A patient with hypertension is started on hydrochlorothiazide. Which transporter is directly inhibited?

A) Na/K/2Cl transporter

B) Na/Cl transporter

C) Vesicular amine transporter

D) L-type calcium channel

B. Na/Cl transporter

Chlorthalidone lowers blood pressure by acting primarily in which nephron segment?

A) Collecting tubule

B) Proximal tubule

C) Loop of Henle

D) Distal convoluted tubule

D. Distal convoluted tubule

Which drug pair belongs to the thiazide diuretic class?

A) Hydrochlorothiazide and chlorthalidone

B) Furosemide and torsemide

C) Spironolactone and eplerenone

D) Captopril and losartan

A. Hydrochlorothiazide and chlorthalidone

Thiazide diuretics lower blood pressure primarily through which overall effect?

A) Increased blood volume

B) Increased vascular tone

C) Decreased blood volume

D) Increased cardiac output

C. Decreased blood volume

A patient taking hydrochlorothiazide urinates more frequently. Which mechanism best explains the blood pressure reduction?

A) Blocks alpha-1 receptors

B) Releases nitric oxide

C) Promotes sodium and water loss

D) Opens potassium channels

C. Promotes sodium and water loss

Which name clue helps identify hydrochlorothiazide and chlorthalidone as thiazide-type drugs?

A) They contain “th”

B) They end in “pril”

C) They end in “olol”

D) They contain “dopam”

A. They contain “th”

Furosemide lowers blood pressure and volume by blocking which transporter?

A) Na/Cl transporter

B) Calcium channel

C) Aldosterone receptor

D) Na/K/2Cl transporter

D. Na/K/2Cl transporter

Furosemide acts primarily in which renal region?

A) Collecting tubule

B) Loop of Henle

C) Distal convoluted tubule

D) Proximal tubule

B. Loop of Henle

A patient taking furosemide develops hearing-related toxicity. Which adverse effect is most likely?

A) Ototoxicity

B) Gynecomastia

C) Angioedema

D) Bronchoconstriction

A. Ototoxicity

Which listed antihypertensive is a loop diuretic?

A) Chlorthalidone

B) Eplerenone

C) Furosemide

D) Aliskiren

C. Furosemide

Loop diuretics lower blood pressure mainly by producing which effect?

A) Increased afterload

B) Decreased blood volume

C) Increased vascular tone

D) Decreased potassium retention

B. Decreased blood volume

A drug blocks the Na/K/2Cl transporter in the loop of Henle. Which drug matches this mechanism?

A) Losartan

B) Methyldopa

C) Prazosin

D) Furosemide

D. Furosemide

Spironolactone and eplerenone directly block which receptor?

A) Beta receptor

B) Alpha-1 receptor

C) D1 receptor

D) Aldosterone receptor

D. Aldosterone receptor

Aldosterone receptor blockers act primarily in which nephron region?

A) Collecting tubule

B) Loop of Henle

C) Proximal tubule

D) Distal convoluted tubule

A. Collecting tubule

Blocking aldosterone receptors causes which electrolyte pattern?

A) Sodium retention, potassium loss

B) Calcium retention, sodium loss

C) Sodium loss, potassium retention

D) Chloride retention, calcium loss

C. Sodium loss, potassium retention

Why does sodium loss from aldosterone blockade lower blood pressure?

A) Calcium leaves cardiac cells

B) Water follows sodium out

C) Renin directly increases

D) Bronchi relax directly

B. Water follows sodium out

A man develops gynecomastia after starting an aldosterone blocker. Which drug is most likely responsible?

A) Eplerenone

B) Spironolactone

C) Losartan

D) Aliskiren

B. Spironolactone

Which name clue helps identify spironolactone and eplerenone?

A) They end in “one”

B) They end in “pril”

C) They end in “olol”

D) They end in “pine”

A. They end in “one”

Captopril lowers blood pressure by directly inhibiting which enzyme?

A) Renin

B) Aldosterone synthase

C) Vesicular transporter

D) ACE

D. ACE

Captopril prevents which conversion in the renin-angiotensin system?

A) Angiotensinogen to angiotensin I

B) Angiotensin I to angiotensin II

C) Aldosterone to angiotensin II

D) Renin to angiotensinogen

B. Angiotensin I to angiotensin II

Which suffix commonly identifies ACE inhibitors such as captopril?

A) “pril”

B) “sartan”

C) “olol”

D) “pine”

A. “pril”

ACE inhibition with captopril causes which downstream change?

A) Increased aldosterone signaling

B) Increased angiotensin II

C) Decreased angiotensin II

D) Increased vasoconstriction

C. Decreased angiotensin II

A patient with bilateral renal artery stenosis starts captopril. Which complication is most concerning?

A) Bronchoconstriction

B) Worsened renal function

C) Ototoxicity

D) Prostatic relaxation

B. Worsened renal function

ACE inhibitors can lower GFR in renal artery stenosis by reducing which support mechanism?

A) Proximal bicarbonate secretion

B) Afferent arteriole dilation

C) Collecting duct sodium loss

D) Efferent arteriole constriction

D. Efferent arteriole constriction

Losartan belongs to which antihypertensive drug class?

A) Angiotensin receptor blocker

B) ACE inhibitor

C) Renin inhibitor

D) Alpha-1 blocker

A. Angiotensin receptor blocker

Which suffix commonly identifies angiotensin receptor blockers such as losartan?

A) “pril”

B) “sartan”

C) “sin”

D) “ren”

B. “sartan”

Losartan lowers blood pressure mainly by blocking which effect?

A) Dopamine-mediated vasodilation

B) Aldosterone receptor blockade

C) Angiotensin-mediated vasoconstriction

D) Vesicular amine storage

C. Angiotensin-mediated vasoconstriction

Compared with ACE inhibitors, ARBs are less associated with which adverse effects?

A) Ototoxicity and vertigo

B) Gynecomastia and impotence

C) Bronchospasm and wheezing

D) Cough and angioedema

D. Cough and angioedema

A patient develops cough while taking captopril. Which related drug is less likely to cause cough?

A) Losartan

B) Furosemide

C) Prazosin

D) Clonidine

A. Losartan

Which drug directly inhibits renin enzyme activity?

A) Captopril

B) Aliskiren

C) Losartan

D) Fenoldopam

B. Aliskiren

Which name clue helps identify aliskiren as a renin inhibitor?

A) “sin” in the name

B) “pine” in the name

C) “ren” in the name

D) “olol” in the name

C. “ren” in the name

Renin inhibition with aliskiren causes which downstream effect?

A) Increased angiotensin II

B) Increased aldosterone signaling

C) Increased norepinephrine stores

D) Decreased angiotensin I and II

D. Decreased angiotensin I and II

Aliskiren most directly reduces activity in which pathway?

A) Renin-angiotensin pathway

B) Nitric oxide pathway

C) Dopamine receptor pathway

D) Calcium channel pathway

A. Renin-angiotensin pathway

Which drug pair consists of centrally acting sympathoplegics?

A) Reserpine and guanethidine

B) Clonidine and methyldopa

C) Prazosin and terazosin

D) Verapamil and diltiazem

B. Clonidine and methyldopa

Clonidine and methyldopa lower blood pressure by activating which receptor?

A) Beta-1 receptor

B) D1 receptor

C) Alpha-2 receptor

D) Alpha-1 receptor

C. Alpha-2 receptor

Activation of alpha-2 adrenoceptors causes which sympathetic effect?

A) Increased norepinephrine release

B) Increased vasoconstriction

C) Increased cardiac stimulation

D) Decreased norepinephrine release

D. Decreased norepinephrine release

How do alpha-2 agonists such as clonidine lower blood pressure?

A) Reduce sympathetic output

B) Increase cardiac contractility

C) Increase aldosterone release

D) Block calcium entry

A. Reduce sympathetic output

A pregnant patient is treated with methyldopa for hypertension. Which receptor action explains its effect?

A) Blocks alpha-1 receptors

B) Activates alpha-2 receptors

C) Blocks beta receptors

D) Activates D1 receptors

B. Activates alpha-2 receptors

Which drug group blocks sympathetic nerve terminals by depleting transmitter stores?

A) ACE inhibitors

B) Calcium channel blockers

C) Sympathetic nerve terminal blockers

D) Aldosterone receptor blockers

C. Sympathetic nerve terminal blockers

Reserpine lowers blood pressure by blocking which transporter in noradrenergic nerves?

A) Na/Cl transporter

B) L-type calcium channel

C) Na/K/2Cl transporter

D) Vesicular amine transporter

D. Vesicular amine transporter

Blocking vesicular amine transporters causes which effect in noradrenergic nerves?

A) Depleted transmitter stores

B) Increased norepinephrine storage

C) Increased angiotensin II release

D) Increased calcium entry

A. Depleted transmitter stores

Which drug is a sympathetic nerve terminal blocker?

A) Atenolol

B) Guanethidine

C) Diltiazem

D) Eplerenone

B. Guanethidine

Guanadrel lowers blood pressure mainly by reducing which physiologic output?

A) Dopamine renal effects

B) Aldosterone adrenal effects

C) Cardiovascular sympathetic effects

D) Parasympathetic cardiac effects

C. Cardiovascular sympathetic effects

Which set contains sympathetic nerve terminal blockers from the notes?

A) Prazosin, terazosin, doxazosin

B) Captopril, losartan, aliskiren

C) Verapamil, diltiazem, amlodipine

D) Reserpine, guanethidine, guanadrel

D. Reserpine, guanethidine, guanadrel

Which drug pair consists of selective alpha-1 blockers?

A) Prazosin and terazosin

B) Metoprolol and atenolol

C) Clonidine and methyldopa

D) Aliskiren and captopril

A. Prazosin and terazosin

Which suffix clue is shared by prazosin, terazosin, and doxazosin?

A) “pril”

B) “sin”

C) “olol”

D) “sartan”

B. “sin”

Alpha-1 blockers lower blood pressure by preventing which sympathetic effect?

A) Bronchodilation

B) Renin inhibition

C) Vasoconstriction

D) Calcium blockade

C. Vasoconstriction

A patient with hypertension and BPH is started on prazosin. Which additional effect explains the BPH benefit?

A) Blocks renal sodium reabsorption

B) Inhibits angiotensin conversion

C) Opens vascular potassium channels

D) Relaxes prostatic smooth muscle

D. Relaxes prostatic smooth muscle

Which adverse effect is especially important with alpha-1 blockers such as terazosin?

A) Orthostatic hypotension

B) Ototoxicity

C) Dry cough

D) Gynecomastia

A. Orthostatic hypotension

Which drug group contains beta blockers from the notes?

A) Prazosin and terazosin

B) Captopril and losartan

C) Clonidine and methyldopa

D) Metoprolol and atenolol

D. Metoprolol and atenolol

Which suffix commonly identifies beta blockers such as propranolol?

A) “olol”

B) “sartan”

C) “pril”

D) “pine”

A. “olol”

Beta blockers lower blood pressure by blocking which receptor type?

A) Alpha-1 receptors

B) Beta receptors

C) D1 receptors

D) Aldosterone receptors

B. Beta receptors

Metoprolol lowers blood pressure mainly by decreasing which cardiac variables

A) Venous tone and preload

B) Sodium filtration and excretion

C) Heart rate and contractility

D) Prostatic tone and resistance

C. Heart rate and contractility

Which adverse effect is most concerning when giving propranolol to a patient with asthma?

A) Ototoxicity

B) Angioedema

C) Gynecomastia

D) Bronchoconstriction

D. Bronchoconstriction

Which drug group contains calcium channel blockers from the notes?

A) Verapamil and diltiazem

B) Captopril and losartan

C) Reserpine and guanethidine

D) Spironolactone and eplerenone

A. Verapamil and diltiazem

Calcium channel blockers used for hypertension block which channel type?

A) T-type calcium channels

B) L-type calcium channels

C) Sodium leak channels

D) Chloride ligand channels

B. L-type calcium channels

Why are L-type calcium channels important for cardiac antihypertensive effects?

A) They store norepinephrine

B) They activate renin

C) They support cardiac contraction

D) They block sodium excretion

C. They support cardiac contraction

Which calcium channel blockers contain the “-pine” clue?

A) Verapamil and diltiazem

B) Captopril and aliskiren

C) Prazosin and doxazosin

D) Nifedipine and amlodipine

D. Nifedipine and amlodipine

A patient taking amlodipine has reduced blood pressure. Which mechanism best explains the effect?

A) L-type calcium channel blockade

B) Vesicular transporter blockade

C) Aldosterone receptor blockade

D) Alpha-2 receptor activation

A. L-type calcium channel blockade

Which listed drug is a calcium channel blocker?

A) Losartan

B) Diltiazem

C) Atenolol

D) Hydralazine

B. Diltiazem

Which listed drug is a non-dihydropyridine calcium channel blocker?

A) Nifedipine

B) Amlodipine

C) Verapamil

D) Losartan

C. Verapamil

Hydralazine lowers blood pressure through which mechanism?

A) Blocks beta receptors

B) Opens potassium channels

C) Blocks angiotensin receptors

D) Causes nitric oxide release

D. Causes nitric oxide release

Hydralazine affects which vessels more strongly?

A) Arterioles more than veins

B) Veins more than arterioles

C) Capillaries more than arteries

D) Venules more than arteries

A. Arterioles more than veins

Hydralazine lowers blood pressure primarily by decreasing which hemodynamic variable?

A) Plasma potassium

B) Vascular resistance

C) Bronchial resistance

D) Renal oncotic pressure

B. Vascular resistance

A patient receives hydralazine and develops increased heart rate. Which mechanism best explains this response?

A) Direct beta stimulation

B) Direct D1 activation

C) Reflex tachycardia

D) Direct ACE inhibition

C. Reflex tachycardia

Which pair lowers blood pressure by opening potassium channels in vascular smooth muscle?

A) Captopril and losartan

B) Verapamil and diltiazem

C) Prazosin and terazosin

D) Minoxidil and diazoxide

D. Minoxidil and diazoxide

Opening potassium channels in vascular smooth muscle causes which blood pressure-lowering effect?

A) Vasodilation

B) Vasoconstriction

C) Bronchoconstriction

D) Prostatic contraction

A. Vasodilation

A patient is treated with diazoxide. Which mechanism explains its antihypertensive effect?

A) Blocks ACE

B) Opens potassium channels

C) Blocks beta receptors

D) Activates alpha-2 receptors

B. Opens potassium channels

Which listed drug lowers blood pressure by opening vascular smooth muscle potassium channels?

A) Methyldopa

B) Metoprolol

C) Minoxidil

D) Losartan

C. Minoxidil

Nitroprusside rapidly lowers blood pressure by releasing which mediator?

A) Angiotensin II

B) Norepinephrine

C) Aldosterone

D) Nitric oxide

D. Nitric oxide

Which antihypertensive is described as producing powerful rapid vasodilation?

A) Nitroprusside

B) Chlorthalidone

C) Prazosin

D) Eplerenone

A. Nitroprusside

A patient in hypertensive emergency receives nitroprusside. Which mechanism best explains the rapid BP decrease?

A) Aldosterone receptor blockade

B) Nitric oxide-mediated vasodilation

C) Beta receptor blockade

D) Renin enzyme inhibition

B. Nitric oxide-mediated vasodilation

Which drug activates dopamine D1 receptors to lower blood pressure?

A) Labetalol

B) Nebivolol

C) Fenoldopam

D) Hydralazine

C. Fenoldopam

Which clue helps connect fenoldopam to its receptor target?

A) “pril” suggests ACE inhibition

B) “sartan” suggests angiotensin blockade

C) “sin” suggests alpha blockade

D) “dopam” suggests dopamine

D. “dopam” suggests dopamine

Which adverse effect is associated with fenoldopam?

A) Ototoxicity

B) Reflex tachycardia

C) Gynecomastia

D) Dry cough

B. Reflex tachycardia

Labetalol lowers blood pressure by blocking which receptor groups?

A) D1 and D2 receptors

B) ACE and renin enzymes

C) Aldosterone and calcium receptors

D) Alpha and beta receptors

D. Alpha and beta receptors

Labetalol lowers blood pressure through which combined effect?

A) Increased diuresis and cough

B) Decreased resistance and cardiac stimulation

C) Decreased potassium and sodium

D) Increased calcium and contractility

B. Decreased resistance and cardiac stimulation

Which clue helps distinguish labetalol from typical “olol” beta blockers in the notes?

A) “sartan” instead of “pril”

B) “ren” instead of “sin”

C) “alol” instead of “olol”

D) “pine” instead of “one”

C. “alol” instead of “olol”

A 32-year-old woman with hypertension wishes to become
pregnant. Her physician informs her that she will have to
switch to another antihypertensive drug. Which of the following drugs is absolutely contraindicated in pregnancy?
(A) Atenolol
(B) Losartan
(C) Methyldopa
(D) Nifedipine
(E) Propranolol

(B) Losartan

ACE inhibitors and ARBs (choice B) have
been shown to be teratogenic, causing severe renal abnormali￾ties in the fetus.

A patient is admitted to the emergency department with
severe tachycardia after a drug overdose. His family reports
that he has been depressed about his hypertension. Which
one of the following drugs increases the heart rate in a dose-dependent manner?
(A) Captopril
(B) Hydrochlorothiazide
(C) Losartan
(D) Minoxidil
(E) Verapamil

(D) Minoxidil

minoxidil, a very efficacious vasodila￾tor, causes severe tachycardia that must be controlled with β
blockers

Which one of the following is characteristic of nifedipine
treatment in patients with essential hypertension?
(A) Competitively blocks angiotensin II at its receptor
(B) Decreases calcium efflux from skeletal muscle
(C) Decreases renin concentration in the blood
(D) Decreases calcium influx into smooth muscle
(E) Increases calcium excretion in the urine

(D) Decreases calcium influx into smooth muscle

Nifedipine is a prototype L-type calcium channel blocker and
lowers blood pressure by reducing calcium influx into vascular smooth muscle.

A 73-year-old man with a history of a recent change in his
treatment for moderately severe hypertension is brought to
the emergency department because of a fall at home. Which
of the following drug groups is most likely to cause postural
hypotension and thus an increased risk of falls?
(A) ACE inhibitors
(B) Alpha1-selective receptor blockers
(C) Arteriolar dilators
(D) Beta1-selective receptor blockers
(E) Calcium channel blockers

(B) Alpha1-selective receptor blockers

postural hypotension is the same thing as orthostatic hypotension

A significant number of patients started on ACE inhibitor
therapy for hypertension are intolerant and must be switched
to a different class of drug. What is the most common manifestation of this intolerance?
(A) Angioedema
(B) Glaucoma
(C) Headache
(D) Incessant cough
(E) Ventricular arrhythmias

(D) Incessant cough

Which one of the following is a significant unwanted effect
of the drug named?
(A) Constipation with verapamil
(B) Heart failure with hydralazine
(C) Hemolytic anemia with atenolol
(D) Hypokalemia with aliskiren
(E) Lupus-like syndrome with hydrochlorothiazide

(A) Constipation with verapamil

Verapamil (choice A) often causes constipation, probably by blocking L-type calcium channels in the colon.

Comparison of prazosin with atenolol shows that
(A) Both decrease heart rate
(B) Both increase cardiac output
(C) Both increase renin secretion
(D) Both increase sympathetic outflow from the CNS
(E) Both produce orthostatic hypotension

(D) Both increase sympathetic outflow from the CNS

by reducing blood flow

A patient with hypertension and angina is referred for treatment. Metoprolol and verapamil are among the drugs considered. Both metoprolol and verapamil are associated with
which one of the following?
(A) Diarrhea
(B) Hypoglycemia
(C) Increased PR interval
(D) Tachycardia
(E) Thyrotoxicosis

(C) Increased PR interval

A 45-year-old man is brought to the emergency department
with mental obtundation. He is found to have a blood pressure of 220/160 and retinal hemorrhages. Which one of the
following is used in severe hypertensive emergencies, is short-acting, acts on a G-protein-coupled receptor, and must be
given by intravenous infusion?
(A) Aliskiren
(B) Captopril
(C) Fenoldopam
(D) Hydralazine

(C) Fenoldopam

Fenoldopam, nitroprusside, and propranolol are the drugs
in the list that have been used in hypertensive emergencies.
Fenoldopam and nitroprusside are used by infusion only, but
nitroprusside releases nitric oxide, which acts on intracellular
guanylyl cyclase. The answer is C.

Which of the following is very short acting and acts by releasing nitric oxide?
(F) Losartan
(G) Minoxidil
(H) Nitroprusside
(I) Prazosin

(H) Nitroprusside