Comprehensive Critical Care
Pharmacology Practice Exam – 150
Questions with Rationale
2025/2026
1. A patient in septic shock requires vasopressor support. Which
drug is considered first-line for increasing systemic vascular
resistance?
A. Dopamine
B. Norepinephrine
C. Epinephrine
D. Phenylephrine
B. Norepinephrine
Rationale: Norepinephrine is the first-line vasopressor in septic shock
due to its strong alpha-adrenergic effects, increasing vascular tone
without significantly increasing heart rate.
2. Which sedative is preferred for long-term ICU sedation due to
minimal accumulation?
A. Midazolam
B. Propofol
C. Lorazepam
D. Dexmedetomidine
D. Dexmedetomidine
Rationale: Dexmedetomidine provides sedation with minimal
respiratory depression and limited accumulation, making it suitable for
long-term ICU sedation.
3. A patient with acute decompensated heart failure needs inotropic
support. Which drug increases cardiac contractility with minimal
, increase in heart rate?
A. Dobutamine
B. Milrinone
C. Dopamine
D. Epinephrine
B. Milrinone
Rationale: Milrinone is a phosphodiesterase-3 inhibitor that increases
cardiac contractility and causes vasodilation with minimal chronotropic
effect.
4. Which medication is used to treat torsades de pointes?
A. Lidocaine
B. Amiodarone
C. Magnesium sulfate
D. Procainamide
C. Magnesium sulfate
Rationale: Magnesium sulfate is the drug of choice for torsades de
pointes, even if serum magnesium levels are normal.
5. For rapid sequence intubation in a critically ill patient, which
paralytic has the fastest onset and shortest duration?
A. Succinylcholine
B. Rocuronium
C. Vecuronium
D. Pancuronium
A. Succinylcholine
Rationale: Succinylcholine is a depolarizing neuromuscular blocker with
rapid onset (~30–60 seconds) and short duration (~5–10 minutes), ideal
for rapid sequence intubation.
, 6. A patient develops hypotension after anaphylaxis. Which drug
should be administered immediately?
A. Epinephrine
B. Norepinephrine
C. Dopamine
D. Phenylephrine
A. Epinephrine
Rationale: Epinephrine is the first-line treatment for anaphylactic shock
due to its combined alpha and beta agonist effects, improving blood
pressure and bronchodilation.
7. Which medication is preferred for ICU patients to prevent stress-
related gastric bleeding?
A. Famotidine
B. Omeprazole
C. Sucralfate
D. Ranitidine
A. Famotidine
Rationale: H2 receptor antagonists like famotidine reduce gastric acid
secretion and are commonly used for stress ulcer prophylaxis in critically
ill patients.
8. A patient with ARDS requires sedation without significant
respiratory depression. Which drug is most appropriate?
A. Propofol
B. Lorazepam
C. Dexmedetomidine
D. Midazolam
C. Dexmedetomidine
Rationale: Dexmedetomidine provides sedative and some analgesic
, effects with minimal respiratory depression, ideal for patients with
ARDS.
9. In a patient with severe septic shock refractory to norepinephrine,
which agent is often added?
A. Vasopressin
B. Dopamine
C. Epinephrine
D. Phenylephrine
A. Vasopressin
Rationale: Vasopressin can be added to norepinephrine in refractory
septic shock to improve blood pressure through vasoconstriction
without increasing heart rate.
10. Which vasopressor is preferred in cardiogenic shock with
low cardiac output?
A. Norepinephrine
B. Dopamine
C. Epinephrine
D. Phenylephrine
B. Dopamine
Rationale: Dopamine has dose-dependent effects: at moderate doses, it
provides inotropic support improving cardiac output, useful in
cardiogenic shock.
11. Which anticoagulant is preferred in critically ill patients
requiring continuous renal replacement therapy?
A. Heparin
B. Warfarin
C. Apixaban
D. Enoxaparin
Pharmacology Practice Exam – 150
Questions with Rationale
2025/2026
1. A patient in septic shock requires vasopressor support. Which
drug is considered first-line for increasing systemic vascular
resistance?
A. Dopamine
B. Norepinephrine
C. Epinephrine
D. Phenylephrine
B. Norepinephrine
Rationale: Norepinephrine is the first-line vasopressor in septic shock
due to its strong alpha-adrenergic effects, increasing vascular tone
without significantly increasing heart rate.
2. Which sedative is preferred for long-term ICU sedation due to
minimal accumulation?
A. Midazolam
B. Propofol
C. Lorazepam
D. Dexmedetomidine
D. Dexmedetomidine
Rationale: Dexmedetomidine provides sedation with minimal
respiratory depression and limited accumulation, making it suitable for
long-term ICU sedation.
3. A patient with acute decompensated heart failure needs inotropic
support. Which drug increases cardiac contractility with minimal
, increase in heart rate?
A. Dobutamine
B. Milrinone
C. Dopamine
D. Epinephrine
B. Milrinone
Rationale: Milrinone is a phosphodiesterase-3 inhibitor that increases
cardiac contractility and causes vasodilation with minimal chronotropic
effect.
4. Which medication is used to treat torsades de pointes?
A. Lidocaine
B. Amiodarone
C. Magnesium sulfate
D. Procainamide
C. Magnesium sulfate
Rationale: Magnesium sulfate is the drug of choice for torsades de
pointes, even if serum magnesium levels are normal.
5. For rapid sequence intubation in a critically ill patient, which
paralytic has the fastest onset and shortest duration?
A. Succinylcholine
B. Rocuronium
C. Vecuronium
D. Pancuronium
A. Succinylcholine
Rationale: Succinylcholine is a depolarizing neuromuscular blocker with
rapid onset (~30–60 seconds) and short duration (~5–10 minutes), ideal
for rapid sequence intubation.
, 6. A patient develops hypotension after anaphylaxis. Which drug
should be administered immediately?
A. Epinephrine
B. Norepinephrine
C. Dopamine
D. Phenylephrine
A. Epinephrine
Rationale: Epinephrine is the first-line treatment for anaphylactic shock
due to its combined alpha and beta agonist effects, improving blood
pressure and bronchodilation.
7. Which medication is preferred for ICU patients to prevent stress-
related gastric bleeding?
A. Famotidine
B. Omeprazole
C. Sucralfate
D. Ranitidine
A. Famotidine
Rationale: H2 receptor antagonists like famotidine reduce gastric acid
secretion and are commonly used for stress ulcer prophylaxis in critically
ill patients.
8. A patient with ARDS requires sedation without significant
respiratory depression. Which drug is most appropriate?
A. Propofol
B. Lorazepam
C. Dexmedetomidine
D. Midazolam
C. Dexmedetomidine
Rationale: Dexmedetomidine provides sedative and some analgesic
, effects with minimal respiratory depression, ideal for patients with
ARDS.
9. In a patient with severe septic shock refractory to norepinephrine,
which agent is often added?
A. Vasopressin
B. Dopamine
C. Epinephrine
D. Phenylephrine
A. Vasopressin
Rationale: Vasopressin can be added to norepinephrine in refractory
septic shock to improve blood pressure through vasoconstriction
without increasing heart rate.
10. Which vasopressor is preferred in cardiogenic shock with
low cardiac output?
A. Norepinephrine
B. Dopamine
C. Epinephrine
D. Phenylephrine
B. Dopamine
Rationale: Dopamine has dose-dependent effects: at moderate doses, it
provides inotropic support improving cardiac output, useful in
cardiogenic shock.
11. Which anticoagulant is preferred in critically ill patients
requiring continuous renal replacement therapy?
A. Heparin
B. Warfarin
C. Apixaban
D. Enoxaparin
