Hypertension

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Pharmacology Corner
USMLE-like questions on antihypertensives

Author: Flavio Guzman, MD.
These questions from the UMKC School of Medicine have a different degree of difficulty, but are
useful to review pharmacology of hypertension.
Antihypertensives
Item Number: 11201 correct answer: 4 category: Antihypertensives
1. Gynecomastia, hyperkalemia, and menstrual abnormalities are potential adverse
effects associated with:
A. amiloride
B. captopril
C. triamterene
D. spironolactone
1. A,B,C
2. A,C
3. B,D
4. D only
5. All are correct

2. Diuretics which may result in hyperkalemia when used in a patient also
receiving potassium supplementation include:
A. amiloride
B. mannitol
C. triamterene
D. bumetanide
1. A,B,C
2. A,C
3. B,D
4. D only
5. All are correct

3. Metabolic alkalosis may be a complication of the administration of:
A. hydrochlorothiazide
B. bumetanide
C. furosemide
D. acetazolamide
1. A,B,C
2. A,C
3. B,D
4. D only
5. All are correct

4. Beta blockers which are relatively cardioselective include:
A. metoprolol
B. pindolol
C. atenolol
D. timolol
1. A,B,C
2. A,C
3. B,D
4. D only
5. All are correct

5. Reflex tachycardia is not likely to occur during therapy with:
A. clonidine
B. diazoxide
C. reserpine
D. minoxidil
1. A,B,C
2. A,C
3. B,D
4. D only
5. All are correct

6. Beta blockers which may be less likely to produce CNS-related adverse effects
include
A. metoprolol
B. nadolol
C. timolol
D. atenolol
1. A,B,C
2. A,C
3. B,D
4. D only
5. All are correct

7. Guanadrel is pharmacologically similar to:
A. clonidine
B. guanabenz
C. methyldopa
D. guanethidine
1. A,B,C
2. A,C
3. B,D
4. D only
5. All are correct

8. Adverse effects associated with guanethidine include:
A. orthostatic hypotension
B. enhanced sensitivity to sympathomimetics
C. diarrhea
D. sedation
1. A,B,C
2. A,C
3. B,D
4. D only
5. All are correct

9. Adverse effects associated with hydralazine include:
A. reflex tachycardia
B. hypertrichosis
C. lupus syndrome
D. orthostatic hypotension
1. A,B,C
2. A,C
3. B,D
4. D only
5. All are correct

10. Risk factors associated with increased risk of toxicity during captopril
therapy include:
A. bilateral renal artery stenosis
B. congestive heart failure
C. systemic lupus erythematosus
D. female gender
1. A,B,C
2. A,C
3. B,D
4. D only
5. All are correct

11. Diazoxide, a drug used for treatment of hypertensive crises, is most closely
related to:
1. nitrofuran
2. sulfonamides
3. dopamine antagonists
4. thiazide diuretics
5. nitrates

12. Which of the following drugs is(are) known to induce hyperuricemia and
occasionally to bring about an acute gouty attack?
1. salicylates (6 grams per day)
2. chlorothiazide
3. phenytoin
4. spironolactone
5. All of the above

13. Undesirable side effects of reserpine include:
1. bradycardia
2. postural hypotension
3. diarrhea
4. All of the above
5. None of the above

14. Propranolol may cause all of the following EXCEPT:
1. bradycardia
2. bronchiolar constriction
3.hyperglycemia
4. reduced myocardial contractility
5. prevention of the dilation of vessels caused by circulating epinephrine

15. Alpha methyldopa has been used successfully in the control of hypertension.
Side effects include all of the following, EXCEPT:
1. positive direct Coomb’s test
2. diarrhea
3. hemolytic anemia
4. fever
5. nephrotic syndrome

16. A 48-year old salesman with known hypertension complains of a decreasing
annual income, a loss of “drive”, and a depressed outlook on life. His blood
pressure is normal on medication. The antihypertensive drug most likely to be
the cause of his new complaints is:
1. hydralazine
2. alpha methyldopa
3. reserpine
4. hydrochlorothiazide
5. guanethidine

17. Side effects of medications are often responsible for a patient not complying
with the prescribed drug regimen. An agent which has somnolence as a primary
side effect is:
1. methyldopa
2. hydralazine
3. guanethidine
4. 1,2
5. 1,3

18. One of the mechanisms for ‘resistance” to an antihypertensive drug regimen is
a retention of salt and water and an increase in extracellular fluid volume.
Agents which have been shown to cause retention of salt and water include:
1. methyldopa
2. clonidine
3. guanethidine
4. All of the above
5. 1,2

19. Clonidine hydrochloride lowers blood pressure by reducing sympathetic tone.
It is believed to act by inhibiting sympathetic outflow from the vasomotor
center in the medulla. A potentially serious adverse reaction that has been
reported is:
1. ventricular fibrillation
2. anaphylaxis
3. irreversible nephrotoxicity
4. withdrawal syndrome resembling hypertensive crisis
5. systemic lupus erythematosus
20. Propranolol produces most of its important effects by antagonizing the beta
adrenergic effects of catecholamines released by sympathetic nerve stimulation
or from the adrenal medulla. It therefore results in all of the following
EXCEPT:
1. negative inotropic effect on the heart
2. bronchoconstriction
3. lowering plasma renin activity
4. hyperglycemia
5. negative chronotropic effect on the heart

21. The antihypertensive agent most likely to increase cardiac output is:
1. chlorothiazide
2. reserpine
3. hydralazine
4. alpha-methyldopa
5. guanethidine

22. An agent which produces its antihypertensive effect by blocking autonomic
ganglia, thus lowering the sympathetic tone of blood vessels, is:
1. trimethaphan
2. diazoxide
3. phenoxybenzamine
4. reserpine
5. alpha-methyldopa

23. The most useful drugs in the long-term treatment of essential hypertension
are:
1. thiazide diuretics
2. osmotic diuretics
3. mercurial diuretics
4. carbonic anhydrase inhibitors
5. xanthine diuretics

24. Antihypertensive agents that act primarily at arterioles include:
1. hydralazine
2. minoxidil
3. diazoxide
4. nitroglycerin
5. 1,2,3

25. Antihypertensive agents have different modes of action. The expected
onset of action of IV nitroprusside is:
1. seconds
2. several minutes
3. 15 to 30 minutes
4. several hours
5. 12 to 24 hours

26. Antihypertensive agents must be used with caution. The medical condition for
which methyldopa is most contraindicated is:
1. renal insufficiency
2. coronary insufficiency
3.mental depression
4. liver disease
5. asthma

which hydralazine is most contraindicated is:
3. mental depression
4. liver disease
5. asthma

which reserpine is most contraindicated is:
3. mental depression
4. liver disease
5. asthma

29. Reduced tissue levels of norepinephrine may result from long-term treatment
with:
1. guanethidine
2. reserpine
3. alpha-methyl-tyrosine
4. All of the above
5. 1,2

30. Propranolol is a potent blocker of beta-adrenergic sympathetic activity. It
has been found to be detrimental, however, in patients with:
1. bronchial asthma
2. hypertension
3. hyperthyroidism
4. atrial fibrillation
5. ventricular arrhythmias

31. It is important to understand the mechanism of action of the various drugs
used in the treatment of hypertension. The antihypertensive action of
propranolol involves all of the following EXCEPT:
1. decreased stroke volume
2. inhibition of renin release
3. central nervous system effect
4. depletion of catecholamines
5. decreased heart rate

32. It is important to understand the side effects of the various antihypertensive
agents. Drugs such as guanethidine that block the function of postganglionic
adrenergic neurons may produce all of the following EXCEPT:
1. orthostatic hypotension
2. bradycardia
3. retrograde ejaculation
4. constipation
5. dry mouth

33. Propranolol is contraindicated in all of the following EXCEPT:
1. bronchial asthma
2. sinus bradycardia
3. second or third degree heart block
4. migraine headache prophylaxis
5. congestive heart failure

34. Which of the following diuretics has a greater antihypertensive activity?
1. hydrochlorothiazide 50 mg
2. chlorothiazide 500 mg
3. spironolactone 100 mg
4. all are equivalent antihypertensive agents
5. 1,2

35. A patient complains of headache and his blood pressure is 120/80. His
medications include hydrochlorothiazide and hydralazine. Which of the
following would seem most likely?
1. The headaches are secondary to thiazide-induced hypokalemia
2. The headaches are secondary to hydralazine therapy
3. The headaches are probably unrelated to drug therapy
4. The headaches are related to hydralazine-induced agranulocytosis
5. 1,2

36. A patient is admitted to the hospital for surgery and has been taking 2.4 mg
of clonidine plus 50 mg hydrochlorothiazide daily for several months prior to
surgery. You would expect in this patient:
1. A low likelihood of problems if the clonidine is continued
2. A possibility of markedly increased blood pressure if the clonidine is
stopped
3. Severe postural hypotension if clonidine is discontinued abruptly
4. 1,2
5. 1,3

37. Drugs which may have their effectiveness diminished if the patient
concomitantly receives a tricyclic antidepressant include:
1. hydralazine
2. guanethidine
3. clonidine
4. 1,2
5. 2,3

38. Tachycardia is a prominent side effect of:
1. diazoxide
2. hydralazine
3. clonidine
4. 1,2
5. 2,3
39. All of the following statements concerning the use of sodium nitroprusside are
true EXCEPT:
1. it is metabolized to thiocyanate
2. it must be given by rapid IV push injection
3. it dilates both arterial and venous vessels
4. 1,3
5. 2,3

40. Chronic administration of ethacrynic acid without proper electrolyte
management produces:
1. potassium retention
2. metabolic alkalosis
3. metabolic acidosis
4. excessive inhibition of carbonic anhydrase
5. respiratory alkalosis

41. A diuretic agent which has been associated with hearing loss when given
intravenously is:
1. spironolactone
2. triamterene
3. ethacrynic acid
4. chlorothiazide
5. sucrose

42. A diuretic agent which has a steroid-like nucleus is:
1. spironolactone
2. triamterene
3. ethacrynic acid
4. chlorothiazide
5. sucrose

43. The diuretic agent which acts by inhibiting aldosterone at the distal tubular
renal cell is:
1. spironolactone
2. triamterene
3. ethacrynic acid
4. chlorothiazide
5. bumetanide

44. A diuretic agent which is potassium-sparing and does not depend upon the
adrenal cortex for action is:
1. spironolactone
2. triamterene
3. ethacrynic acid
4. chlorothiazide
5. sucrose

45. Which of the following diuretic agents may produce hypokalemic alkalosis but
is a very useful drug in the treatment of volume-dependent hypertension?
1. spironolactone
2. triamterene
3. amiloride
4. chlorothiazide
5. sucrose

46. Hypercalcemia following thiazide administration is characterized by which of
the following?
1. hypercalciuria
2. hypocalciuria
3. increased serum phosphorus
4. decreased serum phosphorus
5. increased urinary phosphorus

47. The diuretic agent, furosemide, is known to produce:
1. decreased renin production and aldosterone release
2. increased renal blood flow and glomerular filtration rate
3. redistribution of blood from the renal cortex to the medulla
4. All of the above
5. 1,3

48. Complications of treatment of edema with thiazides include all of the
following EXCEPT:
1. hyperuricemia
2. hyperkalemia
3. hyperglycemia
4. hyponatremia
5. alkalosis

49. Possible consequences of chlorothiazide administration include all of the
following EXCEPT:
1. thrombocytopenia and agranulocytosis
2. jaundice, skin eruptions, and photosensitivities
3. hypoglycemia
4. hypokalemic nephropathy
5. hyperuricemia

50. Which of the following diuretics may cause hyperkalemia:
1. ethacrynic acid
2. mercurials
3. thiazides
4. triamterene
5. acetazolamide

51. The dominant action of the thiazide diuretics (e.g. hydrochlorothiazide)is to
increase the renal excretion of sodium and chloride and an accompanying volume
of water. This results from:
1. alterations in acid-base balance
2. an indirect renal effect
3. inhibition of the tubular mechanisms of electrolyte transport
4. increased glomerular filtration rate
5. inhibition of carbonic anhydrase

52. The oral diuretics are an effective group of drugs in the treatment of
hypertension. The mechanism of action mainly responsible for the reduction of
blood pressure after 2 months of treatment is:
1. reduction in plasma volume
2. reduction in cardiac output
3. drug-induced saluresis
4. reduction in serum potassium concentration
5. effects on the neurotransmission at adrenergic ganglions

53. About 20 percent of adults in north America have arterial blood pressures
above the normal range. The aldosterone antagonist, spironolactone, has been
used to treat hypertension with some success. Side effects of spironolactone
include:
1. hyponatremia
2. azotemia
3. gynecomastia
4. all of the above
5. 1,3
54. The effectiveness of which of the following diuretics is diminished in
metabolic acidosis?
1. triamterene
2. spironolactone
3. acetazolamide
4. All of the above
5. 1,3

55. The inhibition of carbonic anhydrase in proximal renal tubular cells caused by
acetazolamide causes a loss in urine of:
1. hydrogen ions
2. glucose
3. bicarbonate ions
4. glycine

56. Complications common to ethacrynic acid and thiazides include:
1. alkalosis
2. potassium depletion
3. hyperuricemia
4. All of the above
5. 1,3

57. Hypokalemia may result from all of the following EXCEPT:
1. flumethiazide
2. hydrochlorothiazide
3. chlorthalidone
4. bendroflumethiazide
5. triamterene

58. Hypochloremic alkalosis may result from prolonged use of:
1. furosemide
2. mannitol
3. ethacrynic acid
4. All of the above
5. 1,3

59. Triamterene:
1. antagonizes aldosterone
2. can produce systemic hyperkalemia
3. is classified as a sodium-sparing diuretic
4. is of no clinical usefulness
5. interferes with the diuretic activity of spironolactone

which spironolactone is most contraindicated is:
3. central depression
4. liver disease
5. asthma

61. With which of the following side effects is spironolactone most closely
identified with?
1. hyperkalemia
2. metabolic acidosis
3. metabolic alkalosis
4. hypoglycemia
5. hypokalemia

62. A diuretic which acts by inhibition of the sodium-hydrogen exchange is:
1. furosemide
2. chlormerodrin
3. acetazolamide
4. mannitol
5. triamterene

63. To achieve smooth reduction of blood pressure, all of the oral diuretics
must be administered at least once daily. Maximum effectiveness is achieved only
after:
1. 1 to 2 weeks
2. 3 to 4 weeks
3. 5 to 6 weeks
4. 7 to 8 weeks
5. 9 to 10 weeks

64. Diuretics may reduce blood pressure through several mechanisms. The critical
effect, however, appears to be:
1. reduction of vascular smooth muscle reactivity
2. effect on autonomic control of vascular tone
3. reduction of total body sodium content
4. effect on electrolyte content of arterial tissues
5. reduction of plasma renin activity

65. Gynecomastia, hyperkalemia, and menstrual abnormalities are potential adverse
effects associated with:
A. amiloride
B. captopril
C. triamterene
D. spironolactone
1. A,B,C
2. A,C
3. B,D
4. D only
5. All are correct

66. Diuretics which should not be used in a patient also receiving potassium
supplementation include:
A. amiloride
B. mannitol
C. triamterene
D. bumetanide
1. A,B,C
2. A,C
3. B,D
4. D only
5. All are correct

67. Metabolic alkalosis is a complication of the administration of:
A. hydrochlorothiazide
B. bumetanide
C. furosemide
D. acetazolamide
1. A,B,C
2. A,C
3. B,D
4. D only
5. All are correct

68. Which of the following drugs may be hazardous if give to a patient receiving
spironolactone?
1. epinephrine
2. propranolol
3. potassium chloride
4. monoamine oxidase inhibitors
5. All of the above

69. A side effect of spironolactone, when utilized to treat hypertension is:
1. hyperkalemia
2. acne
3. hypomagnesemia
4. male pattern baldness
5. bronchospasm

70. The principle site of action of furosemide is the:
1. ascending loop of Henle
2. descending loop of Henle
3. proximal tubule
4. distal tubule

71. The site of action of mannitol is:
1. ascending loop of Henle
2. descending loop of Henle
3. proximal tubule
4. distal tubule

72. A diuretic which is contraindicated in a patient with hyperkalemia is:
1. acetazolamide
2. chlorothiazide
3. ethacrynic acid
4. furosemide
5. spironolactone

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USMLE-like questions on antihypertensives

Item Number: 11218 correct answer: 2 category: Antihypertensives

Item Number: 11220 correct answer: 1 category: Antihypertensives

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Item Number: 13718 correct answer: 4 category: Antihypertensives

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