PHARMACOLOGY I (BP404TP)

SEMESTER IV
Pharmacology I

(BP404 TP)
Multiple Choice Questions
Chapter 1 & 2

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General Pharmacological Principles
1 Essential drugs’ are:
A. Life saving drugs
B. Drugs that meet the priority health care needs of the population
C. Drugs that must be present in the emergency bag of a doctor
D. Drugs that are listed in the pharmacopoia of a country

2 An 'orphan drug' is:

A.A very cheap drug
B.A drug which has no therapeutic use
C.A drug needed for treatment or prevention of a rare disease
D.A drug which acts on Orphanin receptors

3 Drug administered through the following route is most likely to be subjected

to first-pass metabolism:
A. Oral
B. Sublingual
C. Subcutaneous
D. Rectal

4 Transdermal drug delivery systems offer the following advantages except:

A. They produce high peak plasma concentration of the drug
B. They produce smooth and nonfluctuating plasma concentration of the drug
C. They minimise interindividual variations in the achieved plasma drug
concentration
D.They avoid hepatic first-pass metabolism of the drug

5 Compared to subcutaneous injection, the intramus- cular injection of drugs:

A. Is more painful
B. Produces faster response
C. Is unsuitable for depot preparations
D. Carries greater risk of anaphylactic reaction

6 Select the route of administration which carries the highest risk of adversely
affecting vital functions:
A. Intra arterial injection
B. Intrathecal injection
C. Intravenous injection
Intramuscularinjection

7 Alkalinization of urine hastens the excretion of:

A. Weakly basic drugs
B. Weakly acidic drugs
C. Strong electrolytes

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D. Nonpolar drugs

8 Majority of drugs cross biological membranes primarily by:

A. Passive diffusion
B. Facilitated diffusion
C. Active transport
D. Pinocytosis

9 Diffusion of drugs across cell membrane:

A. Is dependent upon metabolic activity of the cell
B. Is competitively inhibited by chemically related drugs
C. Is affected by extent of ionization of drug mole- cules
D. Exhibits saturation kinetics
10 Which of the following drugs is most likely to be absorbed from the
stomach:
A Morphine sulfate
B Diclofenac sodium
C Hyoscine hydrobromide
D Quinine dihydrochloride

11 The most important factor which governs diffusion of drugs across

capillaries other than those in the brain is:
A. Blood flow through the capillary
B. Lipid solubility of the drug
C. pKa value of the drug
D. pH of the medium

12 Active transport of a substance across biological membranes has the

following characteristics except:
A. It is specific
B. It is pH dependent
C. It is saturable
D. It requires metabolic energy

13 Tricyclic antidepressants can alter the oral absorption of many drugs by:
A. Complexing with the other drug in the intesti- nal lumen
B. Altering gut motility
C. Altering gut flora
D. Damaging gut mucosa

14 Bioavailability of drug refers to:

A. Percentage of administered dose that reaches systemic circulation in
the unchanged form

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B. Ratio of oral to parenteral dose
C. Ratio of orally administered drug to that excre- ted in the faeces
D. Ratio of drug excreted unchanged in urine to that excreted as metabolites

15 Bioavailability differences among oral formulations of a drug are most

likely to occur if the drug:

A. Is freely water soluble

B. Is completely absorbed
C. Is incompletely absorbed
D. Undergoes little first-pass metabolism

16 The most important factor governing absorption of a drug from intact skin
is:
A. Molecular weight of the drug
B. Site of application
C. Lipid solubility of the drug
D. Nature of the base used in the formulation

17 The following attribute of a drug tends to reduce its volume of distribution:

A. High lipid solubility
B. Low ionisation at physiological pH values
C. High plasma protein binding
D. High tissue binding

18 Marked redistribution is a feature of:

A. Highly lipid soluble drugs
B. Poorly lipid soluble drugs
C. Depot preparations
D. Highly plasma protein bound drugs

19 The blood-brain barrier, which restricts entry of many drugs into brain, is
constituted by:
A. P-glycoprotein efflux carriers in brain
capillary cells
B. Tight junctions between endothelial cells of brain capillaries
C. Enzymes present in brain capillary walls
D. All of the above

20 Which of the following is not true of the blood-brain barrier:

A. It is constituted by tight junctions between the endothelial cells of brain
capillaries and the glial tissue
B. It allows passage of lipid soluble drugs into the brain
C. It limits entry of highly ionized drugs into the brain
D. It regulates passage of substances from brain into blood

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21 Weakly acidic drugs:
A. Are bound primarily to 1 acid glycoprotein in plasma
B. Are excreted faster in alkaline urine
C. Are highly ionized in the gastric juice
D. Do not cross blood-brain barrier

22 High plasma protein binding:

A. Increases volume of distribution of the drug
B. Facilitates glomerular filtration of the drug
C. Minimises drug interactions
D. Generally makes the drug long acting

23 The plasma protein bound fraction of a drug:

A. Contributes to the response at the given moment
B. Remains constant irrespective of the total drug concentration
C. Remains constant irrespective of the disease state
D. Is not available for metabolism unless actively extracted by the liver

24 Biotransformation of drugs is primarily directed to:

A. Activate the drug
B. Inactivate the drug
C. Convert lipid soluble drugs into nonlipid solu- ble metabolites
D. Convert nonlipid soluble drugs into lipid solu- ble metabolites

25 Which of the following is a prodrug:

A. Hydralazine
B. Clonidine
C. Captopril
D. Enalapril

26 A prodrug is:
A. The prototype member of a class of drugs
B. The oldest member of a class of drugs
C. An inactive drug that is transformed in the body to an active
metabolite
D. A drug that is stored in body tissues and is then gradually released in the circulation

27 Which of the following cytochrome P450 isoenzymes is involved in the

metabolism of largest number of drugs in human beings and has been
implicated in some dangerous drug interactions:
E. CYP 3A4
F. CYP 2C9
G. CYP 2E1
D. CYP 1A2

28 The most commonly occurring conjugation reaction for drugs and their
metabolites is:
A. Glucuronidation

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B. Acetylation
C. Methylation
D. Glutathioneconjugation

29 Microsomal enzyme induction can be a cause of:

A. Tolerance
B. Physical dependence
C. Psychological dependence
D. Idiosyncrasy

30 The following drug metabolizing reaction is entirely nonmicrosomal:

A. Glucuronide conjugation
B. Acetylation
C. Oxidation
D. Reduction

31Which of the following types of drug metabolizing enzymes are inducible:

A. Microsomal enzymes
B. Nonmicrosomal enzymes
C. Both microsomal and nonmicrosomal enzymes
D. Mitochondrial enzymes

32Induction of drug metabolizing enzymes involves:

A. A conformational change in the enzyme protein to favour binding of substrate
molecules
B. Expression of enzyme molecules on the surface of hepatocytes
C. Enhanced transport of substrate molecules into hepatocytes
D. Increased synthesis of enzyme protein

33 Drugs which undergo high degree of first-pass meta- bolism in liver:

A. Have low oral bioavailability
B. Are excreted primarily in bile
C. Are contraindicated in liver disease
D. Exhibit zero order kinetics of elimination

34 Glomerular filtration of a drug is affected by its:

A. Lipid solubility
B. Plasma protein binding
C. Degree of ionization
D. Rate of tubular secretion

35 If a drug undergoes net tubular secretion, its renal clearance will be:
A. More than the glomerular filtration rate
B. Equal to the glomerular filtration rate
C. Less than the glomerular filtration rate
D. Equal to the rate of urine formation

36 The plasma half life of penicillin-G is longer in the new born because their:
A. Plasma protein level is low
B. Drug metabolizing enzymes are immature

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C. Glomerular filtration rate is low
D. Tubular transport mechanisms are not well developed

37 Which of the following is not a primary/fundamental, but a derived

pharmacokinetic parameter:
A. Bioavailability
B. Volume of distribution
C. Clearance
D. Plasma half life

38 If a drug is eliminated by first order kinetics:

A. A constant amount of the drug will be elimi- nated per unit time
B. Its clearance value will remain constant
C. Its elimination half life will increase with dose
D. It will be completely eliminated from the body in 2 half life period

39 If a drug has a constant bioavailability and first order elimination, its

maintenance dose rate will be directly proportional to its:
A. Volume of distribution
B. Plasma protein binding
C. Lipid solubility
D. Total body clearance

40 The loading dose of a drug is governed by its:

A. Renal clearance
B. Plasma half life
C. Volume of distribution
D. Elimination rate constant

41Monitoring of blood levels of diuretic drugs is not practised because:

A. No sensitive methods for measuring blood levels of diuretics are available
B. It is easier to measure the effect of these drugs
C. Response to diuretics is not related to their blood levels
D. Diuretics need activation in the body

42 Monitoring plasma drug concentration is useful while using:

A. Antihypertensive drugs
B. Levodopa
C. Lithium carbonate
D. MAO inhibitors

43 Microsomal enzyme induction has one of the following features:

A. Takes about one week to develop
B. Results in increased affinity of the enzyme for the substrate
C. It is irreversible
D. Can be used to treat acute drug poisonings

44 Which of the following drugs acts by inhibiting an enzyme in the body:

A. Atropine

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B. Allopurinol
C. Levodopa
D. Metoclopramide

45The following is a competitive type of enzyme inhibitor:

A. Acetazolamide
B. Disulfiram
C. Physostigmine
D. Theophylline

46 What is true in relation to drug receptors:

A. All drugs act through specific receptors
B. All drug receptors are located on the surface of the target cells
C. Agonists induce a conformational change in the receptor
D. Partial agonists have low affinity for the receptor

47Drugs acting through receptors exhibit the following features except:

A. Structural specificity
B. High potency
C. Competitive antagonism
D. Dependence of action on lipophilicity

48 Study of drug-receptor interaction has now shown that:

A. Maximal response occurs only when all recep- tors are occupied by the drug
B. Drugs exert an ‘all or none’ action on a receptor
C. Receptor and drugs acting on it have rigid complementary ‘lock and key’
structural features
D. Properties of ‘affinity’ and ‘intrinsic activity’ are independently variable

49A partial agonist can antagonise the effects of a full agonist because it has:
A. High affinity but low intrinsic activity
B. Low affinity but high intrinsic activity
C. No affinity and low intrinsic activity
D. High affinity but no intrinsic activity

50 Receptor agonists possess:

A. Affinity but no intrinsic activity
B. Intrinsic activity but no affinity
C. Affinity and intrinsic activity with a + sign
D. Affinity and intrinsic activity with a – sign
51 Agonists affect the receptor molecule in the following manner:
A. Alter its amino acid sequence
B. Denature the receptor protein
C. Alter its folding or alignment of subunits
D. Induce covalent bond formation

52 Receptors perform the following function/functions:

A. Ligand recognition
B. Signal transduction
C. Both ligand recognition and signal transduction
D. Disposal of agonists and antagonists

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53 The following receptor type has 7 helical membrane spanning amino acid
segments with 3 extracellular and 3 intracellular loops:
A. Tyrosine protein kinase receptor
B. Gene expression regulating receptor
C. Intrinsic ion channel containing receptor
D. G protein coupled receptor

54 Which of the following is a G protein coupled recep- tor:

A. Muscarinic cholinergic receptor
B. Nicotinic cholinergic receptor
C. Glucocorticoid receptor
D. Insulin receptor
55 The following receptor has an intrinsic ion channel:
A. Histamine H1 receptor
B. Histamine H2 receptor
C. Adrenergic alfa receptor
D. GABA-benzodiazepine receptor

56 Select the receptor that is located intracellularly:

A. Opioid receptor
B. Steroid receptor
C. Prostaglandin receptor
D. Angiotensin receptor
57Agonist induced autophosphorylation, internalization and down regulation
is a distinctive feature of:
A. G-protein coupled receptors
B. Intrinsic ion channel containing receptors
C. Tyrosine protein kinase receptors
D. Receptors regulating gene expression

58 All of the following sub serve as intracellular second messengers in

receptor mediated signal transduction except:
A. Cyclic AMP
B. Inositol trisphosphate
C. Diacyl glycerols
D. G proteins

59 The receptor transduction mechanism with the fastest time-course of

response effectuation is:
A. Adenylyl cyclase-cyclic AMP pathway
B. Phospholipase C-IP3: DAG pathway
C. Intrinsic ion channel operation
D. Protein synthesis modulation

60 A receptor which itself has enzymatic property is:

A. Insulin receptor

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B. Progesterone receptor
C. Thyroxine receptor
D. Glucagonreceptor

61 The following statement is not true of log dose-response curve:

A. It is almost linear except at the ends
B. It is a rectangular hyperbola
C. It facilitates comparison of different agonists
D. It can help in discriminating between competitive and noncompetitive antagonists

62 The following statement is not true of ‘potency’ of a drug:

A. Refers to the dose of the drug needed to produce
a certain degree of response
B. Can be related to that of its congeners by the relative position of its dose-
response curve on the dose axis
C. It is often not a major consideration in the choice of a drug
D. It reflects the capacity of the drug to produce a drastic response
63‘Drug efficacy’ refers to:
A. The range of diseases in which the drug is beneficial
B. The maximal intensity of response that can be produced by the drug
C. The dose of the drug needed to produce half maximal effect
D. The dose of the drug needed to produce thera- peutic effect

64 Which of the following is always true:

A. A more potent drug is more efficacious
B. A more potent drug is safer
C. A more potent drug is clinically superior
D. A more potent drug can produce the same response at lower doses
65Higher efficacy of a drug necessarily confers:
A. Greater safety
B. Therapeutic superiority
C. Capacity to produce more intense response
D. Cost saving

66 The antidotal action of sodium nitrite in cyanide poison- ing is based on:
A. Physical antagonism
B. Chemical antagonism
C. Physiological antagonism
D. Noncompetitive antagonism

67 A drug ‘R’ producing no response by itself causes the log dose-response

curve of another drug ‘S’ to shift to the right in a parallel manner without
decreasing the maximal response: Drug ‘R’ is a:
A. Partial agonist
B. Inverse agonist
C. Competitive antagonist
D. Noncompetitive antagonist
68 A drug which does not produce any action by itself but decreases the slope of

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the log dose-response curve and suppresses the maximal response to another
drug is a:
A. Physiological antagonist
B. Competitive antagonist
C. Noncompetitive antagonist
D. Partial agonist

69 The following is not a feature of competitive antagonists:

A. Chemical resemblance with the agonist
B. Parallel rightward shift of the agonist log dose- response curve
C. Suppression of maximal agonist response
D. Apparent reduction in agonist affinity for the receptor
70 The dose of the following class of drugs has to be adjusted by repeated
measurement of the affected physiological parameter:
A. Oral contraceptives
B. Antiepileptics
C. Antidepressants
D. Oralanticoagulants

71 Which of the following statements is not true of fixed dose combination

formulations:
A. They are more convenient
B. Contraindication to one of the components does not contraindicate the
formulation
C. The dose of any one component cannot be independently adjusted
D. The time course of action of the different compo- nents may not be identical

72 Fixed dose combination formulations are not necessarily appropriate for:

A. Drugs administered in standard doses
B. Drugs acting by the same mechanism
C. Antitubercular drugs
D. Antihypertensive drugs

73 Which of the following adverse drug reactions is due to a specific genetic

abnormality:
A. Tetracycline induced sunburn like skin lesions
B. Quinidine induced thrombocytopenia
C. Metoclopramide induced muscle dystonia
D. Primaquineinduced massivehaemolysis

74 Drug metabolism can be induced by the following factors except:

A. Cigarette smoking
B. Acute alcohol ingestion
C. Exposure to insecticides
D. Consumptioncharcoal broiled meat

75 A drug which produces qualitatively different actions when administered

through different routes is:
A. Phenytoin sodium

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B. Hydralazine
C. Magnesium sulfate
D. Nitroglycerine

76 Which of the following is true of ‘placebos’:

A. Placebo is a dummy medication
B. Placebo is the inert material added to the drug for making tablets
C. Placebos do not produce any effect
D.All patients respond to placebos

77 Drug cumulation is the basis of organ toxicity of the following drug when
used for prolonged periods:
A. Prednisolone
B. Chloroquine
C. Aspirin
D. Hydralazine

78 Tolerance is generally not acquired to:

A. Antisecretory action of atropine
B. Sedative action of chlorpromazine
C. Emetic action of levodopa
D. Vasodilator action of nitrates
79 In an anaesthetized dog, repeated intravenous injec- tion of ephedrine
shows the phenomenon of:
A. Anaphylaxis
B. Tachyphylaxis
C. Idiosyncrasy
D. Drug resistance

80An undesirable effect of a drug that occurs at thera- peutic doses and can
be predicted from its pharma- cological actions is called:
A. Side effect
B. Toxic effect
C. Allergic reaction
D. Idiosyncrasy

81Which of the following is a type B (unpredictable) adverse drug reaction:

A. Side effect
B. Toxic effect
C. Idiosyncrasy
D. Physical dependence

82The side effect of a drug which has been used as a therapeutic effect in
another condition is:
A. Constipation caused by codeine
B. Cough caused by captopril
C. Uterine stimulation caused by quinine
D. Diarrhoea caused by ampicillin

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83A ‘toxic effect’ differs from a ‘side effect’ in that:
A. It is not a pharmacological effect of the drug
B. It is a more intense pharmacological effect that occurs at high dose or
after prolonged medication
C. It must involve drug induced cellular injury
D. It involves host defence mechanisms

84The following statement is true in relation to ‘drug toxicity’ and

‘poisoning’:
A. The two terms are synonymous
B. When a toxic effect requires specific treat- ment, it is called poisoning
C. A toxic effect which endangers life by markedly affecting vital functions
is called poisoning
D. Toxicity is caused by drugs while poisoning is caused by other harmful
chemicals

85An immunologically mediated reaction to a drug pro- ducing stereotyped

symptoms unrelated to its pharma- codynamic actions is:
A. Hypersensitivity
B. Supersensitivity
C. Intolerance
D. Idiosyncrasy

86 Drugs producing allergic reactions generally act as:

A. Complete antigens
B. Haptenes
C. Antibodies
D. Mediators

87 The following allergic drug reaction is caused by circulating antibodies:

A. Serum sickness
B. Anaphylactic shock
C. Systemic lupus erythematosus
D. Angioedema

88 Which of the following is the only life saving measure in case of

anaphylactic shock:
A. Intravenous hydrocortisonehemisuccinate
B. Intravenous chlorpheniramine maleate
C. Intramuscular adrenaline hydrochloride
D. Intravenous glucose-saline

89 The type II, type III and type IV hypersensitivity reactions can be
suppressed by:
A. Adrenaline
B. Antihistaminics
C. Corticosteroids

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D. Sod. cromoglycate
90 The most appropriate route of administration for adrenaline in a case of
anaphylactic shock is:
A. Intracardiac
B. Intravenous
C. Intramuscular
D. Subcutaneous

91 Intradermal drug sensitivity tests can detect the pres- ence of following
type of hypersensitivity:
A. Type I (anaphylactic)
B. Type II (cytolytic)
C. Type III (retarded)
D. All of the above

92 An addicting drug which produces little or no physical dependence is:

A. Diazepam
B. Phenobarbitone
C. Amphetamine
D. Methadone

93 The essential feature in drug addiction is:

A. Physical dependence
B. Psychologicaldependence
C. Both physical and psychological dependence
D. Psychiatric abnormality
94 Adaptive neurophysiological changes produced by repeated administration
of a drug, which result in the appearance of characteristic withdrawal
syndrome on discontinuation of the drug is called:
A. Drug addiction
B. Drug abuse
C. Psychologicaldependence
D. Physicaldependence

95 Which of the following constitutes ‘drug abuse’:

A. Physician prescribed use of penicillin G for the cure of viral fever
B. Self administration of aspirin to relieve headache
C. Repeated self administration of morphine to derive euphoria
D. All of the above

96 ‘Addiction’ and ‘habituation’:

A. Are fundamentally different phenomena
B. Areproducedby different setofdrugs/substances
C. Differfrom oneanotherby thepresenceor absence of physical dependence
D. Differ from each other in the degree of attendant psychologicaldependence

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97 Adverse consequences may follow sudden discon- tinuation of the following

drug after chronic intake:
A. Cocaine
B. Cannabis
C. Clonidine
D. All of the above

98 The following is a proven human teratogen:

A. Chloroquine
B. Warfarin sodium
C. Dicyclomine
D. Methyldopa

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Drugs Acting on Autonomic Nervous System

➢ CHOOSE THE MOST APPROPRIATE RESPONSE

1 Which of the following organs is innervated only by parasympathetic nerves:
A. Iris muscles
B. Ciliary muscle
C. Sweat glands
D. Splenic capsule

2 The sympathetic and parasympathetic systems exert functionally opposite influences on the following
para- meters except:
A. Heart rate
B. Atrial refractory period
C. Pupil diameter
D. Intestinal motility

3 The cotransmitter may serve the following function/ functions:

A. Regulate the release of the primary trans- mitter from the nerve ending
B. Alter postjunctional action of the primary transmitter
C. Itself act as an alternative transmitter
D. All of the above

4 The following cotransmitter is most probably involved in mediating nonadrenergic noncholinergic

(NANC) relaxation of the gut:
A. Neuropeptide Y (NPY)
B. Adenosine
C. Nitric oxide (NO)
D. Kallidin

5 The major postjunctional cholinergic receptor is of the muscarinic type at the following site:
A. Postganglionic parasympathetic
B. Adrenal medulla
C. Autonomic ganglia
D. Neuromuscular junction

6 Pseudocholinesterase differs from true cholinesterase in that:

E. It does not hydrolyse acetylcholine
F. It hydrolyses acetylcholine at a slower rate
G. It is more susceptible to inhibition by physo- stigmine
H. It is the only form of circulating cholinesterase

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7 The choline ester resistant to both true and pseudo- cholinesterase is:
A. Methacholine
B. Bethanechol
C. Benzoylcholine
D. Butyrylcholine
8 Muscarinic cholinergic receptors:

A. Are located only on parasympathetically innervated effector cells

B. Mediate responses by opening an intrinsic Na+ ion channel
C. Are present on vascular endothelium which has no cholinergic nerve
supply
D. Predominate in the autonomic ganglia

9 The cardiac muscarinic receptors:

A. Are of the M1 subtype
B. Are of the M2 subtype
C. Are selectively blocked by pirenzepine
D. Function through the PIP2 IP3/DAG path- way
10 Cholinergic muscarinic receptor stimulation produces the following effects except:
A. Sweating
B. Rise in blood pressure
C. Bradycardia
D. Urination
11 The smooth muscle structure that is relaxed by choli- nergic drugs is:

A. Colon
B. Gastric fundus
C. Major bronchi
D. Bladder trigone

12 Which of the following secretions is not stimulated by acetylcholine:

A. Tear
B. Bile/
C. Pancreatic juice
D. Sweat

13 Acetylcholine has no therapeutic application because:

E. None of its actions are beneficial in any condition

F. Its effects are transient
G. It produces wide spread actions affecting many organs
H. Both ‘B’ and ‘C’ are correct

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14 Pilocarpine is used for:

I. Glaucoma
J. Paralytic ileus
K. Urinary retention
L. D. All of the above

15 Actions of pilocarpine include the following except:

A. Sweating
B. Salivation
C. Miosis
D. Cycloplegia

16 The following inhibitor binds only to the ani-onic site of the cholinesterase enzyme:
A. Neostigmine
B. Physostigmine
C. Edrophonium
D. D. Dyflos

17 Reactivation of cholinesterase enzyme occurs on hydrolysis of the inhibitor by the same enzyme mole- cule in
case of the following anticholinesterase:
A. Edrophonium
B. Neostigmine
C. Dyflos
D. Tacrine

18 The anticholinesterase action of edrophonium is short lasting because termination of its action depends
on:
A. Dissociation and diffusion of the drug from the enzyme
B. Hydrolysis of the drug by the enzyme
C. Synthesis of fresh enzyme molecules
D. A combination of the above three processes

19 he organophosphates produce irreversible inhibition of cholinesterase because:

A. They bind to an allosteric site of the enzyme resulting in unfavourable conformation of
este- ratic site to bind acetylcholine
B. Regeneration time of the phosphorylated enzyme is longer than the turnover
time of the enzyme molecules
C. Phosphorylation results in rapid degradation of enzyme molecules
D. They are neither metabolized nor excreted from the body

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20 Out of two anticholinesterases, drug ‘X’ is a tertiary amine while drug ‘Y’ is a quarternary ammonium
com- pound. Then:
A. Drug ‘X’ is likely to be more potent than ‘Y’
B. Drug ‘X’ will be more suitable to be used as a miotic
C. Drug ‘Y’ will be completely metabolized in the body
D. Drug ‘Y’ will produce CNS effects

21 Neostigmine is preferred over physostigmine for treat- ing myasthenia gravis because:
A. It is better absorbed orally
B. It has longer duration of action
C. It has additional direct agonistic action on nicotinic receptors at the muscle
end plate
D. It penetrates blood-brain barrier

22 The mechanism by which neostigmine improves con- traction of myasthenic muscle involves:
A. Repetitive binding of the acetylcholine mole- cules to the same receptors at the muscle
end- plate
B. Diffusion of acetylcholine released from motor nerve endings to a wider area activating
neigh- bouring receptors
C. Activation of motor end-plate receptors by neostigmine molecules themselves
D. All of the above

23 Pyridostigmine differs from neostigmine in that:

A. It is more potent orally
B. It is longer acting
C. It produces less muscarinic side effects
D. It does not have any direct action on NM receptor

24 Edrophonium is more suitable for differentiating myas- thenic crisis from cholinergic crisis because of its:
A. Shorter duration of action
B. Longer duration of action
C. Direct action on muscle end-plate
D. Selective inhibition of true cholinesterase

25 Pilocarpine reduces intraocular tension in open angle glaucoma by:

A. Contracting sphincter pupillae
B. Increasing tone of ciliary muscle
C. Reducing aqueous formation
D. Enhancing uveo-scleral outflow

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26 The site of action of miotics for therapeutic effect in angle closure glaucoma is:
A. Canal of Schlemm
B. Ciliary body
C. Ciliary muscle
Sphincter pupillae muscle

27 Currently, the first choice drug for open angle glaucoma is:
A. Miotic eye drops
B. Ocular 2 adrenergic agonists
C. Ocular prostaglandin analogues
Ocular adrenergic blockers

28 Timolol eye drops are preferred over pilocarpine eye drops by glaucoma patients because:
A. Timolol is more effective than pilocarpine
B. Timolol acts by enhancing uveo-scleral outflow
C. Timolol produces less ocular side effects
D. There are no contraindications to timolol

29 Beta adrenergic blockers lower intraocular tension by:

A. Down regulating adenylyl cyclase in ciliary body through reduced activation of 2
adreno- ceptors
B. Constricting ciliary blood vessels
C. Blocking adrenergic action on trabecular meshwork
D. Reducing aqueous formation unrelated to beta adrenoceptor mediation

30 Agonistic action on which of the following adrenergic receptors located on ciliary epithelial cells
reduces aqueous secretion:
A. 1 receptor
B. 2 receptor
C. 1 receptor
D. 2 receptor

31To be used as a topically applied ocular beta blocker a drug should have the following properties except:
A. Strong local anaesthetic activity
B. High lipophilicity
C. High ocular capture
D. Low systemic activit

32 Betaxolol differs from timolol in that it:

A. Is a 1 selective blocker
B. Is more efficacious in glaucoma
C. Produces less ocular side effects
D. Is longer acting

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33 Select the longer acting ocular beta blocker:

A. Timolol
B. Betaxolol
C. Cartiolol
D. Levobunolol

34 The following is an 2 adrenergic agonist used as eyedrops to lower intraocular pressure:

A. Brinzolamide
B. Bambuterol
C. Brimonidine
D. Latanoprost

35 Which of the following is a prodrug of adrenaline used topically in glaucoma:

A. Brimonidine
B. Dipivefrine
C. Phenylpropanolamine
D. Dorzolamide

36 Apraclonidine is a clonidine congener which is used:

A. To suppress opioid withdrawal syndrome
B. To suppress menopausal syndrome
C. As Analgesic
D. To reduce intraocular tension

37 Dorzolamide is a:
A. Topically applied ocular carbonic anhydrase inhibitor
B. Second generation sulfonylurea hypoglycaemic
C. Topical sulfonamide antibacterial
D. Luminal amoebicide

38 Choose the correct statement about latanoprost:

A. It is a PGF2 derivative used in glaucoma
B. It is a selective 1 blocker used in benign hypertrophy of prostate
C. It is a 5- -reductase inhibitor used to reduce the size of enlarged prostate gland
D. It is a PGE2 analogue used intravaginally for cervical priming

39 Select the diuretic that is most effective in acute congestive glaucoma:

A. Indapamide
B. Amiloride
C. Mannitol
D. Furosemide

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40 Neostigmine is beneficial in cobra envenomation because:

A. It binds to and inactivates cobra toxin
B. It reverses coma due to cobra toxin
C. It counteracts the cardio-depressant action of cobra toxin
D. It antagonizes the paralysing action of cobra toxin

41 Which is the most important drug in the treatment of organophosphate poisoning:

A. Atropine sulfate
B. Pralidoxime
C. Diazepam
D. Adrenaline

42 Atropine does not antagonise the following feature of anticholinesterase poisoning:

A. Hypotension
B. Central excitation
C. Muscle paralysis
D. Bronchoconstriction

43 Pralidoxime can reactivate cholinesterase enzyme that has been inactivated by:

A. Carbamate anticholinesterases
B. Organophosphate anticholinesterases
C. Both carbamate and organophosphate antcholinesterases
D. Reversible anticholinesterases

44 Initial bradycardia caused by intramuscular injection of atropine is believed to be caused by:

A. Stimulation of medullary vagal centre
B. Stimulation of vagal ganglia
C. Blockade of M2 receptors on SA nodal cells
D. Blockade of muscarinic autoreceptors on vagal nerve endings

45 Atropine does not exert relaxant/antispasmodic effect on the following muscle:

A. Intestinal
B. Ureteric
C. Bronchial
D. Laryngeal

46 Atropine produces the following actions except:

A. Tachycardia
B. Mydriasis
C. Dryness of mouth
D. Urinary incontinence

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47 The organ most sensitive to actions of atropine is:

A. Gastric glands
B. Salivary glands
C. Urinary bladder muscle
D. Heart

48 Hyoscine differs from atropine in that it:

A. Exerts depressant effects on the CNS at relati- vely low doses
B. Exerts more potent effects on the heart than on the eye
C. Is longer acting
D. Has weaker antimotion sickness activity

49 The quarternary analogues of belladonna alkaloids are preferred over the natural alkaloids for
antisecretory/ antispasmodic indications because:
A. They have additional nicotinic receptor block- ing activity
B. They are incompletely absorbed after oral administration
C. They are devoid of CNS and ocular effects
D. Dose to dose they are more potent than atropine

(Note: Many quarternary anticholinergics do have addi- tional nicotinic blocking activity and because of high
ionization they are incompletely absorbed. But the reason for preferring them is lack of central and ocular
effects. Most compounds are dose to dose less potent than atropine.)

50 Inhaled ipratropium bromide has the following advan- tages except:

A. It does not alter respiratory secretions
B. It does not depress airway mucociliary clearance
C. It has faster onset of bronchodilator action than inhaled salbutamol
D. It only rarely produces systemic side effects

51 Which of the following anticholinergic drugs is primarily used in preanaesthetic medication and during
surgery:
A. Glycopyrrolate
B. Pipenzolate methyl bromide
C. Isopropamide
D. Dicyclomine

52 Children are more susceptible than adults to the following action of atropine:
A. Tachycardia producing
B. Cycloplegic
C. Gastric antisecretory
D. Central excitant and hyperthermic

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53 Glycopyrrolate is the preferred antimuscarinic drug for use before and during surgery because:
A. It is potent and fast acting
B. It has no central action
C. It has antisecretory and vagolytic actions
D. All of the above

54 Which of the following mydriatics has the fastest and briefest action:
A. Atropine
B. Homatropine
C. Tropicamide
D. Cyclopentolate

55 The following mydriatic does not produce cycloplegia:

A. Phenylephrine
B. Tropicamide
C. Cyclopentolate
D. Homatropine

56 The most suitable mydriatic for a patient of corneal ulcer is:

A. Atropine sulfate
B. Homatropine
C. Cyclopentolate
D. Tropicamide

57 The mydriatic incapable of producing cycloplegia sufficient for refraction testing in children is:
A. Atropine
B. Hyoscine
C. Homatropine
D. Cyclopentolate

58 The most effective antidote for belladonna poisoning is:

A. Neostigmine
B. Physostigmine
C. Pilocarpine
D. Methacholine

59 Atropine is contraindicated in:

A. Pulmonary embolism
B. Digitalis toxicity
C. Iridocyclitis
D. Raised intraocular tension

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60 Choose the correct statement about nicotine:

A. It selectively stimulates parasympathetic gan- glia
B. It has no clinical application
C. It is used as an aid during smoking cessation
D. It is used in Alzheimer's disease

61 Ganglion blocking drugs are no longer used in thera- peutics because:

A. They have few and weak pharmacological actions
B. They produce many side effects
C. They are inactive by oral route
D. They have short duration of action

62 Which of the following is a noncatecholamine sympathomimetic:

A. Adrenaline
B. Ephedrine
C. Dopamine
D. Isoprenaline
(Note: Ephedrine has no-OH group on the benzene ring; hence it is a phenylamine.)

63 The rate limiting enzyme in the synthesis of catecho- lamines is:

A. Tyrosine hydroxylase
B. Dopa decarboxylase
C. Dopamine -hydroxylase
D. Noradrenaline N-methyl transferase

64 The most efficacious inhibitor of catecholamine syn- thesis in the body is:
A. α-methyl-p-tyrosine
B. α-methyldopa
C. α-methyl-norepinephrine
D. Entacapone

65 The following type/types of noradrenaline uptake is blocked by reserpine:

A. Axonal uptake
B. Granular uptake
C. Extraneuronal uptake
D. All of the above

66 The principal process which terminates the action of noradrenaline released from adrenergic nerve ending
is:
A. Degradation by MAO
B. Methylation by COMT
C. Axonal uptake

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D. Extraneuronal uptake

67 The β3 adrenoceptor differs from the other subtypes ofβ receptor in that it:
A. Is not blocked by the conventional doses of propranolol
B. Is located primarily in the heart
C. Regulates blood sugar level
D. Is not coupled to G proteins

68The α2 adrenoceptors are:

A. Located exclusively on the adrenergic nerve endings
B. Prejunctional, postjunctional as well as extra- junctional in location
C. Selectively activated by phenylephrine
D. Selectively blocked by clonidine

69 The following is a selective α2 adrenoceptor antagonist:

A. Prazosin
B. Phentolamine
C. Yohimbine
D. clonidine

70 A sympathomimetic amine that acts almost exclu- sively by releasing noradrenaline from the nerve
endings is:
A. Ephedrine
B. Dopamine
C. Isoprenaline
D. Tyramine

71 The following sympathomimetic amine has agonistic action on α1 + α2 + β1 + β3 adrenoceptors, but not
on
β2 receptors:
A. Adrenaline
B. Noradrenaline
C. Isoprenaline
D. Phenylephrine

72 The following action of adrenaline is mediated by both

α and β receptors producing the same directional effect:
A. Cardiac stimulation
B. Intestinal relaxation
C. Dilatation of pupil
D. Bronchodilatation

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73 The following action of adrenaline is not mediated by β

receptors:

A. Dilatation of blood vessels

B. Dilatation of pupil
C. Bronchodilation
D. Renin release from kidney

74 Low doses of adrenaline dilate the following vascular bed:

A. Cutaneous
B. Mucosal
C. Renal
D. Skeletal muscle

75 Vasomotor reversal phenomenon after administration of an α adrenergic blocker is seen with:

A. Adrenaline
B. Noradrenaline
C. Isoprenaline
D. All of the above drugs

76 Adrenergic β2 agonists produce muscle tremor by:

A. Facilitating neuromuscular transmission
B. Incomplete fusion of contractile response of individual fibres
C. Enhanced firing of muscle spindles
D. Both (b) and (c) are correct

77 Adrenaline is inactive orally because it is:

A. Not absorbed from the gastrointestinal tract
B. Destroyed by gastric acid
C. Completely metabolized in the intestinal mucosa and liver before reaching systemic
circulation
D. Taken up by adrenergic nerve endings of the intestinal wall, liver and lungs

78 Adrenaline raises blood glucose level by the following actions except:

A. Inducing hepatic glycogenolysis
B. Inhibiting insulin secretion from pancreatic β cells
C. Augmenting glucagon secretion from pan- creatic α cells
D. Inhibiting peripheral glucose utilization

79 The metabolic actions of adrenaline include the follo- wing except:

A. Glycogenolysis in liver and muscle
B. Inhibition of neoglucogenesis in liver
C. Lipolysis in adipose tissue

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D. Release of potassium from liver followed by its uptake

80 Noradrenaline is administered by:

E. Subcutaneous injection
F. Intramuscular injection
G. Slow intravenous infusion
H. All of the above routes

81 Dopaminergic D1 and D2 as well as adrenergic α and

β1, but not β2 receptors are activated by:
A. Dopamine
B. Dobutamine
C. Methoxamine
D. Phenylephrine

82 Dobutamine differs from dopamine in that:

A. It does not activate peripheral dopaminergic receptors
B. It does not activate adrenergic β receptors
C. It causes pronounced tachycardia
D. It has good blood-brain barrier penetrability

83 Choose the drug which is used as a short-term inotropic in severe congestive heart failure and has
selective adrenergic β1 agonistic activity but no dopaminergic agonistic activity:
A. Dopamine
B. Dobutamine
C. Amrinone
D. Salmeterol

84 Ephedrine is similar to adrenaline in the following feature:

A. Potency
B. Inability to penetrate blood-brain barrier
C. Duration of action
D. Producing both αand β adrenergic effects

85 Amphetamine potentiates the following class of drugs:

A. Diuretics
B. Analgesics
C. Neuroleptics
D. Antihypertensives

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86 Which pressor agent acts directly as well as indirectly and produces both vasoconstriction and cardiac
stimulation:
A. Phenylephrine
B. Methoxamine
C. Noradrenaline
D. Mephentermine

87 Phenylephrine instilled in the eye produces:

A. Mydriasis but no cycloplegia
B. Cycloplegia but no mydriasis
C. Both mydriasis and cycloplegia
D. Neither mydriasis nor cycloplegia

88 While undergoing a surgical procedure a patient deve- lops hypotension. Which drug can be injected
intramuscularly to raise his BP:
A. Noradrenaline
B. Isoprenaline
C. Mephentermine
D. Isoxsuprine

89 Which of the following drugs has been used both as orally active nasal decongestant as well as appetite
suppressant, and has been implicated in precipitating haemorrhagic stroke:
A. Dexfenfluramine
B. Phenylpropanolamine
C. Isoxsuprine
D. Oxymetazoline

90 The following is true of fenfluramine except:

A. It lacks CNS stimulant action
B. Its use has been associated with cardiac abnormalities and pulmonary hypertension
C. It causes weight loss independent of reduced food intake
D. It enhances serotonergic transmission in the brain

91 Vasoconstrictors should not be used in:

A. Neurogenic shock
B. Haemorrhagic shock
C. Secondary shock
D. Hypotension due to spinal anaesthesia

92 Adrenaline injected with a local anaesthetic:

A. Reduces local toxicity of the local anaesthetic
B. Reduces systemic toxicity of the local anaes- thetic
C. Shortens duration of local anaesthesia
D. Makes the injection less painful

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93 The most likely complication of prolonged use of nasal decongestant drops is:
A. Atrophic rhinitis
B. Hypertrophy of nasal mucosa
C. Naso-pharyngeal moniliasis
D. Blockage of eustachian tubes

94 Adrenergic neurone blocking drugs:

A. Block the action of adrenaline on neuronal α2 adrenoceptors
B. Block both α and β adrenoceptor mediated effects of injected adrenaline
C. Do not block any effect of injected adrenaline
D. Do not block the effects of sympathetic nerve stimulation

95 The nonselective α adrenergic blockers produce the following actions except:

A. Postural hypotension
B. Bradycardia
C. Miosis
D. Inhibition of ejaculation

96 The drug which produces vasoconstriction despite being an α adrenergic blocker is:
A. Phenoxybenzamine
B. Ergotamine
C. Dihydroergotoxine
D. Tolazoline

97 The bladder trigone and prostatic muscles are relaxed by:

A. Adrenergic α1 agonists
B. Adrenergic α1 antagonists
C. Adrenergic α2 agonists
D. Adrenergic α2 antagonists

98 The primary reason for preferring phentolamine as the

α adrenergic blocker for performing diagnostic test for pheochromocytoma is:

A. It produces rapid and short lasting α-adre- nergic blockade

B. It equally blocks α1 and α2 adrenoceptors
C. It is the most potent α blocker
D. It has no additional β adrenergic blocking property

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99 Prazosin is an effective antihypertensive while non- selective α adrenergic blockers are not because:
A. It is the only orally active α blocker
B. It improves plasma lipid profile
C. It does not concurrently enhance noradrena- line release
D.It improves urine flow in males with prostatic hypertrophy

100 Select the drug which affords faster and greater symptomatic relief in benign hypertrophy of prostate:
E. Terazosin
F. Desmopressin
G. Finasteride
H. Sildenafil

101 Select the drug which can improve urinary flow rate in benign prostatic hypertrophy without affecting
pros- tate size:
A. Amphetamine
B. Prazosin
C. Finasteride
D. Goserelin

102 Which of the following is a selective α1A receptor bloc- ker that affords symptomatic relief in benign
prostatic hypertrophy without producing significant fall in blood pressure:
A. Terazosin
B. Doxazosin
C. Trimazosin
D. Tamsulosin

103 Sildenafil is contraindicated in patients taking the following class of drugs:

A. α-adrenergic blockers
B. β-adrenergic blockers
C. Organic nitrates
D. Angiotensin converting enzyme inhibitors

104 What is true of sildenafil:

A. It enhances sexual enjoyment in normal men
B. It delays ejaculation
C. It improves penile tumescence in men with erectile dysfunction
D. It blocks cavernosal α2 adrenoceptors

105 Select the drug which is administered orally for erectile dysfunction in men:
A. Yohimbine
B. Papaverine
C. Alprostadil
D. Sildenafil

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106 The β adrenergic blocker having β1 selectivity, intrinsic sympathomimetic activity and membrane
stabilizing property is:
A. Carvedilol
B. Atenolol
C. Acebutolol
D. Metoprolol

107 All of the following contribute to the antihypertensive action of propranolol except:
A. Direct vasodilatation
B. Decreased renin release from kidney
C. Adaptation of blood vessels to reduced cardiac output
D. Less noradrenaline release from sympathetic nerve endings

108 The effect of propranolol on heart rate is least marked under the following condition:
A. Physical exercise
B. Rest
C. Anxiety
D. Sick sinus syndrome

109 Propranolol does not block the following action of adrenaline:

A. Bronchodilatation
B. Lipolysis
C. Muscle tremor
D. Mydriasis

110 The following disease is worsened by propranolol:

A. Glaucoma
B. Raynaud’s disease
C. Benign prostatic hypertrophy
D. Parkinsonism

111 β -adrenergic blockers are indicated in the following conditions except:

A. Hypertrophic cardiomyopathy
B. Congestive heart failure
C. Vasospastic angina pectoris
D. Dissecting aortic aneurysm

112 Select the ultrashort acting cardioselective β adre- nergic blocker:

A. Bisoprolol
B. Timolol
C. Sotalol
D. Esmolol

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113 In patients of congestive heart failure, β-adrenergic blockers:

A. Are absolutely contraindicated
B. Can prolong survival
C. Can improve haemodynamics after compen- sation has been restored
D. Both B and C are correct

114 The basis for use of β-adrenergic blockers in congestive heart failure (CHF) is:
A. They exert positive inotropic effect in CHF
B. They counteract deleterious effect of sympa- thetic overactivity on the
myocardium
C. They exert antiischaemic effect on the heart
D. They prevent cardiac arrhythmias

115 Adrenergic β1 selective blockers offer the following advantages except:

A.Lower propensity to cause bronchospasm
B.Less prone to produce cold hands and feet as side effect
C.Withdrawal is less likely to exacerbate angina pectoris
D.Less liable to impair exercise capacity

116 The following is not a feature of cardioselective beta blockers, when compared to propranolol:
A. They are ineffective in suppressing muscle tremor
B. They are safer in diabetics
C. They are less likely to cause bradycardia
D. They are less likely to worsen Raynaud’s disease

117 Select the β adrenergic blocker that is primarily eliminated unchanged by renal excretion:
A. Propranolol
B. Metoprolol
C. Esmolol
D. Atenolol

118 In a patient of myocardial infarction, β adrenergic blockers are used with the following aim/aims:
A. To reduce the incidence of reinfarction
B. To prevent cardiac arrhythmias
C. To limit size of the infarct
D. All of the above

119 Select the β-adrenergic blocker that has additional β1blocking, vasodilator and antioxidant properties:
A. Carvedilol
B. Celiprolol
C. Acebutolol
D. Metoprolol

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120 Labetalol has:

A. More potent β adrenergic blocking than α blocking activity
B. More potent α adrenergic blocking than β blocking activity
C. Equal α and β adrenergic blocking activity
D. β1 agonistic activity in addition to α and β adrenergic blockade

121 Labetalol differs from propranolol in that:

A.It has additional α1 blocking property
B.It is a selective βS1 blocker
C.It does not undergo first pass metabolism
D.All of the above

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