Diuretics MCQs

Metolazone In common with loop diuretics it is able to evoke a clinically useful response even in severe renal failure (g.f.r. ~15 ml/min), and has marked additive action when combined with furosemide. An additional proximal tubular action has been demonstrated; PO4 reabsorption that occurs in PT, is inhibited. It is excretedunchanged in urine. Metolazone has been usedmainly for edema and occasionally for hypertension

Chronic HF is typically managed by A reduction in physical activity Low dietary intake of sodium ( Treatment of comorbid conditions Judicious use of diuretics, inhibitors of the renin-angiotensin system, and inotropic agents. Drugs that may precipitate or exacerbate HF, such as NSAIDs drugs, alcohol, calcium channel blockers, high-dose beta-blockers, and some antiarrhythmic drugs, should be avoided if possible. Patients with HF complain of dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, fatigue, and dependent edema. Vigorous exercise in this deconditioned patient may worsen heart function. Use of calcium channel blockers at high doses can worsen heart failure. Use of beta-blockers at high doses can worsen heart failure. Reference: Basic & Clinical Pharmacology, Fourteenth Edition By Bertram G. Katzung Pg no. 221

Paresthesias and gastrointestinal 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 suggests the use of a carbonic anhydrase inhibitor like acetazolamide. Reference : Basic & Clinical Pharmacology, Fourteenth Edition By Bertram G. Katzung Pg no. 262

The case history suggests that the syncope (fainting) is associated with diuretic use. Complications of diuretics that can result in syncope include both postural hypotension (which this patient exhibits) 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. Reference : Basic & Clinical Pharmacology, Fourteenth Edition By Bertram G. Katzung Pg no. 262

Aldosterone antagonists like Spironolactone and Eplerenone are the drugs of choice for Cirrhotic edema, resistant edema and hypertension. Uses of Spironolactone & Eplerenone It is a weak diuretic in its own right and is used mostly in combination with other more efficacious diuretics. To counteract K+ loss due to thiazide and loop diuretics. Edema: Spironolactone is more useful in cirrhotic and nephritic edema in which aldosterone levels are generally high. It potentiates thiazides and loop diuretics and is frequently added to them in the treatment of ascites due to cirrhosis of the liver. It breaks resistance to the thiazide/loop diuretic that develops due to secondary hyperaldosteronism and re-establishes the response. Thus, spironolactone is particularly employed in refractory edema. Hypertension: Spironolactone is used to augment a thiazide in the treatment of resistant hypertension.

Metolazone and Indapamide are two thiazide diuretics that can be administered even in patients with renal insufficiency. Metolazon e: In common with loop diuretics, it is able to evoke a clinically useful response even in severe renal failure (g.f.r. ~15 ml/min), and has marked additive action when combined with furosemide. An additional proximal tubular action has been demonstrated; PO4 reabsorption that occurs in PT, is inhibited. It is excreted unchanged in urine. Metolazone has been used mainly for edema.

Ans. is 'A' i.e., Hypocalcemia Thiazides cause hypercalcemia (see above explanation).

Acute gouty arthritis (AGA) is characterized by the rapid onset of pain, swelling, and inflammation. The attack is often monoarticular at first, affecting the first metatarsophalangeal (MTP) joint. Uric acid levels are generally >7.5 mg/dL when an attack occurs. Changes in rate levels, leading to gout flares, can result from acute alcohol intoxication, overindulgence of foods high in purines, rapid weight loss, dehydration, and trauma. Medications (e.g., thiazide or loop diuretics, allopurinol, uricosuric agents, Low-dose aspirin) can also precipitate gout. Mnemonic : TH e NI ce PYR A mid Th iazides(+loop diuretics), ni acin, pyr azinamide, a spirin Reference : Basic & Clinical Pharmacology, Fourteenth Edition By Bertram G. Katzung Pg no. 262