Study your flashcards anywhere!

Download the official Cram app for free >

  • Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key

image

Play button

image

Play button

image

Progress

1/17

Click to flip

17 Cards in this Set

  • Front
  • Back
A 70-y/o man is admitted with a history of heart failure and an acute left ventricular myocardial infarction. He has severe pulmonary edema. Which of the following drugs is LEAST likely to prove useful in the treatment of acute pulmonary edema?
a. Bumetanide
b. Ethacrynic acid
c. Furosemide
d. Hydrochlorothiazide
e. Torsemide
D. Hydrochlorothiazide. Loop diuretics have a rapid onset of action, are very efficacious, and appear to have significant direct smooth muscle-relaxing effects in the pulmonary vessels. They are therefore drugs of choice in acute pulmonary edema. The only drug in the list that is not a loop agent is hydrochlorothiazide.
A 50-y/o man has a history of frequent episodes of renal colic with high-calcium renal stones. The most useful diuretic agent in the treatment of recurrent calcium stones is
A. Mannitol
B. Furosemide
C. Spironolactone
D. Hydrochlorothiazide
E. Acetazolamide
D. Hydrochlorothiazide. The thiazides are useful in the prevention of calcium stones because these drugs inhibit the renal excretion of calcium. In contrast, the loop agents facilitate calcium excretion.
When used chronically, thiazide diuretics have all of the following properties or effects EXCEPT
A. Elevation of blood cholesterol
B. Elevation of blood glucose
C. Elevation of plasma uric acid
D. Decreased urinary excretion of calcium
E. Ototoxicity
E. Ototoxicity. Thiazides do not cause ototoxicity; loop diuretics do.
Which of the following drugs is correctly associated with its site of action and maximal diuretic efficacy?
A. Thiazides - DCT - 7% of filtered Na+
B. Spironolactone - PCT - 40%
C. Bumetanide - TAL - 15%
D. Metolazone - CCT - 2%
E. All of the above
Spironolactone acts in the CCT, not the PCT. This drug is not usually capable of causing a 40% sodium diuresis. Bumetanide, a loop diuretic, can produce a 30% to 40% increase in sodium excretion. Metolazone, a thiazide-like drug, acts in the DCT, not in the CCT. The answer is A.
A patient with long-standing diabetic renal disease and hyperkalemia and recent-onset heart failure requires a diuretic. Which of the following agents would be LEAST harmful in a patient with severe hyperkalemia?
A. Amiloride
B. Hydrochlorothiazide
C. Losartan
D. Spironolactone
E. Triamterene
B. Hydrochlorothiazide. Hyperkalemia should not be treated with drugs that interfere with aldosterone production (e.g., losartan, an ATIIRB) or CCT potassium excretion (e.g., amilioride, spironolactone, triamterene). These agents are all capable of increasing serum potassium. Hydrochlorothiazide would not reduce serum potassium rapidly, but it would not increase it.
Which of the following diuretics would be most useful in a comatose patient with cerebral edema?
A. Acetazolamide
B. Amilioride
C. Ethacrynic acid
D. Furosemide
E. Mannitol
An osmotic agent is needed to remove water from the cells of the edematous brain and reduce intracranial pressure rapidly. The answer is E.
Which of the following is not associated with use of thiazide diuretics?
a. Hypercalciuria
b. Hyponatremia
c. Hypokalemia
d. Hyperuricemia
e. Metabolic alkalosis
A. Hypercalciuria. Thiazides produce all of the effects listed except hypercalciuria. They REDUCE urine calcium and for this reason are useful in chronic stone-formers.
Which of the following therapies would be most useful in the management of severe hypercalcemia?
a. Amiloride plus saline infusion
b. Furosemide plus saline infusion
c. Hydrochlorothiazide plus saline infusion
d. Mannitol plus saline infusion
e. Spironolactone plus saline infusion
B. Furosemide plus saline infusion. Diuretic therapy of hypercalcemia requires a reduction in calcium reabsorption in the TAL. However, a loop diuretic alone would reduce blood volume around the remaining calcium so that serum calcium would not decrease appropriately. Therefore, saline infusion should accompany the loop diuretic. The answer is B
A 60-y/o patient complains of paresthesias and occasional nausea associated with one of her drugs. She is found to have hyperchloremic metabolic acidosis. She is probably taking
Paresthesias and GI distress are common adverse effects of acetazolamide, especially when it is taken chronically, as in glaucoma. The observation that the patient has metabolic acidosis also suggest the use of acetazolamide. The answer is a. Acetazolamide for glaucoma.
A 70-y/o woman is admitted to the emergency room because of a "fainting spell" at home. She appears to have suffered no trauma from her fall, but her bp is 110/60 when lying down and 60/40 when she sits up. Neurologic examination and an ECG are within normal limits when she is lying down. Questioning reveals that she has recently started taking "water pills" for a heart condition. Which of the following drugs is the most likely cause of her fainting spell?
a. Acetazolamide
b. Amilioride
c. Furosemide
d. Hydrochlorothiazide
e. Spironolactone
The case history suggests that the syncope is associated with diuretic use. Complications of diuretics that can result in syncope include both postural hypotension due to excessive reduction of blood volume and arrhythmias due to excessive potassium loss. Potassium wasting is more common with thiazides (because of their long duration of action), but these drugs rarely cause reduction of blood volume sufficient to result in orthostatic hypotension. The answer is C, furosemide.
A 55-y/o patient with severe posthepatitis cirrhosis is started on a diuretic for another condition. Two days later he is found in a coma. The drug most likely to cause coma in a patient with cirrhosis is
a. Acetazolamide
b. Amilioride
c. Furosemide
d. Hydrochlorothiazide
e. Spironolactone
The answer is a, acetazolamide. The carbonic anhydrase inhibitors cause metabolic acidosis and urinary alkalosis. Patients with severe impairment of liver function are unable to synthesize urea efficiently and become dependent on renal excretion of ammonium ion to rid the body of nitrogenous wastes. However, in alkaline urine the ammonium ion is rapidly converted to ammonia gas, which is very rapidly absorbed. Hyperammonemia results, with severe neurological consequences. The answer, again, is A.
A drug that has its major effect in the DCT is
a. Acetazolamide
b. Amilioride
c. Demeclocycline
d. Desmopressin
e. Ethacrynic acid
f. Furosemide
g. Metolazone
h. Mannitol
i. Spironolactone
j. Triamterene
Metolazone, although not a thiazide, is often used as a thiazide substitute. Metolazone's site of action, effects, and toxicities (including sulfonamide allergy) are indistinguishable from the true thiazides. The answer is G.
A drug that increases the formation of dilute urine in water-loaded subjects and is used to treat SIADH is
a. Acetazolamide
b. Amilioride
c. Demeclocycline
d. Desmopressin
e. Ethacrynic acid
f. Furosemide
g. Hydrochlorothiazide
h. Mannitol
i. Spironolactone
j. Triamterene
Inability to form dilute urine in the fully hydrated condition is characteristic of SIADH. Antagonists of ADH are needed to treat this condition. The answer is C.
A drug that is useful in acute glaucoma and high-altitude sickness is
a. Acetazolamide
b. Amilioride
c. Demeclocycline
d. Desmopressin
e. Ethacrynic acid
f. Furosemide
g. Hydrochlorothiazide
h. Mannitol
i. Spironolactone
j. Triamterene
Carbonic anhydrase inhibitors are useful in glaucoma and altitude sickness. The answer is A.
Different diuretic drugs act at different sites in the nephron. Site of action of a drug that blocks a steroid receptor and causes potassium retention?
Spironolactone is an aldosterone receptor antagonist, acts intracellularly in the CCT, and causes potassium retention
Site of action of a drug that blocks a sodium, potassium, and chloride co-transporter and increases calcium excretion
Loop diuretics block the Na+/K+/2Cl-co-transporter in the TAL of Henle's loop
17. Identify the substance denoted 17
18. Identify the substance denoted in 18
19. Identify the substance denoted 19
20. Identify the substance denoted 20
17. The substance denoted in 17 results from the combination of bicarbonate ion with a proton; this is carbonic acid
18. The substance in 18 is countertransported against sodium in the PCT cell and combines with bicarnoate ion to yield carbonic acid; it is a proton (H+)
19. Substance 19 and water are the products of the dissociation of carbonic acid; this is carbon dioxide
20. The substance denoted 20 is the enzyme that catalyzes the dissociation of carbonic acid into water and carbon dioxide. The answer is carbonic anhydrase