Lippincott Chapter 18: Diuretics Flashcards
18.1 An elderly patient with a history of heart disease is
brought to the emergency room with difficulty breathing.
Examination reveals that she has pulmonary edema.
Which treatment is indicated?
A. Acetazolamide.
B. Chlorthalidone.
C. Furosemide.
D. Hydrochlorothiazide.
E. Spironolactone.
Correct answer = C. This is a potentially fatal situation. It
is important to administer a diuretic that will reduce fluid
accumulation in the lungs and, thus, improve oxygenation
and heart function. The loop diuretics are most effective in
removing large fluid volumes from the body and are the
treatment of choice in this situation. In this situation, furo-
semide should be administered intravenously. The other
choices are inappropriate
18.2 A group of college students is planning a mountain
climbing trip to the Andes. Which would be appropriate
for them to take to prevent mountain sickness?
A. A thiazide diuretic such as hydrochlorothiazide.
B. An anticholinergic such as atropine.
C. A carbonic anhydrase inhibitor such as
acetazolamide.
D. A loop diuretic such as furosemide.
E. A β-blocker such as metoprolol.
Correct answer = C. Acetazolamide is used prophylactically
for several days before an ascent above 10,000 feet. This
treatment prevents the cerebral and pulmonary problems
associated with the syndrome as well as other difficulties,
such as nausea.
18.3 An alcoholic male has developed hepatic cirrhosis.
To control the ascites and edema, which should be
prescribed?
A. Acetazolamide.
B. Chlorthalidone.
C. Furosemide.
D. Hydrochlorothiazide.
E. Spironolactone.
Correct answer = E. Spironolactone is very effective in the
treatment of hepatic edema. These patients are frequently
resistant to the diuretic action of loop diuretics, although
a combination with spironolactone may be beneficial. The
other agents are not indicated.
18.4 A 55-year-old male with kidney stones has been placed
on a diuretic to decrease calcium excretion. However,
after a few weeks, he develops an attack of gout. Which
diuretic was he taking?
A. Furosemide.
B. Hydrochlorothiazide.
C. Spironolactone.
D. Triamterene.
E. Urea.
Correct answer = B. Hydrochlorothiazide is effective in
increasing calcium reabsorption, thus decreasing the amount
of calcium excreted, and decreasing the formation of kidney
stones that contain calcium phosphate or calcium oxalate.
However, hydrochlorothiazide can also inhibit the excretion of
uric acid and cause its accumulation, leading to an attack of
gout in some individuals. Furosemide increases the excretion
of calcium, whereas the K+-sparing osmotic diuretics, spi-
ronolactone and triamterene, and urea do not have an effect.
18.5 A 75-year-old woman with hypertension is being treated
with a thiazide. Her blood pressure responds well and
reads at 120/76 mm Hg. After several months on the
medication, she complains of being tired and weak. An
analysis of the blood indicates low values for which of
the following?
A. Calcium.
B. Glucose.
C. Potassium.
D. Sodium.
E. Uric acid.
Correct answer = C. Hypokalemia is a common adverse
effect of the thiazides and causes fatigue and lethargy in the
patient. Supplementation with potassium chloride or foods
high in K+ corrects the problem. Alternatively, a potassium-
sparing diuretic, such as spironolactone, may be added.
Calcium, uric acid, and glucose are usually elevated by thi-
azide diuretics. Sodium loss would not weaken the patient.
18.6 Which is contraindicated in a patient with hyperkalemia?
A. Acetazolamide.
B. Chlorthalidone.
C. Chlorothiazide.
D. Ethacrynic acid.
E. Spironolactone.
Correct answer = E. Spironolactone acts in the collect-
ing tubule to inhibit Na+ reabsorption and K+ excretion. It
is extremely important that patients who are treated with
any potassium-sparing diuretic be closely monitored for
potassium levels. Exogenous potassium supplementation
is usually discontinued when potassium-sparing diuretic
therapy is instituted and spironolactone is contraindicated
in patients with hyperkalemia. The other drugs promote the
excretion of potassium
18.7 Which of the following should be avoided in a patient
with a history of severe anaphylactic reaction to sulfa
medications?
A. Amiloride.
B. Hydrochlorothiazide.
C. Mannitol.
D. Spironolactone.
E. Triamterene.
Correct answer = B. Hydrochlorothiazide, like many thiazide
and thiazide-like diuretics, contains a sulfa moiety within its
chemical structure. It is important to avoid use in those indi-
viduals with severe hypersensitivity to sulfa medications. It
may be used with caution, however, in those with only minor
reaction to sulfa medications.
18.8 A male patient is placed on a new medication and
notes that his breasts have become enlarged and
tender to the touch. Which medication is he most likely
taking?
A. Chlorthalidone.
B. Furosemide.
C. Hydrochlorothiazide.
D. Spironolactone.
E. Triamterene.
Correct answer = D. An adverse drug reaction to spirono-
lactone is gynecomastia due to its effects on androgens
and progesterone in the body. Eplerenone may be a suit-
able alternative if the patient is in need of an aldosterone
antagonist but has a history of gynecomastia.
18.9 A patient presents to the emergency department with
an extreme headache. After a thorough workup, the
attending physician concludes that the pain is due to
increased intracranial pressure. Which diuretic would
work best to reduce this pressure?
A. Acetazolamide.
B. Indapamide.
C. Furosemide.
D. Hydrochlorothiazide.
E. Mannitol.
Correct answer = E. Osmotic diuretics, such as mannitol,
are a mainstay of treatment for patients with increased
intracranial pressure or acute renal failure due to shock,
drug toxicities, and trauma.
18.10 Which diuretic has been shown to improve blood
pressure in resistant hypertension or those already
treated with three blood pressure medications
including a thiazide or thiazide-like diuretic?
A. Chlorthalidone.
B. Indapamide.
C. Furosemide.
D. Mannitol.
E. Spironolactone.
Correct answer = E. Resistant hypertension, defined by
the use of three or more medications without reaching the
blood pressure goal, often responds well to aldosterone
antagonists. This effect can be seen in those with or without
elevated aldosterone levels.
