Goodman & Gilman's Chapter 25: Drugs Affecting Renal Excretory Function Quiz
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Questions and Answers

What is the primary site of action for osmotic diuretics?

  • Distal convoluted tubule
  • Proximal tubule
  • Thick ascending limb
  • Loop of Henle (correct)

Which type of diuretic is known for inhibiting carbonic anhydrase?

  • Inhibitors of Na+-Cl- symport
  • Inhibitors of Na+-K+-2Cl- symport
  • Renal epithelial Na+ channel inhibitors
  • Osmotic diuretics (correct)

What effect do symport inhibitors have on bicarbonate and phosphate levels?

  • Increase bicarbonate, decrease phosphate
  • Decrease both
  • Increase both (correct)
  • Decrease bicarbonate, increase phosphate

Where do inhibitors of renal epithelial Na+ channels primarily act?

<p>Late distal tubule, collecting duct (A)</p> Signup and view all the answers

Which diuretic type affects the reabsorption of Na+ and Cl- in the distal convoluted tubule?

<p>Inhibitors of Na+-Cl- symport (A)</p> Signup and view all the answers

What characterizes the action of antagonists of mineralocorticoid receptors?

<p>&quot;Volume-depleting&quot; effect (A)</p> Signup and view all the answers

What is the average number of times the kidney filters the extracellular fluid volume across the renal glomeruli in a day?

<p>12 times (B)</p> Signup and view all the answers

In the context of renal physiology, what is the function of diuretics?

<p>Adjust the volume or composition of body fluids (B)</p> Signup and view all the answers

How does the finely tuned homeostatic mechanism control body fluid osmolality?

<p>By adjusting both water intake and solute-free water excretion (A)</p> Signup and view all the answers

What can abnormalities in the homeostatic system controlling body fluid osmolality potentially cause?

<p>Deviations in plasma osmolality (C)</p> Signup and view all the answers

How are diuretics integrated into the discussion of renal physiology in this chapter?

<p>By influencing urinary composition (D)</p> Signup and view all the answers

What do diuretics primarily aim to adjust in patients with disorders like hypertension and heart failure?

<p>Volume or composition of body fluids (A)</p> Signup and view all the answers

What was the primary focus of the CAPRIE trial?

<p>Comparison of clopidogrel with aspirin (B)</p> Signup and view all the answers

Which enzyme was identified for the bioactivation of nitroglycerin?

<p>Endothelial nitric oxide synthase (A)</p> Signup and view all the answers

What cardiovascular condition was the ACC/AHA expert consensus document focused on?

<p>Ischemic heart disease (B)</p> Signup and view all the answers

In which year was the study comparing ticagrelor with clopidogrel published?

<p>2010 (B)</p> Signup and view all the answers

What is the focus of managing peripheral edema in patients with arterial hypertension?

<p>Regulation of endothelial nitric oxide synthase (B)</p> Signup and view all the answers

What aspect of nitroglycerin bioactivation was identified in the study by Chen Z, et al.?

<p>$6:10$ regulation (A)</p> Signup and view all the answers

Which condition can be exacerbated by thiazide diuretics in patients with primary hyperparathyroidism?

<p>Hypercalcemia (B)</p> Signup and view all the answers

What therapeutic benefit may thiazide-induced decreased Ca2+ excretion provide for patients?

<p>Treatment for osteoporosis (B)</p> Signup and view all the answers

What effect have thiazide diuretics been associated with regarding plasma lipids and glucose tolerance?

<p>Worsened glucose tolerance (D)</p> Signup and view all the answers

How do thiazide diuretics affect pregnant women who take them?

<p>Cause direct adverse effects on the fetus (C)</p> Signup and view all the answers

Why should nursing mothers avoid thiazide diuretics?

<p>To prevent exposure through breast milk (B)</p> Signup and view all the answers

In patients with normal renal function, which type of diuretic is less effective as an antihypertensive agent compared to thiazides?

<p>Loop diuretics (D)</p> Signup and view all the answers

What is the topic of the article by Fleckenstein A, et al. published in 1969?

<p>Selective inhibition of myocardial contractility (D)</p> Signup and view all the answers

Which study provides a selectivity scale of calcium antagonists in the human cardiovascular system?

<p>Godfraind T, et al. (1992) (C)</p> Signup and view all the answers

Which article discusses the management of peripheral edema in patients with arterial hypertension?

<p>Epstein BJ, Roberts ME (2009) (C)</p> Signup and view all the answers

In which study was Ivabradine used as a treatment approach for stable coronary artery disease?

<p>Fox K, et al. (2014) (C)</p> Signup and view all the answers

Which article discusses the identification of the enzymatic mechanism of nitroglycerin bioactivation?

<p>Chen Z, et al. (2002) (A)</p> Signup and view all the answers

Which article provides guidelines for the diagnosis and management of patients with stable ischemic heart disease?

<p>Fihn SD, et al. (2012) (B)</p> Signup and view all the answers

What is the primary action of β1 blockers that contributes to their antihypertensive effect?

<p>Antagonism of β1 receptors (A)</p> Signup and view all the answers

Which additional effect unrelated to β adrenergic receptors is exhibited by labetalol and carvedilol?

<p>Blockade of α1 receptors (C)</p> Signup and view all the answers

What is a characteristic of standard therapies like atenolol and bisoprolol among β blockers?

<p>Intrinsic sympathomimetic activity (C)</p> Signup and view all the answers

Which receptor antagonism by β blockers results in major unwanted effects such as bronchoconstriction?

<p>β2 receptors (B)</p> Signup and view all the answers

What is a common effect experienced with the presence of intrinsic sympathomimetic activity among β blockers?

<p>Hypoglycemia (A)</p> Signup and view all the answers

Which factor influences the clinical pharmacology and spectrum of adverse effects of different β blockers?

<p>Partial agonist activity (B)</p> Signup and view all the answers

What is the second choice for the prevention of angina, with adverse effects similar to direct NO donors?

<p>Verapamil (D)</p> Signup and view all the answers

Which dihydropyridine is the first choice for vasospastic angina?

<p>Amlodipine (B)</p> Signup and view all the answers

Which drug can cause tachycardia, hypotension, and trigger angina among the immediate-release calcium channel blockers?

<p>Nifedipine (A)</p> Signup and view all the answers

Which drug should not be used concurrently with beta blockers due to its effect on heart rate and AV conduction?

<p>Verapamil (A)</p> Signup and view all the answers

Which drug inhibits carbonic anhydrase and has a relative potency of 1?

<p>Acetazolamide (A)</p> Signup and view all the answers

Which drug is a second choice for preventing exertional angina among calcium channel blockers?

<p>Felodipine (C)</p> Signup and view all the answers

Which class of antihypertensive drugs includes atenolol, bisoprolol, and propranolol?

<p>Sympatholytic drugs (C)</p> Signup and view all the answers

What is the primary mechanism of action of beta blockers in hypertension treatment?

<p>Blocking the beta-adrenergic receptors (D)</p> Signup and view all the answers

Which of the following is a side effect associated with beta blockers?

<p>Bronchoconstriction (D)</p> Signup and view all the answers

Which type of diuretic might be preferred over beta blockers in patients with asthma or chronic obstructive pulmonary disease (COPD)?

<p>Thiazides (B)</p> Signup and view all the answers

Which of the following is a mixed alpha/beta blocker used in hypertension treatment?

<p>Labetalol (A)</p> Signup and view all the answers

In addition to hypertension, beta blockers like propranolol are also used in the management of which condition?

<p>Hyperthyroidism (B)</p> Signup and view all the answers

What is the primary mechanism of action of osmotic diuretics?

<p>Alteration of renal hemodynamics indirectly (A)</p> Signup and view all the answers

Which cations are affected by diuretics in terms of excretion and renal hemodynamics?

<p>Na+ and K+ (A)</p> Signup and view all the answers

What is a common effect of diuretics on the reabsorption of anions in the kidney?

<p>Reducing reabsorption of HCO3- (A)</p> Signup and view all the answers

Which diuretic class primarily targets Na+-Cl- symport in the distal convoluted tubule?

<p>Thiazides (D)</p> Signup and view all the answers

What is a significant difference between loop diuretics and thiazides in terms of their actions on renal hemodynamics?

<p>Loop diuretics increase GFR, while thiazides reduce it. (C)</p> Signup and view all the answers

Which anion's renal handling is significantly altered by various diuretics?

<p>HCO3- (B)</p> Signup and view all the answers

What is the primary site of action for osmotic diuretics?

<p>Loop of Henle (C)</p> Signup and view all the answers

Which type of diuretic is known for inhibiting carbonic anhydrase?

<p>Osmotic diuretics (C)</p> Signup and view all the answers

Where do inhibitors of renal epithelial Na+ channels primarily act?

<p>Collecting duct (C)</p> Signup and view all the answers

What aspect of nitroglycerin bioactivation was identified in the study by Chen Z, et al.?

<p>Enzymatic mechanism (D)</p> Signup and view all the answers

What is the mechanism of action of inhibitors of Na+- Cl- symport?

<p>Distal convoluted tubule (C)</p> Signup and view all the answers

Which diuretic type affects the reabsorption of Na+ and Cl- in the distal convoluted tubule?

<p>Thiazide diuretics (C)</p> Signup and view all the answers

What is the potential downside of prescribing loop diuretics once daily for the treatment of hypertension?

<p>They can cause excessive acute diuresis and side effects. (A)</p> Signup and view all the answers

Which receptors do amiloride and triamterene act on to prevent urinary potassium loss?

<p>Epithelial Na+ channel (ENaC) (D)</p> Signup and view all the answers

What is the primary mechanism of action of loop diuretics to induce natriuresis?

<p>Inhibition of sodium reabsorption in the ascending loop of Henle (D)</p> Signup and view all the answers

Which diuretic type is particularly useful for patients with severe edema associated with vasodilators?

<p>Loop diuretics (A)</p> Signup and view all the answers

What condition is caused by hyperactivity of the Epithelial Na+ channel (ENaC) in the distal tubule membrane according to the text?

<p>Liddle syndrome (A)</p> Signup and view all the answers

How does hypokalemia increase the risk of ventricular arrhythmias?

<p>By increasing the binding activity of K+ channel inhibiting drugs (B)</p> Signup and view all the answers

What is a well-known risk factor for ventricular arrhythmias associated with diuretic treatment?

<p>Hypokalemia resulting from K+ depletion (A)</p> Signup and view all the answers

How does hypokalemia directly affect cardiac repolarization?

<p>By decreasing outward K+ conductances (B)</p> Signup and view all the answers

What is a consequence of hypokalemia on Na+,K+-ATPase activity?

<p>Increased intracellular Na+ and Ca2+ accumulation (C)</p> Signup and view all the answers

Why is hypokalemia associated with an increased risk of drug-induced ventricular tachycardia?

<p>It decreases repolarization reserve (D)</p> Signup and view all the answers

How does hypokalemia contribute to the risk of ischemic ventricular fibrillation?

<p>By increasing intracellular Ca2+ accumulation (C)</p> Signup and view all the answers

What is the most favorable efficacy-safety ratio in the context of acute coronary syndromes?

<p>Bivalirudin (C)</p> Signup and view all the answers

Which medication has an unclear advantage over heparin in the treatment of heparin-induced thrombocytopenia (HIT)?

<p>Lepirudin (B)</p> Signup and view all the answers

Which factor does Fondaparinux inhibit in the context of percutaneous coronary interventions?

<p>Factor Xa (B)</p> Signup and view all the answers

In what situation does low-molecular-weight heparin accumulate?

<p>In patients with renal insufficiency (B)</p> Signup and view all the answers

Which medication is indicated for parenteral use only?

<p>Lepirudin (A)</p> Signup and view all the answers

'Heparin-induced thrombocytopenia (HIT)' is associated with which medication?

<p>Bivalirudin (C)</p> Signup and view all the answers

In which publication can information about the selective inhibition of myocardial contractility by competitive divalent Ca++ antagonists be found?

<p>Fleckenstein A, et al. Selective inhibition of myocardial contractility by competitive divalent Ca++ antagonists (iproveratril, D 600, prenylamine) [in German]. (B)</p> Signup and view all the answers

Which study focused on the identification of the enzymatic mechanism of nitroglycerin bioactivation?

<p>Chen Z, et al. Identification of the enzymatic mechanism of nitroglycerin bioactivation. (A)</p> Signup and view all the answers

Which article provides information about ivabradine in stable coronary artery disease?

<p>Fox K, et al. Ivabradine in stable coronary artery disease. (D)</p> Signup and view all the answers

Which article focuses on the management of peripheral edema in patients with arterial hypertension?

<p>Epstein BJ, Roberts ME. Managing peripheral edema in patients with arterial hypertension. (A)</p> Signup and view all the answers

Which publication discusses calcium antagonism and calcium entry blockade?

<p>Godfraind T, et al. Calcium antagonism and calcium entry blockade. (D)</p> Signup and view all the answers

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