South University | NSG 6001: Advanced Pharmacology
Week 4 Quiz 1 | 100% Correct
Part A: Hypertension (HTN) Management
Q1: According to current guidelines, which class of medications is considered a first-line
option for most patients with uncomplicated primary hypertension?
A. Alpha-1 blockers (e.g., doxazosin)
B. Beta-blockers (e.g., metoprolol)
C. Thiazide diuretics (e.g., hydrochlorothiazide), ACE inhibitors, ARBs, or Dihydropyridine
CCBs [CORRECT]
D. Loop diuretics (e.g., furosemide)
Correct Answer: C
Rationale: Current 2017 ACC/AHA and JNC 8 guidelines recommend thiazide diuretics,
ACE inhibitors (ACE-Is), angiotensin II receptor blockers (ARBs), or dihydropyridine
calcium channel blockers (CCBs) as first-line pharmacologic options for most adults
with uncomplicated hypertension. Beta-blockers (B) are not first-line for uncomplicated
HTN but have compelling indications (e.g., post-MI, HF, arrhythmias). Loop diuretics (D)
are reserved for volume overload states (HF, CKD), not first-line HTN. Alpha-1 blockers
(A) are not recommended due to inferior cardiovascular outcomes (ALLHAT trial).
Q2: For a patient with hypertension and type 2 diabetes with albuminuria, which drug
class has a compelling indication due to its proven renal protective effects?
, A. Nondihydropyridine CCB (e.g., diltiazem)
B. ACE inhibitor or ARB [CORRECT]
C. Thiazide diuretic
D. Centrally-acting alpha-2 agonist (e.g., clonidine)
Correct Answer: B
Rationale: ACE inhibitors and ARBs are recommended for patients with HTN and
diabetes, especially with albuminuria, because they reduce intraglomerular pressure and
have been shown to slow the progression of diabetic kidney disease independent of
their blood pressure-lowering effect. This is a classic "compelling indication" for drug
selection. While thiazides (C) and CCBs (A) lower BP, they lack the specific
renoprotective benefits of RAAS blockade in diabetic nephropathy.
Q3: A 68-year-old African American male has newly diagnosed stage 2 hypertension (BP
155/95 mmHg) with no compelling indications. According to current guidelines, which
initial therapy is most appropriate?
A. ACE inhibitor monotherapy
B. Thiazide diuretic or dihydropyridine CCB, or combination therapy [CORRECT]
C. Beta-blocker monotherapy
D. ARB plus ACE inhibitor combination
Correct Answer: B
Rationale: For African American patients, thiazide diuretics and dihydropyridine CCBs
have demonstrated superior BP-lowering efficacy compared to ACE-I/ARB monotherapy.
Week 4 Quiz 1 | 100% Correct
Part A: Hypertension (HTN) Management
Q1: According to current guidelines, which class of medications is considered a first-line
option for most patients with uncomplicated primary hypertension?
A. Alpha-1 blockers (e.g., doxazosin)
B. Beta-blockers (e.g., metoprolol)
C. Thiazide diuretics (e.g., hydrochlorothiazide), ACE inhibitors, ARBs, or Dihydropyridine
CCBs [CORRECT]
D. Loop diuretics (e.g., furosemide)
Correct Answer: C
Rationale: Current 2017 ACC/AHA and JNC 8 guidelines recommend thiazide diuretics,
ACE inhibitors (ACE-Is), angiotensin II receptor blockers (ARBs), or dihydropyridine
calcium channel blockers (CCBs) as first-line pharmacologic options for most adults
with uncomplicated hypertension. Beta-blockers (B) are not first-line for uncomplicated
HTN but have compelling indications (e.g., post-MI, HF, arrhythmias). Loop diuretics (D)
are reserved for volume overload states (HF, CKD), not first-line HTN. Alpha-1 blockers
(A) are not recommended due to inferior cardiovascular outcomes (ALLHAT trial).
Q2: For a patient with hypertension and type 2 diabetes with albuminuria, which drug
class has a compelling indication due to its proven renal protective effects?
, A. Nondihydropyridine CCB (e.g., diltiazem)
B. ACE inhibitor or ARB [CORRECT]
C. Thiazide diuretic
D. Centrally-acting alpha-2 agonist (e.g., clonidine)
Correct Answer: B
Rationale: ACE inhibitors and ARBs are recommended for patients with HTN and
diabetes, especially with albuminuria, because they reduce intraglomerular pressure and
have been shown to slow the progression of diabetic kidney disease independent of
their blood pressure-lowering effect. This is a classic "compelling indication" for drug
selection. While thiazides (C) and CCBs (A) lower BP, they lack the specific
renoprotective benefits of RAAS blockade in diabetic nephropathy.
Q3: A 68-year-old African American male has newly diagnosed stage 2 hypertension (BP
155/95 mmHg) with no compelling indications. According to current guidelines, which
initial therapy is most appropriate?
A. ACE inhibitor monotherapy
B. Thiazide diuretic or dihydropyridine CCB, or combination therapy [CORRECT]
C. Beta-blocker monotherapy
D. ARB plus ACE inhibitor combination
Correct Answer: B
Rationale: For African American patients, thiazide diuretics and dihydropyridine CCBs
have demonstrated superior BP-lowering efficacy compared to ACE-I/ARB monotherapy.
