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Pharm 15

front 1

A patient with mountain sickness is treated with acetazolamide. Which nephron segment contains the main target of this drug?

A) Collecting tubule

B) Proximal tubule

C) Thick ascending limb

D) Distal convoluted tubule

back 1

B. Proximal tubule

front 2

Acetazolamide directly inhibits which enzyme in the proximal tubule?

A) Carbonic anhydrase

B) SGLT2

C) Aldosterone synthase

D) Na/K ATPase

back 2

A. Carbonic anhydrase

front 3

Carbonic anhydrase inhibitors cause urinary loss of which major buffer?

A) Potassium

B) Glucose

C) Bicarbonate

D) Calcium

back 3

C. Bicarbonate

front 4

A patient taking acetazolamide develops metabolic acidosis. Which mechanism best explains this?

A) Increased glucose excretion

B) Bicarbonate loss in urine

C) Aldosterone receptor blockade

D) ADH receptor blockade

back 4

B. Bicarbonate loss in urine

front 5

When acetazolamide causes bicarbonate loss, which substances follow into the urine?

A) Sodium and water

B) Calcium and protein

C) Potassium and urea

D) Glucose and chloride

back 5

A. Sodium and water

front 6

Acetazolamide produces which overall diuretic strength in the notes?

A) Strong diuresis

B) No diuresis

C) Mild diuresis

D) Maximal diuresis

back 6

C. Mild diuresis

front 7

Which side effect is associated with acetazolamide?

A) Hyperglycemia

B) Metabolic acidosis

C) Gynecomastia

D) Genital yeast infection

back 7

B. Metabolic acidosis

front 8

A patient taking acetazolamide develops low potassium. Which side effect is this?

A) Hyperkalemia

B) Hypokalemia

C) Hyponatremia

D) Hypercalcemia

back 8

B. Hypokalemia

front 9

Which side effect can occur with carbonic anhydrase inhibitors due to urinary changes?

A) Kidney stones

B) Ototoxicity

C) Hyperlipidemia

D) Volume overload

back 9

A. Kidney stones

front 10

A patient on acetazolamide reports tingling sensations. Which side effect best fits?

A) Gout

B) Paresthesias

C) Hypotension

D) Gynecomastia

back 10

B. Paresthesias

front 11

A drug inhibits carbonic anhydrase and causes bicarbonate wasting. Which drug is it?

A) Acetazolamide

B) Furosemide

C) Chlorthalidone

D) Tolvaptan

back 11

A. Acetazolamide

front 12

Which drug class includes canagliflozin, dapagliflozin, and empagliflozin?

A) Loop diuretics

B) SGLT2 inhibitors

C) Thiazide diuretics

D) ADH antagonists

back 12

B. SGLT2 inhibitors

front 13

Which name clue helps identify canagliflozin, dapagliflozin, and empagliflozin?

A) “th” clue

B) “-one” ending

C) “flozin” suffix

D) “-vaptan” ending

back 13

C. “flozin” suffix

front 14

SGLT2 inhibitors act primarily in which nephron segment?

A) Proximal tubule

B) Collecting tubule

C) Distal convoluted tubule

D) Thick ascending limb

back 14

A. Proximal tubule

front 15

Blocking SGLT2 decreases reabsorption of which substances?

A) Calcium and chloride

B) Sodium and glucose

C) Potassium and hydrogen

D) Bicarbonate and protein

back 15

B. Sodium and glucose

front 16

SGLT2 inhibitors cause glucose and sodium to leave in urine, so what follows?

A) Water

B) Aldosterone

C) Calcium

D) ADH

back 16

A. Water

front 17

Which clinical effect follows SGLT2 inhibition in the proximal tubule?

A) Severe potassium wasting

B) Mild diuresis

C) Increased preload

D) Increased blood pressure

back 17

B. Mild diuresis

front 18

Why can SGLT2 inhibitors lower blood pressure mildly?

A) They retain sodium

B) They increase ADH

C) They promote water loss

D) They block calcium channels

back 18

C. They promote water loss

front 19

Which side effect is associated with SGLT2 inhibitors?

A) Urinary tract infections

B) Ototoxicity

C) Lupus-like syndrome

D) Metabolic alkalosis

back 19

A. Urinary tract infections

front 20

A patient taking dapagliflozin develops vulvovaginal candidiasis. Which side effect category fits?

A) Genital yeast infection

B) Carbonic acidosis

C) Sulfonamide allergy

D) Tendon rupture

back 20

A. Genital yeast infection

front 21

A patient taking empagliflozin becomes dehydrated from excess urinary losses. Which side effect best fits?

A) Bone marrow suppression

B) Volume depletion

C) AV block

D) Ototoxicity

back 21

B. Volume depletion

front 22

Why are SGLT2 inhibitor side effects often related to urine?

A) Glucose appears in urine

B) Calcium enters tubules

C) ADH rises sharply

D) Bile acids are trapped

back 22

A. Glucose appears in urine

front 23

Which side effect set best matches SGLT2 inhibitors?

A) Gout, ototoxicity, alkalosis

B) UTIs, yeast infections, volume depletion

C) Acidosis, stones, paresthesias

D) Gynecomastia, hyperkalemia, remodeling

back 23

B. UTIs, yeast infections, volume depletion

front 24

Which drug class includes furosemide, bumetanide, torsemide, and ethacrynic acid?

A) Thiazide diuretics

B) SGLT2 inhibitors

C) Loop diuretics

D) ENaC blockers

back 24

C. Loop diuretics

front 25

Most listed loop diuretics have which rough name clue?

A) “-vaptan” ending

B) “th” in name

C) “-one” ending

D) “ides” sound

back 25

D. “ides” sound

front 26

Loop diuretics block which transporter?

A) Na/K/2Cl transporter

B) Na/Cl transporter

C) SGLT2

D) ENaC

back 26

A. Na/K/2Cl transporter

front 27

Loop diuretics act in which nephron segment?

A) Distal convoluted tubule

B) Thick ascending limb

C) Collecting tubule

D) Proximal tubule

back 27

B. Thick ascending limb

front 28

A patient receives furosemide for pulmonary edema. What is the major renal effect?

A) Mild glucose wasting

B) Strong salt and water loss

C) Bicarbonate retention

D) Pure water retention

back 28

B. Strong salt and water loss

front 29

Loop diuretics decrease edema by causing urinary loss of what?

A) Salt and water

B) LDL and bile acids

C) Glucose only

D) ADH only

back 29

A. Salt and water

front 30

Which listed loop diuretic is not a sulfonamide?

A) Furosemide

B) Bumetanide

C) Torsemide

D) Ethacrynic acid

back 30

D. Ethacrynic acid

front 31

Which side effect is highly associated with loop diuretics?

A) Gynecomastia

B) Ototoxicity

C) Genital yeast infection

D) Paresthesias

back 31

B. Ototoxicity

front 32

Loop diuretics can increase uric acid and cause which condition?

A) Diabetes

B) Gout

C) Yeast infection

D) Constipation

back 32

B. Gout

front 33

Which drug is a loop diuretic that can be useful with sulfa allergy?

A) Ethacrynic acid

B) Dapagliflozin

C) Triamterene

D) Conivaptan

back 33

A. Ethacrynic acid

front 34

A patient has edema and needs a strong diuretic effect. Which class best fits?

A) ENaC blockers

B) Carbonic anhydrase inhibitors

C) Loop diuretics

D) ADH antagonists

back 34

C. Loop diuretics

front 35

Which class includes hydrochlorothiazide and chlorthalidone

A) Loop diuretics

B) Thiazide diuretics

C) Osmotic diuretics

D) SGLT2 inhibitors

back 35

B. Thiazide diuretics

front 36

Which name clue helps identify hydrochlorothiazide and chlorthalidone?

A) “flozin” suffix

B) “-one” ending

C) “-vaptan” ending

D) “th” in both

back 36

D. “th” in both

front 37

Thiazide diuretics act in which nephron segment?

A) Distal convoluted tubule

B) Proximal tubule

C) Thick ascending limb

D) Collecting tubule

back 37

A. Distal convoluted tubule

front 38

Hydrochlorothiazide directly blocks which transporter?

A) SGLT2

B) Na/K/2Cl transporter

C) Na/Cl transporter

D) ENaC

back 38

C. Na/Cl transporter

front 39

Thiazides lower blood pressure mainly by causing loss of what?

A) Salt and water

B) Calcium and protein

C) Glucose only

D) ADH only

back 39

A. Salt and water

front 40

A patient taking chlorthalidone has less blood volume. Which effect caused this?

A) Increased water intake

B) Salt and water diuresis

C) Pure water retention

D) Aldosterone release

back 40

B. Salt and water diuresis

front 41

Which side effect is associated with thiazide diuretics?

A) Hypokalemic metabolic alkalosis

B) Metabolic acidosis

C) Methemoglobinemia

D) Cyanide toxicity

back 41

A. Hypokalemic metabolic alkalosis

front 42

Thiazides can cause increased uric acid, leading to which condition?

A) Asthma

B) Gout

C) Arrhythmia

D) Toxoplasmosis

back 42

B. Gout

front 43

Which metabolic abnormality is associated with thiazides?

A) Hypoglycemia

B) Hyperglycemia

C) Low LDL

D) Low triglycerides

back 43

B. Hyperglycemia

front 44

Thiazide diuretics can increase which blood lipid issue?

A) Hyperlipidemia

B) Hypolipidemia

C) Low VLDL

D) Low LDL

back 44

A. Hyperlipidemia

front 45

Which sodium abnormality is associated with thiazides?

A) Hypernatremia

B) Hyponatremia

C) Sodium excess only

D) No sodium change

back 45

B. Hyponatremia

front 46

Which allergy concern is listed for thiazide diuretics?

A) Penicillin allergy

B) Sulfonamide allergy

C) Latex allergy

D) Nickel allergy

back 46

B. Sulfonamide allergy

front 47

Which side effect set best matches thiazide diuretics?

A) UTIs, yeast infections, depletion

B) Acidosis, paresthesias, stones

C) Hypokalemic alkalosis, gout, hyperglycemia

D) Gynecomastia, hyperkalemia, remodeling

back 47

C. Hypokalemic alkalosis, gout, hyperglycemia

front 48

Spironolactone and eplerenone belong to which diuretic group?

A) Loop diuretics

B) Thiazides

C) Aldosterone-blocking potassium-sparing diuretics

D) Osmotic diuretics

back 48

C. Aldosterone-blocking potassium-sparing diuretics

front 49

Which name clue helps identify spironolactone and eplerenone?

A) “-one” ending

B) “flozin” suffix

C) “th” in name

D) “-vaptan” ending

back 49

A. “-one” ending

front 50

Spironolactone and eplerenone act in which nephron region?

A) Proximal tubule

B) Collecting tubule

C) Thick ascending limb

D) Distal convoluted tubule

back 50

B. Collecting tubule

front 51

Aldosterone-blocking diuretics directly block which receptor?

A) Beta receptor

B) ADH receptor

C) Aldosterone receptor

D) Dopamine receptor

back 51

C. Aldosterone receptor

front 52

Blocking aldosterone receptors causes urinary loss of what?

A) Sodium and water

B) Potassium only

C) Glucose and sodium

D) Bicarbonate only

back 52

A. Sodium and water

front 53

Aldosterone antagonists can help heart failure by decreasing which harmful process?

A) Aldosterone remodeling

B) Glucose excretion

C) Bicarbonate loss

D) Ototoxicity

back 53

A. Aldosterone remodeling

front 54

Which side effect is especially associated with spironolactone

A) Ototoxicity

B) Gynecomastia

C) Genital yeast infection

D) Hypokalemia

back 54

B. Gynecomastia

front 55

Which side effect is shared by aldosterone blockers and ENaC blockers?

A) Hyperkalemia

B) Hypokalemia

C) Ototoxicity

D) Hyperglycemia

back 55

A. Hyperkalemia

front 56

Amiloride and triamterene belong to which potassium-sparing subgroup?

A) Aldosterone receptor blockers

B) ENaC blockers

C) Loop diuretics

D) Osmotic diuretics

back 56

B. ENaC blockers

front 57

Amiloride and triamterene act in which nephron region?

A) Proximal tubule

B) Thick ascending limb

C) Collecting tubule

D) Distal convoluted tubule

back 57

C. Collecting tubule

front 58

Amiloride and triamterene directly block which channel?

A) ENaC

B) SGLT2

C) Na/K/2Cl

D) V2 receptor

back 58

A. ENaC

front 59

ENaC blockers decrease reabsorption of which ion?

A) Potassium

B) Sodium

C) Bicarbonate

D) Calcium

back 59

B. Sodium

front 60

When ENaC blockers decrease sodium reabsorption, what happens to potassium secretion?

A) It increases strongly

B) It stops permanently

C) It decreases

D) It becomes unrelated

back 60

C. It decreases

front 61

Amiloride causes urinary loss of sodium and water while retaining what?

A) Potassium

B) Glucose

C) Bicarbonate

D) Calcium

back 61

A. Potassium

front 62

Which side effect is most associated with amiloride and triamterene?

A) Hyperkalemia

B) Hypokalemia

C) Ototoxicity

D) Hyperglycemia

back 62

A. Hyperkalemia

front 63

Mannitol belongs to which diuretic class?

A) Osmotic diuretic

B) Loop diuretic

C) Thiazide diuretic

D) ADH antagonist

back 63

A. Osmotic diuretic

front 64

Mannitol causes diuresis because it stays where?

A) Blood only

B) Tubule

C) Liver

D) Collecting interstitium

back 64

B. Tubule

front 65

How does mannitol increase urine output?

A) Pulls water into urine

B) Blocks aldosterone receptors

C) Blocks SGLT2 transport

D) Blocks Na/Cl transport

back 65

A. Pulls water into urine

front 66

Which effect best matches mannitol?

A) Excretes lots of water

B) Retains lots of sodium

C) Keeps water in blood only

D) Blocks potassium secretion

back 66

A. Excretes lots of water

front 67

Which clinical use matches mannitol?

A) Increased intracranial pressure

B) High LDL

C) Atrial fibrillation

D) Toxoplasmosis

back 67

A. Increased intracranial pressure

front 68

Mannitol can also be used for increased pressure in which organ?

A) Eye

B) Kidney

C) Pancreas

D) Liver

back 68

A. Eye

front 69

Which drug class includes conivaptan and tolvaptan?

A) Vasopressin/ADH antagonists

B) SGLT2 inhibitors

C) Carbonic anhydrase inhibitors

D) Thiazide diuretics

back 69

A. Vasopressin/ADH antagonists

front 70

Which name clue helps identify conivaptan and tolvaptan?

A) “flozin” suffix

B) “-vaptan” ending

C) “th” in name

D) “-one” ending

back 70

B. “-vaptan” ending

front 71

Tolvaptan specifically blocks which receptor subtype?

A) V1 receptor

B) V2 receptor

C) Beta-1 receptor

D) Alpha-2 receptor

back 71

B. V2 receptor

front 72

ADH normally causes the kidney to do what?

A) Keep water

B) Lose glucose

C) Lose bicarbonate

D) Keep uric acid

back 72

A. Keep water

front 73

Blocking ADH receptors causes what urinary effect?

A) More water excretion

B) More potassium secretion only

C) More bicarbonate retention

D) More glucose reabsorption

back 73

A. More water excretion

front 74

A patient receives tolvaptan and urinates more free water. Which mechanism explains this?

A) Blocks V2 receptors

B) Blocks Na/K/2Cl

C) Blocks Na/Cl

D) Blocks ENaC

back 74

A. Blocks V2 receptors

front 75

Which drug is a vasopressin antagonist?

A) Conivaptan

B) Empagliflozin

C) Eplerenone

D) Acetazolamide

back 75

A. Conivaptan

front 76

Which drug is a vasopressin antagonist?

A) Tolvaptan

B) Torsemide

C) Triamterene

D) Chlorthalidone

back 76

A. Tolvaptan

front 77

Which diuretic class acts in the proximal tubule by blocking glucose and sodium reabsorption?

A) SGLT2 inhibitors

B) Loop diuretics

C) Aldosterone blockers

D) Osmotic diuretics

back 77

A. SGLT2 inhibitors

front 78

Which diuretic class acts in the distal convoluted tubule?

A) Thiazides

B) SGLT2 inhibitors

C) Carbonic anhydrase inhibitors

D) Osmotic diuretics

back 78

A. Thiazides

front 79

Which two drug groups act in the collecting tubule?

A) Aldosterone blockers and ENaC blockers

B) Loops and thiazides

C) SGLT2 inhibitors and CA inhibitors

D) Osmotic agents and loops

back 79

A. Aldosterone blockers and ENaC blockers

front 80

Which diuretic class is most associated with genital yeast infections?

A) SGLT2 inhibitors

B) Carbonic anhydrase inhibitors

C) Loop diuretics

D) Thiazides

back 80

A. SGLT2 inhibitors

front 81

Which diuretic class is most associated with hypokalemic metabolic alkalosis?

A) Carbonic anhydrase inhibitors

B) Thiazides

C) ENaC blockers

D) ADH antagonists

back 81

B. Thiazides

front 82

Which diuretic class is most associated with metabolic acidosis?

A) Acetazolamide class

B) Loop diuretics

C) Thiazides

D) Aldosterone blockers

back 82

A. Acetazolamide class

front 83

Which diuretic class keeps potassium by blocking aldosterone signaling? A) Aldosterone blockers B) SGLT2 inhibitors C) Loop diuretics D) Thiazides

back 83

A. Aldosterone blockers

front 84

Which diuretic class keeps potassium by blocking epithelial sodium channels? A) ENaC blockers B) ADH antagonists C) Osmotic diuretics D) Carbonic anhydrase inhibitors

back 84

A. ENaC blockers

front 85

He has marked peripheral edema and metabolic alkalosis (pH, 7.50; pCO2, 45; HCO3, 36; Na+, 140). Which of the following
drugs is most appropriate for the treatment of his edema?
(A) Acetazolamide
(B) Digoxin
(C) Eplerenone
(D) Hydrochlorothiazide
(E) Tolvaptan

back 85

(A) Acetazolamide

front 86

A 50-year-old man has a history of frequent episodes of renal
colic with calcium-containing renal stones. A careful workup
indicates that he has a defect in proximal tubular calcium
reabsorption, which results in high concentrations of calcium
salts in the tubular urine. The most useful diuretic agent in
the treatment of recurrent calcium stones is
(A) Chlorthalidone
(B) Diazoxide
(C) Ethacrynic acid
(D) Mannitol
(E) Spironolactone

back 86

(A) Chlorthalidone

The thiazides are useful in the prevention of calcium stones
because these drugs reduce tubular calcium concentration,
probably by increasing passive proximal tubular and distal
convoluted tubule reabsorption of calcium.

front 87

Which of the following is an important effect of chronic
therapy with loop diuretics?
(A) Decreased urinary excretion of calcium
(B) Elevation of blood pressure
(C) Elevation of pulmonary vascular pressure
(D) Metabolic alkalosis
(E) Teratogenic action in pregnancy

back 87

(D) Metabolic alkalosis

front 88

Which of the following diuretics would be most useful in the
acute treatment of a comatose patient with traumatic brain
injury and cerebral edema?
(A) Acetazolamide
(B) Amiloride
(C) Chlorthalidone
(D) Furosemide
(E) Mannitol

back 88

(E) Mannitol

front 89

Which of the following therapies would be
most useful in the management of severe hypercalcemia?
(A) Acetazolamide plus saline infusion
(B) Furosemide plus saline infusion
(C) Hydrochlorothiazide plus saline infusion
(D) Mannitol plus saline infusion
(E) Spironolactone plus saline infusion

back 89

(B) Furosemide plus saline infusion

Diuretic therapy of hypercalcemia requires a reduction in
calcium reabsorption in the thick ascending limb, an effect of
loop diuretics.

front 90

A 60-year-old patient complains of paresthesias and occasional nausea associated with one of the drugs she is taking.
She is found to have hyperchloremic metabolic acidosis. She
is probably taking
(A) Acetazolamide for glaucoma
(B) Amiloride for edema associated with aldosteronism
(C) Furosemide for severe hypertension and heart failure
(D) Hydrochlorothiazide for hypertension
(E) Mannitol for cerebral edema

back 90

(A) Acetazolamide for glaucoma

Paresthesias and gastrointestinal distress are common adverse
effects of acetazolamide, especially when it is taken chroni￾cally, as in glaucoma.

front 91

A graduate student is planning to make a high-altitude climb
in South America while on vacation. He will not have time to
acclimate slowly to altitude. A drug that is useful in prevent￾ing high-altitude sickness is
(A) Acetazolamide
(B) Amiloride
(C) Demeclocycline
(D) Desmopressin
(E) Ethacrynic acid

back 91

(A) Acetazolamide

front 92

A 58-year-old woman with lung cancer has abnormally low
serum osmolality and hyponatremia. A drug that increases
the formation of dilute urine and is used to treat SIADH is
(G) Mannitol
(H) Spironolactone
(I) Triamterene
(J) Tolvaptan

back 92

(J) Tolvaptan