Adrenergic drugs: midodrine: practice question

A Pharmacology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pharmacology · Adrenergic drugs: midodrine

Sample item

A 68-year-old man with diabetic autonomic neuropathy has a fall in systolic pressure of 40 mmHg on standing despite fluids and compression stockings. Midodrine is prescribed. Which counselling point is most important?

AExpect bradycardia and hypoglycaemia as common effectsBAvoid doses late in the day and lying flat soon after, because of supine hypertensionCStop all fluids and salt while on the drugDTake it at bedtime to prevent morning dizziness

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Avoid doses late in the day and lying flat soon after, because of supine hypertension

Midodrine is a prodrug converted to desglymidodrine, a selective alpha1 agonist that raises vascular tone and standing pressure. Its main hazard is supine hypertension, so the last dose should be given several hours before bedtime and the head of the bed raised. Piloerection, scalp tingling and urinary retention are other effects.

Option by option

A. Expect bradycardia and hypoglycaemia as common effects
Midodrine causes reflex bradycardia, not hypoglycaemia, and neither is the main counselling concern.
B. Avoid doses late in the day and lying flat soon after, because of supine hypertension (correct)
Correct. Supine hypertension is the main limiting adverse effect of an alpha1 agonist.
C. Stop all fluids and salt while on the drug
Fluid and salt are part of standard measures for orthostatic hypotension and are not withdrawn.
D. Take it at bedtime to prevent morning dizziness
Bedtime dosing would exaggerate supine hypertension.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Pharmacology question

What is the answer to this Pharmacology question?

The best answer is B, Avoid doses late in the day and lying flat soon after, because of supine hypertension. Midodrine is a prodrug converted to desglymidodrine, a selective alpha1 agonist that raises vascular tone and standing pressure.

Why is "Expect bradycardia and hypoglycaemia as common effects" not the answer?

Midodrine causes reflex bradycardia, not hypoglycaemia, and neither is the main counselling concern.

Why is "Stop all fluids and salt while on the drug" not the answer?

Fluid and salt are part of standard measures for orthostatic hypotension and are not withdrawn.

Why is "Take it at bedtime to prevent morning dizziness" not the answer?

Bedtime dosing would exaggerate supine hypertension.

What concept does this question test?

It tests Adrenergic drugs: midodrine in Pharmacology. Its main hazard is supine hypertension, so the last dose should be given several hours before bedtime and the head of the bed raised. Piloerection, scalp tingling and urinary retention are other effects.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Adrenergic drugs: midodrine?

Learn drugs as classes, then the exception in each class that an examiner would pick. Then use the flashcards and the other Pharmacology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.