Esmolol cardiovascular pharmacology — FRCA Primary MCQ

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ModeratePharmacologyEsmolol cardiovascular pharmacologyFRCA Primary

A patient receives a drug that lowers heart rate and myocardial contractility before laryngoscopy. Coronary perfusion pressure improves as diastolic time lengthens, but cardiac output falls. Which drug is most likely responsible?

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Correct answer: E — Atropine

Esmolol is a short-acting beta-1 antagonist that reduces heart rate and contractility, which can reduce cardiac output while prolonging diastole. Atropine and glycopyrronium increase heart rate through muscarinic antagonism. Ephedrine is an indirect sympathomimetic and would tend to increase heart rate and contractility. The teaching point is that short-acting beta blockade may blunt sympathetic responses but requires haemodynamic reserve.

Reference: RCoA Primary FRCA Syllabus 2026; Peck, Hill & Williams Pharmacology for Anaesthesia