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Paper I — 2013 April (2010 Scheme) — Q2

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Paper I
2013 April (2010 Scheme) · 40 marks · 180 min

Question

Classify diuretic agents. Describe the mechanism of action, uses and adverse effects of furosemide. (2+2+1+1=6)

Q26 marksEssays

Answer

Classification of diuretics

  • High-efficacy (loop) diuretics: Furosemide, Bumetanide, Torsemide
  • Medium-efficacy (thiazide/thiazide-like): Hydrochlorothiazide, Chlorthalidone, Metolazone
  • Weak/adjunctive:
    • Carbonic anhydrase inhibitors — Acetazolamide
    • Potassium-sparing — Spironolactone, Amiloride, Triamterene
    • Osmotic diuretics — Mannitol

Mechanism of action of furosemide

  • Acts on the thick ascending limb of the loop of Henle
  • Inhibits the Na⁺-K⁺-2Cl⁻ (NKCC2) cotransporter on the luminal membrane
  • Abolishes the medullary concentration gradient, causing marked natriuresis, kaliuresis, and loss of the ability to concentrate/dilute urine
  • Also increases renal blood flow and has some venodilator action (useful in acute pulmonary oedema)

Uses

  • Acute pulmonary oedema / left ventricular failure
  • Chronic congestive cardiac failure
  • Oedema of hepatic and renal origin (nephrotic syndrome)
  • Acute renal failure (to maintain urine flow)
  • Hypertension (especially with renal impairment)
  • Hypercalcaemia, forced diuresis in poisoning

Adverse effects

  • Hypokalaemia, hyponatraemia, hypomagnesaemia
  • Hypotension, dehydration
  • Ototoxicity (especially with rapid IV injection or with aminoglycosides)
  • Hyperuricaemia (may precipitate gout)
  • Hyperglycaemia
  • Metabolic alkalosis
  1. 1Renal Pharmacology

Other Years Asked

  1. 1Compare the Mechanism of action, uses and adverse effects of Thiazides and Loop diuretics.2024 March (Supplementary) (2019 Scheme)Short Essay · 8 marks
  2. 2Enumerate three drug groups with two examples each for treating chronic simple glaucoma. Write the mechanism of action of all three groups. (3+3)2024 December (Supplementary) (2019 Scheme)Short Essay · 6 marks
  3. 3Spironolactone2018 July (Supplementary) (2010 Scheme)Short Note · 3 marks
  4. 4Furosemide.2016 October (Supplementary) (2010 Scheme)Short Note · 3 marks
  5. 5Furosemide2019 February (2010 Scheme)Short Note · 3 marks
  6. 6Mechanism of action of loop diuretics.2016 February (2010 Scheme)Short Note · 3 marks
  7. 7Thiazide diuretics.2025 March (Supplementary) (2010 Scheme)Short Note · 3 marks
  8. 8Mannitol2023 July (Supplementary) (2010 Scheme)Short Note · 3 marks
  9. 9Potassium sparing diuretics2021 December (Supplementary) (2010 Scheme)Short Note · 3 marks
  10. 10Furosemide2019 July (Supplementary) (2010 Scheme)Short Note · 3 marks
  11. 11Furosemide.2017 August (Supplementary) (2010 Scheme)Short Note · 3 marks
  12. 12Acetazolamide2021 May (Supplementary) (2010 Scheme)Short Answer · 1 mark
  13. 13Potassium sparing diuretics2017 February (2010 Scheme)Short Answer · 1 mark
  14. 14Uricosuric agent2018 July (Supplementary) (2010 Scheme)Short Answer · 1 mark
  15. 15Ototoxic diuretics.2015 February (2010 Scheme)Short Answer · 1 mark
  16. 16Cerebral edema.2014 September (Supplementary) (2010 Scheme)Short Answer · 1 mark
  17. 17Potassium sparing diuretics2018 February (2010 Scheme)Short Answer · 1 mark
  18. 18Treatment of acute glaucoma2017 February (2010 Scheme)Short Answer · 1 mark
  19. 19Potassium channel openers2022 October (Supplementary) (2010 Scheme)Short Answer · 1 mark
  20. 20The following statements about spironolactone are true: 1. It is a potassium sparing diuretic 2. It can cause gynecomastia and impotence 3. It acts on the thick ascending limb of Loop of Henle 4. It is combined with lisinopril to counteract hypokalemia2024 December (Supplementary) (2019 Scheme)MCQ · 1 mark
  21. 21 Amiloride in lithium induced nephrogenic diabetes insipidus Name the following (Two examples for each): (5x1=5)2022 May (Supplementary) (2010 Scheme)Short Answer · 0.3 marks
  22. 22Carbonic anhydrase inhibitors used to treat glaucoma2024 March (Supplementary) (2019 Scheme)Short Answer · 0.2 marks
  23. 23Carbonic anhydrase inhibitors2022 February (2019 Scheme)Short Answer · 0.2 marks
  24. 24Carbonic anhydrase inhibitors in glaucoma2023 January (Supplementary) (2019 Scheme)Short Answer · 0.2 marks
  25. 25Osmotic diuretics.2024 June (Supplementary) (2019 Scheme)Short Answer · 0.2 marks
  26. 26Aldosterone antagonist.2023 July (Supplementary) (2019 Scheme)Short Answer · 0.2 marks
  27. 27Uricosuric agents.2023 July (Supplementary) (2019 Scheme)Short Answer · 0.2 marks

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