Lippincott Chapter 17: Antihypertensives Flashcards
17.1 A 45-year-old man was just started on therapy for
hypertension and developed a persistent, dry cough.
Which is most likely responsible for this side effect?
A. Enalapril.
B. Losartan.
C. Nifedipine.
D. Prazosin.
E. Propranolo
Correct answer = A. The cough is most likely an adverse
effect of the ACE inhibitor enalapril. Losartan is an ARB
that has the same beneficial effects as an ACE inhibitor but
is less likely to produce a cough. Nifedipine, prazosin, and
propranolol do not cause this side effect.
17.2 Which may cause reflex tachycardia and/or postural
hypotension on initial administration?
A. Atenolol.
B. Hydrochlorothiazide.
C. Metoprolol.
D. Prazosin.
E. Verapamil.
Correct answer = D. Prazosin produces first-dose hypoten-
sion, presumably by blocking α1
receptors. This effect is
minimized by initially giving the drug in small, divided doses.
The other agents do not have this adverse effect.
17.3 Which can precipitate a hypertensive crisis following
abrupt cessation of therapy?
A. Clonidine.
B. Diltiazem.
C. Enalapril.
D. Losartan.
E. Hydrochlorothiazide.
Correct answer = A. Increased sympathetic nervous system
activity occurs if clonidine therapy is abruptly stopped after
prolonged administration. Uncontrolled elevation in blood
pressure can occur. Patients should be slowly weaned
from clonidine while other antihypertensive medications
are initiated. The other drugs on the list do not produce this
phenomenon.
17.4 A 48-year-old hypertensive patient has been
successfully treated with a thiazide diuretic for the last 5
years. Over the last 3 months, his diastolic pressure has
steadily increased, and he was started on an additional
antihypertensive agent. He complains of several
instances of being unable to achieve an erection and
not being able to complete three sets of tennis as he
once did. Which is the likely second antihypertensive
medication?
A. Captopril.
B. Losartan.
C. Metoprolol.
D. Minoxidil.
E. Nifedipine.
Correct answer = C. The side effect profile of β-blockers,
such as metoprolol, is characterized by interference with
sexual performance and decreased exercise tolerance.
None of the other drugs is likely to produce this combina-
tion of side effects.
17.5 A 40-year-old male has recently been diagnosed with
hypertension due to pressure readings of 163/102
and 165/100 mm Hg. He also has diabetes that is well
controlled with oral hypoglycemic medications. Which
is the best initial treatment regimen for treatment of
hypertension in this patient?
A. Felodipine.
B. Furosemide.
C. Lisinopril.
D. Lisinopril and hydrochlorothiazide.
E. Metoprolol.
Correct answer = D. Because the systolic blood pressure
is more than 20 mm Hg above goal (10 mm Hg above goal
diastolic), treatment with two different medications is pre-
ferred. Because the patient is diabetic, he also has a com-
pelling indication for an ACE inhibitor or ARB
17.6 A 60-year-old white female has not reached her blood
pressure goal after 1 month of treatment with a low dose
of lisinopril. All of the following would be appropriate
next steps in the treatment of her hypertension except:
A. Increase dose of lisinopril.
B. Add a diuretic medication.
C. Add on a calcium channel blocker medication.
D. Add on an ARB medication.
Correct answer = D. Increasing the dose of lisinopril or add-
ing a second medication from a different class (such as a
calcium channel blocker or diuretic) would be appropriate
steps to control the blood pressure. Adding an ARB as the
second medication is not recommended. ARBs have a simi-
lar mechanism of action to ACE inhibitors, and combination
therapy may increase the risk of adverse effects.
17.7 A patient returns to her health care provider for routine
monitoring 3 months after her hypertension regimen
was modified. Labs reveal elevated serum potassium.
Which is likely responsible for this hyperkalemia?
A. Chlorthalidone.
B. Clonidine.
C. Furosemide.
D. Losartan.
E. Nifedipine.
Correct answer = D. Losartan, an ARB, can cause an
increase in serum potassium similar to ACE inhibitors.
Furosemide and chlorthalidone can cause a decrease in
serum potassium. Nifedipine and clonidine do not affect
potassium levels.
17.8 A 58-year-old female reports that she recently stopped
taking her blood pressure medications because of
swelling in her feet that began shortly after she started
treatment. Which is most likely to cause peripheral
edema?
A. Atenolol.
B. Clonidine.
C. Felodipine.
D. Hydralazine.
E. Prazosin.
Correct answer = C. Peripheral edema is one of the most
common side effects of calcium channel blockers. None of
the other agents commonly cause peripheral edema.
17.9 Which is an appropriate choice for hypertension
treatment during pregnancy?
A. Aliskiren.
B. Fosinopril.
C. Hydralazine.
D. Valsartan.
Correct answer = C. Hydralazine is an appropriate choice
for a hypertensive pregnant patient. ACE inhibitors, ARBs,
and the direct renin inhibitor, aliskiren, are all contraindi-
cated in pregnancy due to their potential for fetal harm.
17.10 DD is a 50-year-old male with newly diagnosed
hypertension. His comorbidities include diabetes
and chronic hepatitis C infection with moderate liver
impairment. He requires two drugs for initial treatment
of his hypertension. Which should be prescribed in
combination with a thiazide diuretic?
A. Lisinopril.
B. Spironolactone.
C. Fosinopril.
D. Furosemide.
E. Hydralazine.
Correct answer = A. Because DD has diabetes, he has
a compelling indication for an ACE inhibitor or ARB for
the treatment of his hypertension and prevention of dia-
betic nephropathy. However, most ACE inhibitors undergo
hepatic conversion to active metabolites, so his hepatic
impairment is of concern. Because lisinopril is one of the
two ACE inhibitors that does not undergo hepatic conver-
sion to active metabolites, it is the best choice. Fosinopril is
the only ACE inhibitor that is not eliminated primarily by the
kidneys but does undergo hepatic conversion. An additional
diuretic like spironolactone or furosemide is not indicated.
DD does not have a compelling indication for hydralazine.
