Hypertension Drugs – 50 Questions!

The following questions cover major classes of anit-hypertensive drugs including:

1. Thiazide diuretics
2. Calcium channel blockers
3. RAAS-inhibitors
4. Beta-blockers
5. Potassium-sparing diuretics
6. Alpha-2 agonists
7. Direct vasodilators 

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1 . What is the site of action of thiazide diuretics? 

A – Proximal tubule

B – Distal convoluted tubule

C – Collecting duct

D – Loop of Henle 

E – None of the above 

 

2. Hydrochlorothiazide doses > ___ mg have limited clinical benefit and increased risk of adverse effects? 

A – 12.5 mg 

B – 25 mg 

C – 50 mg

D – 100 mg 

E – None of the above

 

3. Chlorthalidone doses > ___ mg have limited clinical benefit and increased risk of adverse effects? 

A – 12.5 mg

B – 25 mg 

C – 50 mg

D – 100 mg 

E – None of the above

 

4. Which of the following thiazide diuretics is available in an intravenous (IV) formulation? 

A – Indapamide

B – Metolazone

C – Chlorothiazide

D – Chlorthalidone

E – None of the above

 

5. BP is a 50 year old man seen at your ambulatory clinic. PMH: HTN, DM, BPH. Allergies: Sulfa, penicillin. CrCl 45ml/min

He has been taking hydrochlorothiazide 25 mg daily for the past year. You know that chlorthalidone has better evidence than hydrochlorothiazide and is often preferred by some clinicians. What is the most appropriate course of action? 

A – Continue hydrochlorothiazide as the patient is tolerating it well 

B – Switch to chlorthalidone 

C – Switch to an Ace-inhibitor because patient has a sulfa allergy 

D – Switch to an Ace-inhibitor because thiazides are not effective when CrCl < 50mL/min

E – None of the above

 

6. Thiazides are not effective when CrCl < _____ except metolazone. 

A – 60mL/min

B – 50mL/min

C – 30mL/min

D – 15 mL/min

E – None of the above

 

7. Which of the following is not a side effect of thiazide diuretics? 

A – Hyponatremia

B – Hypomagnesemia

C – Hypokalemia 

D – Hypocalcemia

E – All are side effects of thiazide diuretics 

 

8. Which of the following is a side effect of thiazide diuretics? 

A – Hyperglycemia

B – Hyperuricemia 

C – Hyperkalemia

D – Both A & B 

E – Both B & C

 

9. Which of the following is true regarding thiazide diuretics? 

A – Thiazide diuretics may help lower LDL and triglyceride levels

B – Thiazides should be dosed in the morning to avoid nocturia

C – Hydrochlorothiazide is the preferred drug because of its prolonged half-life and proven reduction in cardiovascular events

D – Thiazides should be titrated as needed up to the max dose 

E – All are true statements 

 

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Calcium Channel Blockers (CCB) 

 

10. Calcium channel blockers consist of two types: dihydropyridines (DHP) and non-dihydropyridines (Non-DHP). Which of the following is a non- DHP calcium channel blocker? 

A – Nifedipine

B – Amlodipine

C – Diltiazem 

D – Nicardipine

E – Felodipine

 

11. Which of the following DHP calcium channel blocker is the drug of choice in pregnancy? 

A – Verapamil

B – Diltiazem

C – Amlodipine 

D – Felodipine ER

E – Nifedipine ER 

 

12. Which of the following CCB is a lipid emulsion and requires strict aseptic techniques due to infection risk? 

A – Nicardipine

B – Clevidipine 

C – Nifedipine

D – Felodipine 

E – Isradipine

 

13. MJ is a 45 year-old male with an egg allergy. Which of the following drugs should be avoided? 

A – Amlodipine

B – Clevidipine 

C – Felodipine

D – Nifedipine 

E – Isradipine

 

14. Which of the following is NOT a side effect of Calcium channel blockers? 

A – Tachycardia

B – Gingival Hyperplasia

C – Flushing 

D – Insomnia

E – Peripheral edema 

 

15. Constipation is a common side effect associated with which of the following calcium channel blockers? 

A – Verapamil 

B – Diltiazem

C – Amlodipine

D – Nifedipine

E – Felodipine 

 

16. Dihydropyridine (DHP) calcium channel blockers should be avoided in patients with heart failure and reduced ejection fraction. If a DHP CCB must be used, which agent(s) is the safest option? 

A – Amlodipine 

B – Felodipine

C – Nifedipine

D – Nicardipine

E – A and B 

 

17. Diltiazem and Verapamil are moderate inhibitors of which CYP enzyme? 

A – CYP 2C9

B – CYP 3A4

C – CYP 1A2

D – CYP 2D6

E – None of the above 

 

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RAAS-inhibitors

 

18. ACE-inhibitors inhibit the breakdown of bradykinin which results in the following side effect(s)? 

A – Hyperkalemia 

B – Cough 

C – Angioedema

D – Hypotension 

E – B and C

 

19. Which of the following should be monitored in a patient taking lisinopril? 

A – Sodium 

B – Potassium 

C – Calcium 

D – White blood cells 

E – None of the above

 

20. What is the mechanism of action of ACE-inhibitors? 

A – They block Angiotensin II from binding to the angiotensin II receptor 

B – They prevent the conversion of angiotensin I to angiotensin II 

C – They black the angiotensin I from binding to the angiotensin I receptor

D – They prevent the conversion of Angiotensinogen to angiotensin I 

E – None of the above 

 

21. Which of the following statements is false regarding ACE-inhibitors? 

A – Avoid use in pregnancy 

B – Hyperkalemia is a common side effect of ACE-inhibitors

C – Monitor signs and symptoms of angioedema with ACE-inhibitor therapy

D – Fosinopril is the only ACE-inhibitor available in an IV formulation

E – ACE-inhibitors lower blood pressure by decreasing vasoconstriction and aldosterone secretion

 

22. Which of the following is true regarding the mechanism of Angiotensin receptor blockers (ARB)? 

A – They block angiotensin II from binding to the angiotensin II receptor 

B – They prevent the breakdown of bradykinin

C – They black the angiotensin I from binding to angiotensin I receptor 

D – They breakdown bradykinin, resulting in vasodilation 

E – None of the above 

 

23. Which of the following statements is true? 

A – Cough and angioedema may occur with ARBs but are less common 

B – ARBs are not associated with cough or angioedema 

C – Cough and angioedema are caused by the breakdown of bradykinin

D – A and C

E – None of the above 

 

24. TJ is a 45 year old male with a history of angioedema with lisinopril. The physician wants to start the patient on Losartan. Choose the most appropriate course of action? 

A – Losartan in contraindicated in TJ because of history of angioedema 

B – The physician may start the patient on Losartan 6 weeks after ACE-inhibitor discontinuation 

C – The physician may start the patient on Losartan as ARBs are not associated with angioedema

D – The physician may start the patient on Losartan 8 weeks after ACE-inhibitor discontinuation

E – None of the above

 

25. MJ is a 60 year old female picking up her prescription for Aliskiren. What is an important counseling point regarding her medication? 

A – This medication may result in weight loss 

B – Avoid high fat foods when taking this medication due to decreased absorption 

C – Take on an empty stomach in the morning 

D – This medication may increase your blood sugar levels 

E – B and D

 

26. Which of the following is a side effect of Olmesartan? 

A – Productive cough 

B – Hyperkalemia 

C – Gingival hyperplasia 

D – Amenorrhea

E – Hyperglycemia 

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Potassium sparing diuretics 

 

27. _________ is a selective aldosterone antagonist and therefore does not exhibit endocrine side effects.

A – Spironolactone

B – Amiloride

C – Triamterene

D – Eplerenone

E – A and D 

 

28. Which of the following is NOT a side effect of spironolactone? 

A – Hyperkalemia

B – Gynecomastia 

C – Amenorrhea 

D – Hypertriglyceridemia 

E – Breast tenderness 

 

29. Where do potassium sparing diuretics work in the nephron? 

A – Distal convoluted tubule

B – Collecting duct

C – Proximal convoluted tubule

D – A and B

E – B and C 

 

30. Which of the following is true regarding Eplerenone? 

A – It blocks androgen resulting in endocrine side effects

B – It may help lower triglycerides

C – It is a major substrate of CYP3A4

D – Common side effects include hyperkalemia and hypernatremia 

E – It is available as a suspension

 

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Beta Blockers

 

31. Which of the following beta blockers should be taken with food?

A – Atenolol

B – Bisoprolol

C – Metoprolol tartrate

D – Acebutalol

E – Esmolol

 

32. Which of the following beta blockers is NOT beta-1 receptor selective? 

A – Atenolol

B – Metoprolol

C – Esmolol

D – Bisoprolol

E – Nebivolol

 

33. Which of the following beta blockers is beta-1 receptor selective? 

A – Acebutalol 

B – Carvedilol

C – Timolol

D – Pindolol

E – Nadolol

 

34. Some beta blockers also block alpha1 receptors decreasing peripheral vasoconstriction and lowering blood pressure as a result. Which of the following agents has alpha1 blocking properties? 

A – Labetalol

B – Propranolol

C – Atenolol

D – Metoprolol

E – Pindolol

 

35. What is the IV to PO ratio for metoprolol tartrate? 

A – 1:2

B – 1:1

C – 2:1

D – 1:2.5

E – 1:3

 

36. A physician wants to initiate beta blocker therapy in a patient with a history of COPD. Which is the most appropriate oral agent for this patient? 

A – Nadolol

B – Pindolol

C – Bisoprolol

D – Esmolol

E – Propranolol

 

37. Beta blockers block beta1 and beta2 receptors resulting in:

A – Decreased HR, increased myocardial contractility 

B – Decreased HR, decreased myocardial contractility

C – Increased HR, increased myocardial contractility 

D – Increased HR, decreased myocardial contractility 

E – None of the above 

 

38. Which of the following is a side effect of Metoprolol? 

A – Hypoglycemia

B – Decreased libido

C – Hyperglycemia 

D – Depression 

E – All of the above 

 

39. TJ is a 45 year old male on Coreg 6.25 mg BID. What is an equivalent dose of Coreg CR?

A – 12.5 mg daily 

B – 10 mg daily

C – 20 mg daily 

D – 40 mg daily 

E – 80 mg daily 

 

40. What is a key counseling point for a patient starting beta blocker therapy? 

A – Take on an empty stomach 

B – Do not abruptly discontinue this medication 

C – It may cause photosensitivity; avoid sun exposure 

D – This medication may cause difficulty sleeping

E – None of the above 

 

41. Which of the following beta blockers is the drug of choice in pregnancy? 

A – Carvedilol

B – Metoprolol

C – Labetalol

D – Atenolol

E – Propranolol

 

42. MJ is a 55 year old female with PMH of Hyperlipidemia, Diabetes and Myocardial Infarction. Her physician wants to initiate metoprolol however given her history of diabetes, what is an important counseling point regarding her new medication? 

A – It may mask the symptoms of hypoglycemia except sweating and hunger

B – It can increase insulin secretion causing hyperglycemia

C – It may mask the symptoms of hypoglycemia except palpitations

D – It can decrease insulin secretion causing hypoglycemia

E – None of the above 

 

43. Clonidine is available as a patch. How often does the patch need to be changed? 

A – Daily

B – Every 36 hours

C – Every 72 hours

D – Weekly 

E – Biweekly 

 

44. Which alpha2 agonist is the drug of choice in pregnancy? 

A – Clonidine

B – Methyldopa

C – Guanfacine

D – Guanabenz

E – Alpha 2 agonists are contraindicated in pregnancy 

 

45. Which of the following is true regarding clonidine? 

A – Abrupt discontinuation may cause rebound hypertension

B – Side effects include dry mouth, sexual dysfunction, dizziness and somnolence

C – Clonidine patch must be removed before MRI 

D – Clonidine patch may cause skin irritation including rash, itching and redness 

E – All of the above

 

46. What is the mechanism of action of Methyldopa? 

A – Alpha 1 agonist

B – Alpha 1 antagonist

C – Alpha 2 agonist

D – Alpha 2 antagonist

E – None of the above 

 

47. Which of the following statements is true regarding clonidine? 

A – A common side effect is insomnia and hyperactivity 

B – It is often used in cases of resistant hypertension 

C – It is available in a patch formulation that is dosed once daily 

D – It lowers blood pressure by stimulation alpha-1 adrenergic receptor in the brain 

E – All of the above 

 

48. What is an important counseling point for a patient using clonidine patch? 

A – Rotate sites every 7 days to avoid irritation  

B – Apply to a dry, hairless area on the upper arm or chest 

C – Do not apply the patch on broken or irritate skin 

D – Remove patch if going for an MRI

E – All of the above 

 

49. What is the primary mechanism of action of hydralazine? 

A – Arteriole vasodilation; decreased systemic vascular resistance

B – Venous vasodilation; decreased systemic vascular resistance

C – Arteriole vasodilation; increased systemic vascular resistance

D – Venous vasodilation; increased systemic vascular resistance

E – None of the above 

 

50. What is a common side effect associated with Minoxidil? 

A – Dry mouth

B – Hair growth

C – Constipation

D – Hypoglycemia

E – None of the above 

 

Answer Key:

 

1. B
2. C
3. B
4. C
5. A
6. C
7. D
8. D
9. B
10. C
11. E
12. B
13. B
14. D
15. A
16. E
17. B
18. E
19. B
20. B
21. D
22. A
23. A
24. B
25. B
26. B
27. D
28. D
29. D
30. C
31. C
32. E
33. A
34. A
35. D
36. C
37. B
38. E
39. C
40. B
41. C
42. A
43. D
44. B
45. E
46. A
47. B
48. E
49. A
50. B