This MCQ relates to the learning outcomes in the drugs and the kidney lecture. Good luck!
Reviewed by: awaiting review
Drugs and the kidney
Which of the following is not a consideration when prescribing for a patient with renal disease?
How their renal impairment affects their ability to process/ excrete the drug
Whether the drug will worsen their renal impairment
If they will be able to handle the dose normally given to people without kidney disease
Whether the drug should be delivered orally or intravenously
A patient with Acute Kidney Injury (AKI) is prescribed spironolactone to help reduce their blood pressure. What are the issues with prescribing this drug?
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
Side effects of the drug can end up worsening the AKI in the long term
It can cause hyperkalemia
It can suppress normal functioning of other organs
Which of the following is not a consideration when adjusting drug dose?
Degree of renal impairment
Proportion of drug eliminated by renal excretion
A patient with chronic kidney disease and heart disease is placed on dialysis and atenolol. What is the issue with their treatment?
This drug is only effective in patients with AKI
The atenolol prescribed for their heart disease will be removed by dialysis and thus may not be effective for their heart condition
The drug is nephrotoxic
Being put on dialysis can worsen their heart disease
What is a diuretic?
A substance that promotes the formation of urine by promoting renal excretion of sodium
A substance that makes you retain water
A substance that makes you excrete potassium
A substance that makes you excrete calcium
A patient with heart failure has pre-tibial oedema. Why would prescribing furosemide help to reduce their oedema?
The drug prevents water from exiting the bloodstream by osmosis
The drug causes diuresis, thus excess interstitial fluid would be removed from the interstitial space and back into blood vessels by osmosis
The drug can cause hypokalemia and thus water moves into cells more easily, causing oedema
It blocks the expression of ENAC channels in the distal convoluted tubule, increasing diuresis
Which of the following is not a mechanism related to its drug class?
Thiazides act by blocking the sodium and chloride symporter in the eDCT
Loop diuretics block the sodium, potassium, 2 chloride symporter, increasing the concentration of the filtrate and promoting diuresis
Carbonic anhydrase inhibitors block the conversion of water and carbon dioxide to protons and bicarbonate
Osmotic diuretics cross the cell and nuclear membrane blocking transcription of ENAC channels that are subsequently expressed on the cell membrane
A patient with high blood pressure is prescribed furosemide and subsequently develops hypokalaemia. Explain why this has happened
Furosemide causes uptake of potassium, causing a down regulation in other potassium channels and ultimately causing hypokalaemia
Furosemide blocks the sodium, potassium and 2 chloride symporter, resulting in increase of sodium ion delivery to the distal convoluted tubule
Furosemide is an anion that preferentially binds potassium, forming a salt that is excreted
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
Which of the following is not an indication for acetazolamide?
Raised intraoccular pressure
Prophylaxis for mountain sickness
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?
Describe the mechanism of action of Amiloride
It increases the oncotic pressure of the filtrate, preventing water to flow into the tubular epithelial cells by osmosis
It prevents the movement of sodium and chloride into the tubular epithelial cells
It blocks ENAC channels in the DCT, preventing sodium uptake into tubular epithelial cells
It blocks the enzyme carbonic anhydrase in the proximal convoluted tubule
A patient has an adrenal gland tumor causing an increase in serum aldosterone concentration. What can be a consequence of this?
A patient is prescribed Losartan for their hypertension. Relating to its mechanism of action, which of the following are correct?
Renin is released by juxtaglomerular cells —> Losartan blocks angiotensinogen to angiotensin 1 —> No angiotensin 2 is produced
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
Losartan inhibits the synthesis of renin in the kidney
Losartan blocks the synthesis of Angiotensin converting enzyme (ACE), preventing the conversion of angiotensin 1 to angiotensin 2 by ACE
Where is Angiotensin converting enzyme (ACE) produced?
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?
Production of Angiotensin converting enzyme (ACE)
Production of spironolactone
Production of renin
Production of alpha-1 hydroxylase
What is the intermediate step of the reaction catalysed by carbonic anhydrase?
Bicarbonate and proton
There is a high concentration of H+ + HCO3- inside a tubular epithelial cell. What is the most likely product of this reaction?
H2O + CO2
H+ + HCO3-
Which of the following is not considered a thiazide
Why would indapamide decrease afferent arteriole vasoconstriction?
Because it acts as a vasodilator at the afferent arteriole
Because it acts as a vasodilator at the efferent arteriole and in order to keep GFR the same, afferent arteriole vasoconstriction increases
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
Because it blocks the action of angiotensin 2 at it’s receptor