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Last edited: 10/17/2022

ANTIHYPERTENSIVE DRUGS
Antihypertensive Drugs

I) REVIEW QUESTIONS WITH ANSWERS

QUESTIONS ANSWERS

1) Which of the following drugs lowers the blood D. Clonidine

pressure by preventing fusion of NE with the
presynaptic neuron membrane? ▪
a. Spironolactone
b. Furosemide
c. Alpha-methyldopa
d. Clonidine.

2) Which of the following beta blockers is not cardio- D. Propranolol

selective?
a. Atenolol Propranolol is a nonselective beta blocker, it exerts its effects
b. Ezmolol on both types of beta receptors.
c. Metoprolol
a. Propranolol

3) Which of the following drugs may cause orthostatic D. Prazosin

hypotension secondary to venodilation and decreasing
the preload? ▪ Prazosin (and alpha-1 blockers)
a. Hydrochlorothiazide shouldn’t be used in patients who are
b. Spironolactone preload-dependent because it may lead
c. Clonidine to orthostatic hypotension.
d. Prazosin

4) Which of the following drugs carries a risk of D. Labetalol

bronchospasm? ▪
a. Prazosin ▪ Labetalol is a mixed blocker, it has
b. Atenolol effects on beta-2 receptors which are
c. Alpha-methyldopa present on the bronchioles. Blocking
d. Labetalol them may cause bronchospasm.

5) Which of the following drugs is used as a 1st line agent D. Hydrochlorothiazide

for treating essential hypertension?
a. Propranolol ▪ Thiazides are very effective in
b. Furosemide decreasing plasma volume and
c. Clonidine therefore lowering the blood pressure.
d. Hydrochlorothiazide

6) Which of the following drugs may cause D. Spironolactone

gynecomastia?
a. Hydrochlorothiazide Spironolactone is an aldosterone antagonist, this means it
b. Atenolol has blocking effects on androgens and may lead to
c. Nadolol gynecomastia
d. Spironolactone

7) What is the adverse effect that can be found in c. Hyperkalemia

aldosterone antagonist?
a. Coronary steal syndrome Because we’re inhibiting aldosterone
b. Hypernatremia o We have the ability to cause hyperkalemia
c. Hyperkalemia ▪ Watch out for this
d. Hypokalemia Because spironolactone blocks androgens
e. Fluid overload o This can potentially lead to gynecomastia
f. ▪

8) Dihydropyridine calcium channel blockers such as a. True

amlodipine might potentially cause orthostatic
Orthostatic hypotension
hypotension
a. True Because they have very minimal venodilation effect, they
b. False may cause orthostatic hypotension
c. Mild amount of calcium channels that are present on veins
o Because of that we could potentially see some
venodilation effect but it’s very mild

Antihypertensive Drugs PHARMACOLOGY: NOTE #13. 1 of 3

9) Angiotensin II receptor blocker might be able to a. True
prevent the progression of chronic kidney disease
because it reduces the intraglomerular pressure ARBs also inhibits angiotensin II from being able to bind
a. True onto angiotensin II receptors on efferent arteriole
b. False o That’s going to lower the glomerular blood pressure that
will then
▪ Reduce GFR
▪ Reduce protein loss
▪ Reduce the thickening of GBM

10) What is the adverse effect that can be found in ACE a. Angioedema
inhibitors but not in angiotensin II receptor blockers? d. Dry cough
(May choose more than 1)
a. Angioedema So, there are some things that we want to consider with
b. Orthostatic hypotension these particular drugs
c. Increased creatinine level o Angiotensin receptor blockers
d. Dry cough ▪ They may bump the K+
e. Hyperkalemia ▪ Increase creatinine level by dropping the GFR
f. Fluid overload o We see more cough dry and angioedema more
particularly from ACE inhibitors
ACE inhibitors can also cause hyperkalemia and drop GFR
which increases creatinine level

11) A 55-year-old non-Hispanic black male has C. Less than 130/80

hypertension. His past medical history also includes
diabetes and hyperlipidemia. According to the a. (A & D) Having a blood
ACC/AHA guidelines, which among the choices pressure below HTN Stage 2
represents the most appropriate blood pressure goal (≥140/≥90) is not ideal.
for the patient? b. (B) A blood pressure less than
Stage 1 (130-139/80-89) is
pretty decent.
c. (C) A blood pressure < 130/80
might be beneficial. Should be
a long-term goal for patients.
d.
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Figure 1. ACC/AHA guidelines.

a. A. Less than 140/85

b. B. Less than 135/85
c. C. Less than 130/80
d. D. Less than 140/80

12) A 59-year-old non-Hispanic white patient presents for A. Enalapril

treatment of hypertension. His past medical history
also includes diabetes, hyperlipidemia, and With Diabetes, the best medication to prevent diabetic
hypertension. The patient's blood pressure is 150/93 nephropathy are ARBs and ACE-inhibitor. Therefore,
(both today and at the last visit). Which is a enalapril.
recommended initial therapy to treat hypertension in
this patient?
a. Enalapril
b. Hydralazine
c. Verapamil
d. Metoprolol

13) A 45-year-old male complains of constipation. He was B. Verapamil

recently started on two antihypertensives due to
elevated systolic blood pressure (greater than 20 mm o Verapamil: a Ca-channel blocker
Hg above goal). His current medications include o *Remember, there are Ca-channels on the GIT.
lisinopril, chlorthalidone, verapamil, rosuvastatin, and Blockage leads to inhibition of the contraction of
aspirin. Which is most likely contributing to his smooth muscle resulting to constipation.
constipation?
a. Chlorthalidone
b. Verapamil
c. Aspirin
d. Lisinopril

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14) Which antihypertensive medication can cause the B. Fosinopril

rare side effect of angioedema? o Angioedema results from inhibition of bradykinin
a. Amlodipine breakdown leads to massive capillary leakage.
b. Fosinopril
c. Prazosin o ACE-inhibitors are most common cause, in this
d. Propranolol situation, of angioedema.

15) A 52-year-old female has uncontrolled hypertension D. Metoprolol

(blood pressure 154/82 mm Hg) on treatment with
lisinopril. She recently had a myocardial infarction, and
her past medical history includes diabetes,
hypertension, hyperlipidemia, and osteoarthritis.
Considering her compelling indications, which agent
may be appropriate to add to her antihypertensive
therapy?
a. Clonidine
b. Olmesartan
c. Furosemide
d. Metoprolol
o Post-MI and diabetes are key comorbidities.
o For post-MI, best to use β-blockers, ACEi, and ARBs.
But you can’t use ACEi and ARBs together.
o For diabetes, it’s best to use ACEi and ARBs.
o So that leaves β-blockers = metoprolol.
o (A) Clonidine = ⍺2 agonist.
o (B) Olmesartan = ARBs
o (C) Furosemide is good for CHF but is used for
symptom control.

16) The blood pressure of a patient with essential
hypertension is at goal on treatment with enalapril.
Since initiation of enalapril, the serum creatinine has
increased 25% above baseline. What is the appropriate
next step for theenalapril therapy?
a. Discontinue enalapril
b. Reduce dose of enalapril
c. Continue current dose of enalapril
d. Increase dose of enalapril
C. Continue current dose of enalapril.
It’s pretty normal to have a bump in creatinine and drop in
GFR. It doesn’t mean that medications have to be stopped.
o Therefore, continue current dose.
If the BUN and creatinine increased significantly,
medications could be discontinued.

17) Which of the following correctly outlines a major
difference in electrolyte disturbances associated with
thiazide and loop diuretics?
a. Thiazide diuretics decrease potassium and loop
diuretics increase potassium
b. Thiazide diuretics increase potassium and loop
diuretics decrease potassium
c. Thiazide diuretics decrease calcium and loop diuretics
increase calcium
d. Thiazide diuretics increase calcium and loop diuretics
decrease calcium
D. Thiazide diuretics increase calcium and loop diuretics
decrease calcium
Thiazides increase Ca and loops decrease Ca.
o Both can cause mild hyponatremia. With thiazide
diuretics, it dilutes urine so they may cause
hypernatremia if given in massive doses. Both can drop
K and Mg.

18) Which can precipitate a hypertensive crisis following A. Clonidine

abrupt cessation of therapy?
a. Clonidine Clonidine suppress the central drive of NE → β-blockade of
b. Diltiazem the heart (=↓HR and ↓contractility), ⍺-blockade of the
c. Valsartan arteries (=↓resistance), ⍺-blockade on the veins
d. HCTZ (=↓preload).
o Therefore, sudden cessation leads to massive NE
surge leading to ↑↑↑HR, ↑↑↑contractility → ↑↑↑BP.

19) Which of the following is a dihydropyridine calcium A. Amlodipine

channel blocker?
a. Amlodipine DHP-CCBs primarily acts on the vascular smooth muscles
b. Metoprolol but have no effect on the nodal cells or the contractile cells.
c. Verapamil o Examples: Amlodipine, nicardipine
d. Lisinopril
(B) Metoprolol = β-blocker
(C) Verapamil = Non-DHP-CCB
(D) Lisinopril = ACE-inhibitor

20) A 45-year-old male was started on therapy for A. Lisinopril

hypertension and developed a persistent, dry cough.
Which is most likely responsible for this side effect? Remember, BRADYKININS.
a. Lisinopril o ACE-inhibitor reduce breakdown bradykinin to inactive
b. Losartan metabolites.
c. Nifedipine o ACE-inhibitors = -prils
d. Atenolol

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