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6
PHARMACY PREP

HYPERTENSION

1. Mr. J ohn is 50 year old. His medical history started HCTZ 12.5 mg po qd 2 months ago.
After 4 months HCTZ increased 25 mg po because his BP was uncontrolled.
He is diabetic, has hypercholesterolemia and asthma.
Drug allergy is Amoxicillin.
Social History: He smokes half pack a day.
Which of the following is the next most appropriate step in treating Mr. J ohn?
a. D/C HCTZ and re-evaluate BP.
b. Adding lisinopril 10mg po qd to HCTZ 50mg po qd
c. Adding Atenolol 100mg po qd to HCTZ 50mg po qd
d. Increase HCTZ to 50mg po qd
e. Lifestyle changes require and D/C HCTZ
Ans: B
Tips: Atenolol masks hypoglycemia and hydrochlorthiazide is diabetogenic

2. Patient with hypertension drinks 1 glass of wine per day and smokes about 15 cigarettes per
day. His diet includes high fat and cholesterol. Which risk factors have the LEAST effect on
his hypertension?
a) Smoking cessation
b) Eating healthy food, balanced diet
c) Eating low-fat diet
d) Decreasing alcohol consumption
e) Low salt diet
Ans: D

3. Counseling on hydrochlorthiazide (HCTZ) 25 mg po qd includes:
A. Do not wear contact lenses
B. Take it in the morning
C. Take with a glass of orange juice or banana (K+supplement)
D. All of the above
E. B and C
Ans-

4. Hydrochlorthiazide causes what?
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A. Increase in LDL, increase in TG
B. Increase in LDL, decrease in TG
C. Increase in TG
D. No effect
Answer: A

Next 2 Questions refer to the following scenario
1-Ms MM 72 year old female was admitted in hospital for acute pulmonary edema. She
aggressively diurest. Started on ACEI therapy. Which of the following can be done to minimize
first dose syncope; medical history includes: furosemide and digoxin:
I-Give test dose
II-Withhold diuretic
III-Use fosinopril instead of captopril
a) I only
b) III only
c) I and II only
d) II and III only
e) All are correct
Ans-D
Tips: Fosinopril have less renal accumulation and daily single dose

2-Which of the following appropriate for angina with CHF:
A-Isosorbide dinitrate
B-verapamil
C-nifedipine
D-Metoprolol
E-Diltiazem
Ans-A

3-Patient with hypertension, drinks 1 glass of wine per day and smokes about 15 cigarettes per
day. His diet include high fat and cholesterol. Which risk factors have the LEAST effect on his
hypertension?
f) Smoking cessation
g) Eating healthy food, balanced diet
h) Eating low-fat diet
i) Decreasing alcohol consumption
Ans: D

4-A 57-year-old patient is regular customer of your pharmacy. His current medication include
hydrochlorothiazide. He complains the following side effects. Which of the following is not
due to his medication:
A-Gout
B-Erectile dysfunction
C-Hyperglycemia
D-Hypokalemia
E-Hypocalcemia
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Ans-D

Next 3 Questions refer to the following case.
1-MB is a diabetic patient with hypertension, currently he started antihypertensive medications,
and after few days MB complains to the doctor that he is current blood sugar levels are
increase. Which of following drug is most likely to cause hyperglycemia.
A-ACEI
B-CCB
C-Hydrochlorothiazide
D-verapamil
E-Felodipine
Ans-C

2-MB complains to the doctor that he is suffering with sexual dysfunction after initiating his
antihypertensive medication. What are the possible antihypertensive he is currently taking?
A-Diuretics
B-Beta blockers
C-ACEI
D-CCB
E-Hydralazine
Ans-B
Tips: beta blocker have erectile dysfunction side effect.
Hydrochlorothiazide has (2% men) erectile dysfunction
Potassium sparing diuretics have erectile dysfunction

3-Complications of hypertension include damage to all of the end organs except:
a. Heart
b. Eyes
c. Liver
d. Large vessels
Ans - C

4-Which of the following is the side effect of hydrochlorthiazide:
I-Metabolic acidosis
II-Gout arthritis
III-Hyperlipidemia
a) I only
b) III only
c) I and II only
d) II and III only
e) All are correct
Ans-D
Tips:
Combination: HCTZ/amiloride, HCTZ/Triamterene, HCTZ/spironolactone


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5-A 75-year-old patient receiving captopril for hypertension may have all of the side effect
EXCEPT:
I-Hyperkalemia
II-Angioedema
III-Pulmonary edema
a) I only
b) III only
c) I and II only
d) II and III only
e) All are correct
Ans-B

Next 4 Questions refer to the following case.
1-A 75 year old man with no medical history recent MI and moderate hypertension what will
you choose for treatment:
A-ACEI
B--blockers
C-CCB
D-Diuretics
E-Vasodilators
Ans-A

2. ACE- inhibitors cause, what?
A. Increase in LDL, decrease in TG
B. No effect on serum lipids
C. Decrease HDL, increase in LDL
D. Lowers total cholesterol
Ans- B

Next 5 Questions refer to the Diuretics
1-Counseling on hydrochlorthiazide (HCTZ) 25 mg po qd includes:
F. Do not wear contact lenses
G. Take it in the morning
H. Take with a glass of orange juice or banana (K+supplement)
I. All of the above
J . B and C
Ans- E

2-Hydrochlorothiazide causes what?
E. Increase in LDL, increase in TG
F. Increase in LDL, decrease in TG
G. Increase in TG
H. No effect
Answer: A

3-Which of the following drugs is associated with sexual dysfunction
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I. Captopril
II. Atenolol
III. Hydrochlorthiazide
A. I only
B. III only
C. I and II only
D. II and III only
E. I, II and III
Ans-D

Next 6 questions refer to the following case
1- A 65 year old patient has peripheral and pulmonary edema. He has renal failure. Also, he is
taking Triamterene/HCTZ. What are other treatment options?
A. Give Furosemide (if acute renal failure)
B. Give Furosemide and Metolazone (chronic renal failure)
C. Increase dose of Triamterene
D. Do not change the dose
E. Add potassium supplements
Answer- A

Next 7 questions refer to the ARBs
1- What is the mechanism of action of ARBs?
A. Do not cause breakdown of bradykinin
B. Do not cause dry cough as ACE
C. Does not allow to bind to the receptors
Answer- C

Next 8 questions refer to the Calcium channel blockers
1-A 60-year-old patient is on verapamil, he is experiencing constipation and was advised to
take docusate sodium PRN. What would you do?
A. Ask patient to take docusate daily and add Senokot 1to 2 tabs
B. Ask patient to take docusate daily and Senokot PRN
C. Ask patient to take docusate PRN only
Ans-C

2-Which of the following is true for Nifedipine 10mg capsule counselling?
A. Do not put cotton inside the vial
B. Give in glass container
C. In light resistant container, In airtight container
D. Use plastic container with metal cap
E. Place cotton inside the vial
Answer- A

3. Calcium channel blockers
A. Study effect on lipids
B. No effect on lipids
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C. Decrease effect with liver disease
D. Use in CHF
Answer-B

Next 9 Questions refer to the following case.
Ms. DM is a 91kg, 52-year old female who was recently diagnosed with type 2 diabetes. On
physical exam her BP was 148/94, serum creatinin was 150umol/L, K is 4.5mmol/L.

1- The recommended BP target for DM is
A. <130/80
B. <140/90
C. <125/75
D. <100/80
Answer- A
Comments: TC chapter Hypertension page 216

2-. Ms DMs family doctor starts her on Ramipril 2.5mg OD and plans on titrating the dose
upward to help control her BP and to decrease the amount of albumin being excreted in her
urine. Which of the following parameters should be monitored upon initiation of the ACE-
inhibitor?
I -Serum potassium
II-serum Creatinine
III-Blood Pressure
A. I only
B. III only
C. I and II only
D. II and III only
E. All of the above
Answer-E

3- The following information should be explained to Ms DM regarding the use of Ramipril:
I. Beneficial effects of ACE-inhibitor is in reducing the risk of complications of diabetes
II. Common side effects: cough, light headedness, dizziness
III. Has rare but serious adverse effects (allergic reactions)
A. I only
B. III only
C. I and II only
D. II and III only
E. All of the above
Ans-: E
Comments: rare but serious side effects are angioedema.

4. Ms. DMs family doctor orders a repeat blood test 5 days after initiating Ramipril 2.5mg
OD. Serum creatinine is 165 umol/L and K is 4.5mmol/L (3.5 mmol/L). Based on these results,
Ramipril should be:
A. Temporarily hold and blood test repeated
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B. Continued and blood tests repeated in once a week
C. Stopped indefinitely
D. Stopped and an ARB started
Answer: B
Tips: An increase in serum creatinin can occur upon initiation of an ACE-inhibitor or ARB.
This is often reversible. In most cases, serum creatinin will stabilize without discontinuing the
ACE inhibitor or ARB. However, if creatinin clearance increases more then 30% above
baseline immediately following initiation of an ACE inhibitor or ARB, the medication should
be stopped and the patient should be reassessed.

5. Ms DM has been experiencing headaches recently because of the stress of being diagnosed
with chronic disease. She would like to purchase something to help manage the pain. You
recommend:
A. Ibuprofen
B. Acetaminophen
C. Naproxen
Ans-A

6. In which of the following situations would caution an additional monitoring of a serum
creatinine upon initiation of an ACE-inhibitor or ARB?
I-CHF
II-Vomiting and diarrhea
III-Concurrent use of diuretics
A-I only
B-III only
C-I and II only
D-II and III only
E-All of the above
Ans-E

7. All are true for Nitroglycerin patches EXCEPT
A. It is used for myocardial infarction
B. It can be applied daily
C. It should be kept for 24 hours
D.
Answer: C

8. Which medication causes first syncope effect?
I. Prazosin
II. Doxazosin
III. Terazosin
a. I only
b. III only
c. I and II only
d. II and III only
E-I, II, and III
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Ans-E

Next 10 Questions refer to the following Beta-blockers
1-A physician asks you about Carvedilol. What type of medicine is this?
I It is an alpha & beta-blocker
II It is good in CHF
III It is a Beta-blocker
A. I only
B. III only
C. I and II only
D. II and III only
E. I, II, and III
Ans.: c

2-Patient is suffering from heart disease and he is under treatment of ramipril, propranolol and
digoxin. Which medication causes sexual impotence?
A. Propranolol
B. Ramipril
C. Digoxin
Ans-A

3- All of the following patients can take beta blockers, EXCEPT
A. Patients with peripheral vascular disease
B. Younger antihypertensive patients with stable angina
C. Patients with systolic hypertension
D. Patients with tachycardia
E. Post MI patients
Ans-A

4 Which of the following drugs can cause drug-induced impotence
I Clonidine
II Methyldopa
III Atenolol
A. I only
B. III only
C. I and II
D. II and III
E. I, II and III
Ans-C

5-Pharmacist is going to prepare a dosseter for patient with following medications. For which
medication, he should be worried to set dose schedule?
A. Ramipril OID
B. Calcium carbonate TID
C. Psyllium TID
D. Metoprolol OID
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Ans-C
Ans: physillium arrange in dosseter for morning, noon and evening

Next 11 Questions refer to the following case
1-Mr. Brown, a 65 year old presents with hypertension, he has diabetes with kidney disease,
which of the following will be appropriate selection:
A-Clonidine
B-Lisinopril
C-Chlorthiazide
D-Propranolol
E-Nitroprusside
1-A

2-Mr. Brown a hypertensive patient who has COPD and he is non compliant, which of the
following would be best choice for Mr Brown:
A-Propranolol
B-Atenolol
C-Bisoprolol
D-Acebutolol
E-Timolol
Ans-D

Mr. Brown a 47 year old returning from clinic for follow up:
Medical history: Started HCTZ 25 mg po qd 2 months ago for HTN. After 4 months HCTZ
increased 50 mg po qd because his BP uncontrolled
Other condition: diabetes, Hypercholesterolemia, asthma
Drug allergies: Amoxicillin
Social history: he smokes half pack a day:

3-Mr, Brown has several questions about risk associated with HBP, which of the following
statement is true:
I-Target organ affected by HBP include brain, heart, kidney and eyes.
II-Untreated HBP is risk factor for CVD
III-Isolated systolic HBP are little or no risk for developing complication secondary to HBP.
A-I only
B-III only
C-I and II only
D-II and III only
E-All of the above
Ans-C
Comments: TC p 216: SBP <140 mm Hg

4-In evaluating Mr. Brown overall cardiovascular risk which of the following is high risk?
I-Smoking
II-Diabetes
III-Hypercholesterolemia
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A-I only
B-III only
C-I and II only
D-II and III only
E-All of the above
Ans-E

5-Which of following is the next most appropriate step in treating Mr. Brown;
A-Discontinue HCTZ and re-evaluate BP
B-Adding lisinopril 10 mg po qd to HCTZ 50 mg po qd
C-Adding atenolol 100 mg po qd to HCTZ 50 mg po qd
D-Increase HCTZ to 7 mg po qd
E-Life style changes require and discontinue HCTZ
Ans-B

6-When assessing Mr. Brown treatment plan, which of the following included in your
evaluation?
I-Asses any secondary complication to his treatment plan
II-Asses any complication secondary to HBP
III-Asses Mr Brown compliance
A-I only
B-III only
C-I and II only
D-II and III only
E-All of the above
Ans-E

Next 12 Questions refer to the following case
Ms. Brown 36 years, has hypertension for 2 years, and has seasonal allergies, gestational
diabetes 5 year ago. She allergic captopril. Her family both parents have hypertension and
diabetes. Denies tobacco and alcohol use.. She presents with high blood pressure.
Medication history; Atenolol, loratadine, Pseudoephridine, Tylenol.

1-Which of the following may contribute to her HBP?
A-Seasonal allergies
B-Bradycardia and her BP increased to compensate
C-Tachycardia
D-Tylenol reported increase HBP
E-Pseudoephridine
Ans-E

2-What is the important monitoring appropriate for Ms. Brown;
I-Renal function test
II-Liver function test
III-Thyroid function test
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A-I only
B-III only
C-I and II only
D-II and III only
E-All of the above
Ans-A

3-A physician asks a suggestion from pharmacist that he wants to change Ms Brown
antihypertensive regimen, which of the following most appropriate suggestion:
A-Increase atenolol to 150 mg po qd
B-Discontinue atenolol and add captopril 25 mg tid
C-Add metoprolol 25 mg bid to atenolol 100 mg qd
D-Add HCTZ 25 mg po qd to atenolol 100 mg qd
E-Add lisinopril 10 mg to atenolol 100 mg qd
Ans-D

4-Ms.Brown is considering having another child in near future, and wants what
antihypertensives are safer in pregnancy?
A-Propranolol
B-Atenolol
C-HCTZ
D-Methyldopa
E-Lisinopril
Ans-D

5-If Ms Brown pregnant. What adjustment would suggest for her chronic seasonal allergies?
I-Discontinue Pseudoephridine and loratadine products
II-suggest nasal steroids
III-Suggest to add phenylephrine nasal sprays.
A-I only
B-III only
C-I and II only
D-II and III only
E-All of the above
Ans-C

Mr. Brown is 65 year old he scheduled to undergo BPH surgery, his wife has second thought
about going ahead with surgery. He has hypertension, and on HCTZ 50mg po qd, lisinopril 40
mg po qd, Multivitamins and Vitamin E. He is lifelong smoker and drinks glass of wine with
dinner, exercise daily.

6-Which of the following fatal but rare side effect of lisinopril?
A-Stevens J ohnson Syndrome
B-Lactic acidosis
C-Angioedema
D-Hepatotoxicity
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E-Pulmonary hypertension
Ans-C

7-Since Mr Brown has BPH symptoms; his physician has decided to add prazosin to his
medications, why should initial dose of prazosin should not exceed 1 mg at bedtime.
A-To maximize effect of drug
B-To minimize side effect of drug
C-To minimize the risk of hypersensitivity of drug
D-To minimize the first dose syncope
Ans-D

8-Which of the following is the major side effect of prazosin?
I-Reflex tachycardia
II-Headache
III-Weakness
A-I only
B-III only
C-I and II only
D-II and III only
E-All of the above
Ans-E
Comments: all of the above and drowsiness as well.

9-Mr Brown notes that the name of his medication bottle does not match with the name of drug
prescribed. Pharmacist informed that a generic drug has dispensed in place of brand product.
Which of the following could be name for prazosin
A-Cardene
B-Hytrin
C-Plendil
D-Minipress
E-Cardura
Ans-D

10-What other medication may be added to Mr. Brown medication to induce atrophy of the
prostate gland and reduce BPH.
A-Finasteride
B-Terazosin
C-Doxazosin
D-Testosterones
E-None of the above can be added
Ans-A

Mr. Beans, 60 year old old male, diagnosed hypertension for the past 30 years and 10 year
history of Ischemic heart disease (IHD), poorly controlled due to poor compliance. He has no
family history of heart disease and social history includes smoked 1 PPD 40 years; currently
smoke 1-2 packs per week and on average drinks a six pack of beer per week.
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Medication History
Hydrochlorothiazide 25 mg PO daily
Nitroglycerine 0.4 mg PRN for chest pain
Ketoprofen, 75 mg PO TID

No known medical allergies, physical examination includes anxious male, BP 125/90, HR 105,
wt 68 kg, 1+ankle edema, bluish-gray skin discoloration on sun exposed areas.

Lab values Na 134, K 3.9, Cl 102, HCO3 28, BUN 6.1, Cr 106, Hct 0.38, Hgb 140, MCV 88,
AST 0.70, ALT 0.64, LDH 3.18, Alk Phos 0.8, Alb 38 & ESR 43 mm/hr.

11-Which of the following monitoring parameters is NOT important in the early assessment of
ACE inhibitor therapy in Mr. Beans?
A- Serum K+
B- Serum Creatinine
C- Renal function test
D- Liver function test
E- Serum Na+
Ans-E

12-Which of the following calcium channel blockers (CCB) would be good choice for Mr.
Beans to control both his hypertension and angina pectoris, EXCEPT
A. Verapamil
B. Diltiazem
C. Amlodipine
D. Nifedipine IR
E. Adalat (Nifedipine) XL
Ans-d

13- Which of the following medication is LEAST likely to affect the potassium homeostasis?
A. Furosemide
B. Captopril
C. Potassium Chloride supplements (KCl)
D. Nitroglycerine
Ans-D

14-Which of the following ACE inhibitor works best if you take it on an empty stomach?
A. Lisonopril
B. Captopril
C. Enalapril
D. Ramipril
E. E-All of the above
Ans-B
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15- which of the following antihypertensive should NOT be used in a patient with systolic
dysfunction?
A. Ramipril
B. Felodipine
C. Amlodipine
D. Verapamil
E. Atenolol
Ans-D

16-All of the following drugs causes postural hypotension, EXCEPT:
A-Clonidine
B-Prazosin
C-Methyldopa
D-Guanethidine
E-Isoproterenol
Ans-E

Next 13 Questions refer to the following case.
1. Mr. GG a 50-year-old male storekeeper, has diagnosed with open angle glaucoma,
tachycardia, and hypertension. A doctor wants to know which of the following
appropriate medication will you recommend for his open angle glaucoma ? Patient, has
no known allergies.
I. Topical Pilocarpine
II. Oral Acetazolamide
III. Topical Beta-blocker
a. I only
b. III only
c. I and II only
d. II and III only
e. All of the above
Ans.: B

2. A patient is on captopril to control his hypertension. He has a history of gout, and his
doctor kept him on a maintenance dose of Allopurinol, which he is going to start from today.
Best thing the pharmacist should do:
(A) Dispense as it is
(B) Call the doctor to increase the dose of Captopril
(C) Call the doctor to alarm him that this combination may cause Stevenson J ohnson syndrome
(D) Tell the patient about non-pharmacological of gout and hypertension
Answer: (C)


3. The most potent ACEI is:

(A) Quinapril
(B) Fosinopril
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(C) Trandolapril
(D) Captopril
(E) None of the above
Answer: (C)
TIPS: It is used as 1mg once daily, maximum 4mg once daily.

4. Patient 50 years old experiencing pneumonia. In his profile we see that he is taking
tetracycline, in addition to other medications. He is experiencing now moderate hypertension
and his doctor wants to prescribe for him an ACEI. All of these ACEI may be used EXCEPT:
(A) Captopril
(B) Fosinopril
(C) Trandolapril
(D) Lisinopril
(E) Quinapril
Answer: (E)
TIPS: Avoid Quinapril with tetracycline since Quinapril contains antacid in its formulation.

5. The monitoring parameters for a patient using Lisinopril EXCEPT:
(A) Creatinine clearance
(B) Dizziness
(C) Potassium levels
(D) Neutropenia
(E) Sodium levels
Answer: (E)