MCQs PHARMACOLOGY: Drugs Acting on Kidney

39.1 Secretion of K+ in the late distal tubule and collecting ducts of kidney depends on:
A. Intracellular K+ content
B. Unabsorbed Na+ load presented to the distal segment
C. Aldosterone level
D. All of the above

39.2 Diuretics acting on the ascending limb of loop of Henle are the most efficacious in promoting salt and water excretion because:
A. Maximum percentage of salt and water is reabsorbed in this segment
B. Reabsorptive capacity of the segments distal to it is limited
C. This segment is highly permeable to both salt and water
D. This segment is responsible for creating corticomedullary osmotic gradient
ANSWERS 3 9 . 1D 3 9 . 2 B

39.3 Select the diuretic which is orally active, efficacious in acidosis as well as alkalosis, causes diuresis even in renal failure and has additional carbonic anhydrase inhibitory action:
A. Mannitol
B. Benzthiazide
C. Indapamide
D. Furosemide

39.4 Furosemide acts by inhibiting the following in the renal tubular cell:
A. Na+-K+-2Cl– cotransporter
B. Na+-Cl– symporter
C. Na+-H+ antiporter
D. Na+ K+ ATPase

39.5 The following diuretic abolishes the corticomedullary osmotic gradient in the kidney:
A. Acetazolamide
B. Furosemide
C. Hydrochlorothiazide
D. Spironolactone

39.6 Intravenous furosemide promptly mitigates dyspnoea in acute left ventricular failure by:
A. Producing bronchodilatation
B. Causing rapid diuresis and reducing circu-lating blood volume
C. Increasing venous capacitance and reducing cardiac preload.
D. Stimulating left ventricular contractility

ANSWERS
3 9 . 3D 3 9 . 4 A 3 9 . 5 B 3 9 . 6 C


39.7 Parenteral furosemide is an alternative diuretic to mannitol in the following condition:
A. Pulmonary edema
B. Cirrhotic edema
C. Cerebral edema
D. Cardiac edema

39.8 Thiazide diuretics and furosemide have directionally opposite effect on the net renal excretion of the following substance:
A. Uric acid
B. Calcium
C. Magnesium
D. Bicarbonate

39.9 Select the diuretic which is similar in efficacy and pattern of electrolyte excretion to furosemide, but is 40 times more potent dose to dose:
A. Piretanide
B. Bumetanide
C. Xipamide
D. Metolazone

39.10 Though ethacrynic acid is also a high ceiling diuretic, it is practically not used because:
A. It is more ototoxic
B. It causes diarrhoea and gut bleeding
C. Its response increases steeply over a narrow dose range
D. All of the above


39.11 The Na+-Cl– symport in the early distal convoluted tubule of the kidney is inhibited by:
A. Thiazides
B. Metolazone
C. Xipamide
D. All of the above
ANSWERS
3 9 . 7 C 3 9 . 8 B 3 9 . 9 B 39.10D 39.11D

39.12 The following diuretic reduces positive free water clearance but does not affect negative free water clearance:
A. Hydroflumethiazide
B. Furosemide
C. Ethacrynic acid
D. Mannitol(Note: Furosemide and ethacrynic acid are loop diuretics which abolish corticomedullary osmotic gra-dient. Mannitol also dissipates this gradient. All these diuretics therefore reduce both positive as well as negative free water clearance.)

39.13 Choose the correct statement about thiazide diuretics:
A. They act in the proximal convoluted tubule
B. They are uricosuric
C. They augment corticomedullary osmotic gradient
D. They induce diuresis in acidosis as well as alkalosis

39.14 Thiazide diuretics enhance K+ elimination in urine primarily by:
A. Inhibiting proximal tubular K+ reabsorption
B. Inhibiting Na+ K+-2Cl– cotransport in the ascending limb of loop of Henle
C. Increasing the availability of Na+ in the distal tubular fluid to exchange with interstitial K+
D. Potentiating the action of aldosterone

ANSWERS
39.12 A 39.13D 39.14 C

39.15 The primary site of action of thiazide diuretics is:
A. Proximal tubule
B. Ascending limb of loop of Henle
C. Cortical diluting segment
D. Collecting ducts

39.16 The most important reason for the thiazides being only moderately efficacious diuretics is:
A. About 9/10th of glomerular filtrate is reabsorbed proximal to their site of action
B. Compensatory increase in reabsorption at sites not affected by these drugs
C. They decrease glomerular filtration
D. They have relatively flat dose response curve

39.17 Individual drugs of thiazide and related class of diuretics differ markedly from each other in the following respect?
A. Diuretic efficacy
B. Diuretic potency
C. Side effects
D. Propensity to cause hyperkalemia

39.18 Combined tablets of thiazide or high ceiling diuretics with potassium chloride are not recommended because:
A. Potassium absorbed while diuresis is occur-ring is largely excreted out
B. Potassium administered concurrently dimi-nishes the diuretic action
C. Potassium chloride in tablet formulation is likely to cause gut ulceration
D. Both ‘A’ and ‘C’ are correct

ANSWERS
39.15 C 39.16 A 39.17 B 39.18D


39.19 Intravenous saline infusion is the treatment of choice for the following complication(s) of vigorous furose-mide therapy:
A. Dilutional hyponatremia
B. Acute saline depletion
C. Hypokalemia
D. All of the above

39.20 Long-term thiazide therapy can cause hyperglycaemia by:
A. Reducing insulin release
B. Interfering with glucose utilization in tissues
C. Increasing sympathetic activity
D. Increasing corticosteroid secretion

39.21 In addition to counteracting potassium loss, triam-terene also opposes the following consequence of thiazide/furosemide therapy:
A. Hyperuricaemia
B. Rise in plasma LDL-cholesterol
C. Magnesium loss
D. Both ‘A’ and ‘C’ are correct

39.22 A patient of congestive heart failure was being treated with furosemide and digoxin. He developed urinary tract infection. Which of the following antimicrobials should be avoided:
A. Ampicillin
B. Gentamicin
C. Norfloxacin
D. Cotrimoxazole

39.19 B 39.20 A 39.21 C 39.22 B


39.23 Nonsteroidal antiinflammatory drugs reduce the diuretic action of furosemide by:
A. Preventing prostaglandin mediated intra-renal haemodynamic actions
B. Blocking the action in ascending limb of loop of Henle.
C. Enhancing salt and water reabsorption in distal tubule
D. Increasing aldosterone secretion

39.24 The most appropriate measure to overcome dimi-nished responsiveness to furosemide after its long-term use is:
A. Switching over to parenteral administration of furosemide
B. Addition of a thiazide diuretic
C. Addition of acetazolamide
D. Potassium supplementation

39.25 At equinatriuretic doses which diuretic causes the maximum K+ loss:
A. Furosemide
B. Hydrochlorothiazide
C. Acetazolamide
D. Amiloride

39.26 Which of the following has a ‘self limiting diuretic’ (action of the drug itself causing changes which limit further diuresis) action:
A. Indapamide
B. Spironolactone
C. Xipamide
D. Acetazolamide

ANSWERS
39.23 A 39.24 B 39.25 C 39.26D


39.27 The following is not itself an efficacious diuretic, and is used only as an adjuvant/corrective to other diuretics:
A. Acetazolamide
B. Metolazone
C. Spironolactone
D. Indapamide

39.28 Spironolactone can be usefully combined with the following diuretics except:
A. Furosemide
B. Amiloride
C. Hydrochlorothiazide
D. Chlorthalidone
(Note: Both spironolactone and amiloride are potassium sparing weak natriuretics. Hence, no purpose is served by combining them.)

39.29 The current therapeutic indication of acetazolamide is:
A. Congestive heart failure
B. Renal insufficiency
C. Cirrhosis of liver
D. Glaucoma

39.30 A patient of liver cirrhosis with ascitis was treated with hydrochlorothiazide 50 mg twice daily. He responded initially, but over a couple of months the diuretic action gradually diminished and ascitis again appeared. Select the measure to reinduce diuresis:
A. Increase hydrochlorothiazide dose to 100 mg twice daily
B. Add acetazolamide 250 mg twice daily
C. Add spironolactone 50 mg thrice daily
D. Substitute hydrochlorothiazide by spirono-lactone 50 mg 6 hourly
ANSWERS
39.27 C 39.28 B 39.29D 39.30 C


39.31 Aldosterone increases Na+ reabsorption and K+ excretion in the renal collecting duct cells by:
A. Inducing synthesis of Na+K+ATPase
B. Inducing synthesis of amiloride sensitive Na+ channels
C. Translocating Na+ channels from cytosolic site to luminal membrane
D. All of the above

39.32 Select the diuretic that can cause gynaecomastia, hirsutism and menstrual disturbance as a side effect on long-term use:
A. Amiloride
B. Spironolactone
C. Metolazone
D. Acetazolamide

39.33 Amiloride inhibits K+ excretion in the distal tubules and collecting ducts by blocking:
A. Electrogenic K+ channels
B. Electrogenic Na+ channels
C. Nonelectrogenic Na+-Cl– symport
D. H+K+ATPase

39.34 Which of the following is a potassium retaining diuretic:
A. Triamterene
B. Trimethoprim
C. Tizanidine
D. Trimetazidine

39.35 Triamterene differs from spironolactone in that:
A. It has greater natriuretic action
B. Its K+ retaining action is not dependent on presence of aldosterone
C. It acts from the luminal membrane side of the distal tubular cells
D. Both ‘B’ and ‘C’ are correct
ANSWERS
39.31D 39.32 B 39.33 B 39.34 A 39.35D


39.36 Choose the correct statement about amiloride:
A. It antagonises the action of aldosterone
B. It can be used to treat lithium induced diabetes insipidus
C. It increases calcium loss in urine
D. It is dose to dose less potent than triamterene (

39.37 Amiloride has the following effect on urinary cation excretion:
A. Decreases both K+ and H+ ion excretion
B. Decreases K+ excretion but increases H+ ion excretion
C. Increases K+ but decreases Na+ excretion
D. Decreases both Na+ and K+ excretion

39.38 Use of potassium sparing diuretics in patients receiving the following drug needs close monitoring:
A. Furosemide
B. Hydrochlorothiazide
C. Captopril
D. Verapamil

39.39 The following diuretic acts on the luminal membrane of distal tubule and collecting ducts to inhibit electrogenic Na+ reabsorption so that K+ excretion is diminished and bicarbonate excretion is enhanced:
A. Xipamide
B. Isosorbide
C. Triamterene
D. Spironolactone

ANSWERS
39.36 B 39.37 A 39.38 C 39.39 C


39.40 Choose the correct statement about osmotic diuretics:
A. They are large molecular weight substances which form colloidal solution
B. Their primary site of action is collecting ducts in the kidney
C. They increase water excretion without increasing salt excretion
D. They can lower intraocular pressure

39.41 The following is true of mannitol except:
A. It inhibits solute reabsorption in the thick ascending limb of loop of Henle
B. It is contraindicated in patients with increa-sed intracranial tension
C. It is contraindicated in acute left ventricular failure
D. It is not used to treat cardiac or hepatic or renal edema

40.1 Which of the following peptides is a selective vasopressin V2 receptor agonist:
A. Arginine vasopressin
B. Desmopressin
C. Lypessin
D. Terlipressin

40.2 The primary mechanism by which antidiuretic hor-mone reduces urine volume is:
A. Decrease in glomerular filtration rate
B. Decreased renal blood flow
C. Decreased water permeability of descending limb of loop of Henle
D. Increased water permeability of collecting duct cells
ANSWERS
39.40 D 39.41 B 40.1 B 40.2 D


40.3 The vasopressin action(s) mediated by V2 receptors include(s):
A. Increased water permeability of collecting duct cells
B. Increased urea permeability of collecting duct cells
C. Vasoconstriction
D. Both 'A' and 'B'

40.4 Desmopressin is preferred over arginine vasopressin in the treatment of diabetes insipidus for the following reasons except:
A. It is a more potent antidiuretic
B. It is a selective vasopressin V1 receptor agonist
C. It has little vasoconstrictor activity
D. It is longer acting

40.5 Select the action of vasopressin exerted through the V1 subtype receptors:
A. Release of coagulation factor VIII and von Willebrands factor from vascular endothelium
B. Increased peristalsis of gut
C. Dilatation of blood vessels
D. Increased water permeability of renal collecting ducts

40.6 The following tissue is most sensitive to vasopressin:
A. Renal collecting ducts
B. Intestinal smooth muscle
C. Vascular smooth muscle
D. Uterus
ANSWERS
4 0 . 3D 4 0 . 4 B 4 0 . 5 B 4 0 . 6 A


40.7 Desmopressin reduces urine volume in:
A. Neurogenic diabetes insipidus
B. Nephrogenic diabetes insipidus
C. Both neurogenic as well as nephrogenic diabetes insipidus
D. Normal individuals but not in diabetes insi-pidus

40.8 Choose the correct statement(s) about terlipressin:
A. It is a prodrug
B. It is used to control bleeding from esophageal varices

C. It is preferred for controlling bleeding in von Willebrand's disease
D. Both 'A' and 'B' are correct

40.9 The following is true of desmopressin except:
A. It is nonselective V1 and V2 receptor agonist
B. It is more potent and longer acting than arginine vasopressin (AVP)
C. It is preferred over AVP for treatment of diabetes insipidus
D. It can be administered orally

40.10 Indications of desmopressin include the following except:
A. Neurogenic diabetes insipidus
B. Nephrogenic diabetes insipidus
C. Bedwetting in children
D. Bleeding due to haemophilia

40.11 Arginine vasopressin is preferred over desmopressin in the following condition:
A. Diabetes insipidus
B. Bedwetting in children
C. Bleeding esophageal varices
D. Bleeding in haemophilia
ANSWERS
4 0 . 7 A 4 0 . 8D 4 0 . 9 A 40.10 B 40.11 C

40.12 The following drug reduces urine volume in both pituitary origin as well as renal diabetes insipidus and is orally active:
A. Vasopressin
B. Hydrochlorothiazide
C. Chlorpropamide
D. Carbamazepine
40.12 B