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BCR 1 > Pharmacology - Diuretics > Flashcards

Pharmacology - Diuretics Flashcards

1
Q

what is diuresis?

a. increased urine volume
b. decreased urine volume
c. increased urine electrolytes
d. decreased urine electrolytes

A

a.increased urine volume

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2
Q

4 types of diuretics

A

osmotic
loop
thiazide
potassium sparing

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3
Q

where do osmotic diuretics act in the kidney?

a. proximal convuluted tubule
b. loop of henle
c. distal convuluted tubule
d. collecting tubule

A

a.proximal convuluted tubule

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4
Q

where do loop diuretics act in the kidney?

a. proximal convuluted tubule
b. loop of henle
c. distal convuluted tubule
d. collecting tubule

A

b.loop of henle

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5
Q

where do thiazide diuretics act in the kidney?

a. proximal convuluted tubule
b. loop of henle
c. distal convuluted tubule
d. collecting tubule

A

c.distal convuluted tubule

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6
Q

where do potassium sparing diuretics act in the kidney?

a. proximal convuluted tubule
b. loop of henle
c. distal convuluted tubule
d. collecting tubule

A

d.collecting tubule

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7
Q

what type of diuretic is mannitol?

a. osmotic
b. loop
c. thiazide
d. potassium sparing

A

a.osmotic

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8
Q

where does mannitol act?

a. proximal convuluted tubule
b. loop of henle
c. distal convuluted tubule
d. collecting tubule

A

a.proximal convuluted tubule

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9
Q

what effect do osmotic diuretics have on water resorption?

a. increase
b. decrease

A

b.decrease

mannitol is filtered by the kidneys into urine increases solute conc and so water follows and is excreted

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10
Q

what effect does mannitol have on electrolyte resorption?

a. increase
b. decrease

A

b.decrease

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11
Q

how is mannitol given?

a. orally
b. IM
c. IV
d. SC

A

c.IV

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12
Q

what diuretic is prescribed for raised intracranial/intraocular pressure?

a. mannitol
b. vendroflumethiazide
c. amiloride
d. trimaterene

A

a.mannitol

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13
Q

hypotension, electrolyte and fluid disturbance are side effects of which diuretic?

a. mannitol
b. vendroflumethiazide
c. amiloride
d. trimaterene

A

a.mannitol

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14
Q

acetazolamide is an example of which type of diuretic?

a. loop
b. carbonic anyhdrase inhibitor
c. thiazide
d. potassium sparing

A

b.carbonic anyhdrase inhibitor

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15
Q

what enzyme interconverts between CO2/H20 and H+/HCO3- (acid base balance)

a. neprilysin
b. guanylate cyclase
c. phosphodiestrase
d. hydroxylase
e. carbonic anhydrase

A

e.carbonic anhydrase

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16
Q

reabsorbtion of which 2 ions is reduced by acetazolamide?

a. K+ and HCO3-
b. Na+ and H2co3
c. Na+ and HCO3-
d. K+ and Na+

A

c.Na+ and HCO3-

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17
Q

what effect does acetazolamide have on sodium and HCO3- resorption?

a. increase
b. decrease

A

b.decrease

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18
Q

what type of diuretic is acetazolamide?

a. strong
b. weak
c. loop
d. potassium sparing

A

b.weak

action partially compensated by increased sodium reabsorption in DCT

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19
Q

what diuretic is used in glaucoma and acute altitude sickness?

a. mannitol
b. acetazolamide
c. chlortalidone
d. bendroflumethiazide

A

b.acetazolamide

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20
Q

metabolic acidosis. hypokalaemia and renal stone formation are adverse effects of which diuretic?

a. mannitol
b. vendroflumethiazide
c. amiloride
d. trimaterene
e. acetazolamide

A

e. acetazolamide

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21
Q

furosemide is an example of which type of diuretic?

a. osmotic
b. loop
c. thiazide
d. potassium sparing

A

b.loop

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22
Q

how are loop diuretics given?

a. orally
b. IV
c. IM
d. SC

A

a. orally

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23
Q

most of which type of diuretic bind to plasma proteins limiting glomerular filtration?

a. osmotic
b. loop
c. thiazide
d. potassium sparing

A

b.loop

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24
Q

where does furosemide work?

a. proximal convuluted tubule
b. loop of henle
c. distal convuluted tubule
d. collecting duct

A

b.loop of henle

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25
Q

how are loop diuretics secreted into the tubular lumen by PCT cells?

a. organic cation transporters
b. sodium channels
b. ATP ase channels
d. organic anion transporters

A

d. organic anion transporters

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26
Q

in what limb of the loop of henle does furosemide inhibit Na+/K+/Cl- co transporter ?

a. descending
b. proximal
c. ascending
d. ascending

A

d. ascending

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27
Q

what effect do loop diuretics have on the osmolarity of the medullary interstitium?

a. increase
b. decrease

A

b.decrease

inhibit pump into tubule from lumen
sodium pottassium etc cannot be transported in
solutes in lumen more than in interstitium on other side
water
water not resorbed into interstitium
remains in tubule lumen for urine

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28
Q

what is the effect of the increased prostaglandin excretion caused by loop diuretics?

a. vasoconstriction
b. vasodilation

A

b.vasodilation
increases renal blood flow
assists diuresis

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29
Q

what effect do loop diuretics have on potential difference across a tubule cell?

a. increase
b. decrease

A

b.decrease

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30
Q

the decreased potential difference across tubule cells caused by loop diuretics has what effect on excretion of ca2+ and mg2+

a. increase
b. decrease

A

a.increase

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31
Q

which diuretic is used in congestive heart failure, resistant hypertension. liver ascites and nephrotic syndrome?

a. osmotic
b. loop
c. thiazide
d. potassium

A

b.loop

causes of oedema and loop are good at removing EXCESS water

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32
Q

what is the main use of IV loop diuretics?

a. intracranial and intraocular pressure
b. congestive heart failure, liver ascites, nephrotic syndrome,resistant hypertension
c. acute relief of symptoms by reduced preload in left ventricular failure (pulmonary congestion)

A

c.acute relief of symptoms by reduced preload in left ventricular failure

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33
Q

what is the main use of oral loop diuretics?

a. intracranial and intraocular pressure
b. congestive heart failure, liver ascites, nephrotic syndrome,resistant hypertension
c. acute relief of symptoms by reduced preload in left ventricular failure eg pulmonary congestion
d. reduce signs and symptoms of chronic heart failure eg ankle oedema

A

d. reduce signs and symptoms of chronic heart failure eg ankle oedema

34
Q

to reduce signs and symptoms of chronic heart failure eg ankle oedema how would loop diuretics administered?

a. IV
b. oral
c. IM
d. SC

A

b.oral

35
Q

how would loop diuretics be administered for .acute relief of symptoms by reduced preload in left ventricular failure (pulmonary congestion)

a. IV
b. oral
c. IM
d. SC

A

a.IV

36
Q

what is the main adverse effect of loop diuretics?

a.hypovolaemia and dehydration
b.hypomagnesaemia
c.hypokalaemia
d.gout
allergic reactions to skin and kidney

A

a.hypovolaemia and dehydration

37
Q

what is the correct set of side effects for loop diuretics?

a. hypotension, fluid and electrolyte balance
b. metabolic acidosis, renal stone formation, hypokalaemia
c. hypovolaemia and dehydration, hypokalaemia,hypomagnesaemia,gout

A

c.hypovolaemia and dehydration, hypokalaemia,hypomagnesaemia,gout

38
Q

which of these adverse effects of loop diuretics leads to cramps and arrhythmias?

a. hypovolaemia
b. hypokalaemia
c. hypomagnesaemia
d. gout
e. hyponatraemia

A

b.hypokalaemia

39
Q

there is an increased risk of electrolyte disturbance when loop diuretics are combined with which other type of diuretic?

a. osmotic
b. thiazide
c. potassium sparing

A

b.thiazide

40
Q

which type of diuretic has increased nephrotoxicity when combined with aminoglycoside antibiotics ?

a. osmotic
b. loop
c. thiazide
d. potassium sparing

A

b.loop

41
Q

theres a risk of hypotension when loop diuretics are combined with which other drug?

a. ARNI
b. Nitrates
c. fibrates
d. ACEi

A

d.ACEi

42
Q

diuresis by loop diuretics is impaired when combined with which drugs ?

a. thiazides
b. aminoglycoside
c. ACEi
d. NSAIDS

A

d.NSAIDS

reduce vasodilatory prostagladin dependent renal bf

43
Q

what type of diuretic is bendroflumethiazide ?

a. osmotic
b. loop
c. thiazide
d. potassium sparing

A

c.thiazide

44
Q

what type of diuretics are indapamide and chlortalidone ?

a. osmotic
b. loop
c. thiazide
d. potassium sparing
e. thiazide like

A

e.thiazide like

45
Q

what group makes determines a thiazide from a thiazide like diuretic?

a. SO2NH2
b. SO2
c. CF3

A

b.SO2

46
Q

what do thiazide diuretics inhibit?

a. Na+/Cl- cotransporter
b. Na+/K+/Cl- pump
c. ATP ase channel

A

a. Na+/Cl- cotransporter

between lumen and cell

47
Q

whart site do thiazides bind to on the Na+ /Cl- co transporter ?

a. allosteric
b. active site
c. Cl- site
d. Na+ site

A

c.Cl- site

48
Q

what load is reduced by thiazides along with Blood volume and cardiac output?

a. afterload
b. preload

A

b.preload

49
Q

which diuretics progressively activate counter regulatory mechanisms blunting the BP lowering effect when given as monotherapy?

a. osmotic
b. loop
c. thiazide
d. potassium sparing
e. thiazide like

A

c.thiazide

50
Q

who would thiazides work best in?

a. elderly, black african
b. young, black african
c. elderly caucasian
d. young caucasian

A

a.elderly, black african

already volume expanded

51
Q

what line are thiazides in uncomplicated hypertension?

a. first
b. second
c. third

A

c.third

52
Q

in patients with oedema/v elderly/high risk of heart failure and hypertension what line are thiazides considered?

a. 1
b. 2
c. 3
d. 4

A

b.2

53
Q

the increase in cholesterol and hyperglycaemia caused by thiazides is more common in which group?

a. elderly
b. black african
c. south asians
d. young

A

c.south asians

54
Q

which of these has less nephrotoxicity when combined with aminoglycoside antibiotics?

a. loop diuretics
b. thiazides

A

b.thiazides

55
Q

what is the correct side effects for thiazides?

a. electrolyte and fluid disturbance and hypotension
c. hypokolaemia , metabolic acidosis, renal stones
d. hypovolaemia, dehydration, gout
e. hypovolaemia, dehydration, gout,urate retention, increased cholesterol and hypoglycaemia

A

e.hypovolaemia, dehydration, gout,urate retention, increased cholesterol and hypoglycaemia

56
Q

hypotension is less likely with ACEi and which of these diuretics?

a. loop
b. thiazide

A

b.thiazide

57
Q

when prescribed with lithium which of these is more likely to cause lithium toxicity?

a. loop
b. thiazides

A

b.thiazides

58
Q

thiazides are more likely than loops to cause hyponatraemia when coprescribed with what other drug?

a. ACEi
b. aminoglycan antibiotics
c. lithium
d. SSRIs

A

d.SSRIs

59
Q

what type of natriuretic are potassium sparing diuretics?

a. strong
b. weak

A

b.weak

60
Q

amiloride and triameterene are examples of what diuretic group?

a. osmotic
b. loop
c. thiazide
d. potassium sparing
e. thiazide like

A

d.potassium sparing

61
Q

Which of these drug groups is not a sub group of potassium sparing diuretics?

a. aldosterone receptor antagonists
b. sodium channel blockers
c. carbonic anhydrase inhibitor

A

c. carbonic anhydrase inhibitor

62
Q

amiloride and triameterene are examples of what diuretic group?

a. osmotic
b. sodium channel blockers
c. thiazide
d. aldosterone receptor antagonist
e. thiazide like

A

b.sodium channel blockers

63
Q

spironolactone and eplerenorone are examples of what diuretic group?

a. osmotic
b. sodium channel blockers
c. thiazide
d. aldosterone receptor antagonist
e. thiazide like

A

b. sodium channel blockers

64
Q

which of these drugs blocks apical sodium channels?

a. amiloride
b. spironolactone
c. eplerone

A

a.amiloride

65
Q

which diuretics reduce potential difference across the principal cell which act to decrease the driving force for K+ secretion from principal. cell and H+ from intercalated cell. leading to increased sodium excretion and decreased pottasium and H+ excretion?

a. osmotic
b. sodium channel blockers
c. aldosterone receptor antagonists
d. potassium sparing
e. thiazide like

A

b.sodium channel blockers

66
Q

blocking apical sodium channels has what effect on p.d across the principal cell?

a. increase
b. decrease

A

a.increase

67
Q

decreasing the pd across a cell with sodium channel blockers has what effect on the driving force for K+ and H+ secretion from the intercalated cell?

a. increased force
b. decreased force

A

b.decreased force

68
Q

what is synthesised when aldosterone binds to the nuclear receptor?

a. AIPs
b. prostaglandins
c. cytokines

A

a.AIPs

69
Q

what do AIPs do in order to increase potential for Na retentio and K+/H+ loss?

a. increase synthesis of channels and ATP production
b. decrease synthesis of channels and ATP production
c. activate silent Na+ channels and increase synthesis of channels and ATP production

A

c. activate silent Na+ channels and increase synthesis of channels and ATP production

70
Q

in conditions associated with primary (Conns syndrome) and secondary hyperaldosteronism (heart failure , liver ascites) what diuretic is prescribed?

a. amiloride
b. triameterine
c. spironolactone
d. eplerenone

A

c.spironolactone

71
Q

What is the correct set of side effects for potassium sparing diuretics?

a. electrolyte and fluid disturbance and hypotension
c. hypokolaemia , metabolic acidosis, renal stones
d. hypovolaemia, dehydration, gout
e. hypovolaemia, dehydration, gout,urate retention, increased cholesterol and hypoglycaemia
f. hyperkalaemia, metabolic acidosis,

A

f. hyperkalaemia, metabolic acidosis,

72
Q

Gynaecomastia, impotence and testicular
atrophy, menstrual irregularities are specific to which diuretic?

a. mannatol
b. spironolactone
c. amiloride
d. eplerenone
e. indapamide

A

c.amiloride

73
Q

which of these diuretics causes an increase in calcium excretion?

a. thiazide
b. loop

A

b.loop

74
Q

which of these diuretics causes an increase in calcium resorption?

a. thiazide
b. loop

A

a.thiazide

75
Q

which drugs cause hyperkalaemia in combo with ACEi, agt 2 antagonists, renin inhibitors, renin inhibitors, beta adrenoceptor antagonists and NSAIDS?

a. osmotic
b. loop
c. thiazide like
d. potassium sparing

A

d.potassium sparing

76
Q

what is given in chronic kidney diserase associated with oedema?

a. thiazides
b. potassium sparing
c. loop
d. osmotic

A

c.loop

77
Q

true or false diuretics are a routine treatment for renal failure

a. true
b. false

A

a.false

78
Q

A 72 year old lady attends her GP for review of her
hypertension treatment, after serial clinic BP
measures by the practice nurse over the last 2
months have all been >140/90 mmHg despite
amlodipine 10mg daily (and lisinopril 20mg daily).
1. What type of diuretic could be added to her
treatment?

a. loop
b. osmotic
c. thiazide like
d. potassium sparing

A

c. thiazide like
hypertension management
on a CCB and ACE anyway

79
Q

• A 68 year old man attends his GP with increasing ankle
oedema and shortness of breath on exertion. He had a
myocardial infarction 5 years ago.
• He has bipedal oedema and bibasal fine crepitations in
his chest and the GP suspects biventricular failure
what diuretic should be given?

a. loop
b. osmotic
c. thiazide like
d. potassium sparing

A

a.loop

80
Q

A 52 year old woman with a history of difficult to
treat hypertension and recurring headache, muscle
cramping and weakness is found on further
investigation to have bilateral adrenal hyperplasia.

a. loop
b. osmotic
c. thiazide
d. potassium sparing

A

d.potassium sparing

has priumary hyperaldosteronism - conns syndrome
lack of potassium = cramping

BCR 1 (60 decks)

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