Renal function carbonic anhydrase inhibitor

Salicylates Interference with renal excretion of drugs that undergo active tubular secretion. Salicylate renal excretion dependent on urinary pH when large doses of salicylate used. Aspirin (but not other salicylates) interferes with platelet function. Large doses of salicylates have intrinsic hypoglycemic activity. Salicylates may displace drugs from plasma protein binding sites. Carbonic anhydrase inhibitors [NE] Increased acetazolamide serum concentrations increased salicylate toxicity due to decreased blood pH. 

Cowan RA, Hartnell GG, Lowdell CP, Baird IM, Leak AM. Metabolic acidosis induced by carbonic anhydrase inhibitors and salicylates in patients with normal renal function. BMJ (Chn Res Ed) 1984 289(6441) 347-8. 

The sulfonamide carbonic anhydrase inhibitors, such as sulfanilamide, acet-azolamide, and their congeners, have contributed significantly to the knowledge of renal function—e.g., the site and origin of the hydrogen ion excretion and the site of potassium ion excretion. 

The carbonic anhydrase inhibitors cause metabolic acidosis and urinary alkalosis. Patients with severe impairment of liver function are unahle to synthesize urea efficiently and become dependent on renal excretion of ammonium ion to rid the body of nitrogenous wastes. However, in alkaline urine the ammonium ion is rapidly converted to ammonia gas. which is veiy rapidly reabsorbed. Hyperammonemia results, with severe neurologic consequences. The answer is (A). 

Consequently, diuretics have a variety of uses. Thiazide diuretics may be used either alone or in combination with other pharmacotherapy for the treatment of hypertension. Loop diuretics can provide immediate diuresis and are used for heart failure and in lieu of thiazides in patients with compromised renal function. In addition to more traditional uses, certain potassium-sparing diuretics provide added benefit to other pharmacotherapy in patients with primary hyperaldosteronism, heart failure, or post-acute myocardial infarction. Carbonic anhydrase inhibitors have limited use for diuresis however, they may be used to reduce intraocular pressure and treat acute mountain sickness. 

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