Antihypertensive agents are drugs used to manage high blood pressure and reduce cardiovascular risk. This module covers classification, structure–activity relationships (SAR), mechanisms of action, therapeutic uses, adverse effects, and key drug interactions—essential for B. Pharm students. You will study major classes: diuretics, beta‑blockers, ACE inhibitors, ARBs, calcium channel blockers, and vasodilators, plus prototypes like enalapril, losartan, propranolol, amlodipine, and furosemide. Important SAR concepts include the aryloxypropanolamine template of beta‑blockers, dihydropyridine core of vascular CCBs, and the carboxylate/tetrazole motifs in ACE inhibitors and ARBs. Emphasis is on mechanism-based selection, monitoring, and contraindications. Now let’s test your knowledge with 30 MCQs on this topic.
Q1. Which class of antihypertensive agents primarily acts by inhibiting the angiotensin‑converting enzyme (ACE)?
- Beta‑blockers
- ACE inhibitors
- Calcium channel blockers
- Loop diuretics
Correct Answer: ACE inhibitors
Q2. Which structural feature is characteristic of dihydropyridine (DHP) calcium channel blockers?
- Aryloxypropanolamine side chain
- Biphenyl‑tetrazole moiety
- Dihydropyridine ring
- Sulfhydryl group
Correct Answer: Dihydropyridine ring
Q3. Which antihypertensive drug is most commonly associated with a persistent dry cough as a side effect?
- Losartan
- Lisinopril
- Amlodipine
- Furosemide
Correct Answer: Lisinopril
Q4. The SAR of classical beta‑blockers is centered on which pharmacophore?
- Diaryl ether core
- Aryloxypropanolamine
- Dihydropyridine nucleus
- Carboxylate ester
Correct Answer: Aryloxypropanolamine
Q5. Which diuretic class acts by inhibiting the Na+/Cl− symporter in the distal convoluted tubule?
- Loop diuretics
- Thiazide diuretics
- Carbonic anhydrase inhibitors
- Potassium‑sparing diuretics
Correct Answer: Thiazide diuretics
Q6. Losartan belongs to which antihypertensive class and what is the key SAR motif in many ARBs?
- ACE inhibitors; sulfhydryl group
- Calcium channel blockers; dihydropyridine ring
- Angiotensin II receptor blockers; biphenyl‑tetrazole
- Beta‑blockers; aryloxypropanolamine
Correct Answer: Angiotensin II receptor blockers; biphenyl‑tetrazole
Q7. Which mechanism best describes how loop diuretics like furosemide lower blood pressure?
- Block L‑type calcium channels in vascular smooth muscle
- Inhibit NKCC2 in the thick ascending limb to increase natriuresis
- Antagonize aldosterone receptors in collecting tubule
- Inhibit ACE, reducing angiotensin II formation
Correct Answer: Inhibit NKCC2 in the thick ascending limb to increase natriuresis
Q8. Which antihypertensive is a prodrug that is converted to an active carboxylate form in vivo?
- Captopril
- Enalapril
- Losartan
- Propranolol
Correct Answer: Enalapril
Q9. Which calcium channel blocker class is more selective for vascular smooth muscle than for cardiac tissue?
- Non‑dihydropyridines (verapamil, diltiazem)
- Dihydropyridines (nifedipine, amlodipine)
- Benzothiazepines
- Phenylalkylamines
Correct Answer: Dihydropyridines (nifedipine, amlodipine)
Q10. Which antihypertensive causes hyperkalemia by antagonizing aldosterone receptors?
- Spironolactone
- Hydrochlorothiazide
- Propranolol
- Nifedipine
Correct Answer: Spironolactone
Q11. In the SAR of ACE inhibitors, which functional group enhances binding to the zinc ion in the ACE active site?
- Carboxylate or sulfhydryl group
- Tetrazole ring
- Dihydropyridine ring
- Aryloxy group
Correct Answer: Carboxylate or sulfhydryl group
Q12. Which antihypertensive drug should be avoided in asthma due to bronchoconstrictive risk?
- Propranolol
- Atenolol
- Amlodipine
- Enalapril
Correct Answer: Propranolol
Q13. Which drug class reduces peripheral resistance mainly by blocking alpha‑1 adrenergic receptors on vascular smooth muscle?
- Alpha‑1 blockers (e.g., prazosin)
- ACE inhibitors
- Beta‑blockers
- Thiazide diuretics
Correct Answer: Alpha‑1 blockers (e.g., prazosin)
Q14. Which experimental SAR observation is true for beta‑adrenergic blockers regarding stereochemistry?
- R enantiomers are generally more potent than S for beta antagonism
- S enantiomers are usually more potent as beta antagonists
- Stereochemistry has no effect on beta‑blocker activity
- Only racemic mixtures are active
Correct Answer: S enantiomers are usually more potent as beta antagonists
Q15. Which antihypertensive class can cause gingival hyperplasia and constipation as notable adverse effects?
- ACE inhibitors
- Calcium channel blockers
- Beta‑blockers
- Loop diuretics
Correct Answer: Calcium channel blockers
Q16. Which mechanism explains how ARBs lower blood pressure?
- They inhibit renin release directly from the kidney
- They block AT1 receptors, preventing angiotensin II actions
- They inhibit ACE to reduce angiotensin II synthesis
- They increase urinary sodium by blocking Na+/K+ ATPase
Correct Answer: They block AT1 receptors, preventing angiotensin II actions
Q17. Which antihypertensive drug contains a sulfhydryl moiety and may cause taste disturbances and rash?
- Captopril
- Enalapril
- Losartan
- Metoprolol
Correct Answer: Captopril
Q18. Which diuretic is most potent for acute pulmonary edema due to rapid and strong natriuretic effect?
- Hydrochlorothiazide
- Furosemide
- Spironolactone
- Acetazolamide
Correct Answer: Furosemide
Q19. Which pharmacological effect primarily accounts for the antihypertensive action of beta‑1 selective blockers like metoprolol?
- Direct vasodilation via nitric oxide release
- Reduction of heart rate and cardiac output via β1 blockade
- Increased renal sodium excretion via aldosterone antagonism
- Blockade of L‑type calcium channels
Correct Answer: Reduction of heart rate and cardiac output via β1 blockade
Q20. In structure–activity relationships of ARBs, replacing a carboxyl group with a tetrazole often results in:
- Reduced receptor affinity and potency
- Increased lipophilicity and oral bioavailability
- Conversion to ACE inhibitor activity
- Marked increase in diuretic effect
Correct Answer: Increased lipophilicity and oral bioavailability
Q21. Which antihypertensive is known for causing reflex tachycardia because of potent arteriolar dilation?
- Hydralazine
- Propranolol
- Enalapril
- Hydrochlorothiazide
Correct Answer: Hydralazine
Q22. Which combination is most likely to cause symptomatic hypotension if started simultaneously in a patient with volume depletion?
- ACE inhibitor plus thiazide diuretic
- Beta‑blocker plus calcium channel blocker
- ARBs plus potassium supplement
- Loop diuretic plus NSAID
Correct Answer: ACE inhibitor plus thiazide diuretic
Q23. Which antihypertensive class often requires monitoring of serum potassium due to risk of hyperkalemia?
- ACE inhibitors and ARBs
- Thiazide diuretics
- Loop diuretics
- Calcium channel blockers
Correct Answer: ACE inhibitors and ARBs
Q24. A key therapeutic use of beta‑blockers in hypertension beyond blood pressure reduction is:
- Prevention of migraine and control of ischemic heart disease
- Treatment of acute pulmonary edema
- Management of hyperkalemia
- Direct diuresis promotion
Correct Answer: Prevention of migraine and control of ischemic heart disease
Q25. Which antihypertensive agent’s SAR shows that bulky lipophilic substituents on the aromatic ring increase vascular selectivity in DHP CCBs?
- Verapamil
- Nifedipine
- Enalapril
- Propranolol
Correct Answer: Nifedipine
Q26. Which antihypertensive class directly antagonizes mineralocorticoid receptors to reduce sodium retention?
- ACE inhibitors
- Mineralocorticoid receptor antagonists (e.g., spironolactone)
- Thiazide diuretics
- Calcium channel blockers
Correct Answer: Mineralocorticoid receptor antagonists (e.g., spironolactone)
Q27. Which adverse effect is most classically associated with thiazide diuretics?
- Hypokalemia and hyperglycemia
- Hyperkalemia and hyponatremia
- Bronchospasm
- Cough and angioedema
Correct Answer: Hypokalemia and hyperglycemia
Q28. Which antihypertensive drug works intracellularly as a potassium channel opener producing arteriolar vasodilation?
- Minoxidil
- Enalapril
- Verapamil
- Hydrochlorothiazide
Correct Answer: Minoxidil
Q29. Which drug interaction is important to consider when combining ACE inhibitors with NSAIDs?
- NSAIDs enhance ACE inhibitor efficacy, causing hypotension
- NSAIDs can reduce antihypertensive effect and increase risk of renal impairment
- ACE inhibitors prevent NSAID‑induced gastric ulcers
- No clinically relevant interaction exists
Correct Answer: NSAIDs can reduce antihypertensive effect and increase risk of renal impairment
Q30. For a B. Pharm student, which principle is most important when choosing antihypertensive therapy for a diabetic patient?
- Avoid ACE inhibitors because they worsen renal function in all diabetics
- Prefer ACE inhibitors or ARBs for renal protection unless contraindicated
- Choose only beta‑blockers to control blood sugar
- Diuretics are always the first choice regardless of comorbidities
Correct Answer: Prefer ACE inhibitors or ARBs for renal protection unless contraindicated
I am a Registered Pharmacist under the Pharmacy Act, 1948, and the founder of PharmacyFreak.com. I hold a Bachelor of Pharmacy degree from Rungta College of Pharmaceutical Science and Research. With a strong academic foundation and practical knowledge, I am committed to providing accurate, easy-to-understand content to support pharmacy students and professionals. My aim is to make complex pharmaceutical concepts accessible and useful for real-world application.
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