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Diuretics: Review Questions
HCTZ = Hydrochlorothiazide
1- Loop diuretics increase the excretion of all of the following except:
| a- Na | b- Ca and Mg |
| c- Uric acid | d- Water |
2- It is sometimes used to reduce intracranial and intraocular pressures
| a- Furosemide | b- Mannitol |
| c- HCTZ | d- Torsemide |
3- In addition to its moderate diuretic action, this diuretic agent has a persistent vasodilatory effect when used on chronic basis.
| a- Furosemide | b- Mannitol |
| c- HCTZ | d- Torsemide |
4- In an otherwise healthy adult with mild hypertension, appropriate initial antihypertensive therapy would be:
| a- Furosemide | b- HCTZ |
| c- Amiloride | d- Minoxidil |
5- The most common indication for the use of carbonic anhydrase inhibitors is:
| a- Metabolic alkalosis | b- Glaucoma |
| c- Epilepsy | d- Hypokalemic periodic paralysis |
6- Match
For each statement in the right column, select the drug that most closely matches it (may use a drug more than once)
a- Bumetanide
b- Spironolactone
c- Dorzolamide
d- Amiloride
e-Chlorothiazide |
- Inhibits carbonic anhydrase and increases HCO3- excretion. It is used topically to treat glaucoma.
- Antagonizes the effects of aldosterone in the distal nephron. It may cause hyperkalemia and gynecomastia.
- Inhibits the Na/K/2Cl cotransport in the loop of Henle. It helps in the treatment of pulmonary edema and ascites.
- It is the most likely diuretic to cause hypovolemia
- May be useful in treating idiopathic hypercalciuria.
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7- Match each set of drugs (on the left) with the most likely interaction (on the right). HCTZ stands for hydro-chloro-thiazide, the most popular thiazide diuretic.
a- Gentamicin / Furosemide
b- Spironolactone / enalapril
c- HCTZ / Prednisone
d- HCTZ / Carbamazepine (Tegretol)
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- Increased risk of hyperkalemia
- Hyperglycemia
- Ototoxicity and nephrotoxicity
- Increased risk of hyponatremia.
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8- Match each drug (on the left) with its site of action along the nephron (on the right).
a- Furosemide
b- Mannitol
c- Spironolactone
d- HCTZ |
- Thick ascending limb of the loop of Henle.
- The proximal tubule
- The distal convoluted tubule.
- The collecting ducts.
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9- Match each the side effects on the right with the diuretic agent (on the left) most likely to cause it (may use the same drug more than once)
a-Furosemide
b- Spironolactone
c- HCTZ
d- Triamterene
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- Hypercalcemia
- Metabolic Alkalosis
- Gynacomastia
- Hypercalciuria
- Megaloblastic anemia (in pts with liver disease)
- Hypomagnesemia
- Menstrual irregularities
- Glucose intolerance
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10- Match
- Uterine tumor
- Benign hypertrophy of the prostate
- Lupus erythematosus
- Nephrotoxic drugs
- Diarrhea or GI drainage
- Septicemia or hemorrhage
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- Pre-renal cause of acute renal failure
- Renal, intrinsic cause of acute renal failure
- Post-renal cause of acute renal failure
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11- Patients with renal insufficiency often exhibit a markedly reduced diuretic response. In this regard, which of the following statements is true?
- When the GFR drops below 30 mL/min, thiazide diuretics are virtually useless.
- The combination of a thiazide plus a K-sparing diuretic may yield an adequate diuretic response.
- An 80-mg dose of iv furosemide followed an hour later by a 500-mg dose of vi chlorothiazide will probably yield the highest possible response.
- All of the above.
12- Pre-renal ARF is characterized by all of the following except:
- elevated serum creatinine
- elevated BUN/Scr ratio
- normal urinalysis
- relatively high urinary Na
- relatively high urine concentration
13 - The emergent treatment of hyperkalemia does not include the administration of :
| a- Ca gluconate | b- Dextrose and Insulin |
| c- Kayexalate | d- Furosemide |
14- Which of the following diuretic regimens would be most effective for a patient suffering from advanced liver disease and ascites?
| a- Furosemide + Triamterene | b- Furosemide + Spironolactone |
| c- HCTZ + Amiloride | d- Furosemide + HCTZ |
15- Which of the following drugs is indicated specifically for the treatment of secondary hyperparathyroidism in patients with end-stage renal disease:
| a- Calcitriol | b- Paricalcitol (Zemplar) |
| c- Sevelamer (Renagel) | d- Midodrine |
16- Which class of drugs is least likely to compromise renal perfusion?
| a- ß-blockers | b- Ca channel blockers |
| c- ACE inhibitors | d- NSAIDs |
17- Adjustment of antibiotic dosage for patients with renal insufficiency may involve:
- Extension of the dosing interval.
- Reduction of the maintenance dose.
- Administration of a loading dose.
- all of the above.
Answers
Q1 thru Q5: c, b, c, b, b
Q6: 1c, 2b, 3a, 4a, 5e
Q7: 1b, 2c, 3a, 4d
Q8: 1a, 2b, 3d, 4c
Q9: 1c, 2a, 3b, 4a, 5d, 6a, 7b, 8c
Q10: Ic, IIc, IIIb, IVb, Va, VIa
Q11 thru Q17: a, d, d, b, b, b, d
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Thyroid Case
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