Diuretics Flashcards
Spironolactone is an example of a:
a) Thiazide diuretic
b) Loop diuretic
c) Potassium-sparing diuretic
d) Osmotic diuretic
Answer: c) Potassium-sparing diuretic
Which of the following drugs is classified as a loop diuretic?
a) Furosemide
b) Hydrochlorothiazide
c) Spironolactone
d) Triamterene
Answer: a) Furosemide
Which antihypertensive drug class is associated with the risk of causing gynecomastia (enlarged breast tissue) in males?
a) ACE inhibitors
b) Beta-blockers
c) Calcium channel blockers
d) Spironolactone
Answer: d) Spironolactone
- Which of the following is NOT a class of diuretics?
a) Thiazides
b) Loop diuretics
c) Alpha-blockers
d) Potassium-sparing diuretics
Answer: c) Alpha-blockers
Loop diuretics act primarily on which part of the nephron?
a) Distal convoluted tubule
b) Proximal convoluted tubule
c) Loop of Henle
d) Collecting duct
Answer: c) Loop of Henle
Thiazides act primarily on which part of the nephron?
a) Distal convoluted tubule
b) Proximal convoluted tubule
c) Loop of Henle
d) Collecting duct
a) Distal convoluted tubule
Which diuretic is not used in the management of heart failure?
a) Furosemide
b) Hydrochlorothiazide
c) Spironolactone
d) Mannitol
Answer: (d) Mannitol
Which of the following diuretics is most likely to cause ototoxicity?
a) Furosemide
b) Hydrochlorothiazide
c) Spironolactone
d) Amiloride
Answer: a) Furosemide
The primary mechanism of action of diuretics is:
a) Inhibition of sodium reabsorption
b) Stimulation of sodium reabsorption
c) Inhibition of potassium secretion
d) Stimulation of water reabsorption
Answer: a) Inhibition of sodium reabsorption
Which diuretic is contraindicated in patients with anuria?
a) Hydrochlorothiazide
b) Furosemide
c) Spironolactone
d) Mannitol
b) Furosemide
Which diuretic is considered first-line treatment for hypertension in most patients?
a) Furosemide
b) Hydrochlorothiazide
c) Mannitol
d) Spironolactone
b) Hydrochlorothiazide
Which diuretic is known to cause hyperglycemia and hyperuricemia as adverse effects? (more than 1)
a) Furosemide
b) Hydrochlorothiazide
c) Acetazolamide
d) Spironolactone
(a) furosemide (b) Hydrochlorothiazide
Which diuretic is associated with the risk of gynecomastia and menstrual irregularities?
a) Furosemide
b) Hydrochlorothiazide
c) Acetazolamide
d) Spironolactone
d) Spironolactone
Which diuretic is a treatment for primary Hyperaldosteronism?
a) Furosemide
b) Hydrochlorothiazide
c) Acetazolamide
d) Spironolactone
d) Spironolactone
Which diuretic is associated with the risk of metabolic alkalosis? ( more than 1 ans)
a) Furosemide
b) Hydrochlorothiazide
c) Acetazolamide
d) Spironolactone
Answer: a) Furosemide
(b) Hydrochlorothiazide
Which diuretic is contraindicated in patients with sulfa allergies?
a) Furosemide
b) Hydrochlorothiazide
c) Acetazolamide
d) Mannitol
(b) and (a) Hydrochlorothiazide and furosemide
Which diuretic is commonly used in the treatment of nephrogenic diabetes insipidus?
a) Furosemide
b) Hydrochlorothiazide
c) Acetazolamide
d) Amiloride
b) Hydrochlorothiazide
Which diuretic is known to cause hyperuricemia as a side effect? 2 ans
a) Furosemide
b) Hydrochlorothiazide
c) Spironolactone
d) Acetazolamide
Answer: (a)furosemide also b) Hydrochlorothiazide
Which diuretic is contraindicated in patients with renal failure?
a) Furosemide
b) Hydrochlorothiazide
c) Acetazolamide
d) Amiloride
b) Hydrochlorothiazide
Which diuretic is primarily used to prevent hypokalemia induced by other diuretics?
a) Furosemide
b) Hydrochlorothiazide
c) Spironolactone
d) Mannitol
c) Spironolactone
What are the main clinical indications for loop diuretics?
Acute pulmonary edema associated with heart failure, liver cirrhosis, nephrotic syndrome and renal failure.
Hypertension in patients with renal failure, acute hyperkalemia and acute hypercalcemia - with isotonic saline administration
List down 4 thiazide diuretics
Chlorthalidone, Hydrochlorothiazide, Indapamide & Metalozone
List down 2 potassium K sparing diuretics from the 1st class
Amiloride, Triamterene
Explain how does spironolactone and eplerenone cause diuretic effects?
Spironolactone & Eplerenone blocks aldosterone from binding onto the
mineralocorticoid/aldosterone receptor in the cytosol. Therefore, decreases expression of epithelial Na+ channels &
Na+/K+-ATPase pumps in the collecting tubules and ducts.
Which diuretic drug causes metabolic acidosis?
spironolactone and eplerenone
MOA of potassium sparing diuretics (spironolactone)
Spironolactone & Eplerenone blocks aldosterone from binding onto the
mineralocorticoid/aldosterone receptor in the cytosol. Therefore, decreases expression of epithelial Na+ channels &
Na+/K+-ATPase pumps in the collecting tubules and ducts. So more K stays in the blood, but H20 is removed. (very little diuretic effect, so used with loop or thiazide diuretics to usually)
Contraindications of loop diuretics
1). Severe Hypovolemia (↓Blood fluid volume)
2). Severe Hyponatremia (↓Na+ ions in the Blood)
3). Patient Hypersensitivity to sulfonamides, especially to sulfonamide-based Loop diuretics (i.e. Furosemide, Bumetanide &
Torsemide)
4). Anuria (Failure of the kidneys to produce urine) from a trial dose of a loop diuretic
Unwanted side effects of thiazide diuretics
1). Hypovolemia (↓Extracellular Fluid Volume)
4). Hyponatremia (↓Na+ ions in the Blood): Due to decreased reabsorption.
5). Hypochloremia (↓Cl- ions in the Blood): Due to decreased reabsorption.
2). Hypokalemia (↓K+ ions in the Blood): Due to activation of RAAS → Aldosterone stimulates K+ ion secretion from the blood
stream into the collecting duct lumen. Therefore, increases the risk of cardiac arrhythmias.
3). Hyperglycemia (↑Blood Glucose): Due to decreased release of insulin by the pancreas, which is caused by hypokalemia.
6). Hypercalcemia (↑Ca2+ ions in the Blood). Due to increased Ca2+ reabsorption. Beneficial in patients with osteoporosis.
7 metabolic alkalosis, hyperuricemia, hyperlipemia, erectile dysfunction
MOA of amilodride and triamterene
POtassium sparing diuretics: Amiloride and Triamterene inhibit the epithelial Na+ channels in the luminal membrane
of the collecting tubules and ducts of the nephron.Decreasing the reabsorption of Na+ ions back into the tubule cell will
cause the inside of the cell to become more negative, which will stop K+
ions from being secreted into the lumen. Therefore, increasing the
concentration of K+ ions in the tubule cell and ultimately in the blood.
Contraindication of amiloride and triamterene
(potassium sparing diuretics):
Patients with Hyperkalemia.
2). Patients taking ACE inhibitors or ARBs. Due to ACE inhibitors and ARBs causing Hyperkalemia.
3). Patients taking Potassium Supplements.
Clinical indication of spironolactone and eplereone
1). Congestive Heart Failure. Improves survival.
2). Primary Hyperaldosteronism (Conn’s Syndrome)
Side effects of spironolactone
Hyperkalemia (↑K+ ions in the Blood).
2). Gastrointestinal Disturbances
3). Metabolic Acidosis (↓pH in Blood)
4). Gynecomastia (Spironolactone): Due to Spironolactone also blocking androgen receptors.
5). Decreased Libido (Spironolactone): Due to Spironolactone also blocking androgen
6). Impotence receptors.
7). Menstrual Irregularities (Spironolactone
Contraindications of spironacltone and eplerenone
1). Patients with Hyperkalemia.
2). Patients taking ACE inhibitors or ARBs. Due to ACE inhibitors and ARBs causing Hyperkalemia.
3). Patients taking Potassium Supplements.
