Why do ACE inhibitors such as enalapril cause persistent dry cough?

Inhibition of kinase II leading to the accumulation of pulmonary bradykinin and substance P

Direct bronchial smooth muscle stimulation via AT1 receptor activation

Excessive accumulation of circulating angiotensin I in the alveolar parenchyma

Suppression of renal prostaglandin E2 synthesis

What is the main action of ARBs such as losartan?

Selective competitive antagonism at the Angiotensin II Type 1 (AT1) receptor subtype

Irreversible covalent inactivation of renal juxtaglomerular renin granules

Competitive inhibition of the active zinc domain of kininase II

Direct stimulation of central imidazoline I1 receptors in the medulla

Why is verapamil useful in supraventricular tachycardia (SVT)?

Verapamil exerts potent inhibitory effects on voltage-gated L-type calcium channels in the AV node, slowing conduction velocity

Verapamil selectively opens vascular ATP-sensitive potassium channels

Verapamil acts as a competitive antagonist at cardiac beta-1 adrenergic receptors

Verapamil causes marked arterial vasodilation that triggers reflex tachycardia

What is furosemide’s site and target of action in the nephron?

Inhibition of the Na+/K+/2Cl- cotransporter (NKCC2) in the thick ascending limb of the loop of Henle

Competitive antagonism of mineralocorticoid receptors in the cortical collecting duct

Blockade of the Na+/Cl- symporter (NCC) in the early distal convoluted tubule

Inhibition of apical epithelial sodium channels (ENaC) in the late distal tubule

Which effect distinguishes loop diuretics from thiazides regarding urinary calcium?

Increased urinary calcium excretion (hypercalciuria)

Where do thiazide diuretics act, and which transporter do they inhibit?

Inhibition of the electroneutral Na+/Cl- cotransporter (NCC) in the distal convoluted tubule

Blockade of apical aquaporin-2 water channels in the medullary collecting duct

Inhibition of basolateral Na+/K+-ATPase in the collecting duct

Inhibition of the Na+/H+ exchanger (NHE3) in the proximal convoluted tubule

Which metabolic effects are associated with long-term/high-dose thiazide use?

Hypokalemia, hyperglycemia, and hyperuricemia

Hyperkalemia, metabolic acidosis, and hypocalcemia

Hyponatremia, hypoglycemia, and hypercalcemia

Hyperkalemia, hypoglycemia, and hypouricemia

How does spironolactone act as a potassium-sparing diuretic?

Competitive antagonism of cytosolic Mineralocorticoid (Aldosterone) Receptors in principal cells

Direct blockade of the apical Epithelial Sodium Channel (ENaC)

Competitive inhibition of the renal Na+/K+/2Cl- symporter

Inhibition of renal tubular Carbonic Anhydrase type II

Which endocrine adverse effects can spironolactone cause?

Gynecomastia and menstrual irregularities

What is digoxin’s primary molecular target in cardiac cells?

Reversible inhibition of the sarcolemmal Na+/K+-ATPase enzyme pump

Opening of mitochondrial ATP-sensitive potassium channels

Allosteric stimulation of the sarcoplasmic reticulum Ca2+-ATPase (SERCA2a)

Direct agonism at cardiac beta-1 adrenergic receptors

How does digoxin increase cardiac contractility?

Accumulation of intracellular Na+ reduces the trans-sarcolemmal Na+ gradient, slowing Ca2+ extrusion via the 3Na+/1Ca2+ antiporter

Depletion of intracellular potassium directly triggers calcium influx through T-type channels

Elevated extracellular sodium activates voltage-dependent L-type calcium channels continuously

Direct enzymatic phosphorylation of troponin C increases its binding affinity for actin

Which visual disturbance is classically associated with digoxin toxicity?

Xanthopsia (yellow-green colored vision with halo effects)

Central retinal vein occlusion with loss of red-green vision

Tunnel vision with bilateral optic disc edema

What is the specific antidote for life-threatening digoxin overdose?

Digoxin-specific antigen-binding fragments (DigiFab / Digibind)

Oral activated charcoal with high-dose potassium citrate

Intravenous Atropine combined with Quinidine sulfate

How does nitroglycerin produce vascular smooth-muscle relaxation?

Biotransformation into Nitric Oxide (NO) by mitochondrial aldehyde dehydrogenase-2 (ALDH2), activating soluble Guanylyl Cyclase

Inhibition of vascular phosphodiesterase type 3 (PDE3)

Direct competitive blockade of postjunctional vascular Alpha-1 adrenergic receptors

Allosteric opening of vascular voltage-dependent calcium channels

What is nitroglycerin’s main hemodynamic effect in exertional angina?

Potent systemic venous dilation (venodilation) reducing venous return, ventricular preload, and myocardial wall tension

Direct blockade of cardiac pacemaker 'funny' channels (If) to reduce heart rate

Selective dilation of intracranial cerebral arterioles

Marked peripheral arteriolar constriction to increase coronary perfusion pressure

What serious interaction occurs with nitrates and PDE5 inhibitors?

Profound, refractory systemic hypotension and cardiovascular collapse

Complete AV block with marked PR prolongation

Sudden coronary spasm through thromboxane A2 release

Acute hypertensive crisis mediated by rebound catecholamine release

What is the loss of nitrate effectiveness during continuous therapy called?

Nitrate tolerance due to reduced bioactivation and oxidative stress

Precipitation of inactive nitrate crystals within coronary endothelial cells

Rapid upregulation of vascular phosphodiesterase-5 enzymes

Competitive displacement of nitrates from plasma albumin by endogenous fatty acids

How does ranolazine treat chronic stable angina?

Selective blockade of the late inward sodium current (late INa), reducing intracellular calcium overload in ischemic myocytes

Direct competitive antagonism of vascular endothelin ET-A receptors

Potent stimulation of sarcolemmal K-ATP channels causing coronary hyperpolarization

Inhibition of beta-oxidation of fatty acids in cardiomyocyte mitochondria

Which enzyme do statins competitively inhibit in cholesterol synthesis?

HMG-CoA Reductase (3-hydroxy-3-methylglutaryl-coenzyme A reductase)

Acyl-CoA cholesterol acyltransferase (ACAT)

How does sodium nitroprusside lower blood pressure in hypertensive emergencies?

Non-enzymatic spontaneous release of Nitric Oxide (NO) in blood, relaxing both arterioles and venules

Selective agonism at peripheral dopamine D1 receptors

Direct activation of vascular smooth muscle K-ATP channels

Competitive blockade of endothelin-1 receptors

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RRB PH UT12 – Pharmacology Practice Test 4: Cardiovascular & Renal Systems

Diksha Bhatla November 13, 2026 20 views 30 Questions

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About This Practice Test:
This online practice test covers cardiovascular and renal pharmacology for pharmacy and paramedical exam preparation. Revise important medicines used for high blood pressure, fluid retention, heart conditions, angina and high cholesterol. The 30 questions include explanations to help you check your knowledge and revise key concepts.

Syllabus Covered:
– ACE Inhibitors and ARBs: Enalapril, captopril, losartan and aliskiren.
– Calcium Channel Blockers: Amlodipine, verapamil and important drug interactions.
– Diuretics: Furosemide, thiazides, spironolactone and amiloride.
– Cardiac Glycosides: Digoxin’s action, toxicity, electrolyte effects and specific antidote.
– Antianginal Medicines: Nitroglycerin, nitrate tolerance, nitrate-PDE5 inhibitor interaction, ivabradine and ranolazine.
– Cholesterol-Lowering Medicines: Statins, rhabdomyolysis risk and ezetimibe.
– Hypertensive Emergencies: Sodium nitroprusside and direct renin inhibition by aliskiren.

Exams You Can Prepare For:
– RRB Pharmacist and Paramedical exams
– DSSSB Pharmacist exams
– ESIC Pharmacist and healthcare recruitment exams
– AIIMS Paramedical and CGHS-related recruitment exams
– State pharmacist and paramedical recruitment tests

Test Details:
30 Questions | Online Practice Test | Explanations for Every Question | Score and Performance Review

Written & Verified by Diksha Bhatla

Expert Faculty

Diksha Bhatla is a Pharmacy graduate and a passionate academic content creator currently pursuing higher studies in Pharmacy. She contributes to SoloTutes by creating educational content, practice tests, and study resources for students preparing for NEET and Pharmacy examinations. With a strong understanding of **Biology, Chemistry, and Pharmacy**, Diksha focuses on developing clear, exam-oriented content that helps students strengthen their concepts and improve their preparation. At SoloTutes, she writes educational articles and develops practice questions and tests designed to support students in their learning and competitive exam preparation.