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Quizzes > Health & Medicine > Human Anatomy & Medicine

Ready to Ace the Antihypertensive Drugs Quiz?

Think You Know How to Manage a 166/94 Blood Pressure? Take the Quiz!

Difficulty: Moderate
2-5mins
Learning OutcomesCheat Sheet
Paper art illustration of pills heart stethoscope and antihypertensive drugs quiz title on dark blue background

Use this antihypertensive drugs quiz to practice real-world hypertension care: mechanisms, first-line choices, dosing, side effects, and quick case calls. You'll spot gaps before the exam or clinic and build confidence; when you want more, try our NCLEX-style practice cases or sharpen lipid management with the lipid therapy quiz .

What is the primary mechanism of action of thiazide diuretics in lowering blood pressure?
Vasodilation via calcium channel blockade
Inhibition of angiotensin-converting enzyme
Inhibition of the Na+-Cl- cotransporter in the distal convoluted tubule
Blockade of beta-1 adrenergic receptors in the heart
Thiazide diuretics lower blood pressure primarily by inhibiting the Na+-Cl- cotransporter in the distal convoluted tubule, promoting natriuresis and reducing plasma volume. Over time, they also decrease peripheral vascular resistance. This dual action makes them effective first-line agents in uncomplicated hypertension.
Which class of antihypertensive drugs inhibits the conversion of angiotensin I to angiotensin II?
Alpha-1 blockers
Calcium channel blockers
ACE inhibitors
Beta blockers
ACE inhibitors block the angiotensin-converting enzyme, preventing the formation of angiotensin II, a potent vasoconstrictor. This leads to decreased peripheral resistance and lower blood pressure. They also reduce aldosterone secretion, contributing to sodium and water excretion.
Which of the following is a common first-line therapy for uncomplicated hypertension in most guidelines?
Loop diuretic
Hydralazine
Alpha-2 agonist
Thiazide diuretic
Most hypertension guidelines recommend thiazide diuretics as first-line therapy for uncomplicated cases because of their proven efficacy and safety profile. They reduce cardiovascular events and are well tolerated in most patients. Loop diuretics are reserved for fluid overload, and hydralazine and alpha-2 agonists have more side effects.
What is a common side effect associated with ACE inhibitors?
Reflex tachycardia
Gingival hyperplasia
Dry cough
Hypoglycemia
ACE inhibitors increase bradykinin levels, which can irritate the respiratory tract and cause a persistent dry cough. This side effect may lead to switching patients to an ARB. Other adverse effects include hyperkalemia and rare angioedema.
Which of the following is a selective beta-1 adrenergic receptor blocker?
Propranolol
Labetalol
Metoprolol
Carvedilol
Metoprolol selectively blocks beta-1 receptors in the heart at therapeutic doses, reducing heart rate and contractility with less bronchoconstriction. Propranolol is nonselective, and carvedilol and labetalol also block alpha receptors. This selectivity makes metoprolol preferable in patients with reactive airway disease.
Which antihypertensive agent works by antagonizing L-type calcium channels in vascular smooth muscle and cardiac myocytes?
Prazosin
Hydrochlorothiazide
Enalapril
Verapamil
Verapamil, a non-dihydropyridine calcium channel blocker, inhibits L-type calcium channels in both vascular smooth muscle and cardiac myocytes. It decreases heart rate and contractility while also causing vasodilation. This dual action distinguishes it from dihydropyridines that primarily target vasculature.
Which dihydropyridine calcium channel blocker is primarily used to treat hypertension?
Amlodipine
Verapamil
Spironolactone
Propranolol
Amlodipine is a dihydropyridine calcium channel blocker that preferentially acts on vascular smooth muscle, causing potent vasodilation. It has a long half-life allowing once-daily dosing and is widely used in hypertension. It does not significantly affect heart rate.
Spironolactone lowers blood pressure by blocking which receptor?
Alpha-1 adrenergic receptor
Angiotensin II receptor
Beta-1 adrenergic receptor
Mineralocorticoid receptor
Spironolactone antagonizes the mineralocorticoid (aldosterone) receptor in the distal nephron, reducing sodium retention and potassium excretion. This diuretic effect lowers blood volume and pressure. It is often used in resistant hypertension and heart failure.
What electrolyte disturbance is commonly seen with loop diuretic therapy?
Hypernatremia
Hypokalemia
Hypermagnesemia
Hypercalcemia
Loop diuretics increase sodium, potassium, and chloride excretion by inhibiting the Na+-K+-2Cl- cotransporter in the thick ascending limb. This leads to hypokalemia and can also cause hypomagnesemia and hypocalcemia. Monitoring electrolytes is crucial during therapy.
Which antihypertensive drug class is contraindicated in pregnancy due to teratogenicity?
ACE inhibitors
Calcium channel blockers
Beta blockers
Alpha-1 blockers
ACE inhibitors can cause fetal renal dysgenesis, oligohydramnios, and skull hypoplasia if used in pregnancy. They are contraindicated, especially in the second and third trimesters. Alternative agents like labetalol or methyldopa are preferred.
Which antihypertensive agent is preferred for patients with both hypertension and benign prostatic hyperplasia?
Metoprolol
Prazosin
Losartan
Hydrochlorothiazide
Prazosin is an alpha-1 blocker that relaxes both prostatic smooth muscle and vascular smooth muscle, improving urinary symptoms and lowering blood pressure. It is particularly useful in men with coexisting BPH. Side effects include orthostatic hypotension.
Which drug class reduces heart rate and myocardial contractility by antagonizing beta receptors?
Calcium channel blockers (dihydropyridine)
Beta blockers
Thiazide diuretics
ACE inhibitors
Beta blockers antagonize beta-adrenergic receptors, reducing heart rate, contractility, and renin release. This decreases cardiac output and lowers blood pressure. They are beneficial in patients with ischemic heart disease and arrhythmias.
Losartan belongs to which class of antihypertensive agents?
Calcium channel blockers
Angiotensin II receptor blockers
Beta blockers
ACE inhibitors
Losartan is an angiotensin II receptor blocker (ARB) that selectively inhibits the AT1 receptor, preventing angiotensin II - mediated vasoconstriction and aldosterone release. ARBs are an alternative to ACE inhibitors, with a lower incidence of cough.
Which diuretic class is most potent and often used in acute pulmonary edema?
Thiazide diuretics
Potassium-sparing diuretics
Loop diuretics
Carbonic anhydrase inhibitors
Loop diuretics inhibit the Na+-K+-2Cl- transporter in the thick ascending limb of Henle, producing a powerful diuretic effect. They rapidly reduce pulmonary congestion by mobilizing large volumes of fluid. They are the agents of choice in acute pulmonary edema.
In which patient scenario would you choose an ACE inhibitor as first-line therapy?
Patient with gout and hyperuricemia
Diabetic patient with microalbuminuria
Asthmatic patient with mild hypertension
Elderly patient with isolated systolic hypertension
ACE inhibitors reduce intraglomerular pressure and proteinuria, making them first-line in diabetic patients with microalbuminuria to slow progression of nephropathy. They also lower systemic blood pressure. They are less ideal in gout and are contraindicated in asthma with severe cough.
Which drug is a direct renin inhibitor used in the management of hypertension?
Spironolactone
Aliskiren
Enalapril
Losartan
Aliskiren directly inhibits renin, blocking the conversion of angiotensinogen to angiotensin I. It reduces plasma renin activity and aldosterone levels. It is an alternative RAS blocker but is not first-line due to cost and limited long-term data.
What is the main hemodynamic effect of hydralazine in blood pressure control?
Direct arteriolar vasodilation
Venous dilation
Inhibition of renin release
Reduced heart rate
Hydralazine causes direct relaxation of arteriolar smooth muscle, reducing afterload and blood pressure. It has minimal effect on venous capacitance vessels. Reflex tachycardia and fluid retention often occur, so it is combined with a beta blocker and diuretic.
Which adverse effect is particularly associated with hydrochlorothiazide?
Hyperuricemia
Hypernatremia
Hypocalcemia
Hypomagnesemia
Hydrochlorothiazide reduces renal uric acid excretion, leading to hyperuricemia and potential gout flares. It also causes mild hypokalemia and hyperglycemia. Monitoring uric acid levels is advised in susceptible patients.
Why are nonselective beta blockers less preferred in initial therapy for hypertension in asthma patients?
Increased risk of orthostatic hypotension
Risk of bronchoconstriction via beta-2 blockade
Greater incidence of dry cough
Higher risk of reflex tachycardia
Nonselective beta blockers block beta-2 receptors in bronchial smooth muscle, leading to bronchoconstriction and worsening asthma. Beta-1 selective agents may be safer but still require caution. This risk makes them less desirable as first-line in asthmatic patients.
Which combination therapy is recommended for initial treatment in stage 2 hypertension?
ACE inhibitor plus thiazide diuretic
Hydralazine plus beta blocker
Loop diuretic plus alpha blocker
Diltiazem plus nitrates
Stage 2 hypertension often requires two first-line agents, commonly an ACE inhibitor plus a thiazide diuretic. This combination targets different pathways and improves blood pressure control. Fixed-dose combinations improve adherence.
Which antihypertensive increases bradykinin levels contributing to its vasodilatory effect?
ACE inhibitors
Calcium channel blockers
Beta blockers
ARBs
ACE inhibitors block bradykinin breakdown by inhibiting kininase II, leading to increased bradykinin levels and enhanced vasodilation. This also underlies the dry cough side effect. ARBs do not affect bradykinin metabolism.
Which calcium channel blocker predominantly affects vascular smooth muscle over the heart?
Metoprolol
Nifedipine
Verapamil
Enalapril
Nifedipine, a dihydropyridine calcium channel blocker, selectively targets vascular L-type calcium channels, causing potent vasodilation with minimal direct cardiac effects. Verapamil acts on both heart and vessels, while metoprolol and enalapril are in different classes.
What is the mechanism of action of spironolactone in hypertension management?
Inhibition of Na+-Cl- cotransporter
Beta-adrenergic blockade
Blockade of calcium channels
Aldosterone receptor antagonism in the distal nephron
Spironolactone antagonizes the aldosterone receptor in the distal nephron, reducing sodium reabsorption and potassium excretion. This decreases plasma volume and blood pressure. It is especially useful in resistant hypertension and heart failure.
Which antihypertensive is most likely to cause gingival hyperplasia?
Lisinopril
Amlodipine
Propranolol
Chlorthalidone
Amlodipine and other dihydropyridine calcium channel blockers can cause gingival hyperplasia by stimulating fibroblast proliferation in the gums. Good oral hygiene and plaque control help mitigate this effect. ACE inhibitors and thiazides are less likely to cause this.
Which drug can cause a lupus-like syndrome as an adverse effect?
Amlodipine
Atenolol
Lisinopril
Hydralazine
Hydralazine can induce a lupus-like syndrome characterized by arthralgias, rash, and positive anti-histone antibodies. Slow acetylators are at higher risk. Symptoms typically resolve upon discontinuation.
Which antihypertensive should be avoided in patients with second- or third-degree atrioventricular block?
Hydralazine
Hydrochlorothiazide
Losartan
Verapamil
Verapamil slows AV nodal conduction through calcium channel blockade and can worsen existing high-grade AV block. It is contraindicated in second- or third-degree block unless a pacemaker is in place. Other agents like thiazides and ARBs do not affect AV conduction.
What is the primary benefit of using ACE inhibitors in patients with heart failure?
Enhanced sodium retention
Reduction of afterload and prevention of remodeling
Stimulation of aldosterone secretion
Increase in heart rate
ACE inhibitors reduce afterload by lowering angiotensin II - mediated vasoconstriction and prevent ventricular remodeling by decreasing maladaptive hypertrophy and fibrosis. This improves cardiac output and survival in heart failure. They are a cornerstone of guideline-directed therapy.
Which antihypertensive class decreases proteinuria in diabetic patients besides ACE inhibitors?
Calcium channel blockers
Angiotensin II receptor blockers
Alpha-1 blockers
Beta blockers
ARBs block the AT1 receptor, reducing glomerular hypertension and proteinuria similarly to ACE inhibitors. They are preferred in patients intolerant to ACE inhibitors due to cough or angioedema. Both classes slow diabetic nephropathy progression.
Which pharmacokinetic property of amlodipine contributes to its once-daily dosing?
High oral bioavailability
Rapid renal excretion
Extensive protein binding
Long elimination half-life
Amlodipine has an elimination half-life of 30 - 50 hours, allowing sustained plasma levels and once-daily dosing. Its slow tissue equilibration also contributes to prolonged action. Oral bioavailability and protein binding play lesser roles in dosing frequency.
Why might a patient develop rebound hypertension upon sudden withdrawal of clonidine?
Upregulation of central alpha-2 receptors and sympathetic surge
Loss of beta-2 receptor sensitivity
Extrarenal sodium retention
Sudden increase in angiotensin II levels
Clonidine is a central alpha-2 agonist that reduces sympathetic outflow. Abrupt withdrawal causes a rebound increase in sympathetic activity because receptors have been upregulated, leading to dangerously high blood pressure. Gradual tapering is necessary to prevent this.
Which ion channel in principal cells is functionally reduced by spironolactone therapy leading to potassium retention?
Epithelial sodium channel (ENaC)
Aquaporin-2 channel
Na+-K+-2Cl- cotransporter
Na+-Cl- cotransporter
By antagonizing aldosterone receptors, spironolactone reduces expression and activity of ENaC in the principal cells of the collecting duct. This decreases sodium reabsorption and diminishes the electrochemical gradient for potassium secretion, resulting in potassium retention.
Which genetic polymorphism is known to affect patient response to beta blocker therapy?
?1-adrenergic receptor Arg389Gly variant
SLCO1B1 c.521T>C
ACE insertion/deletion polymorphism
CYP3A4*22 variant
The Arg389Gly polymorphism in the ?1-adrenergic receptor gene influences receptor signaling and patient response to beta blockers like metoprolol. Patients with the Arg389 variant often have a greater reduction in heart rate and blood pressure. Pharmacogenetic testing can guide personalized therapy.
Which antihypertensive is contraindicated in bilateral renal artery stenosis?
Propranolol
Hydrochlorothiazide
ACE inhibitor
Amlodipine
In bilateral renal artery stenosis, ACE inhibitors can precipitate acute renal failure by reducing angiotensin II - mediated efferent arteriole constriction and glomerular filtration pressure. Thiazides and calcium channel blockers do not have this effect. Monitoring renal function during ACE inhibitor initiation is essential.
Which drug is indicated for resistant hypertension and potentiates cerebral vasodilation by blocking L-type calcium channels?
Metoprolol
Losartan
Enalapril
Nicardipine
Nicardipine, a dihydropyridine calcium channel blocker, has potent arteriolar vasodilatory effects, including cerebral vessels, and is used in hypertensive emergencies and resistant hypertension. Its rapid onset and titratable IV infusion make it useful in acute settings.
What effect does using an ARB have on bradykinin levels compared to ACE inhibitors?
No increase in bradykinin levels
Marked increase in bradykinin levels
Slight decrease in bradykinin levels
Direct inactivation of bradykinin
ARBs block the AT1 receptor without affecting kininase II, so they do not increase bradykinin levels. This avoids the cough and angioedema seen with ACE inhibitors. Their side-effect profile is different despite similar hemodynamic benefits.
Eplerenone differs from spironolactone by having less of which adverse effect?
Hypotension
Hyperkalemia risk
Endocrine side effects (e.g., gynecomastia)
Renal impairment
Eplerenone is a selective mineralocorticoid receptor antagonist with minimal affinity for androgen and progesterone receptors, reducing endocrine side effects like gynecomastia seen with spironolactone. Both drugs share hyperkalemia risk.
Which antihypertensive could be beneficial in a patient with gout due to its uricosuric effect?
Spironolactone
Hydrochlorothiazide
Losartan
Furosemide
Losartan increases renal uric acid excretion by inhibiting URAT1 transporters, providing a mild uricosuric effect. This property can benefit hypertensive patients with gout. Other diuretics often worsen hyperuricemia.
In malignant hypertension, which intravenous agent releases nitric oxide and provides rapid blood pressure control?
Sodium nitroprusside
Labetalol
Nitroglycerin
Hydralazine
Sodium nitroprusside is a potent arterial and venous vasodilator that releases nitric oxide, causing rapid reduction in blood pressure. It is titratable by infusion, making it ideal for malignant hypertension. Monitoring for cyanide toxicity is necessary.
Which receptor subtype is primarily targeted by prazosin to reduce blood pressure?
Alpha-2 adrenergic receptor
Alpha-1 adrenergic receptor
Beta-1 adrenergic receptor
Dopamine D1 receptor
Prazosin selectively antagonizes alpha-1 adrenergic receptors on vascular smooth muscle, leading to vasodilation and decreased peripheral resistance. It does not block alpha-2 or beta receptors. Its use can cause first-dose orthostatic hypotension.
What is the mechanism of action of fenoldopam in hypertensive emergencies?
ACE inhibition
Dopamine D1 receptor agonism causing renal vasodilation
Nitric oxide donation
Alpha-1 blockade
Fenoldopam is a selective dopamine D1 receptor agonist that produces vasodilation, particularly in renal and mesenteric beds, improving renal perfusion and promoting diuresis. It rapidly lowers blood pressure in emergencies and does not affect heart rate directly.
Which calcium channel blocker is more selective for cardiac tissue than vascular smooth muscle?
Hydrochlorothiazide
Amlodipine
Diltiazem
Nifedipine
Diltiazem, a benzothiazepine, has balanced effects on cardiac L-type calcium channels and vascular smooth muscle, but it is relatively more cardioselective than dihydropyridines. It decreases heart rate and contractility while still causing some vasodilation.
In a patient with refractory hypertension on maximal doses of ACE inhibitor, thiazide, and calcium channel blocker, which agent specifically antagonizes the mineralocorticoid receptor?
Nitroprusside
Clonidine
Eplerenone
Hydralazine
Eplerenone is a selective mineralocorticoid receptor antagonist that blocks aldosterone's effects, reducing sodium retention and fibrosis. It is effective in resistant hypertension and heart failure but has fewer endocrine side effects than spironolactone.
What is the rationale for combining an ACE inhibitor with an ARB in resistant hypertension, and why is this combination generally not recommended?
Synergistic vasodilation with no increase in side effects
Prevention of cough by bradykinin blockade
Reduced thirst and fluid intake
Enhanced RAS blockade but increased risk of hyperkalemia and renal impairment
Combining ACE inhibitors and ARBs provides more complete RAS blockade, potentially improving blood pressure control. However, trials have shown increased rates of hyperkalemia, hypotension, and renal dysfunction without mortality benefit, so this combination is not routinely recommended.
How does genetic polymorphism in CYP2D6 affect the pharmacokinetics of metoprolol?
Ultrarapid metabolizers have reduced risk of hypotension
CYP2D6 variation only affects propranolol, not metoprolol
Polymorphisms have no impact on metoprolol levels
Poor metabolizers have higher plasma concentrations and increased risk of adverse effects
Metoprolol is metabolized by CYP2D6. Poor metabolizers have decreased clearance, resulting in higher plasma levels, exaggerated beta blockade, and increased risk of bradycardia and hypotension. Genotyping can guide dose adjustments.
Which novel antihypertensive agent acts by inhibiting neprilysin and is combined with an ARB in heart failure therapy?
Eplerenone
Sacubitril (in combination with valsartan)
Fenoldopam
Aliskiren
Sacubitril is a neprilysin inhibitor that prevents the breakdown of natriuretic peptides, enhancing vasodilation and natriuresis. It is combined with valsartan (an ARB) in the sacubitril/valsartan formulation (Entresto) for heart failure with reduced ejection fraction. This dual action improves outcomes.
Which interventional procedure can be used as a non-pharmacological adjunct for resistant hypertension by modulating sympathetic nerve activity?
Renal sympathetic denervation
Carotid endarterectomy
Coronary artery stenting
Pacemaker insertion
Renal sympathetic denervation involves radiofrequency ablation of renal sympathetic nerves, reducing sympathetic tone and lowering blood pressure in resistant hypertension. Initial trials showed promise, though results have varied, and patient selection is key.
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Study Outcomes

  1. Identify Antihypertensive Drug Classes -

    Recognize and categorize major classes of blood pressure medications, including ACE inhibitors, beta-blockers, and calcium channel blockers.

  2. Explain Mechanisms of Action -

    Describe how different antihypertensive agents work at the molecular and physiological levels to lower blood pressure.

  3. Match Therapy to Blood Pressure Readings -

    Apply knowledge from the antihypertensive drugs quiz to select appropriate treatments for readings like 166/94.

  4. Differentiate Drug Profiles -

    Analyze side effect profiles, contraindications, and pharmacokinetics to distinguish between various hypertension drugs.

  5. Apply Evidence-Based Guidelines -

    Integrate current hypertension management recommendations into clinical decision-making during the antihypertensive pharmacology quiz.

  6. Evaluate Clinical Scenarios -

    Assess patient cases and use critical thinking to optimize antihypertensive therapy in practice and trivia settings.

Cheat Sheet

  1. Fundamental Drug Classes -

    Antihypertensive drugs are grouped into four core categories: ACE inhibitors/ARBs, beta-blockers, calcium channel blockers, and diuretics (AHA, 2017). Remember the mnemonic 'ABCD' - 'A'CEi, 'B'Blockers, 'C'CBs, 'D'iuretics - to ace your antihypertensive drugs quiz effortlessly.

  2. Thiazide Diuretics as First-Line Agents -

    Thiazide diuretics (e.g., hydrochlorothiazide) inhibit the Na+/Cl− co-transporter in the distal tubule, reducing intravascular volume and peripheral resistance (Journal of Clinical Hypertension, 2018). Per JNC 8 guidelines, they're recommended as first-line therapy unless contraindicated - just what you need to know when interpreting a 166/94 blood pressure reading.

  3. Stage 2 Hypertension: Interpreting 166/94 mm Hg -

    A reading of 166/94 mm Hg qualifies as stage 2 hypertension under ACC/AHA 2017 criteria, often necessitating combination therapy for optimal control. Familiarize yourself with thresholds and algorithm-based management to confidently tackle any hypertension drug trivia question in your quiz.

  4. ACE Inhibitors and Renal Protection -

    ACE inhibitors like lisinopril block the conversion of angiotensin I to II, decreasing vasoconstriction and aldosterone release (American Society of Nephrology). Remember the suffix '-pril' and monitor for cough and hyperkalemia, especially if you're quizzing on blood pressure 166/94 scenarios in diabetic patients.

  5. Calcium Channel Blocker Subtypes -

    Dihydropyridines (e.g., amlodipine) primarily cause vasodilation, while non-dihydropyridines (e.g., verapamil) have negative chronotropic effects (UpToDate, 2020). Use this distinction to answer "which CCB?" swiftly during an antihypertensive pharmacology quiz - just visualize 'DHP for Dilate, Non-DHP for Decelerate'.

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