AGNP CORE EXAM EVALUATION QUESTIONS WITH
ANSWERS 2025/2026 GRADED A
HTN management first line - lifestyle modification
diet rich in K/mag/Ca, decrease Na
decrease weight, exercise, no ETOH/tob
Follow up in 1-2 weeks to reassess lifestyle mod.
Trial of lifestyle mod&nonpharm for up to 6mnths
Sodium daily for elderly, AA, DM, HTN pts - sodium <2000mg/d
HTN target BP for JNC 8 - >60 = <150/90
<60, DM/CKD = <140/90
HTN target BP for ACC/AHA - <130/80
Calculate ASCVD score, significant = 10yr risk of >10%
Diagnosis of HTN general population (no DM/CKD) - >60 = <150/90
<60 = <140/90
Diagnosis of HTN (with DM/CKD) - DM only = <140/90
DM & CKD = <140/90
1st line pharmocology for HTN - Thiazide diuretics
CCB
ACE/ARB
Use of beta blockers - use with preexisting heart disease or with migraines, CAD, CHF
Pharmacology for HTN for African Americans - Thiazide or CCB
Pharm for HTN for Non-blacks, with DM - Thiazide or CCB OR ACE/ARB
Stage 1 without TOD/CV risk - non-pharm interventions, outpatient BP/home
measurements, up to 6month eval before starting meds.
Confirm with 3 readings
after med initiation, follow up 2-3 weeks
BMP at baseline and at follow up
Partial response to 1 medication but not at goal - increase dose or add second
medication in first line choice
No response to 1 medication - change to different med in first line choice.
Max all 1st line before moving to 2nd line
,Stage 1 with TOD/CV risk - evaluate BP over 3 months, consider % of risk and patient
characteristics.
Stage 2 with TOD/CV risk - immediate non-pharm therapy
if BP is not at goal in 1-2 weeks, add 1st line agent
less wait time to initiation w/ severity of HTN/profile risk
Thiazide diuretics - enhance Na excretion reducing intravascular volume and peripheral
vascular volume
HCTZ, metalazone, chlorthalidone
S/E of thiazide diuretics - hypokalemia, hyponatremia, increased uric acid/GOUT
monitor K, Na, uric acid, glucose
CCB non-dihydropyridines - Verapamil, Diltiazem
Affect automaticity and conduction, can cause bradycardia/heart block
s/e: slows conduction thru AV node, arrythmias, bradycardia, sinus block, av block,
edema
CCB: Dihydropyridines - Norvasc, Nicardipine, nifedipine, felodipine
decrease peripheral resistance
mild naturesis, well tolerated, good in AAand elderly
used in angina, HTN, Afib, atrial tachycardia
ACE-I - Lisinopril, Benzapril, Captopril, Ramipril
blocks conversion of angiotensin 1 to 2, which blocks the production of aldosterone,
arterioles dilate and PVR is reduced
s/e of ACE - dry cough
ACE-I used in - LV failure, dec EF, post MI
first choice for DM, CKD
NOT used in bilateral renal artery stenosis
ACE-I considerations - baseline Creatinine, monitor, must be stable because ACE's
increase creat.
Can tolerate up to 35% rise
monitor BMP for Cr and K
ARBs - blocks ngiotensin 2 receptor--> blocks stimulation of aldosterone.
no effect on bradykinin associated w/ cough and angioedema!
no benefit when ACE/ARB are combined.
can used with DM and CHF
, s/e of ARBs - increased K. ARF if used with bilateral renal artery stenosis
Beta Blockers - reduce cardiac output, renin, catecholamine release and decrease
peripheral resistance
blocks adrenergic B1 receptors and dec HR
used in preexisting heart conditions
cardioselective beta blockers - B1
preferred w/ asthma and COPD
metoprolol succinate/tartrate, atenolol
less sexual dysfunction
Noncardioselective beta blockers - B1 and B2
more lipid soluble, CNS penetration, crosses bb barrier
propanolol, nadolol, good w/ migraines
Alpha-1 Beta Adrenergic - alpha blockade dilation of peripheral blood vessels and B1
effects
Labetolol, Carvedilol
Second line therapy for HTN is used in... - renal failure or those with refractory to
combination of first line agents.
Second line therapy HTN examples - alpha blockers
loop/K sparing diuretics
centrally acting sympatholytics
direct vasodilators
Alpha blockers - dilation of arterial and venous blood vessels via SNS
less reflex tachy
Doxazosin, Terazosin
HS dosing! d/t orthostasis
useful in BPH, it relaxes the bladder and muscle tone
Loop diuretics - Decreases Na reabsorption = inc Na and H2o loss
Lasix, Bumex, Toresimide
S/e = decrease K/Na/Cl/mag. Inc glycemia/LDLs
K sparing diuretics - used with thiazide or loop to reduce decreases in K.
spironolactone
Extreme caution w/ CKD. Avoid Cr >2.5 and with the use of ARBs/ACEs!
Central acting Sympatholytics - causes Na retention, used with a diuretic
clonidine, methyldopa
CNS s/e--drowsy, fatigue, impotence, dry mouth
rebound HTN w/ abrupt cessation
ANSWERS 2025/2026 GRADED A
HTN management first line - lifestyle modification
diet rich in K/mag/Ca, decrease Na
decrease weight, exercise, no ETOH/tob
Follow up in 1-2 weeks to reassess lifestyle mod.
Trial of lifestyle mod&nonpharm for up to 6mnths
Sodium daily for elderly, AA, DM, HTN pts - sodium <2000mg/d
HTN target BP for JNC 8 - >60 = <150/90
<60, DM/CKD = <140/90
HTN target BP for ACC/AHA - <130/80
Calculate ASCVD score, significant = 10yr risk of >10%
Diagnosis of HTN general population (no DM/CKD) - >60 = <150/90
<60 = <140/90
Diagnosis of HTN (with DM/CKD) - DM only = <140/90
DM & CKD = <140/90
1st line pharmocology for HTN - Thiazide diuretics
CCB
ACE/ARB
Use of beta blockers - use with preexisting heart disease or with migraines, CAD, CHF
Pharmacology for HTN for African Americans - Thiazide or CCB
Pharm for HTN for Non-blacks, with DM - Thiazide or CCB OR ACE/ARB
Stage 1 without TOD/CV risk - non-pharm interventions, outpatient BP/home
measurements, up to 6month eval before starting meds.
Confirm with 3 readings
after med initiation, follow up 2-3 weeks
BMP at baseline and at follow up
Partial response to 1 medication but not at goal - increase dose or add second
medication in first line choice
No response to 1 medication - change to different med in first line choice.
Max all 1st line before moving to 2nd line
,Stage 1 with TOD/CV risk - evaluate BP over 3 months, consider % of risk and patient
characteristics.
Stage 2 with TOD/CV risk - immediate non-pharm therapy
if BP is not at goal in 1-2 weeks, add 1st line agent
less wait time to initiation w/ severity of HTN/profile risk
Thiazide diuretics - enhance Na excretion reducing intravascular volume and peripheral
vascular volume
HCTZ, metalazone, chlorthalidone
S/E of thiazide diuretics - hypokalemia, hyponatremia, increased uric acid/GOUT
monitor K, Na, uric acid, glucose
CCB non-dihydropyridines - Verapamil, Diltiazem
Affect automaticity and conduction, can cause bradycardia/heart block
s/e: slows conduction thru AV node, arrythmias, bradycardia, sinus block, av block,
edema
CCB: Dihydropyridines - Norvasc, Nicardipine, nifedipine, felodipine
decrease peripheral resistance
mild naturesis, well tolerated, good in AAand elderly
used in angina, HTN, Afib, atrial tachycardia
ACE-I - Lisinopril, Benzapril, Captopril, Ramipril
blocks conversion of angiotensin 1 to 2, which blocks the production of aldosterone,
arterioles dilate and PVR is reduced
s/e of ACE - dry cough
ACE-I used in - LV failure, dec EF, post MI
first choice for DM, CKD
NOT used in bilateral renal artery stenosis
ACE-I considerations - baseline Creatinine, monitor, must be stable because ACE's
increase creat.
Can tolerate up to 35% rise
monitor BMP for Cr and K
ARBs - blocks ngiotensin 2 receptor--> blocks stimulation of aldosterone.
no effect on bradykinin associated w/ cough and angioedema!
no benefit when ACE/ARB are combined.
can used with DM and CHF
, s/e of ARBs - increased K. ARF if used with bilateral renal artery stenosis
Beta Blockers - reduce cardiac output, renin, catecholamine release and decrease
peripheral resistance
blocks adrenergic B1 receptors and dec HR
used in preexisting heart conditions
cardioselective beta blockers - B1
preferred w/ asthma and COPD
metoprolol succinate/tartrate, atenolol
less sexual dysfunction
Noncardioselective beta blockers - B1 and B2
more lipid soluble, CNS penetration, crosses bb barrier
propanolol, nadolol, good w/ migraines
Alpha-1 Beta Adrenergic - alpha blockade dilation of peripheral blood vessels and B1
effects
Labetolol, Carvedilol
Second line therapy for HTN is used in... - renal failure or those with refractory to
combination of first line agents.
Second line therapy HTN examples - alpha blockers
loop/K sparing diuretics
centrally acting sympatholytics
direct vasodilators
Alpha blockers - dilation of arterial and venous blood vessels via SNS
less reflex tachy
Doxazosin, Terazosin
HS dosing! d/t orthostasis
useful in BPH, it relaxes the bladder and muscle tone
Loop diuretics - Decreases Na reabsorption = inc Na and H2o loss
Lasix, Bumex, Toresimide
S/e = decrease K/Na/Cl/mag. Inc glycemia/LDLs
K sparing diuretics - used with thiazide or loop to reduce decreases in K.
spironolactone
Extreme caution w/ CKD. Avoid Cr >2.5 and with the use of ARBs/ACEs!
Central acting Sympatholytics - causes Na retention, used with a diuretic
clonidine, methyldopa
CNS s/e--drowsy, fatigue, impotence, dry mouth
rebound HTN w/ abrupt cessation
