Pharmacotherapy Of Hypertension (Htn)

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  • 1/42 Questions

    Can you diagnose HTN based on a single elevated blood pressure reading?

    • Yes
    • No
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About This Quiz

Hypertension is a very serious case if not managed as it caused a lot of death daily. This condition is a result of blood having high force against the artery and can cause even heart attacks. As a pharmacist, you need to know how to perform pharmacotherapy on a patient with high blood pressure. The quiz below will test out just how much you understood.

Pharmacotherapy Of Hypertension (Htn) - Quiz

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  • 2. 

    The DASH trial demonstrated that a diet high in fruits, vegetables, and low-fat dairy products, along with a reduced intake of total and saturated fat, significantly reduced blood pressure in as little 8 weeks.

    • True

    • False

    Correct Answer
    A. True
    Explanation
    The DASH trial showed that a specific diet, which includes a high intake of fruits, vegetables, and low-fat dairy products, while reducing total and saturated fat intake, can lead to a significant reduction in blood pressure within just 8 weeks.

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  • 3. 

    Increasing stroke volume and cardiac output:

    • Increases BP

    • Decreases BP

    Correct Answer
    A. Increases BP
    Explanation
    Increasing stroke volume and cardiac output refers to the amount of blood pumped by the heart with each contraction and the total amount of blood pumped per minute, respectively. When stroke volume and cardiac output increase, it means that the heart is pumping more blood. This increased blood volume leads to an increase in blood pressure. Therefore, the correct answer is that increasing stroke volume and cardiac output increases blood pressure.

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  • 4. 

    You should be cautious when using beta blockers AND calcium channel blockers in 2nd and 3rd-degree heart block.

    • True

    • False

    Correct Answer
    A. True
    Explanation
    When using beta blockers and calcium channel blockers in patients with 2nd and 3rd-degree heart block, caution should be exercised because both medications can further slow down the heart rate. Beta blockers work by blocking the effects of adrenaline on the heart, which can reduce the heart rate. Calcium channel blockers relax and widen blood vessels, which can also lower the heart rate. In patients with heart block, where the electrical signals that control the heartbeat are disrupted, using these medications can potentially worsen the condition and lead to further heart rhythm abnormalities. Therefore, it is important to be cautious and closely monitor patients when using both beta blockers and calcium channel blockers in these cases.

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  • 5. 

    Angioedema, rash, metallic taste, and cough can occur with what drug?

    • Metoprolol

    • Captopril

    • HCTZ

    • Spironolactone

    Correct Answer
    A. Captopril
    Explanation
    Captopril is known to cause angioedema, rash, metallic taste, and cough as side effects. Angioedema is a condition characterized by swelling beneath the skin, often in the face, lips, or throat. Rash refers to a skin irritation or redness. Metallic taste is an abnormal taste sensation in the mouth. Cough is a common side effect of captopril due to its effect on the respiratory system. Therefore, captopril is the drug that can cause these symptoms.

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  • 6. 

    Which drug can cause hyperkalemia and gynecomastia?

    • Chlorthalidone

    • Carteolol

    • Terazosin

    • Spironolactone

    Correct Answer
    A. Spironolactone
    Explanation
    Spironolactone is a medication that can cause both hyperkalemia (high levels of potassium in the blood) and gynecomastia (enlargement of breast tissue in males). It is a potassium-sparing diuretic, which means it helps the body retain potassium and excrete sodium and water. However, this can sometimes lead to an excessive buildup of potassium, resulting in hyperkalemia. Additionally, spironolactone has anti-androgen effects, which can disrupt the balance of male and female sex hormones and lead to gynecomastia.

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  • 7. 

    Hypertensive patients are usually symptomatic.

    • True

    • False

    Correct Answer
    A. False
    Explanation
    Hypertensive patients are usually asymptomatic, meaning they do not typically exhibit any noticeable symptoms. Hypertension, or high blood pressure, is often referred to as the "silent killer" because it can remain undetected for a long time without causing any obvious signs or symptoms. However, it is important to note that even though hypertensive patients may not experience symptoms, the condition can still have serious health consequences if left untreated.

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  • 8. 

    HTN prevalence is highest in ____________ (43% males, 44% females) when compared to non-Hispanic whites (29%).

    • Hispanics

    • African-Americans

    • Asians

    • Native Americans

    • McDonaldicans

    Correct Answer
    A. African-Americans
    Explanation
    The correct answer is African-Americans. According to the given information, the prevalence of HTN (hypertension) is highest in African-Americans (43% males, 44% females) compared to non-Hispanic whites (29%). This suggests that African-Americans have a higher likelihood of having hypertension compared to other racial or ethnic groups mentioned in the options.

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  • 9. 

    Which drugs have a compelling indication for diabetes (in addition to CCBS and chlorthalidone)?

    • ACEs and ARBs

    • Loop Diuretics

    • Aldosterone Antagonists

    • Alpha blockers

    Correct Answer
    A. ACEs and ARBs
    Explanation
    ACEs (angiotensin-converting enzyme inhibitors) and ARBs (angiotensin receptor blockers) have a compelling indication for diabetes because they help to lower blood pressure and protect the kidneys. These drugs are commonly prescribed to patients with diabetes to manage their blood pressure and prevent or delay the progression of kidney disease, which is a common complication of diabetes. By inhibiting the effects of angiotensin, ACEs and ARBs can reduce the risk of cardiovascular events and slow the decline in kidney function in diabetic patients.

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  • 10. 

    Which drug is most likely to cause angioedema?

    • Carteolol

    • Hydralazine

    • Lisinopril

    Correct Answer
    A. Lisinopril
    Explanation
    Lisinopril is most likely to cause angioedema. Angioedema is a severe allergic reaction that causes swelling in the deep layers of the skin, often around the face and throat. Lisinopril is an ACE inhibitor commonly used to treat high blood pressure and heart failure. However, angioedema is a known side effect of ACE inhibitors, with lisinopril being one of the most common culprits. This adverse reaction is more common in individuals with a history of angioedema, African Americans, and women. It is important for healthcare providers to monitor patients taking lisinopril for signs of angioedema and discontinue the medication if necessary.

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  • 11. 

    Increasing volume and decreasing venous dilation (which is constriction?)

    • Increases preload

    • Decreases preload

    Correct Answer
    A. Increases preload
    Explanation
    Increasing volume and decreasing venous dilation both contribute to an increase in preload. Preload refers to the amount of blood that fills the ventricles of the heart during diastole. Increasing volume means there is more blood available to fill the ventricles, while decreasing venous dilation (constriction) enhances the return of blood to the heart, increasing the amount of blood available for filling the ventricles. Both of these factors ultimately lead to an increase in preload.

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  • 12. 

    What is the major cause of essential HTN?

    • Chronic kidney disease

    • Genetics

    • Sympathetic overactivity

    • Increased renin

    • Unknown

    Correct Answer
    A. Unknown
    Explanation
    The major cause of essential hypertension is unknown. This means that there is no specific identifiable cause for the development of high blood pressure in individuals with essential hypertension. While there are various risk factors that contribute to the development of hypertension, such as genetics, chronic kidney disease, sympathetic overactivity, and increased renin levels, none of these factors can fully explain the cause of essential hypertension in all cases. Therefore, the exact reason behind essential hypertension remains unknown.

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  • 13. 

    Hypertension is a significant cause of heart failure, but not of endstage renal disease.

    • True

    • False

    Correct Answer
    A. False
    Explanation
    Hypertension is a significant cause of heart failure, but not of endstage renal disease. This means that while hypertension can lead to heart failure, it is not a major factor in the development of endstage renal disease. Other factors such as diabetes, chronic kidney disease, and certain medications are more commonly associated with endstage renal disease. Therefore, the statement is false.

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  • 14. 

    The proposed mechanisms behind high sodium intake and blood pressure include an increase in intracellular calcium, insulin resistance, a paradoxical rise in atrial natriuretic peptide, and other pressor effects.

    • True

    • False

    Correct Answer
    A. True
    Explanation
    The explanation for the given answer is that high sodium intake can lead to an increase in intracellular calcium, which can cause blood vessels to constrict and raise blood pressure. Additionally, high sodium intake can contribute to insulin resistance, which is associated with higher blood pressure. Furthermore, it has been observed that high sodium intake can lead to a paradoxical rise in atrial natriuretic peptide, a hormone that usually helps to lower blood pressure. Finally, high sodium intake can have other pressor effects, meaning it can directly increase blood pressure.

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  • 15. 

    A stethoscope placed over the brachial artery in the antecubital fossa identifies the first and last audible ________, which should be taken as systolic and diastolic pressure, respectively.

    • S3

    • Korotkoff sounds

    • Split S2

    • Wernicke sounds

    Correct Answer
    A. Korotkoff sounds
    Explanation
    When a stethoscope is placed over the brachial artery in the antecubital fossa, the first audible sound heard is the systolic pressure, which indicates the pressure when the heart is contracting and forcing blood through the arteries. The last audible sound heard is the diastolic pressure, which indicates the pressure when the heart is at rest and filling with blood. These sounds are known as Korotkoff sounds and are used to measure blood pressure. S3, Split S2, and Wernicke sounds are not related to measuring blood pressure.

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  • 16. 

    If you have renal disease, or diabetes, your goal BP should be:

    • 115/75

    • 120/80

    • 130/80

    • 130/90

    • 140/90

    Correct Answer
    A. 130/80
    Explanation
    If you have renal disease or diabetes, your goal blood pressure (BP) should be 130/80. Renal disease and diabetes can increase the risk of cardiovascular complications, and maintaining a lower BP can help reduce this risk. The first number (systolic pressure) represents the pressure in the arteries when the heart beats, and the second number (diastolic pressure) represents the pressure when the heart is at rest between beats. A BP goal of 130/80 is considered appropriate for individuals with these conditions to help protect their kidneys and reduce the risk of complications.

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  • 17. 

    What is the best anti-HTN med to use in African Americans and the elderly?

    • Diuretic and B-blocker

    • Diuretic and ACE-I

    • Diuretic and CCB

    Correct Answer
    A. Diuretic and CCB
    Explanation
    The best anti-HTN medication to use in African Americans and the elderly is a combination of a diuretic and a calcium channel blocker (CCB). Diuretics help to decrease blood volume and lower blood pressure, while CCBs relax and widen the blood vessels, reducing the resistance to blood flow. This combination is particularly effective in African Americans and the elderly because they tend to have higher rates of salt sensitivity and calcium channel blockers have been shown to be more effective in these populations. Additionally, diuretics are well-tolerated and have a long history of use in these patient populations.

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  • 18. 

    This drug can cause flushing, headache, GERD, and edema. It is useful in the elderly.  IR formulations should be avoided.

    • Propranolol

    • Benazepril

    • Metoprolol

    • Nifedipine

    • Terazosin

    Correct Answer
    A. Nifedipine
    Explanation
    Nifedipine is the correct answer because it is a calcium channel blocker commonly used to treat high blood pressure and angina. Flushing, headache, GERD (gastroesophageal reflux disease), and edema are common side effects of nifedipine. It is also mentioned that the drug is useful in the elderly, which further supports the choice of nifedipine as the correct answer. Additionally, the statement advises avoiding immediate-release (IR) formulations of the drug, which is consistent with the use of nifedipine extended-release formulations.

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  • 19. 

    If BP is greater than ________ above goal, initiate therapy with two agents, one usually should be a thiazide-type diuretic.

    • 10/5

    • 20/10

    • 30/10

    • 30/15

    • 40/20

    Correct Answer
    A. 20/10
    Explanation
    If the blood pressure (BP) is greater than 20/10 above the goal, therapy should be initiated with two agents, one of which should usually be a thiazide-type diuretic. This means that if the systolic blood pressure is 20 mmHg or more above the goal (which is typically 120 mmHg), and the diastolic blood pressure is 10 mmHg or more above the goal (which is typically 80 mmHg), then combination therapy with two medications, including a diuretic, is recommended to lower the blood pressure effectively.

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  • 20. 

    Which drugs do not work well alone in the treatment of HTN and should be used cautiously in patients with renal insufficiency.

    • ACE inhibitors

    • Potassium Sparing Diuretics

    • Loop Diuretics

    Correct Answer
    A. Potassium Sparing Diuretics
    Explanation
    Potassium Sparing Diuretics should be used cautiously in patients with renal insufficiency because these drugs can cause hyperkalemia, which is an elevated level of potassium in the blood. In patients with renal insufficiency, the kidneys are not able to properly excrete potassium, so adding a potassium sparing diuretic to the treatment can further increase potassium levels and potentially lead to complications. Therefore, these drugs are not effective when used alone in the treatment of hypertension and should be used with caution in patients with renal insufficiency.

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  • 21. 

    A patient presents with a BP of 140/85. This patient is classified as having:

    • Pre-hypertension

    • Normal

    • Stage I HTN

    • Stage II HTN

    Correct Answer
    A. Stage I HTN
    Explanation
    Normal SBP =100

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  • 22. 

    Abrupt discontinuation of these drugs causes rebound HTN.

    • Indapamide and Atenolol

    • Fosinopril and Atenolol

    • Irbesartan and Clonidine

    • Atenolol and Indapamide

    • Atenolol and Clonidine

    Correct Answer
    A. Atenolol and Clonidine
    Explanation
    Abrupt discontinuation of Atenolol and Clonidine can cause rebound hypertension. Atenolol is a beta-blocker that reduces the workload on the heart by blocking the effects of adrenaline. Clonidine is an alpha-2 adrenergic agonist that lowers blood pressure by stimulating alpha receptors in the brain. When these medications are suddenly stopped, there is a sudden increase in sympathetic activity, leading to an increase in blood pressure. This rebound hypertension can be dangerous and should be avoided by gradually tapering off the medications under medical supervision.

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  • 23. 

    What is the percentage of patients with HTN  have controlled HTN?

    • 84%

    • 64%

    • 44%

    Correct Answer
    A. 44%
    Explanation
    The answer of 44% suggests that only 44% of patients with HTN have their condition controlled. This means that a majority of patients with HTN do not have their blood pressure adequately managed. It highlights the need for better management strategies and interventions to improve control rates among this population.

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  • 24. 

    ISH is defined as a SBP > ______ and a diastolic < 90.

    • 130

    • 140

    • 150

    • 160

    Correct Answer
    A. 140
    Explanation
    ISH stands for Isolated Systolic Hypertension, which is a condition characterized by high systolic blood pressure (SBP) and normal or low diastolic blood pressure. In this case, the correct answer is 140 because it is the threshold for defining high SBP in ISH. A SBP greater than 140 and a diastolic pressure lower than 90 are the criteria used to diagnose ISH.

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  • 25. 

    Which drug is twice as potent as hydrochlorothiazide?

    • Indapamide

    • Chlorthalidone

    • Furosemide

    • Bumetanide

    • Doxazosin

    Correct Answer
    A. Chlorthalidone
    Explanation
    Chlorthalidone is twice as potent as hydrochlorothiazide because it has a greater diuretic effect. This means that chlorthalidone is more effective at increasing urine production and reducing fluid retention compared to hydrochlorothiazide. Therefore, a lower dose of chlorthalidone is needed to achieve the same therapeutic effect as hydrochlorothiazide.

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  • 26. 

    A patient presents with a blood pressure of 55 bpm. Which drug(s) should you use cautiously with this patient?

    • Hydrochlorothiazide

    • Metoprolol

    • Amlodipine

    • Metoprolol and Amlodipine

    • Metoprolol and Verapamil/Diltiazem

    Correct Answer
    A. Metoprolol and Verapamil/Diltiazem
    Explanation
    Patients with a blood pressure of 55 bpm are likely experiencing bradycardia, a slower than normal heart rate. Metoprolol and Verapamil/Diltiazem are both medications that can further decrease heart rate, so they should be used cautiously in this patient. Hydrochlorothiazide and Amlodipine do not have significant effects on heart rate and would not be contraindicated in this situation.

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  • 27. 

    What are some causes of secondary hypertension? Select all that apply.

    • Cushing's syndrome

    • Chronic kidney disease

    • Pheochromocytoma

    • Drug-induced

    • COPD

    Correct Answer(s)
    A. Cushing's syndrome
    A. Chronic kidney disease
    A. Pheochromocytoma
    A. Drug-induced
    Explanation
    Secondary hypertension refers to high blood pressure that is caused by an underlying medical condition or medication. Cushing's syndrome is a hormonal disorder that leads to high levels of cortisol in the body, which can increase blood pressure. Chronic kidney disease can cause hypertension due to the kidneys' inability to properly regulate fluid and salt balance. Pheochromocytoma is a rare tumor that produces excess adrenaline, leading to high blood pressure. Drug-induced hypertension can occur as a side effect of certain medications. COPD, or chronic obstructive pulmonary disease, is not a known cause of secondary hypertension.

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  • 28. 

    Alpha-1 blockers are third-line agents in heart failure.

    • True

    • False

    Correct Answer
    A. False
    Explanation
    NEVER USE IN HEART FAILURE

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  • 29. 

    Hemodynamically, blood pressure is a product of ____________. Select the two that best apply.

    • Blood flow

    • Stroke volume

    • Peripheral resistance

    • Atrial natriuretic peptide

    • Cardiac output

    Correct Answer(s)
    A. Peripheral resistance
    A. Cardiac output
    Explanation
    Blood pressure is determined by two main factors: peripheral resistance and cardiac output. Peripheral resistance refers to the resistance encountered by blood flow in the blood vessels. When the blood vessels constrict, the resistance increases, leading to an increase in blood pressure. Cardiac output, on the other hand, refers to the volume of blood pumped by the heart per minute. An increase in cardiac output can also lead to an increase in blood pressure. Therefore, both peripheral resistance and cardiac output play a role in determining blood pressure.

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  • 30. 

    Which drug is useful in slowing the demineralization in osteoporosis?

    • BBs

    • CCBs

    • Thiazides

    • ACEs and ARBs

    • Renin-Is

    Correct Answer
    A. Thiazides
    Explanation
    Thiazides are a type of diuretic medication that can be useful in slowing the demineralization process in osteoporosis. These drugs work by increasing the reabsorption of calcium in the kidneys, which helps to maintain a higher level of calcium in the bones. This can help to slow down the loss of bone density and reduce the risk of fractures associated with osteoporosis. Thiazides are commonly used in the treatment of high blood pressure, but they can also have a beneficial effect on bone health in individuals with osteoporosis.

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  • 31. 

    From 1999 to 2000 HTN was slightly more prevalent in men (30.1%) than women (27.1%). However, the prevalence is increasing in women and remaining unchanged in men. Men have a higher prevalence of HTN than women until age ___.  

    • 35

    • 45

    • 55

    • 65

    Correct Answer
    A. 55
    Explanation
    The correct answer is 55. From 1999 to 2000, HTN (hypertension) was slightly more prevalent in men than women. However, the prevalence of HTN is increasing in women and remaining unchanged in men. This suggests that as women age, they are more likely to develop HTN, while men maintain a higher prevalence of HTN until around the age of 55.

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  • 32. 

    51% of patients with CV disease die of:

    • Stroke

    • HBP

    • Coronary Heart Disease

    • HF

    Correct Answer
    A. Coronary Heart Disease
    Explanation
    Coronary Heart Disease is the correct answer because it is the leading cause of death among patients with cardiovascular disease. It refers to the narrowing or blockage of the coronary arteries, which supply oxygen-rich blood to the heart muscle. This can lead to heart attacks and other complications that can be fatal. Stroke, high blood pressure, and heart failure are also common in patients with cardiovascular disease, but they are not the primary cause of death in the majority of cases.

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  • 33. 

    Peripheral resistance is mainly responsible for?

    • SBP

    • DBP

    Correct Answer
    A. DBP
    Explanation
    Peripheral resistance refers to the resistance that blood encounters as it flows through the blood vessels in the peripheral (or outer) parts of the body. This resistance is mainly determined by the diameter of the blood vessels and the degree of constriction or relaxation of the smooth muscles in the vessel walls. Increased peripheral resistance leads to an increase in diastolic blood pressure (DBP), which is the pressure in the arteries when the heart is at rest between beats. Therefore, peripheral resistance is mainly responsible for DBP.

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  • 34. 

    What are some drugs that cause secondary hypertension? Select all that apply.

    • NSAIDS

    • Erythropoietin

    • Gemfibrozil

    • Oral contraceptives

    • Ambien

    Correct Answer(s)
    A. NSAIDS
    A. Erythropoietin
    A. Oral contraceptives
    Explanation
    Some drugs that can cause secondary hypertension include NSAIDs (nonsteroidal anti-inflammatory drugs) because they can cause fluid retention and vasoconstriction, erythropoietin because it can increase red blood cell production and lead to increased blood pressure, and oral contraceptives because they can increase the risk of developing high blood pressure. Gemfibrozil and Ambien are not known to cause secondary hypertension.

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  • 35. 

    What is the number one lifestyle modification to decrease blood pressure?

    • Restriction of sodium

    • Exercise

    • Increase calcium and potassium in foods

    • Avoid tobacco

    • Lose weight

    Correct Answer
    A. Lose weight
    Explanation
    Losing weight is the number one lifestyle modification to decrease blood pressure because excess weight puts additional strain on the heart and blood vessels, leading to higher blood pressure. By losing weight, individuals can reduce the workload on their cardiovascular system, resulting in lower blood pressure levels. This lifestyle modification is particularly effective for individuals who are overweight or obese, as even a modest weight loss can have significant benefits for blood pressure control.

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  • 36. 

    Patient failing to achieve goal blood pressure despite maximum doses of two antihypertensive agents should be carefully screened for resistant hypertension.

    • True

    • False

    Correct Answer
    A. False
    Explanation
    Three antihypertensive agents

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  • 37. 

    Which drugs can increase potassium? Select all that apply.

    • Hydrochlorothiazide

    • Spironolactone

    • Benazepril

    • Valsartan

    • Propranolol

    Correct Answer(s)
    A. Spironolactone
    A. Benazepril
    A. Valsartan
    Explanation
    Spironolactone, Benazepril, and Valsartan are drugs that can increase potassium levels. Spironolactone is a potassium-sparing diuretic, meaning it helps the body retain potassium instead of excreting it. Benazepril and Valsartan are both angiotensin-converting enzyme (ACE) inhibitors, which can also increase potassium levels by reducing the production of aldosterone, a hormone that promotes potassium excretion. Hydrochlorothiazide and Propranolol, on the other hand, do not have this effect and do not increase potassium levels.

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  • 38. 

    Which aldosterone antagonist is contraindicated in patients with estimated creatinine clearance less than 50mL/minute or serum creatinine greater than 1.8mg/dL in women or greater than 2mg/dL in men?

    • Spironolactone

    • Eplerenone

    • Doxazosin

    • Verapamil

    • Quinapril

    Correct Answer
    A. Eplerenone
    Explanation
    Eplerenone is contraindicated in patients with estimated creatinine clearance less than 50mL/minute or serum creatinine greater than 1.8mg/dL in women or greater than 2mg/dL in men. This means that patients with impaired kidney function or high levels of creatinine should not take Eplerenone. It is important to avoid Eplerenone in these patients to prevent potential adverse effects or complications.

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  • 39. 

    CVD risk factors include: (select all that apply.)

    • Dyslipidemia

    • Cigarette smoking

    • Microalbuminuria or estimated GFR <60 mL/min

    • DM

    • Age (older than 35 for men, 45 for women)

    Correct Answer(s)
    A. Dyslipidemia
    A. Cigarette smoking
    A. Microalbuminuria or estimated GFR <60 mL/min
    A. DM
    Explanation
    The correct answer includes dyslipidemia, cigarette smoking, microalbuminuria or estimated GFR

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  • 40. 

    What drugs should you avoid in angina? Check all that apply.

    • CCBs

    • Hydralazine

    • Minoxidil

    • B-blockers (non-ISA)

    • Thiazides

    Correct Answer(s)
    A. Hydralazine
    A. Minoxidil
    Explanation
    Hydralazine and minoxidil are drugs that should be avoided in angina. These drugs are vasodilators, meaning they relax and widen the blood vessels. While this may seem beneficial, in the case of angina, it can actually worsen the condition. Angina is caused by a reduced blood flow to the heart, and vasodilators can further decrease blood flow, potentially leading to more severe symptoms. Therefore, it is recommended to avoid these drugs in angina treatment.

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  • 41. 

    What is the difference from hypertensive urgency to an emergency? Select all that apply.

    • Urgency does not cause organ damage

    • An example of urgency is unstable angina, while an emergency is an acute MI.

    • You can treat an emergency is nifedipine IR.

    • Perioperative HTN and optic disk edema are examples of urgency.

    • You can treat urgency with nifedipine IR.

    Correct Answer(s)
    A. Urgency does not cause organ damage
    A. Perioperative HTN and optic disk edema are examples of urgency.
    Explanation
    Unstable angina is an emergency. Do not use nifedipine IR.

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  • 42. 

    Which drugs can be used in patients with a CrCl <30? Select all that apply.

    • Thiazides

    • Loops

    • Half the dose of ACE-I

    • Fosinopril

    Correct Answer(s)
    A. Loops
    A. Half the dose of ACE-I
    A. Fosinopril

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