Hypertension Pharmacology (40 High-Yield Questions)

HTN-001 • Question 1

A definite contraindication to ACE inhibitors and ARBs is:

Asthma Unilateral renal artery stenosis Pregnancy Diabetes mellitus Hypokalemia

HTN-002 • Question 2

Which adverse effect is most characteristic of ACE inhibitors (and not ARBs)?

Peripheral edema Dry cough Hypercalcemia Reflex tachycardia Severe hypoglycemia

HTN-003 • Question 3

A patient develops lip/tongue swelling shortly after starting lisinopril. Best next step?

Add a diuretic and continue lisinopril Stop lisinopril; avoid ACE inhibitors in future Switch to another ACE inhibitor Treat with epinephrine only and restart later Add NSAID for swelling

HTN-004 • Question 4

Which drug is most associated with hyperkalemia and gynecomastia?

Hydrochlorothiazide Furosemide Spironolactone Amlodipine Hydralazine

HTN-005 • Question 5

Which diuretic is most effective for BP control when eGFR is ~20 mL/min/1.73m²?

Hydrochlorothiazide Chlorthalidone Furosemide Amiloride Acetazolamide

HTN-006 • Question 6

Which antihypertensive is considered relatively safe in pregnancy and acts via multiple mechanisms including 'false neurotransmitter' effects?

Lisinopril Losartan Methyldopa Aliskiren Spironolactone

HTN-007 • Question 7

Abrupt cessation of which agent can precipitate rebound hypertension/hypertensive crisis?

Hydrochlorothiazide Losartan Diltiazem Clonidine Amlodipine

HTN-008 • Question 8

A patient with hypertension and diabetes (albuminuria) needs first-line BP medication for kidney protection. Best choice:

Amlodipine Hydrochlorothiazide Lisinopril Hydralazine Minoxidil

HTN-009 • Question 9

Which is the most common cause of ankle edema among antihypertensive classes?

ACE inhibitors ARBs Dihydropyridine CCBs Beta blockers Thiazides

HTN-010 • Question 10

A patient with hypertension and asthma needs rate control in atrial fibrillation. Best option that also lowers BP:

Atenolol Metoprolol Verapamil Propranolol Nebivolol

HTN-011 • Question 11

Which BP medication is contraindicated in bilateral renal artery stenosis due to risk of acute kidney injury?

Amlodipine Hydrochlorothiazide Benazepril Hydralazine Prazosin

HTN-012 • Question 12

Thiazide diuretics can worsen which metabolic parameter most commonly?

Hyperkalemia Glucose intolerance Severe hypocalcemia Hypermagnesemia Respiratory acidosis

HTN-013 • Question 13

Preferred initial 2-drug combination for stage 2 hypertension (e.g., 165/100) in most patients:

ACE inhibitor + thiazide Beta blocker + alpha blocker Loop diuretic + nitrate Non-DHP CCB + beta blocker Direct renin inhibitor + ACE inhibitor

HTN-014 • Question 14

Which drug is most likely to cause hypertrichosis and pericardial effusion?

Hydralazine Minoxidil Clonidine Labetalol Diltiazem

HTN-015 • Question 15

Hydralazine is most associated with which adverse effect?

Agranulocytosis Drug-induced lupus Ototoxicity Angioedema Bradycardia

HTN-016 • Question 16

Which medication class is first-line for chronic hypertension in Black adults without CKD (general rule)?

ACE inhibitor ARB Thiazide diuretic or dihydropyridine CCB Alpha-1 blocker Central alpha-2 agonist

HTN-017 • Question 17

A patient on captopril has K+ 7.0 mEq/L and peaked T waves. Most likely mechanism?

Increased aldosterone secretion Decreased aldosterone secretion Increased ENaC activity Increased bicarbonate loss Increased calcium reabsorption

HTN-018 • Question 18

Which agent is a direct renin inhibitor?

Aliskiren Eplerenone Losartan Captopril Amlodipine

HTN-019 • Question 19

Hypertensive emergency (end-organ damage) initial management generally requires:

Oral clonidine at home Immediate normalization of BP to <120/80 IV titratable agent with controlled reduction (≈25% MAP in first hour) Start a thiazide and recheck in 3 months High-dose ACE inhibitor plus ARB

HTN-020 • Question 20

Best IV agent choice for hypertensive emergency with acute pulmonary edema/heart failure:

Nitroprusside or nitroglycerin Phenylephrine Epinephrine Verapamil bolus Oral amlodipine

HTN-021 • Question 21

A 65-year-old with isolated systolic hypertension needs drug therapy. Best initial class:

Thiazide diuretic or dihydropyridine CCB Central alpha-2 agonist Alpha-1 blocker monotherapy Direct vasodilator monotherapy Loop diuretic monotherapy

HTN-022 • Question 22

Which combination is contraindicated due to AV block/bradycardia risk?

ACE inhibitor + thiazide ARB + CCB Non-DHP CCB + beta blocker Thiazide + CCB ACE inhibitor + CCB

HTN-023 • Question 23

Thiazides increase calcium reabsorption and can be helpful for prevention of:

Nephrolithiasis from hypercalciuria Ototoxicity Hyperkalemia Pulmonary edema Atrial fibrillation

HTN-024 • Question 24

Which beta blocker has additional alpha-1 blocking activity?

Atenolol Metoprolol Labetalol Propranolol Bisoprolol

HTN-025 • Question 25

Primary hyperaldosteronism (Conn syndrome) is suggested by HTN plus:

Hyperkalemia Hypokalemia and metabolic alkalosis Severe bradycardia Hypercalcemia Low renin and low aldosterone

HTN-026 • Question 26

Best add-on medication for resistant hypertension (already on ACEi/ARB + CCB + thiazide) if K+ allows:

Spironolactone Hydralazine Clonidine Minoxidil Prazosin

HTN-027 • Question 27

Which agent is most likely to cause first-dose syncope/orthostatic hypotension?

Amlodipine Prazosin Losartan Hydrochlorothiazide Lisinopril

HTN-028 • Question 28

A patient with gout has HTN. Which drug may worsen gout via hyperuricemia?

Losartan Hydrochlorothiazide Amlodipine Lisinopril Diltiazem

HTN-029 • Question 29

Which ARB has a mild uricosuric effect?

Valsartan Losartan Candesartan Olmesartan Telmisartan

HTN-030 • Question 30

Hypertension with BPH symptoms: medication that may help urinary symptoms but is NOT first-line for HTN monotherapy:

Tamsulosin Prazosin Hydrochlorothiazide Lisinopril Amlodipine

HTN-031 • Question 31

A patient on amlodipine has bothersome pedal edema. Best strategy to reduce edema without losing BP control:

Increase amlodipine dose Add ACE inhibitor/ARB Stop all antihypertensives Add NSAID Switch to clonidine

HTN-032 • Question 32

Which drug class can mask adrenergic symptoms of hypoglycemia and cause bradycardia?

Dihydropyridine CCBs Beta blockers ACE inhibitors Thiazides Alpha-1 blockers

HTN-033 • Question 33

In hypertensive urgency (severe BP without acute end-organ damage), best approach is usually:

IV nitroprusside immediately Gradual reduction over 24–48 hours with oral meds and close follow-up Rapid drop to normal within minutes No treatment ever needed Start two ACE inhibitors

HTN-034 • Question 34

Which class can cause gingival hyperplasia?

Dihydropyridine CCBs ACE inhibitors ARBs Thiazides Central alpha-2 agonists

HTN-035 • Question 35

Which diuretic is most commonly associated with hyponatremia?

Hydrochlorothiazide Spironolactone Furosemide Amiloride Acetazolamide

HTN-036 • Question 36

A patient with stable ischemic heart disease (post-MI) and HTN: which class is high-yield for outcome benefit (when no contraindication)?

Alpha-1 blocker Beta blocker Hydralazine Minoxidil Methyldopa

HTN-037 • Question 37

Creatinine rises ~25% after starting ACE inhibitor in CKD, then stabilizes; K+ acceptable. Best action:

Stop ACE inhibitor immediately Continue and monitor; mild rise can be expected Add NSAID to reduce creatinine Switch to thiazide only Add ARB to ACE inhibitor

HTN-038 • Question 38

Severe-range BP in pregnancy requiring acute treatment: best option (typical inpatient protocols):

ACE inhibitor ARB IV labetalol or IV hydralazine Aliskiren Spironolactone

HTN-039 • Question 39

Which electrolyte effect is most associated with thiazides (vs loops) regarding calcium?

Hypocalcemia Hypercalcemia No effect on calcium Severe hypermagnesemia Severe metabolic acidosis

HTN-040 • Question 40

Starting spironolactone for resistant HTN: which labs must be monitored closely soon after initiation?

AST/ALT Potassium and creatinine CK TSH INR