CARDIOVASCULAR – ANTIHYPERTENSIVES
1. Which of the following statements regarding antihypertensives and their site of action is
INCORRECT?
a. Vasomotor centre – methyldopa
b. Beta receptors of the heart – propranolol
c. Alpha receptors of vessels – hydralazine
d. Vascular smooth muscle – nitroprusside
e. Angiotensin receptors of vessels – losartan
2. Hydralazine
a. Dilates veins but not arterioles – arterioles >veins
b. Has low first pass metabolism – well absorbed, high FPM – 25% BA
c. Works best as single therapy for hypertension – often in combination
d. In patients with ischaemic heart disease, may provoke angina or ischaemic arrythmias – due to
reflex tachycardia
e. Has a half life of 10-12 hours – low t½ but effects last longer due to tissue binding
3. Hydralazine
a. classically has a biphasic response to BP control
b. should not be used in eclampsia
c. causes significant postural hypotension – no, but causes reflex tachycardia
d. predominantly a vasodilator - correct
e. ?
4. Diazoxide
a. can be used in a hypertensive emergency – true
b. structurally related to thiazide – true, but has no diuretic activity
c. ?
d. ?
e. ?
5. ACE inhibitors
a. Can be used in second and third trimesters – no, cause fetal hypotension, renal failure
b. Have been associated with angioedema - true
c. ?
d. ?
e. ?
6. alpha methyl-dopa
a. can cause a positive Coombs test
b. is a potent vasoconstrictor
c. ?
d. ?
e. ?
7. prazosin
a. has a half life of 18 hours – 3-4hr
b. adversely affects lipid profiles – b-blockers do this
c. produces a reflex bradycardia – selective a1 blocker, so less reflex tachy than non-selective
d. has a first dose hypotensive effect
e. can increase CO by decreasing preload and leaving afterload unchanged – works on both
resistance and capacitance
8. Female patient on ACE inhibitor, which is most likely to impair hypotensive effects?
a. Prostaglandin inhibitor (indomethacin)
b. ?
c. ?
d. ?
e. ?
9. With respect to angiotensin converting enzyme (ACE) inhibitors:
a. Decreased levels of bradykinin are associated with their use
b. They cause reflex tachcardia
c. There is a strong correlation between plasma renin activity and antihypertensive response
d. Concomitant use of NSAIDs may decrease the hypotensive effects
e. Most ACE inhibitors are cleared by hepatic metabolism – mostly renal
10. Which of the following is selective for arteriolar dilation only?
a. Glyceryl trinitrate
b. Nifedipine
c. Prazosin
d. Hydralazine – arteries, not veins
e. Clonidine
11. With regard to sodium nitroprusside, which is not true?
a. It dilates both arterial and venous vessels - true
b. Toxicity can be managed with sodium thiosulfate and hydroxycobalamin -?
c. It is rapidly metabolized by the liver to cyanide and to thiocyanate – rapidly by RBCs -> cyanide,
then by liver -> thiocyanate
d. It acts by activating guanylyl cyclase - true
e. Its effects disappear within 1 to 10 minutes of discontinuing an infusion - true
12. Regarding methyl-dopa, which is NOT true?
a. It undergoes extensive metabolism by GIT mucosa resulting in low bioavailability
b. It is metabolized to alpha-methylnoradrenaline in order to be active
c. Its antihypdertensive effect results primarily from peripheral action – central -adrenoceptors
d. Long use is associated with a positive Coombs test and haemolytic anaemia
e. Common side effects are sedation and impaired concentration
13. Regarding antihypertensive medication
a. Thiazide diuretics are the drugs of choice in cases of moderate to severe hypertension
b. Losartan inhibits synthesis of angiotensin II
c. Clonidine causes a brief rise in blood pressure followed by prolonged hypotension - true
d. Propranolol does not prevent reflex tachycardia
e. Bioavailability of captopril may increase if taken with food
14. The adverse effects of captopril include
a. Hypokalaemia – hyperkalaemia (esp w/ K sparring diuretics)
b. Hypoglycaemia – no, prolonged hypoglycemia in T1DM due to decr glycogenolyis
c. Increased cholesterol – b-blocker
d. Polycythaemia -?
e. Dry cough - true
15. Hydralazine
a. May provoke angina through reflex sympathetic stimulation - true
b. Exerts its effect through arteriolar and venous dilation – arterioles, not veins
c. Decreases heart rate – reflex tachy
d. Has high oral bioavailability
e. Tachyphylaxis precludes intravenous use
16. Inhibition of angiotensin converting enzyme results in which of the following?
a. A decrease in vascular tone
b. Inhibition of aldosterone release
c. Increase in plasma renin activity
d. All of the above
e. None of the above
17. Indications for an ACEI include all of the following EXCEPT:
a. Hypertension
b. Heart failure
c. Diabetic nephropathy
d. Post myocardial infarct
e. Angioedema
18. AT2 receptor antagonists have which of the following actions?
a. Inhibit increased aldosterone release
b. Reduce K+ plasma concentration
c. Reduce Na+ plasma concentration
d. Inhibit bradykinin breakdown
e. Inhibit H+ secretion
19. Sodium nitroprusside
a. Increases cGMP by release of nitric oxide
b. Decreases vascular resistance but increases blood pressure
c. Is a complex of calcium and cyanide groups
d. Is predominantly an arterodilator
e. Has its onset of action in 10-15 minutes
20. ACE inhibitors
a. Cause a concomitant reduction in bradykinin
b. Directly inhibit angiotensin receptors
c. Work predominantly by venodilation
d. Can cause angioneurotic oedema
e. Are only available intravenously
21. Regarding diazoxide, which of the following is INCORRECT?
a. Is used to treat severe hypertension
b. Acts by direct smooth muscle relaxation
c. Causes salt and water retention
d. ?
e. is a thiazide derivative
22. Hydralazine
a. Causes an abrupt but transient fall in blood pressure
b. Displays a biphasic blood pressure response
c. ?
d. ?
e. ?
23. Losartan differs from enalapril in:
a. Its selective action on angiotensin type 1 receptors
b. Its enhanced effect on bradykinin metabolism
c. Its prolonged half life
d. Its higher incidence of drug related angioedema
e. Its increased incidence of cough
24. All of the following anti-hypertensives act directly on vascular smooth muscle EXCEPT:
a. Felodipine
b. Nitroprusside
c. Indapamide
d. Prazosin
e. Hydralazine