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

B. Proximal tubule

Acetazolamide directly inhibits which enzyme in the proximal tubule?

A) Carbonic anhydrase

B) SGLT2

C) Aldosterone synthase

D) Na/K ATPase

A. Carbonic anhydrase

Carbonic anhydrase inhibitors cause urinary loss of which major buffer?

A) Potassium

B) Glucose

C) Bicarbonate

D) Calcium

C. Bicarbonate

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

B. Bicarbonate loss in urine

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

A. Sodium and water

Acetazolamide produces which overall diuretic strength in the notes?

A) Strong diuresis

B) No diuresis

C) Mild diuresis

D) Maximal diuresis

C. Mild diuresis

Which side effect is associated with acetazolamide?

A) Hyperglycemia

B) Metabolic acidosis

C) Gynecomastia

D) Genital yeast infection

B. Metabolic acidosis

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

A) Hyperkalemia

B) Hypokalemia

C) Hyponatremia

D) Hypercalcemia

B. Hypokalemia

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

A) Kidney stones

B) Ototoxicity

C) Hyperlipidemia

D) Volume overload

A. Kidney stones

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

A) Gout

B) Paresthesias

C) Hypotension

D) Gynecomastia

B. Paresthesias

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

A) Acetazolamide

B) Furosemide

C) Chlorthalidone

D) Tolvaptan

A. Acetazolamide

Which drug class includes canagliflozin, dapagliflozin, and empagliflozin?

A) Loop diuretics

B) SGLT2 inhibitors

C) Thiazide diuretics

D) ADH antagonists

B. SGLT2 inhibitors

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

A) “th” clue

B) “-one” ending

C) “flozin” suffix

D) “-vaptan” ending

C. “flozin” suffix

SGLT2 inhibitors act primarily in which nephron segment?

A) Proximal tubule

B) Collecting tubule

C) Distal convoluted tubule

D) Thick ascending limb

A. Proximal tubule

Blocking SGLT2 decreases reabsorption of which substances?

A) Calcium and chloride

B) Sodium and glucose

C) Potassium and hydrogen

D) Bicarbonate and protein

B. Sodium and glucose

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

A) Water

B) Aldosterone

C) Calcium

D) ADH

A. Water

Which clinical effect follows SGLT2 inhibition in the proximal tubule?

A) Severe potassium wasting

B) Mild diuresis

C) Increased preload

D) Increased blood pressure

B. Mild diuresis

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

C. They promote water loss

Which side effect is associated with SGLT2 inhibitors?

A) Urinary tract infections

B) Ototoxicity

C) Lupus-like syndrome

D) Metabolic alkalosis

A. Urinary tract infections

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

A. Genital yeast infection

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

B. Volume depletion

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

A. Glucose appears in urine

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

B. UTIs, yeast infections, volume depletion

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

A) Thiazide diuretics

B) SGLT2 inhibitors

C) Loop diuretics

D) ENaC blockers

C. Loop diuretics

Most listed loop diuretics have which rough name clue?

A) “-vaptan” ending

B) “th” in name

C) “-one” ending

D) “ides” sound

D. “ides” sound

Loop diuretics block which transporter?

A) Na/K/2Cl transporter

B) Na/Cl transporter

C) SGLT2

D) ENaC

A. Na/K/2Cl transporter

Loop diuretics act in which nephron segment?

A) Distal convoluted tubule

B) Thick ascending limb

C) Collecting tubule

D) Proximal tubule

B. Thick ascending limb

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

B. Strong salt and water loss

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

A. Salt and water

Which listed loop diuretic is not a sulfonamide?

A) Furosemide

B) Bumetanide

C) Torsemide

D) Ethacrynic acid

D. Ethacrynic acid

Which side effect is highly associated with loop diuretics?

A) Gynecomastia

B) Ototoxicity

C) Genital yeast infection

D) Paresthesias

B. Ototoxicity

Loop diuretics can increase uric acid and cause which condition?

A) Diabetes

B) Gout

C) Yeast infection

D) Constipation

B. Gout

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

A) Ethacrynic acid

B) Dapagliflozin

C) Triamterene

D) Conivaptan

A. Ethacrynic acid

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

C. Loop diuretics

Which class includes hydrochlorothiazide and chlorthalidone

A) Loop diuretics

B) Thiazide diuretics

C) Osmotic diuretics

D) SGLT2 inhibitors

B. Thiazide diuretics

Which name clue helps identify hydrochlorothiazide and chlorthalidone?

A) “flozin” suffix

B) “-one” ending

C) “-vaptan” ending

D) “th” in both

D. “th” in both

Thiazide diuretics act in which nephron segment?

A) Distal convoluted tubule

B) Proximal tubule

C) Thick ascending limb

D) Collecting tubule

A. Distal convoluted tubule

Hydrochlorothiazide directly blocks which transporter?

A) SGLT2

B) Na/K/2Cl transporter

C) Na/Cl transporter

D) ENaC

C. Na/Cl transporter

Thiazides lower blood pressure mainly by causing loss of what?

A) Salt and water

B) Calcium and protein

C) Glucose only

D) ADH only

A. Salt and water

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

B. Salt and water diuresis

Which side effect is associated with thiazide diuretics?

A) Hypokalemic metabolic alkalosis

B) Metabolic acidosis

C) Methemoglobinemia

D) Cyanide toxicity

A. Hypokalemic metabolic alkalosis

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

A) Asthma

B) Gout

C) Arrhythmia

D) Toxoplasmosis

B. Gout

Which metabolic abnormality is associated with thiazides?

A) Hypoglycemia

B) Hyperglycemia

C) Low LDL

D) Low triglycerides

B. Hyperglycemia

Thiazide diuretics can increase which blood lipid issue?

A) Hyperlipidemia

B) Hypolipidemia

C) Low VLDL

D) Low LDL

A. Hyperlipidemia

Which sodium abnormality is associated with thiazides?

A) Hypernatremia

B) Hyponatremia

C) Sodium excess only

D) No sodium change

B. Hyponatremia

Which allergy concern is listed for thiazide diuretics?

A) Penicillin allergy

B) Sulfonamide allergy

C) Latex allergy

D) Nickel allergy

B. Sulfonamide allergy

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

C. Hypokalemic alkalosis, gout, hyperglycemia

Spironolactone and eplerenone belong to which diuretic group?

A) Loop diuretics

B) Thiazides

C) Aldosterone-blocking potassium-sparing diuretics

D) Osmotic diuretics

C. Aldosterone-blocking potassium-sparing diuretics

Which name clue helps identify spironolactone and eplerenone?

A) “-one” ending

B) “flozin” suffix

C) “th” in name

D) “-vaptan” ending

A. “-one” ending

Spironolactone and eplerenone act in which nephron region?

A) Proximal tubule

B) Collecting tubule

C) Thick ascending limb

D) Distal convoluted tubule

B. Collecting tubule

Aldosterone-blocking diuretics directly block which receptor?

A) Beta receptor

B) ADH receptor

C) Aldosterone receptor

D) Dopamine receptor

C. Aldosterone receptor

Blocking aldosterone receptors causes urinary loss of what?

A) Sodium and water

B) Potassium only

C) Glucose and sodium

D) Bicarbonate only

A. Sodium and water

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

A) Aldosterone remodeling

B) Glucose excretion

C) Bicarbonate loss

D) Ototoxicity

A. Aldosterone remodeling

Which side effect is especially associated with spironolactone

A) Ototoxicity

B) Gynecomastia

C) Genital yeast infection

D) Hypokalemia

B. Gynecomastia

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

A) Hyperkalemia

B) Hypokalemia

C) Ototoxicity

D) Hyperglycemia

A. Hyperkalemia

Amiloride and triamterene belong to which potassium-sparing subgroup?

A) Aldosterone receptor blockers

B) ENaC blockers

C) Loop diuretics

D) Osmotic diuretics

B. ENaC blockers

Amiloride and triamterene act in which nephron region?

A) Proximal tubule

B) Thick ascending limb

C) Collecting tubule

D) Distal convoluted tubule

C. Collecting tubule

Amiloride and triamterene directly block which channel?

A) ENaC

B) SGLT2

C) Na/K/2Cl

D) V2 receptor

A. ENaC

ENaC blockers decrease reabsorption of which ion?

A) Potassium

B) Sodium

C) Bicarbonate

D) Calcium

B. Sodium

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

C. It decreases

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

A) Potassium

B) Glucose

C) Bicarbonate

D) Calcium

A. Potassium

Which side effect is most associated with amiloride and triamterene?

A) Hyperkalemia

B) Hypokalemia

C) Ototoxicity

D) Hyperglycemia

A. Hyperkalemia

Mannitol belongs to which diuretic class?

A) Osmotic diuretic

B) Loop diuretic

C) Thiazide diuretic

D) ADH antagonist

A. Osmotic diuretic

Mannitol causes diuresis because it stays where?

A) Blood only

B) Tubule

C) Liver

D) Collecting interstitium

B. Tubule

How does mannitol increase urine output?

A) Pulls water into urine

B) Blocks aldosterone receptors

C) Blocks SGLT2 transport

D) Blocks Na/Cl transport

A. Pulls water into urine

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

A. Excretes lots of water

Which clinical use matches mannitol?

A) Increased intracranial pressure

B) High LDL

C) Atrial fibrillation

D) Toxoplasmosis

A. Increased intracranial pressure

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

A) Eye

B) Kidney

C) Pancreas

D) Liver

A. Eye

Which drug class includes conivaptan and tolvaptan?

A) Vasopressin/ADH antagonists

B) SGLT2 inhibitors

C) Carbonic anhydrase inhibitors

D) Thiazide diuretics

A. Vasopressin/ADH antagonists

Which name clue helps identify conivaptan and tolvaptan?

A) “flozin” suffix

B) “-vaptan” ending

C) “th” in name

D) “-one” ending

B. “-vaptan” ending

Tolvaptan specifically blocks which receptor subtype?

A) V1 receptor

B) V2 receptor

C) Beta-1 receptor

D) Alpha-2 receptor

B. V2 receptor

ADH normally causes the kidney to do what?

A) Keep water

B) Lose glucose

C) Lose bicarbonate

D) Keep uric acid

A. Keep water

Blocking ADH receptors causes what urinary effect?

A) More water excretion

B) More potassium secretion only

C) More bicarbonate retention

D) More glucose reabsorption

A. More water excretion

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

A. Blocks V2 receptors

Which drug is a vasopressin antagonist?

A) Conivaptan

B) Empagliflozin

C) Eplerenone

D) Acetazolamide

A. Conivaptan

Which drug is a vasopressin antagonist?

A) Tolvaptan

B) Torsemide

C) Triamterene

D) Chlorthalidone

A. Tolvaptan

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

A. SGLT2 inhibitors

Which diuretic class acts in the distal convoluted tubule?

A) Thiazides

B) SGLT2 inhibitors

C) Carbonic anhydrase inhibitors

D) Osmotic diuretics

A. Thiazides

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

A. Aldosterone blockers and ENaC blockers

Which diuretic class is most associated with genital yeast infections?

A) SGLT2 inhibitors

B) Carbonic anhydrase inhibitors

C) Loop diuretics

D) Thiazides

A. SGLT2 inhibitors

Which diuretic class is most associated with hypokalemic metabolic alkalosis?

A) Carbonic anhydrase inhibitors

B) Thiazides

C) ENaC blockers

D) ADH antagonists

B. Thiazides

Which diuretic class is most associated with metabolic acidosis?

A) Acetazolamide class

B) Loop diuretics

C) Thiazides

D) Aldosterone blockers

A. Acetazolamide class

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

A. Aldosterone blockers

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

A. ENaC blockers

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

(A) Acetazolamide

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

(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.

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

(D) Metabolic alkalosis

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

(E) Mannitol

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

(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.

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

(A) Acetazolamide for glaucoma

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

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

(A) Acetazolamide

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

(J) Tolvaptan