Abstract
This chapter examines the commonly prescribed drugs used for the treatment and management of certain clinical conditions that alter the excretory functions of the kidneys. The drugs reviewed include those that affect water and sodium losses such as diuretics as well as drugs that alter the pH of the urine (alkalizing agents), for example, sodium and potassium citrate and ammonium chloride. These drugs are reviewed in relation to their pharmacokinetics, mechanism of action, clinical indications, contraindications, drug–drug interactions and unwanted effects. The clinical uses of these drugs are reviewed in the context of the management of what is termed volume overload, hypertension and heart failure.
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Appendices
Multiple Choice Questions
-
1.
A 35-year-old patient has been admitted to your ward with mild hypertension. Her blood pressure during observations was 145/95 mmHg; there is no other clinically significant complaint. She is otherwise physically fit and adheres to a dietary regimen. She was prescribed antihypertensive drugs on admission, and chlorothiazide was added to her medications. How does this diuretic cause action and effect?
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(a)
Inhibition of sodium and chloride reabsorption in the early distal convoluted tubule
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(b)
Decreases net excretion of chloride, sodium and potassium
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(c)
Increases calcium excretion
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(d)
Inhibits reabsorption of sodium chloride in the thick ascending loop of Henle
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(e)
Interferes with potassium secretion
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(a)
-
2.
A person presented at A&E with complaints of sharp pain in his flanks and dysuria is admitted to the ward with a diagnosis of idiopathic hypercalcaeuria. What is the common type of medication used for the condition?
-
(a)
Loop diuretics
-
(b)
Carbonic anhydrase inhibitors
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(c)
Thiazide diuretics
-
(d)
Potassium-sparing diuretics
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(e)
Osmotic diuretics
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(a)
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3.
A 45-year-old patient with a history of medication-controlled hypertension has been readmitted to the ward with a left painful swollen big toe. A provisional diagnosis of gout has been made. A laboratory analysis of blood requested this morning revealed raised uric acid levels. From the list of his medication below, which of them might be a contributory factor for his current symptoms?
-
(a)
Acetazolamide
-
(b)
Amiloride
-
(c)
Mannitol
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(d)
Hydrochlorothiazide
-
(e)
Spironolactone
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(a)
-
4.
A patient diagnosed with a first episode of congestive heart failure secondary to alcoholic cardiomyopathy has been admitted to the ward. The cardiologist has recommended the inclusion of a diuretic as part of the routine medications, which of the following is the preferred diuretic for this patient?
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(a)
Loop diuretics due to their action at the distal convoluted tubule
-
(b)
Thiazide diuretics due to their effect on the thick ascending limb of the loop of Henle
-
(c)
Loop diuretics due to its high capacity for sodium chloride reabsorption
-
(d)
Thiazide diuretics because they increase peripheral vascular resistance
-
(e)
Thiazide diuretics because they increase cardiac output
-
(a)
-
5.
A patient admitted with myocardial infarction develops respiratory distress. Upon assessment by the medical team, flash pulmonary oedema secondary to myocardial infarction was confirmed. Furosemide was included as part of the pharmacological management. What is the mechanism of action of this diuretic?
-
(a)
Furosemide inhibits the action of aldosterone
-
(b)
It inhibits bicarbonate and sodium reabsorption
-
(c)
Furosemide inhibits active reabsorption of sodium chloride at the distal convoluted tubule
-
(d)
It alters the diffusion of water relative to sodium and hence reduces sodium reabsorption
-
(e)
Furosemide inhibits active reabsorption of sodium chloride at the thick ascending loop of Henle
-
(a)
-
6.
Which of the following diuretic cause dizziness and tinnitus?
-
(a)
Spironolactone
-
(b)
Mannitol
-
(c)
Furosemide
-
(d)
Amiloride
-
(a)
-
7.
Which of the following might not be prescribed for the patient taking potassium supplements?
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(a)
Furosemide
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(b)
Amiloride
-
(c)
Mannitol
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(d)
Hydrochlorothiazide
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(a)
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8.
Which of the below mentioned drug produce its action by competitively inhibiting the sodium-potassium-chloride cotransporter?
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(a)
Loop diuretics
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(b)
Thiazide diuretics
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(c)
Inhibitors of carbonic anhydrase
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(d)
Potassium-sparing diuretics
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(a)
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9.
Which diuretic drug produces its action by acting on proximal tubules?
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(a)
Thiazide diuretics
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(b)
Potassium-sparing diuretics
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(c)
Loop diuretics
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(d)
Inhibitors of carbonic anhydrase
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(a)
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10.
Which of the below mentioned diuretic drug produce its action by acting on distal convoluted tubule?
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(a)
Carbonic anhydrase inhibitors
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(b)
Thiazide diuretics
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(c)
Loop diuretics
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(d)
Potassium-sparing diuretics
-
(a)
Answers
-
1.
a
-
2.
c
-
3.
e
-
4.
c
-
5.
e
-
6.
d
-
7.
b
-
8.
a
-
9.
d
-
10.
b
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Agyekum, R.E. (2020). Medications Used for the Renal System. In: Hood, P., Khan, E. (eds) Understanding Pharmacology in Nursing Practice . Springer, Cham. https://doi.org/10.1007/978-3-030-32004-1_8
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