37 若病人有高血壓且因腎功能不好，其腎絲球體水分濾過速率小於30 mL/min，則下列那一種利尿劑較適合？
(A) Acetazolamide
(B) Bumetanide
(C) Chlorothiazide
(D) Metolazone

最佳解寫錯了

Acetazolamide是CAI

In choosing a diuretic for the patient with kidney disease, there are a number of important limitations. Acetazolamide must usually be avoided because it causes NaHCO3 excretion and can exacerbate acidosis. Potassium-sparing diuretics may cause hyperkalemia. Thiazide diuretics are thought to be ineffective when GFR falls below 30 mL/min, although the exact GFR at which they no longer prove to be beneficial is still a matter of debate.

high-dose loop diuretics (up to 500 mg/d of furosemide) or a combination of metolazone (5–10 mg/d) with furosemide (40–80 mg/d) may be useful in treating volume overload in dialysis or predialysis patients. Finally, although excessive use of diuretics can impair renal function in all patients, the consequences are obviously more serious in patients with underlying renal disease

rf. basic 14e p.270-271