Paper I
2023 July (Supplementary) (2019 Scheme) · 100 marks · 180 min

Question

Classify Diuretics. Briefly describe Frusemide. (4+4)

Q58 marksShort Essays

Answer

a) Classification of diuretics (by site of action)

SiteClassExamples
Proximal convoluted tubuleCarbonic anhydrase inhibitorsAcetazolamide
Thick ascending limbHigh-ceiling (loop) diureticsFurosemide, Bumetanide
Distal convoluted tubuleThiazidesHydrochlorothiazide, Chlorthalidone
Collecting ductPotassium-sparingSpironolactone, Amiloride
Throughout the nephronOsmotic diureticsMannitol

b) Frusemide (Furosemide) A high-efficacy loop diuretic. MOA: inhibits the Na⁺-K⁺-2Cl⁻ (NKCC2) cotransporter in the thick ascending limb of the loop of Henle, blocking reabsorption of Na⁺, K⁺, and Cl⁻, producing marked natriuresis and diuresis — abolishes the medullary concentration gradient, so both dilution and concentration of urine are impaired. Uses: acute pulmonary edema/heart failure, edema of cardiac/hepatic/renal origin, hypertensive emergencies (adjunct), hyperkalemia/hypercalcemia, acute renal failure to maintain urine output. Adverse effects: hypokalemia, hyponatremia, hypochloremic metabolic alkalosis, ototoxicity (especially with rapid IV administration), hyperuricemia, hypovolemia/hypotension.

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