This MCQ relates to the learning outcomes in the drugs and the kidney lecture. Good luck!

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Drugs and the kidney

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Question 1

Which of the following is not a consideration when prescribing for a patient with renal disease?

A
How their renal impairment affects their ability to process/ excrete the drug
B
Whether the drug will worsen their renal impairment
C
If they will be able to handle the dose normally given to people without kidney disease
D
Whether the drug should be delivered orally or intravenously
Question 2

A patient with Acute Kidney Injury (AKI) is prescribed spironolactone to help reduce their blood pressure. What are the issues with prescribing this drug?

A
Spironolactone is filtered and not secreted so the kidney needs to be functioning properly in order for the drug to enter the kidney and have its effect
B
Side effects of the drug can end up worsening the AKI in the long term
C
It can cause hyperkalemia
D
It can suppress normal functioning of other organs
Question 3

Which of the following is not a consideration when adjusting drug dose?

A
Degree of renal impairment
B
Proportion of drug eliminated by renal excretion
C
Drug toxicity
D
Their diet
Question 4

A patient with chronic kidney disease and heart disease is placed on dialysis and atenolol. What is the issue with their treatment?

A
This drug is only effective in patients with AKI
B
The atenolol prescribed for their heart disease will be removed by dialysis and thus may not be effective for their heart condition
C
The drug is nephrotoxic
D
Being put on dialysis can worsen their heart disease
Question 5

What is a diuretic?

A
A substance that promotes the formation of urine by promoting renal excretion of sodium
B
A substance that makes you retain water
C
A substance that makes you excrete potassium
D
A substance that makes you excrete calcium
Question 6

A patient with heart failure has pre-tibial oedema. Why would prescribing furosemide help to reduce their oedema?

A
The drug prevents water from exiting the bloodstream by osmosis
B
The drug causes diuresis, thus excess interstitial fluid would be removed from the interstitial space and back into blood vessels by osmosis
C
The drug can cause hypokalemia and thus water moves into cells more easily, causing oedema
D
It blocks the expression of ENAC channels in the distal convoluted tubule, increasing diuresis
Question 7

Which of the following is not a mechanism related to its drug class?

A
Thiazides act by blocking the sodium and chloride symporter in the eDCT
B
Loop diuretics block the sodium, potassium, 2 chloride symporter, increasing the concentration of the filtrate and promoting diuresis
C
Carbonic anhydrase inhibitors block the conversion of water and carbon dioxide to protons and bicarbonate
D
Osmotic diuretics cross the cell and nuclear membrane blocking transcription of ENAC channels that are subsequently expressed on the cell membrane
Question 8

A patient with high blood pressure is prescribed furosemide and subsequently develops hypokalaemia. Explain why this has happened

A
Furosemide causes uptake of potassium, causing a down regulation in other potassium channels and ultimately causing hypokalaemia
B
Furosemide blocks the sodium, potassium and 2 chloride symporter, resulting in increase of sodium ion delivery to the distal convoluted tubule
C
Furosemide is an anion that preferentially binds potassium, forming a salt that is excreted
D
Furosemide causes a decrease in potassium in the filtrate, where it is then drawn out of cells into the filtrate down its concentration gradient through diffusion
Question 9

Which of the following is not an indication for acetazolamide?

A
Raised intraoccular pressure
B
Prophylaxis for mountain sickness
C
Diarrhoea
D
Hypertension
Question 10

You are using an ophthalmoscope on a patient and you notice that they have papilledema. Which of the following drugs are indicated for the condition this is associated with?

A
Macrogol
B
Mannitol
C
Bisacodyl
D
Spironolactone
Question 10 Explanation: 
An optalmascope is used to visualise the back of a patient’s eye. Papilledema is swelling of the optic nerve inside the eye, that can be visualised using this instrument. Papilledema is a sign of raised intracranial pressure, which can be treated using Mannitol.
Question 11

Describe the mechanism of action of Amiloride

A
It increases the oncotic pressure of the filtrate, preventing water to flow into the tubular epithelial cells by osmosis
B
It prevents the movement of sodium and chloride into the tubular epithelial cells
C
It blocks ENAC channels in the DCT, preventing sodium uptake into tubular epithelial cells
D
It blocks the enzyme carbonic anhydrase in the proximal convoluted tubule
Question 12

A patient has an adrenal gland tumor causing an increase in serum aldosterone concentration. What can be a consequence of this?

A
Polyuria
B
Polydipsia
C
Hypokalaemia
D
Hyponatremia
Question 12 Explanation: 
Aldosterone acts in the nucleus to increase transcription and translation of ENAC channels on tubular epithelial cells. As a consequence sodium uptake into the cell is increased and the sodium , potassium ATPase activity increases to return the cell to its resting membrane potential. Since the sodium, potassium ATPase activity is increased, more potassium is drawn out from the interstitial fluid, thus causing hypokalaemia.
Question 13

A patient is prescribed Losartan for their hypertension. Relating to its mechanism of action, which of the following are correct?

A
Renin is released by juxtaglomerular cells —> Losartan blocks angiotensinogen to angiotensin 1 —> No angiotensin 2 is produced
B
Renin is released by juxtaglomerular cells —> Renin converts angiotensinogen to angiotensin 1 —> angiotensin 1 is converted to angiotensin 2 by Angiotensin converting enzyme —> Losartan binds to Angiotensin 2 receptors, preventing its actions
C
Losartan inhibits the synthesis of renin in the kidney
D
Losartan blocks the synthesis of Angiotensin converting enzyme (ACE), preventing the conversion of angiotensin 1 to angiotensin 2 by ACE
Question 13 Explanation: 
Angiotensin 2 causes potent vasoconstriction, aldosterone and ADH release. Losartan blocks the last step in this pathway by competitively binding to Angiotensin 2 receptors, preventing an increase in blood pressure.
Question 14

Where is Angiotensin converting enzyme (ACE) produced?

A
Lungs
B
Liver
C
Kidney
D
Brain
Question 15

A patient on your ward is admitted with Acute Kidney Injury(AKI). What part of the RAAS system would most likely be affected by this?

A
Production of Angiotensin converting enzyme (ACE)
B
Production of spironolactone
C
Production of renin
D
Production of alpha-1 hydroxylase
Question 16

What is the intermediate step of the reaction catalysed by carbonic anhydrase?

A
Sulfuric acid
B
Carbonic acid
C
Bicarbonate and proton
D
Calcium carbonate
Question 16 Explanation: 
  H2O + CO2 <- ->H2CO3<- -> H+ + HCO3-
Question 17

There is a high concentration  of H+ + HCO3- inside a tubular epithelial cell. What is the most likely product of this reaction?

A
H2O + CO2 
B
H2O only
C
H2CO3
D
H+ + HCO3-
Question 17 Explanation: 
According to Le Chatelier’s principle, in a readily reversible reaction, the side of the reaction with a higher concentration of molecules will move to the opposite side of the equation in an attempt to restore equilibrium. In this case as there is a higher concentration of products (H+ + HCO3- ) the reaction will be forced to the side of the reactants (H2O + CO2 ) to restore equilibrium, thus increasing the concentration of reactants.
Question 18

Which of the following is not considered a thiazide

A
Bendroflumethiazide
B
Hydrochlorothiazide
C
Chloroflumethiazide
D
Indapamide
Question 19

Why would indapamide decrease afferent arteriole vasoconstriction?

A
Because it acts as a vasodilator at the afferent arteriole
B
Because it acts as a vasodilator at the efferent arteriole and in order to keep GFR the same, afferent arteriole vasoconstriction increases
C
It prevents the detection of sodium and chloride by macula densa cells in the early DCT, which are then unable to initiate a cascade of events to vasoconstrict the afferent arteriole
D
Because it blocks the action of angiotensin 2 at it’s receptor
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