Antihypertensives Mastery Exam – Updated 150
Questions & Rationales
2025/2026
1. Which class of drugs is considered first-line therapy for
hypertension in most patients without comorbidities?
A. Beta-blockers
B. Calcium channel blockers
C. Thiazide diuretics
D. ACE inhibitors
Rationale: Thiazide diuretics are recommended as first-line therapy for
uncomplicated hypertension due to their efficacy and proven
cardiovascular risk reduction.
2. Which of the following drugs works by inhibiting the angiotensin-
converting enzyme, thereby reducing angiotensin II formation?
A. Losartan
B. Lisinopril
C. Aliskiren
D. Spironolactone
Rationale: ACE inhibitors like lisinopril block the conversion of
angiotensin I to angiotensin II, reducing vasoconstriction and
aldosterone-mediated sodium retention.
3. Which adverse effect is most commonly associated with ACE
inhibitors?
A. Bradycardia
B. Dry cough
C. Hyperglycemia
D. Hypokalemia
,Rationale: ACE inhibitors can cause a dry, persistent cough due to
accumulation of bradykinin in the respiratory tract.
4. A patient develops angioedema after starting an ACE inhibitor.
Which class of medication should be used instead?
A. Beta-blockers
B. Calcium channel blockers
C. Angiotensin II receptor blockers (ARBs)
D. Loop diuretics
Rationale: ARBs block angiotensin II receptors without affecting
bradykinin metabolism, reducing the risk of cough or angioedema.
5. Which beta-blocker is cardioselective and preferred in patients
with asthma?
A. Propranolol
B. Metoprolol
C. Nadolol
D. Labetalol
Rationale: Metoprolol selectively blocks beta-1 receptors in the heart,
minimizing beta-2 mediated bronchoconstriction.
6. Which class of antihypertensives works by blocking L-type calcium
channels in vascular smooth muscle?
A. ACE inhibitors
B. Beta-blockers
C. Calcium channel blockers
D. Alpha-1 blockers
Rationale: Calcium channel blockers inhibit calcium entry into smooth
muscle, causing vasodilation and reduced blood pressure.
7. Which diuretic is most effective for rapid reduction of blood
volume in acute pulmonary edema?
, A. Thiazide diuretics
B. Potassium-sparing diuretics
C. Loop diuretics
D. Carbonic anhydrase inhibitors
Rationale: Loop diuretics like furosemide inhibit sodium and chloride
reabsorption in the loop of Henle, causing potent diuresis.
8. Spironolactone is an example of which type of diuretic?
A. Thiazide diuretic
B. Loop diuretic
C. Potassium-sparing diuretic
D. Osmotic diuretic
Rationale: Spironolactone is an aldosterone antagonist that retains
potassium while promoting sodium and water excretion.
9. Which antihypertensive is safe to use in pregnancy?
A. ACE inhibitors
B. ARBs
C. Methyldopa
D. Aliskiren
Rationale: Methyldopa is a centrally acting alpha-2 agonist
considered safe in pregnancy; ACE inhibitors and ARBs are
contraindicated.
10. Which of the following drugs is classified as a direct renin
inhibitor?
A. Lisinopril
B. Losartan
C. Aliskiren
D. Hydralazine
, Rationale: Aliskiren directly inhibits renin, blocking the conversion of
angiotensinogen to angiotensin I.
11. Which antihypertensive drug may cause reflex tachycardia
due to peripheral vasodilation?
A. Beta-blockers
B. ACE inhibitors
C. Hydralazine
D. Thiazide diuretics
Rationale: Hydralazine causes arteriolar vasodilation, which may
trigger a compensatory increase in heart rate.
12. Which drug is preferred in patients with hypertension and
benign prostatic hyperplasia (BPH)?
A. Thiazides
B. ACE inhibitors
C. Alpha-1 blockers (e.g., doxazosin)
D. Calcium channel blockers
Rationale: Alpha-1 blockers relax smooth muscle in the bladder neck
and prostate, improving urinary symptoms in BPH.
13. Which antiarrhythmic drug is a Class III agent?
A. Amiodarone
B. Lidocaine
C. Atenolol
D. Verapamil
Rationale: Class III antiarrhythmics prolong repolarization by blocking
potassium channels, e.g., amiodarone.
14. Digoxin exerts its primary effect by:
A. Beta-blockade
B. Calcium channel blockade
Questions & Rationales
2025/2026
1. Which class of drugs is considered first-line therapy for
hypertension in most patients without comorbidities?
A. Beta-blockers
B. Calcium channel blockers
C. Thiazide diuretics
D. ACE inhibitors
Rationale: Thiazide diuretics are recommended as first-line therapy for
uncomplicated hypertension due to their efficacy and proven
cardiovascular risk reduction.
2. Which of the following drugs works by inhibiting the angiotensin-
converting enzyme, thereby reducing angiotensin II formation?
A. Losartan
B. Lisinopril
C. Aliskiren
D. Spironolactone
Rationale: ACE inhibitors like lisinopril block the conversion of
angiotensin I to angiotensin II, reducing vasoconstriction and
aldosterone-mediated sodium retention.
3. Which adverse effect is most commonly associated with ACE
inhibitors?
A. Bradycardia
B. Dry cough
C. Hyperglycemia
D. Hypokalemia
,Rationale: ACE inhibitors can cause a dry, persistent cough due to
accumulation of bradykinin in the respiratory tract.
4. A patient develops angioedema after starting an ACE inhibitor.
Which class of medication should be used instead?
A. Beta-blockers
B. Calcium channel blockers
C. Angiotensin II receptor blockers (ARBs)
D. Loop diuretics
Rationale: ARBs block angiotensin II receptors without affecting
bradykinin metabolism, reducing the risk of cough or angioedema.
5. Which beta-blocker is cardioselective and preferred in patients
with asthma?
A. Propranolol
B. Metoprolol
C. Nadolol
D. Labetalol
Rationale: Metoprolol selectively blocks beta-1 receptors in the heart,
minimizing beta-2 mediated bronchoconstriction.
6. Which class of antihypertensives works by blocking L-type calcium
channels in vascular smooth muscle?
A. ACE inhibitors
B. Beta-blockers
C. Calcium channel blockers
D. Alpha-1 blockers
Rationale: Calcium channel blockers inhibit calcium entry into smooth
muscle, causing vasodilation and reduced blood pressure.
7. Which diuretic is most effective for rapid reduction of blood
volume in acute pulmonary edema?
, A. Thiazide diuretics
B. Potassium-sparing diuretics
C. Loop diuretics
D. Carbonic anhydrase inhibitors
Rationale: Loop diuretics like furosemide inhibit sodium and chloride
reabsorption in the loop of Henle, causing potent diuresis.
8. Spironolactone is an example of which type of diuretic?
A. Thiazide diuretic
B. Loop diuretic
C. Potassium-sparing diuretic
D. Osmotic diuretic
Rationale: Spironolactone is an aldosterone antagonist that retains
potassium while promoting sodium and water excretion.
9. Which antihypertensive is safe to use in pregnancy?
A. ACE inhibitors
B. ARBs
C. Methyldopa
D. Aliskiren
Rationale: Methyldopa is a centrally acting alpha-2 agonist
considered safe in pregnancy; ACE inhibitors and ARBs are
contraindicated.
10. Which of the following drugs is classified as a direct renin
inhibitor?
A. Lisinopril
B. Losartan
C. Aliskiren
D. Hydralazine
, Rationale: Aliskiren directly inhibits renin, blocking the conversion of
angiotensinogen to angiotensin I.
11. Which antihypertensive drug may cause reflex tachycardia
due to peripheral vasodilation?
A. Beta-blockers
B. ACE inhibitors
C. Hydralazine
D. Thiazide diuretics
Rationale: Hydralazine causes arteriolar vasodilation, which may
trigger a compensatory increase in heart rate.
12. Which drug is preferred in patients with hypertension and
benign prostatic hyperplasia (BPH)?
A. Thiazides
B. ACE inhibitors
C. Alpha-1 blockers (e.g., doxazosin)
D. Calcium channel blockers
Rationale: Alpha-1 blockers relax smooth muscle in the bladder neck
and prostate, improving urinary symptoms in BPH.
13. Which antiarrhythmic drug is a Class III agent?
A. Amiodarone
B. Lidocaine
C. Atenolol
D. Verapamil
Rationale: Class III antiarrhythmics prolong repolarization by blocking
potassium channels, e.g., amiodarone.
14. Digoxin exerts its primary effect by:
A. Beta-blockade
B. Calcium channel blockade
