Adverse effect of Thiazides does not include?

RUHS, Jaipur, M.Sc Nursing Entrance Exam-2016

Pharmacology

Medium

Appeared in: RUHS, Jaipur, M.Sc Nursing Entrance Exam-2016

Explanation

The question asks to identify the condition that is NOT an adverse effect of thiazide diuretics.
Thiazide diuretics are known to cause hyperuricemia, which is an increase in serum uric acid levels.
This occurs because thiazides compete with uric acid for the organic acid secretory pathway in the proximal tubule, leading to decreased uric acid excretion.
Therefore, hypouricemia (low uric acid) is not an adverse effect; the opposite is true.
All other options listed are well-documented adverse effects of this drug class.

Option A: Hypercalcemia is a known adverse effect of thiazide diuretics. They increase the reabsorption of calcium in the distal convoluted tubule, leading to elevated serum calcium levels.
Option C: Hyperlipidemia is a recognized metabolic side effect of thiazides. They can cause a 5-15% increase in total serum cholesterol and low-density lipoproteins (LDLs).
Option D: Hypomagnesemia is a known electrolyte disturbance caused by thiazide diuretics. They increase the renal excretion of magnesium.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Adverse effects of Thiazide diuretics as background academic context rather than a clinical decision trigger.
Nurses must monitor laboratory values for patients on thiazide diuretics, including electrolytes (potassium, sodium, magnesium, calcium), uric acid, glucose, and lipid panels.
Patient education should include signs and symptoms of electrolyte imbalances, such as muscle weakness (hypokalemia) or confusion (hyponatremia), and the importance of follow-up lab tests.
What if the patient has a history of gout? The nurse should anticipate that the prescriber might avoid thiazides or use them with caution, as the resulting hyperuricemia can precipitate a painful gout attack. The nurse should monitor for joint pain and swelling.

How to Approach the Question

First, identify that this is a negative question, asking for what is NOT an effect. The keyword is 'does not include'.
Next, recall the common adverse effects of the drug class mentioned, Thiazide diuretics.
A useful mnemonic for thiazide side effects is 'HyperGLUC' (Hyperglycemia, Hyperlipidemia, Hyperuricemia, Hypercalcemia) and 'Hypo' for electrolytes like potassium and magnesium.
Evaluate each option against this knowledge: Hypercalcemia (yes), Hyperlipidemia (yes), Hypomagnesemia (yes).
Recognize that 'Hypouricemia' is the opposite of the known side effect 'Hyperuricemia'.
Conclude that hypouricemia is the correct answer because it is not an adverse effect of thiazides.

Concept Tested & Keywords

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E6 Pharmacology Nursing Lilley 11e Part 2 p. 152-154

E6 Pharmacology Katzung 16e p. 410-412