Kerala PGMEE Preparation 2016 – Details of Course & Tips for Study

2 Drugs that mines marks for Kerala PGMEE and AIPGMEE

Kerala Medical PG (Kerala PGMEE 2015) results of 6089 candidates, who had taken the entrance exam on 8th February 2015 was announced on 6th March 2015. The next Kerala PGMEE exam is likely to be in January-February of 2016. The results are published on the link here: result link and the answer key is on this link: answer key link

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Drug – Loop diuretics

Loop diuretics (furosemide, sulfa drug; ethacrynic acid, non sulfa)

Site of Action: Ascending loop of Henle

Mechanism of Action:
Inhibit Na/K/Cl cotransporter to decrease reabsorption and indirectly inhibit Ca reabsorption.

Indications: 

CHF, pulmonary edema,hypercalcemia; rapid onset useful in emergent situations.

Adverse Effects:

Ototoxicity,
Gout (hyperuricemia),
hypokalemia,

hypocalcemia

Remember: “O God Loop Loses Cal and kal”

Drug – Thiazides (HCTZ)

Thiazides (HCTZ)

Site of Action: 

Distal Convoluted Tubules

Mechanism of Action: 

Inhibit Na/Cl cotransporter to decrease NaCl reabsorption and indirectly increases K+  excretion and increase Ca reabsorption

Indications: HTN, CHF, hypercalciuria, diabetes insipidus

Adverse Effects:

Hypokalemic metabolic alkalosis,
hyperGlycemia,
hyperLipidemia,
hyperUricemia,
hyperCalcemia

Remember: “hyperGLUC”

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1. All the following adverse effects are common to loop diuretics and thiazides, EXCEPT:

A. Hypomagnesemia
B. Hyperlipidemia
C. Hypocalcemia
D. Hyperuricemia

GUESS & CLICK HERE

Are Thiazides or Loops safe in Gout?

No. Both causes hyperuricemia. Diuretic safe in gout patient are:

  • Tienilic acid (INN and BAN) or
  • Ticrynafen.

Are Thiazides or Loops safe in severely impaired renal functions?

No. Loop and thiazide diuretics increase potassium loss in the urine. These diuretics are particularly effective for patients with normal to moderately impaired kidney function.

* Thiazide-type diuretics are considered first-line agents in hypertension management due to their efficacy and positive effects on cvs and all-cause mortality.

* The antihypertensive efficacy of thiazide diuretics is reduced by the concurrent use of NSAIDs, including COX-2 inhibitors.

* Thiazides + Lithium: Lithium levels can increase by as much as 40% with the introduction of a thiazide diuretic, potentially resulting in lithium toxicity. Keep in mind that Lithium is fully excreted by the kidneys and there is no liver involvement. 

* Loop diuretic–induced renal insufficiency, hypokalemia, and hypomagnesemia can precipitate digitalis toxicity

* One significant difference between the two drug groups is loop diuretics promote renal calcium excretion, which can potentially promote nephrolithiasis. Loops cause hypocalcemia and Thiazides cause hypercalcemia.

This topic is important for many national and state exams and hence rated a must read.

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