Download antihypertensive drugs

ANTIHYPERTENSIVE DRUGS
Exercises
1. All of the following produce a significant
decrease in peripheral resistance except:
 A. Chronic administration of diuretics
 B. Hydralazine
 C. β–blockers
 D. ACEIs
 E. Clonidine
2. Which one of the following drugs acts at
central presynaptic α2 receptors?
 A. Losartan
 B. Verapamil
 C. Clonidine
 D. Enalapril
 E. Hydrochlorothiazide
3. Which one of the following antihypertensive is
most likely to cause reflex tachycardia?
 A. Propranolol
 B. Hydrochlorothiazide
 C. Prazosin
 D. Hydralazine
 E. Captopril
4. From the list of antihypertensive drugs below
select the one most likely to lower blood sugar.
 A. Prazosin
 B. Propranolol
 C. Nifedipine
 D. Captopril
 E. Hydralazine
5 Which one of the following drugs should not be
given to a pregnant hypertensive woman?
 A. Hydrochlorothiazide
 B. Propranolol
 C. Clonidine
 D. Lisinopril
 E. Verapamil
6. You newly diagnosed hypertensive patient has
vasospastic angina. Which drug and drug class
would be most rational for starting antihypertensive
therapy because it not only exerts antihypertensive
effects, but also directly lowers myocardial oxygen
demand and consumption and tends to inhibit
cellular processes that otherwise favor coronary
vasospasm? Assume there are no other specific
contraindications to the drug you choose.
 A. ACEI or angiotensin receptor blocker
 B. β- blocker
 C. Nifedipine
 D. Thiazide diuretic
 E. Verapamil or diltiazem
7. A patient with newly diagnosed essential
hypertension starts treatment with a commonly used
antihypertensive drug at a dose that is considered to
be therapeutic for the vast majority of patients. Soon
after starting therapy the patient experiences
crushing chest discomfort. ECG changes show
myocardial ischemia. Studies in the cardiac cath lab
show episodes of coronary vasospasm, and it is
likely the antihypertensive drug provoked the
vasospasm. Which antihypertensive drug or drug
class most likely caused the ischemia and the angina?
 A. Atenolol
 B. Diltiazem C. Hydrochlorothiazide D. Losartan
8. A 28-year-old woman is receiving drug therapy for
essential hypertension. She subsequently becomes
pregnant. You realize that the drug she’s been
taking for her high BP can have serious effects on
the fetus. As a result, you stop the current
antihypertensive drug and substitute it with another
drug that is deemed to be equiefficacious in terms
of her BP, and safer for the fetus. Which of the
following drugs was she most likely taking before
she became pregnant?
A. Clonidine
B. Captopril
C. Furosemide
D. Labetalol
E. Verapamil
9. A 30-year-old man who has a history of asthma has
just been diagnosed with Stage 2 essential
hypertension. He regularly uses an inhaled
corticosteroid, which seems to work well as a
control medication, but also needs to use an
albuterol inhale about once every 3 weeks for
surprression of asthma attacks (rescue therapy).
Which antihypertensive drug or drug class poses the
greatest risk of exacerbating the patient’s asthma
and counteracting the desired pulmonary effects of
the albuterol, even though it might control his BP
well?
A. Diltiazem
B. Hydrochlorothiazide
C. Labetalol
D. Ramipril
E. Verapamil
10. Nitroprusside is being infused intravenously to
control BP during surgery. The dose has gotten too
high, and the drug has been administered too long.
Refractories to the antihypertensive effects has
occurred. BP is rising, and other signs and
symptoms of potentially severe toxicity develop.
What nitroprusside metabolite accounts or at least
contributes to these problems?
A. A highly efficacious α–adrenergic agonist
B. An extraordinarily potent and irreversible Na-KATPase inhibitor
C. An irreversible antagonist for angiotensin at the
AngⅡ receptors
D. Nitric oxide
E. Cyanide
11. A patient with stage 2 essential hypertension is
treated with usually effective doses of an ACEI.
After a suitable period of time BP has not been
lowered satisfactorily. The patient has been
compliant with drug therapy and other
recommendations (e.g. Weigh reduction, exercise).
A thiazide is added to the ACEI regimen. Which of
the following is the most likely (but usually transient)
untoward outcome of this drug add-on, for which
you should monitor closely?
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A. Excessive fall of BP sufficient to cause syncope
B. Hypokalemia due to synergistic effects of the
ACEI and the thiazide on renal potassium excretion
C. Onset of acute heart failure from depression of
ventricular contractility
D. Paradoxical hypertensive crisis
E. Sudden prolongation of the PR interval and
increasing degrees of heart block
12. We use standard invasive hemodynamic
techniques to measure or calculate the effects of
various drugs on such parameters as arterial pressure,
total paripheral resistance, and central venous (right
atrial) pressures. The goal is to evaluate whether the
drugs primarily cause arteriolar or venular dilation,
or affect both sides of the circulation. Which of the
following drugs exerts vasodilator effects only in the
arterial side of the circulation?
A. Hydralazine
B. Losartan
C. Nifedipine
D. Nitroglycerin E. Prazosin
13. A 28-year-old female patient has stage Ⅰessential
hypertension (resting BP 144/98), tachycardia, and
occasional palpitations (ventricular ectopic beats).
Normally we might consider prescribing α –
blocker to control the BP and cardiac responses, but
our patient also has asthma, and she is trying to get
pregnant. Which drug would be the best alternative
to the α – blocker in terms of likely efficacy on
pressure and heart rate, and in terms of relative
safety?
A. Diltiazem
B. Enalapril C. Furosemide
D. Phentolamine E. Prazosin
14. For many hypertensive patients we can prescribe either
lisinopril (or an alternative in the same class) or losartan.
What statement correctly summarizes how losartan differs
from lisinopril or other lisinopril-like drugs?
 A. Lisinopril competitively blocks catecholamine-mediated
vasoconstriction, losartan dose not
 B. Lisinopril effectively inhibits synthesis of angiotensin Ⅱ ,
losartan dose not
 C. Losartan causes a higher incidence of bronchospasm and
hyperuricmia
 D. Losartan is preferred for managing hypertension during
pregnancy, whereas captopril is contraindicated
 E. Losartan is suitable for administration to patients with
heart failure, whereas captopril and related drugs should be
avoided
15. An elderly man who has just been referred to your
practice has been taking an oral drug for
symptomatic relief of benign prostatic hypertrophy
(BHP). In addition to its effects on smooth muscles
of the prostatic and urethra, this drug can lower BP
in such a way that it reflexly triggers tachycardia,
positive inotrophy, and increased AV nodal
conduction, at least for a short time after treatment is
started. Initial oral dosages of this drug also have
been associated with a high incidence of syncope.
The drug neither dilates nor constricts the bronchi. It
causes the pupils of the eyes to constrict and
interferes with mydriasis in dim light.
Which prototype is most similar to this unnamed
drug in terms of the pharmacologic profile?
 A. Captopril
 B. Hydrochlorothiazide
 C. Labetalol
 D. Nifedipine
 E. Prazosin
 F. Propranolol
 G. Verapamil
16. A patient with essential hypertension has been
treated with a fixed-dose combination product that
contains hydrochlorothiazide and triamterene. BP
and electrolyte profiles have been kept within
acceptable limits for the last 18 months. Now,
however, BP has risen to the point where
physician wants to add another antihypertensive
drug. The drug is started; after several weeks BP
falls into an acceptable range, but the patient has
become hyperkalemic. What drug was added and
was most likely responsible for the desired BP fall
and the unwanted rise of potassium levels?
A. Diltiazem B. Prazosin C. Propranolol
D. Ramipril
E. Verapamil
17. You’ve diagnosed essential hypertension in a 55-year-old
man. He has adhered well to your instructions with respect
to diet, losing weigh, and exercising, but now, at a followup visit, you believe some drug therapy would be beneficial.
When you initially took his history you learned that he is a
pipe smoker and an avid motorcyclist. Lab tests indicate his
uric acid levels are elevated; he has had five acute gout
attacks over the prior 10 years. He also reported a Raynaudlike problem: even when ambient temperatures are in the
50℉ range, while riding his motocycle the wind and the
“cold” cause his fingers to blanch and become numb
because of cold-induced vasoconstriction.
Which drug or drug group would be the most logical
to try to manage his BP and reduce the incidence or severity
of the hyperuricemia and peripheral vasospasm? Assume
there are no contraindications or precautious, other than
those mentioned above, for the drug you choose.
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A. ACEI
B. Angiotensin receptor blocker
C. Atenolol (or metoprolol)
D. Calcium channel blocker
E. Propranolol
F. Thiazide diuretic
18. A 55-year-old patient has been referred to you.
She complains about a skin rash and a cough. In
the course of history taking, she tells you that she
takes high blood pressure medication but she
doesn’t remember the name. You suspect a drug
toxicity. Which of the following antihypertensive
agents is the patient most likely taking?
 A. Captopril
 B. Nifedipine
 C. Prazosin
 D. Propanolol
 E. Clonidine
19. Which of the following antihypertensive
agents would decrease renin release?
 A. Prazosin
 B. Clonidine
 C. Captopril
 D. Nitroprusside
 E. Hydralazine
20. Your patient is a 50-year-old man with Type 1
diabetes mellitus, normal renal function, and no
microalbuminuria. Although his HbAlc levels are
acceptable, because of his lifestyle and eating habits,
he has experienced more than a few episodes of
symptomatic hypoglycemia following insulin
injections. He currently has asymptomatic
hyperuricemia, but he has had several attacks of acute
gout over the last 5 years. Which of the following
drugs would be the most rational first choice for
starting his antihypertensive therapy?
A. ACEI or ARB
B. β- blocker C. Nifedipine
D. Thiazide diuretic E. Verapamil or diltiazem