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Dr. Austin Antihypertensives

Total questions: 74

Worksheet time: 2hrs 5mins

Name
Class
Date
1.

Which of the following represents Cardiac Outpout? Select all that apply

a)

SVR = ΔP / Q

b)

stroke volume (SV) x heart rate

c)

(HR)– units: [volume] / [time] (such as liters/minute)

d)

(such as ml/minute)

2.

SVR (or peripheral vascular resistance (PVR)) is represented by MAP ≈ CO x SVR

a)

True

b)

False

3.

Is the maximum pressure in mmHg during a heartbeat (occurs during ventricular contraction) - the pressure that the ventricles contract against is called afterload.

a)

Systole (“to squeeze”):

b)

Diastole (“to dilate”):

4.

Is the minimum pressure in mmHg during a heartbeat (occurs during relaxation)–end diastolic ventricular volume is called preload

a)

Systole (“to squeeze”)

b)

Diastole (“to dilate”)

5.

Understand this!

a)

Yes

b)

No

6.

Baroreceptors detect increase in BP → increase firing rate → decrease central sympathetic outflow → decreased CO and decreased vasoconstriction.

a)

True

b)

False

7.

Understand this!

a)

Yes

b)

No

8.

Know this

a)

Yes

b)

No

9.

Which of the following are major risk factors for Hypertension? Select all that apply

a)

heart disease

b)

stroke

c)

vascular disease

d)

chronic kidney disease

e)

vision loss

dementia

10.

Secondary Hypertension may occur by which of the following? Select all that apply

a)

sleep apnea

b)

drug/alcohol use/smoking

c)

certain endocrine disorders

d)

pregnancy

e)

aging

11.

Primary (essential) hypertension may occur by which of the following? Select all that apply

a)

sedentary lifestyle

b)

obesity

c)

diet

d)

aging

e)

drug/alcohol use/smoking

12.

Which of the following statements best describe the General strategies of Antihypertensive Targets? Select all that apply

a)

Inhibit renin-angiotensin-aldosterone system (RAAS)

b)

Decrease blood volume

c)

Blood vessel dilation

d)

Sympatholytics

13.

Thiazide and thiazide-like diuretics increase urination and decrease blood volume. Thiazides are most diuretics most often used for HTN.

a)

True

b)

False

14.

Which of the following best describe the MOA for Hydrochlorothiazide (HCTZ)? Select all that apply

a)

Decrease Ca2+ reabsorption (calcium sparing)

b)

inhibit reabsorption Na/Cl at distal tubule

c)

↑ Ca2+ reabsorption (calcium sparing)

d)

inhibit reabsorption Na/Cl at the Loop of Henle.

15.

Which of the following best describe the ADRs and other effects of Hydrochlorothiazide (HCTZ)? Select all that apply

a)

↑ uric acid

b)

metabolic/electrolyte disruption (increase glucose, lipids)

c)

↓ Na+, Mg2+, K+

d)

allergic reaction due to Sulfa group

16.

Which of the following best describes the MOA for the Calcium Channel Blockers?

a)

inhibit reabsorption Na/Cl at distal tubule

b)

block L-type voltage-gated calcium channels of cardiac muscle and/or blood vessels (“L” → “long lasting” length of activation)

c)

↑ Ca2+ reabsorption (calcium sparing)

d)

Inhibition/slowing of Ca2+-dependent action potentials of cardiac pacemaker cells

17.

Calcium Channel Blockers are often used in specific population like elderly and

African ancestry.

a)

True

b)

False

18.

Calcium Channel Blockers are divided into what two groups? Select all that apply

a)

Dihydropyridines

b)

NON-dihydropyridines

c)

Dipyridamole

d)

NON-Dipyridamole

19.

Which of the following CCB drugs are classified as Dihydropyridines? Select all that apply

a)

Nifedipine

b)

Felodipine

c)

Amlodipine

d)

Diltiazem

e)

Verapamil

20.

Which of the following CCB drugs are classified as NON-Dihydropyridines? Select all that apply

a)

Felodipine

b)

Amlodipine

c)

Nifedipine

d)

Diltiazem

e)

Verapamil

21.

Which of the following drugs is classified as a 1st generation Dihydropyridine under CCB?

a)

Felodipine

b)

Amlodipine

c)

Nifedipine

d)

Diltiazem

e)

Verapamil

22.

 

Which of the following drugs is classified as a 2nd generation Dihydropyridine under CCB?

a)

Felodipine

b)

Amlodipine

c)

Nifedipine

d)

Verapamil

e)

Diltiazem

23.

Which of the following drugs is classified as a 3rd generation Dihydropyridine under CCB?

a)

Felodipine

b)

Amlodipine

c)

Nifedipine

d)

Diltiazem

e)

Verapamil

24.

Know this!

a)

Yes

b)

No

25.

Which of the following statements are TRUE about Diltiazem? Select all that apply

a)

its selectivity is Cardiac muscle > arterial smooth muscle

b)

under

Benzothiazepine

CCB class

c)

its binding site is extracellular

d)

its binding site is intracellular

26.

Which of the following statements are TRUE about Verapamil? Select all that apply

a)

its selectivity is Cardiac muscle

b)

its binding site is extracellular

c)

its binding site is intracellular

d)

its under Phenylalkylamine CCB class

27.

 

Which of the following statements are TRUE about Nifedipine? Select all that apply

a)

its binding site is extracellular

b)

1st generation

c)

its selectivity is Arterial smooth muscle

d)

its under Dihydropyridine CCB class

e)

its binding site is intracellular

28.

A patient presents to your pharmacy with a prescription for an antihypertensive. She reports an allergy to sulfa. You state that you would like to contact her prescriber because:

a)

Rx is for clonidine (risk of cross sensitivity due to imidazoline group)

b)

Rx is for hydrochlorothiazide (risk of cross sensitivity due to imidazoline group)

c)

Rx is for hydrochlorothiazide (risk of cross sensitivity due to sulfonamide group)

d)

Rx is for clonidine (risk of cross sensitivity due to sulfonamide group)

29.

Amlodipine targets which of the following general strategies for treating hypertension?

a)

Inhibit blood vessel constriction

b)

Decrease activity of SNS

c)

Decrease circulating blood volume

d)

Inhibit RAAS activation

30.

Know this

a)

Yes

b)

No

31.

Which of the following statements are TRUE about Non-DHP CCBs? Select all that apply

a)

Verapamil is most selective for cardiac muscle Ca2+ channels

b)

Diltiazem

binds cardiac Ca2+ channels > smooth muscle Ca2+ channels

c)

Both are basic due to amine functional groups

d)

Both Verapamil and Diltiazem undergo CYP metabolism

substrates of 2D6 and 3A4

inhibitors of 3A4

e)

Both Nifedipine and Felodipine undergo CYP metabolism

substrates of 2D6 and 3A4

inhibitors of 3A4

32.

Substrates of 2D6 and 3A4 and inhibitors of 3A4 are potential for drug interactions (DIs) in the Non-DHP CCBs.

a)

True

b)

False

33.

 

Which of the following statements are TRUE about Non-DHP CCBs? Select all that apply

a)

Inhibition/slowing of Ca2+-dependent action potentials of cardiac pacemaker cells

b)

Inhibit Ca2+ channels of myocardium

decrease force of contraction (negative inotrope)

c)

Decrease myocardial O2 demand

d)

Useful in hypertension with concurrent arrhythmias

34.

Which of the following statements are TRUE about DHP CCBs: SAR? Select all that apply

a)

pharmacophore: 1,4-dihydropyridine

b)

perpendicular, substituted (R4 and R5) phenyl ring at position 4 improves activity

c)

ortho and meta substituents beneficial (lock conformation)

d)

substitution at R1 may enhance potency and extend duration

35.

Which of the following statements are TRUE about R1 group in this image of DHP CCBs: SAR?

a)

substitution at R1 may enhance potency and extend duration

b)

perpendicular, substituted (R1) phenyl ring at position 4 improves activity

c)

ortho and meta substituents beneficial (lock conformation)

36.

Which of the following statements are TRUE about R2 group in this image of DHP CCBs: SAR?

a)

perpendicular, substituted (R2) phenyl ring at position 4 improves activity

b)

ortho and meta substituents beneficial (lock conformation)

c)

substitution at R2 may enhance potency and extend duration

37.

Which of the following statements are TRUE about R4 and R5 group in this image of DHP CCBs: SAR?

a)

substitution at R1 may enhance potency and extend duration

b)

ortho and meta substituents beneficial (lock conformation)

c)

perpendicular, substituted (R4 and R5) phenyl ring at position 4 improves activity

38.

If we substitute the R4 and R5 group for two Cl it will become which of the following drugs?

a)

Felodipine

b)

Nifedipine

c)

Amlodipine

d)

Myrbetriq

39.

If we substitute the R4 for Cl and R5 group for H it will become which of the following drugs?

a)

Felodipine

b)

Amlodipine

c)

Nifedipine

d)

Myrbetriq

40.

The DHP CCBs in the relaxation of smooth muscle will cause reflex tachycardia.

a)

True

b)

False

41.

Which of the following are considered ADR for NON-DHPs CCBs? Select all that apply

a)

headache

b)

AV block

c)

constipation

d)

bradycardia

e)

extreme caution in cardiomyopathy

42.

The CCBs has fewer CNS and metabolic ADRs and minimal direct effects on renal function and used in Pregnancy C.

a)

True

b)

False

43.

Know this

a)

Yes

b)

No

44.

Which of the following drug candidates would be the best choice to test as a DHP CCB?

a)
b)
c)
d)
45.

Understand this!

a)

Yes

b)

No

46.

Desmopressin (DDAVP) is a synthetic derivative of ADH used for conditions such as diabetes insipidus.

a)

True

b)

False

47.

Which of the following statements are TRUE about Angiotensin II? Select all that apply

a)

stimulates release of aldosterone, which enhances sodium and water retention

b)

vasoconstriction of arterioles (in glomerular arterioles effect on efferent > than afferent) → raises BP and decreases renal blood flow

c)

is responsible for many of the effects associated with RAAS activation

d)

stimulates release of anti-diuretic hormone (ADH; also known as vasopressin) from pituitary gland which further enhances sodium and water retention

48.

Prostaglandins can also stimulate renin secretion.

a)

True

b)

False

49.

Know this

a)

Yes

b)

No

50.

Inflammatory mediator and vasodilator (induces release of substances such as NO and prostacyclin).

a)

Bradykinin

b)

Prostaglandins

51.

Which of the following is the MOA for Renin Inhibitor?

a)

prevent conversion of angiotensinogen to angiotensin I

b)

block L-type voltage-gated calcium channels of cardiac muscle and/or blood vessels

52.

Which of the following statements are TRUE about Renin Inhibitor? Select all that apply

a)

Boxed warning: fetal toxicity

b)

aliskiren (Tekturna®)

c)

Warnings: hyperkalemia, angioedema, hypotension, decline in renal function (especially early in therapy; ↑SCr and BUN)

d)

prevent conversion of angiotensinogen to angiotensin I

e)

DIs: caution with ACE inhibitors, NSAIDs, potassium sparing agents

53.

Which of the following drugs classifications will cause fetal toxicity as a Boxed Warning? Select all that apply

a)

Renin Inhibitor

b)

ACE Inhibitors (ACEIs) “-pril”

c)

CCB

d)

Angiotensin Receptor Blockers (ARBs) “sartan”

54.

Which of the following statements are TRUE about ACE Inhibitors (ACEIs) “-pril”? Select all that apply

a)

Boxed warning: fetal toxicity

b)

bind Zn2+, arginine residue, and two hydrophobic pockets of ACE

(these four binding interactions are required for ACEIs)

c)

inhibit conversion of angiotensin I to angiotensin II

also blocks degradation of bradykinin

d)

Most are prodrugs (except: lisinopril, captopril, enalapril)

ester improves bioavailability (is then hydrolyzed)

e)

prevent conversion of angiotensinogen to angiotensin I

55.

Which of the following is the only IV ACE Inhibitor?

a)

Ramipril

b)

Enalapril

c)

Monopril

d)

Lisinopril

56.

ACE Inhibitors are most metabolized by phase II conjugation.

a)

True

b)

False

57.

Which of the following are TRUE about the role of Bradykinin? Select all that apply

a)

inflammatory peptide is not degraded (due to inhibition of ACE)

b)

cough: sensitization of sensory neurons increases cough reflex

described as dry, hacking cough

c)

angioedema: increased vascular permeability; most pronounced in head and neck

d)

Neutral effects

58.

Know this!

a)

Yes

b)

No

59.

Most ACEIs; second carboxylate formed by ester hydrolysis.

a)

True

b)

False

60.

Which of the following statements describe this image? Select all that apply

a)

thiol (sulfhydryl) may be associated with taste disturbances and rash

b)

Sulfur containing

c)

Captopril

d)

thiol (sulfhydryl)

interacts with the ACE Zn2+ ion

e)

Fosinopril

61.

Which of the following statements describe this image? Select all that apply

a)

Fosinopril

b)

Captopril

c)

the phosphinate is hydrolyzed to phosphinic acid (prodrug)

d)

this group interacts with the ACE Zn2+ ion

e)

Benazepril

62.

Which of the following statements describe this image? Select all that apply

a)

Dicarboxylate

b)

Benazepril

c)

most ACEIs; second carboxylate formed by ester hydrolysis

d)

Captopril

63.

Understand this!

a)

Yes

b)

No

64.

Which of the following statements are TRUE regarding Angiotensin Receptor Blockers (ARBs) “sartan”? Select all that apply

a)

Boxed warning: fetal toxicity

b)

most are metabolized by phase II conjugation (glucuronidation)

c)

Competitive antagonists of AT1 receptors

d)

Include a tetrazole and/or imidazole groups

e)

metabolites are inactive (exception: losartan has active metabolite)

65.

Which of the following are ADRs for ARBs? Select all that apply

a)

angioedema (less risk)

b)

headache, (slight) increase in risk of MI

c)

hyperkalemia

d)

hypotension, dizziness

66.

Which of the following will cause Drug Interactions with ARBs? Select all that apply

a)

hypotensive (including other RAAS inhibitors)

b)

diuretics

c)

NSAIDs

d)

Acetaminophen

67.

Understand this!

a)

Yes

b)

No

68.

Decrease volume/preload

a)

Diuretics

b)

Vasodilators

69.

Open K+ channels and hyperpolarize membrane, prevents depolarization and activation of voltage-dependent Ca2+ channels. Not preferred agents for hypertension

a)

Diuretics

b)

Vasodilators

70.

Which of the following drugs will cause tachycardia, Na+ retention, lupus-like syndrome as ADRs.

a)

Hydralazine

b)

Lisinopril

71.

Which of the following drugs is reserved for severe hypertension ?

a)

Minoxidil

b)

Hydralazine

72.

Inhibit sodium/water retaining effects of aldosterone

a)

Diuretics

b)

Aldosterone antagonists

73.

Inpatient hypertensive emergency: nitroprusside (releases NO; IV use only → may be lethal if taken orally)

a)

True

b)

False

74.

Which of the following is an effect of angiotensin II that may be decreased by inhibiting RAAS?

a)

Growth of cardiovascular cells

b)

Release of aldosterone

c)

Vascular smooth muscle relaxation

d)

Activity of parasympathetic nervous system

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