Antihypertensives Practice Questions

Question 1

An investigator is comparing the risk of adverse effects among various antiarrhythmic medications. One of the drugs being studied primarily acts by blocking the outward flow of K+ during myocyte repolarization. Further investigation shows that the use of this drug is associated with a lower rate of ventricular tachycardia, ventricular fibrillation, and torsades de pointes when compared to similar drugs. Which of the following drugs is most likely being studied?

Accepted Answer

Amiodarone

Answer

Verapamil

Answer

Procainamide

Answer

Esmolol

Answer

Sotalol

Question 2

A 65-year-old male with a history of hypertension presents to his primary care physician complaining of multiple episodes of chest pain, palpitations, and syncope. Episodes have occurred twice daily for the last week, and he is asymptomatic between episodes. Electrocardiogram reveals a narrow-complex supraventricular tachycardia. He is treated with diltiazem. In addition to its effects on cardiac myocytes, on which of the following channels and tissues would diltiazem also block depolarization?

Accepted Answer

L-type Ca channels in smooth muscle

Answer

L-type Ca channels in skeletal muscle

Answer

T-type Ca channels in bone

Answer

P-type Ca channels in Purkinje fibers

Answer

N-type Ca channels in the peripheral nervous system

Question 3

A 66-year-old man with congestive heart failure presents to the emergency department complaining of worsening shortness of breath. These symptoms have worsened over the last 3 days. He has a blood pressure of 126/85 mm Hg and heart rate of 82/min. Physical examination is notable for bibasilar crackles. A chest X-ray reveals bilateral pulmonary edema. His current medications include metoprolol succinate and captopril. You wish to add an additional medication targeted towards his symptoms. Of the following, which statement is correct regarding loop diuretics?

Accepted Answer

Loop diuretics inhibit the action of the Na+/K+/Cl- cotransporter

Answer

Loop diuretics can cause metabolic acidosis

Answer

Loop diuretics can cause ammonia toxicity

Answer

Loop diuretics can cause hyperlipidemia

Answer

Loop diuretics decrease sodium, magnesium, and chloride but increase calcium

Question 4

A 34-year-old man is being evaluated in an emergency clinic for dizziness and headache after a stressful event at work. He also reports that his face often becomes swollen and he occasionally has difficulty breathing during these spells. Family history is significant for his father who died of a stroke and his mother who often suffers from similar facial swelling. The patient’s blood pressure is 170/80 mm Hg. On physical examination, the patient appears well. Which of the following medications is most likely contraindicated in this patient?

Accepted Answer

Enalapril

Answer

The patient has no contraindications.

Answer

Sulfadiazine

Answer

Penicillin

Answer

Losartan

Question 5

A 53-year-old man presents to the office for a routine examination. The medical history is significant for diabetes mellitus, for which he is taking metformin. The medical records show blood pressure readings from three separate visits to fall in the 130–160 mm Hg range for systolic and 90–100 mm Hg range for diastolic. Prazosin is prescribed. Which of the following are effects of this drug?

Accepted Answer

Vasodilation, bladder sphincter relaxation

Answer

Vasodilation, decreased heart rate, bronchial constriction

Answer

Vasodilation, increased peristalsis, bronchial dilation

Answer

Vasoconstriction, bladder sphincter constriction, mydriasis

Answer

Vasoconstriction, increase in AV conduction rate, bronchial dilation

Question 6

A 70-year-old Caucasian male visits your office regularly for treatment of New York Heart association class IV congestive heart failure. Which of the following medications would you add to this man's drug regimen in order to improve his overall survival?

Accepted Answer

Spironolactone

Answer

Furosemide

Answer

Amiloride

Answer

Acetazolamide

Answer

Hydrochlorothiazide

Question 7

A 56-year-old Caucasian male presents to the clinic to establish care. He has never seen a physician and denies any known medical problems. Physical examination is notable for central obesity, but the patient has regular heart and lung sounds. He has a blood pressure of 157/95 mm Hg and heart rate of 92/min. He follows up 2 weeks later, and his blood pressure continues to be elevated. At this time, you diagnose him with essential hypertension and decide to initiate antihypertensive therapy. Per the Joint National Committee 8 guidelines for treatment of high blood pressure, of the following combinations of drugs, which can be considered for first-line treatment of high blood pressure in the Caucasian population?

Accepted Answer

ACE inhibitor, ARB, CCB, or thiazide

Answer

ACE inhibitor, angiotensin receptor blocker (ARB), beta-blocker (BB), or thiazide

Answer

ACE inhibitor, ARB, CCB, or loop diuretic

Answer

ACE inhibitor, ARB, alpha-blocker, or loop diuretic

Answer

ACE inhibitor, ARB, alpha-blocker, or direct vasodilator

Question 8

A 57-year-old otherwise healthy male presents to his primary care physician for a check-up. He has no complaints. His blood pressure at the previous visit was 160/95. The patient did not wish to be on any medications and at the time attempted to manage his blood pressure with diet and exercise. On repeat measurement of blood pressure today, the reading is 163/92. His physician decides to prescribe a medication which the patient agrees to take. The patient calls his physician 6 days later complaining of a persistent cough, but otherwise states that his BP was measured as 145/85 at a local pharmacy. Which of the following is a contraindication to this medication?

Accepted Answer

Bilateral renal artery stenosis

Answer

Congestive heart failure

Answer

Black race

Answer

Chronic obstructive pulmonary disease

Answer

Gout

Question 9

A physician is choosing whether to prescribe losartan or lisinopril to treat hypertension in a 56-year-old male. Relative to losartan, one would expect treatment with lisinopril to produce which of the following changes in the circulating levels of these peptides?

Accepted Answer

Bradykinin increase; angiotensin II decrease

Answer

Aldosterone increase; bradykinin decrease

Answer

Angiotensin II increase; bradykinin decrease

Answer

Renin decrease; angiotensin I increase

Answer

Renin decrease; angiotensin II increase

Question 10

A 58-year-old woman presents to her physician complaining of a headache in the occipital region for 1 week. Past medical history is significant for essential hypertension, managed with lifestyle modifications and 2 antihypertensives for the previous 6 months. Her blood pressure is 150/90 mm Hg. Neurological examination is normal. A third antihypertensive drug is added that acts as a selective α2 adrenergic receptor agonist. On follow-up, she reports that she does not have any symptoms and her blood pressure is 124/82 mm Hg. Which of the following mechanisms best explains the therapeutic effect of this new drug in this patient?

Accepted Answer

Decreased peripheral sympathetic outflow

Answer

Vasodilation of peripheral arteries

Answer

Vasodilation of peripheral arteries and peripheral veins

Answer

Negative inotropic effect on the heart

Answer

Vasodilation of peripheral veins

Antihypertensives

Study Resources

Lessons

Questions

Flashcards

Lessons

Diuretic classes and mechanisms

ACE inhibitors

Angiotensin II receptor blockers

Calcium channel blockers (dihydropyridine/non-dihydropyridine)

Beta-blockers (cardioselective/non-selective)

Alpha-blockers

Alpha-2 agonists

Direct vasodilators

Direct renin inhibitors

SGLT2 inhibitors in hypertension

Mineralocorticoid receptor antagonists

Combination antihypertensive therapy

Resistant hypertension management

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