Diuretics

Question 1

Spironolactone is an example of a:
a) Thiazide diuretic
b) Loop diuretic
c) Potassium-sparing diuretic
d) Osmotic diuretic

Answer 1

Answer: c) Potassium-sparing diuretic

Question 2

Which of the following drugs is classified as a loop diuretic?
a) Furosemide
b) Hydrochlorothiazide
c) Spironolactone
d) Triamterene

Answer 2

Answer: a) Furosemide

Question 3

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 3

Answer: d) Spironolactone

Question 4

1. Which of the following is NOT a class of diuretics?
   a) Thiazides
   b) Loop diuretics
   c) Alpha-blockers
   d) Potassium-sparing diuretics

Answer 4

Answer: c) Alpha-blockers

Question 5

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 5

Answer: c) Loop of Henle

Question 6

Thiazides act primarily on which part of the nephron?
a) Distal convoluted tubule
b) Proximal convoluted tubule
c) Loop of Henle
d) Collecting duct

Answer 6

a) Distal convoluted tubule

Question 7

Which diuretic is not used in the management of heart failure?
a) Furosemide
b) Hydrochlorothiazide
c) Spironolactone
d) Mannitol

Answer 7

Answer: (d) Mannitol

Question 8

Which of the following diuretics is most likely to cause ototoxicity?
a) Furosemide
b) Hydrochlorothiazide
c) Spironolactone
d) Amiloride

Answer 8

Answer: a) Furosemide

Question 9

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 9

Answer: a) Inhibition of sodium reabsorption

Question 10

Which diuretic is contraindicated in patients with anuria?
a) Hydrochlorothiazide
b) Furosemide
c) Spironolactone
d) Mannitol

Answer 10

b) Furosemide

Question 11

Which diuretic is considered first-line treatment for hypertension in most patients?
a) Furosemide
b) Hydrochlorothiazide
c) Mannitol
d) Spironolactone

Answer 11

b) Hydrochlorothiazide

Question 12

Which diuretic is known to cause hyperglycemia and hyperuricemia as adverse effects? (more than 1)
a) Furosemide
b) Hydrochlorothiazide
c) Acetazolamide
d) Spironolactone

Answer 12

(a) furosemide (b) Hydrochlorothiazide

Question 13

Which diuretic is associated with the risk of gynecomastia and menstrual irregularities?
a) Furosemide
b) Hydrochlorothiazide
c) Acetazolamide
d) Spironolactone

Answer 13

d) Spironolactone

Question 14

Which diuretic is a treatment for primary Hyperaldosteronism?
a) Furosemide
b) Hydrochlorothiazide
c) Acetazolamide
d) Spironolactone

Answer 14

d) Spironolactone

Question 15

Which diuretic is associated with the risk of metabolic alkalosis? ( more than 1 ans)
a) Furosemide
b) Hydrochlorothiazide
c) Acetazolamide
d) Spironolactone

Answer 15

Answer: a) Furosemide
(b) Hydrochlorothiazide

Question 16

Which diuretic is contraindicated in patients with sulfa allergies?
a) Furosemide
b) Hydrochlorothiazide
c) Acetazolamide
d) Mannitol

Answer 16

(b) and (a) Hydrochlorothiazide and furosemide

Question 17

Which diuretic is commonly used in the treatment of nephrogenic diabetes insipidus?
a) Furosemide
b) Hydrochlorothiazide
c) Acetazolamide
d) Amiloride

Answer 17

b) Hydrochlorothiazide

Question 18

Which diuretic is known to cause hyperuricemia as a side effect? 2 ans
a) Furosemide
b) Hydrochlorothiazide
c) Spironolactone
d) Acetazolamide

Answer 18

Answer: (a)furosemide also b) Hydrochlorothiazide

Question 19

Which diuretic is contraindicated in patients with renal failure?
a) Furosemide
b) Hydrochlorothiazide
c) Acetazolamide
d) Amiloride

Answer 19

b) Hydrochlorothiazide

Question 20

Which diuretic is primarily used to prevent hypokalemia induced by other diuretics?
a) Furosemide
b) Hydrochlorothiazide
c) Spironolactone
d) Mannitol

Answer 20

c) Spironolactone

Question 21

What are the main clinical indications for loop diuretics?

Answer 21

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

Question 22

List down 4 thiazide diuretics

Answer 22

Chlorthalidone, Hydrochlorothiazide, Indapamide & Metalozone

Question 23

List down 2 potassium K sparing diuretics from the 1st class

Answer 23

Amiloride, Triamterene

Question 24

Explain how does spironolactone and eplerenone cause diuretic effects?

Answer 24

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.

Question 25

Which diuretic drug causes metabolic acidosis?

Answer 25

spironolactone and eplerenone

Question 26

MOA of potassium sparing diuretics (spironolactone)

Answer 26

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)

Question 27

Contraindications of loop diuretics

Answer 27

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

Question 28

Unwanted side effects of thiazide diuretics

Answer 28

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

Question 29

MOA of amilodride and triamterene

Answer 29

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.

Question 30

Contraindication of amiloride and triamterene

Answer 30

(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.

Question 31

Clinical indication of spironolactone and eplereone

Answer 31

1). Congestive Heart Failure. Improves survival. 2). Primary Hyperaldosteronism (Conn’s Syndrome)

Question 32

Side effects of spironolactone

Answer 32

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

Question 33

Contraindications of spironacltone and eplerenone

Answer 33

1). Patients with Hyperkalemia. 2). Patients taking ACE inhibitors or ARBs. Due to ACE inhibitors and ARBs causing Hyperkalemia. 3). Patients taking Potassium Supplements.