetic patient is prescribed Propranolol for migraine prophylaxis. What critical
safety concern should the pharmacist discuss regarding glycemic control?
A. It masks the sympathetic symptoms of hypoglycemia
B. Propranolol may cause severe hyperglycemia
C. It increases the renal clearance of insulin
D. Propranolol promotes glycogen synthesis in the liver
Correct Answer: A
Expert Explanation: Non-selective beta-blockers like propranolol can mask the
early warning signs of hypoglycemia, such as tachycardia and tremors. These
symptoms are mediated by the sympathetic nervous system and serve as vital alerts
for the patient. However, sweating (diaphoresis) is mediated by cholinergic fibers
and is usually not suppressed by beta-blockers. Furthermore, propranolol can
