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 DIURETICS
OSMOTIC DIURETICS

Where?  Proximal convoluted tubule

Drugs? Mannitol, Urea, Isosorbide, Glycerin

MOA?

Increases excretion of.

Uses?

Oliguria

CAG, Cerebral edema

Drug overdose (Lithium, Salicylates, Barbiturates, Bromide) Dialysis

disequilibrium syndrome

ADR?

Salient:

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 LOOP DIURETICS (HIGH CEILING)

Where Thick ascending limb of Henle’s loop

Drugs  Furosemide, Bumetanide, Torsemide, Ethacrynic acid

MOA?

Increases excretion of.

PK  Secreted in PCT, DOA – 6 hrs, Torsemide  Long DOA

ADR
Hypo: Natremia / Kalemia / Calcemia / Magnesemia / Chloremia / Volemia Hyper:
Uricemia / Glycemia
Also: Metabolic alkalosis / Ototoxicity

Salient:

PYQ - 05
A 34 yr. old male with hypertension diagnosed with stage
4 chronic kidney disease with eGFR<30 ml/min. His doctor
wants to prescribe a thiazide diuretic.
Which of the following can be given?
(A) : Chlorothiazide
(B) : Chlorthalidone
(C) : Metolazone
(D) : Hydrochlorothiazide.

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 THIAZIDE DIURETICS

Where  Distal convoluted tubule

Drugs  Thiazides, Thiazide like diuretics (Chlorthalidone, Indapamide, Metolazone)

MOA?

Increases excretion of.

Uses?

1. CCF 3. Nephrolithiasis

2. HT (Chlorthalidone 4. Nephrogenic DI

ADR?
Hypo: Natremia / Kalemia / Magnesemia / Chloremia / Volemia Hyper:
Uricemia / Glycemia / Calcemia
Also: Metabolic alkalosis / Erectile dysfunction

Salient:

PYQ - 06
A patient is on antihypertensive drug. Follow up ECG
shows tall T waves. what can be the cause?

(A) : Spironolactone
(B) : Prazosin
(C) : Atenolol
(D) : Hydrochlorothiazide.

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 K+ SPARING DIURETICS
Where  Collecting duct

MOA:

ADR: USES:
CCF

HT

Cirrhotic edema

Diabetic nephropathy

Liddle syndrome

PYQ - 07
Lithium induced DI
A patient diagnosed with ascites due to
cirrhosis, the diuretic of choice to reduce
edema would be?
(A) : Eplerenone
(B) : Furosemide
(C) : Chlorthalidone
(D) : Triamterene

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 CARBONIC ANHYDRASE INHIBITORS
Where  PCT

Drugs  Acetazolamide

MOA?

Increases excretion of.

Uses?

1. CAG

2. Urinary alkalinizer agent

3. Acute mountain sickness

ADR?

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 RESPIRATORY SYSTEM
DRUG FOR BRONCHIAL ASTHMA

Drugs causing Bronchospasm:

Drugs

RELIEVERS

MECHANISM OF ACTION

RELAXATION BRONCHIAL SMOOTH MUSCLE CONTRACTION

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 1. ADRENERGIC AGONISTS:

DRUGS

SABA LABA
- Non-selective - Salmeterol
• Epinephrine - Formoterol
• Isoproterenol - Indaceterol
- Selective - Vilanterol
• Salbutamol, Albuterol - Olodaterol
• Terbutaline - Bambuterol
• Pirbuterol,Metaproterenol

ADVERSE EFFECTS:

METHYL XANTHINES

PURINE DERIVATIVES NON-PURINE DERIVATIVES

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MECHANISM OF ACTION:
PYQ – 01
MECHANISM
A male patient with chronic
Adenosine receptor antagonist obstructive pulmonary disease was
prescribed theophylline. He noticed
PDE ¾ inhibition that his urine output had increased
the following day. This action of the
Anti-inflammatory drug is mediated through which of the
following receptors?
Increases apoptosis of granulocytes (A) : Adenosine A1
(B) : Histone deacetylase
Histone deacetylase activator (C) : IL-10
(D) : β2

Adverse effects:
ADVERSE EFFECTS DUE TO
Nausea / Vomiting / Headache /
GI discomfort

Diuresis / seizures

Cardiac arrhythmia

ANTI-CHOLINERGIC DRUGS

PYQ - 02
Paradoxical
bronchoconstriction seen
with ipratropium bromide is
due to all except
(A) : Hypertonic saline
(B) : EDTA
(C) : Benzalkonium chloride
(D) : Prejunctional M2
Blockade

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 GLUCOCORTICOIDS
1. Drugs:
- Prednisolone PYQ - 03
- Triamcinolone A patient was on inhaled steroids for
- Hydrocortisone bronchial asthma. He comes to the clinic
- Budesonide with an oral thrush. Which antifungal is
- Ciclesonide used in the management of it?
- Beclomethasone (A) : Clotrimazole
(B) : Terbinafine
(C) : Flucytosine
2. Mechanism of action: (D) : Griseofulvin.
- Dilates airway.
- Decreases mucus production.
- Decreases bronchial hyperreactivity.
- Increases responsiveness to sympathomimetics.

3. Adverse effects:

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 LT INHIBITORS

Receptor antagonists 5-LOX inhibitors

Anti-IgE monoclonal antibody Cromones

Monoclonal antibodies against bronchial asthma: (Add on therapy)

Drugs Mechanism
Omalizumab Anti - IgE

Mepolizumab (SC) Anti - IL 5

Dupilumab Anti – IL 4-R

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“HAPPY ENDINGS”
4. A 35 yr old asthmatic man with acute exacerbation was administered inhaled
formoterol but the response was not up to the mark. So, he decided to administer
parenteral triamcinolone for this patient. What might be the possible benefit of
administering triamcinolone in this patient?
a. Direct bronchodilation
b. Increased mucociliary clearance
c. Decreased sympathetic tone of airway
d. Increased bronchial responsiveness to formoterol
5. Which of the following best explains the mechanism of action of omalizumab?
a. Inhibits synthesis of IL-4
b. Inhibits synthesis of Ig E antibodies
c. Prevents binding of mast cell receptors to IL-5
d. Prevents binding of mast cell receptors to Ig E
6. Most common drawback of this is?
a. Portability
b. Does not provide instant relief
c. Drug deposited in oropharynx
d. Must be administered in hospital settings
7. Caffeine induced wakefulness is due to
a. Adenosine antagonism
b. Histamine release
c. PDE5 inhibition
d. PDE 3 inhibition.

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