Question 1

Why does acetazolamide work for both glaucoma and altitude sickness?

Accepted Answer

Both effects stem from carbonic anhydrase inhibition. In the eye, it reduces aqueous humor production, lowering intraocular pressure. For altitude sickness, renal bicarbonate loss creates acidosis that stimulates ventilation. Different tissues, same enzyme target.

Question 2

How does acetazolamide's chemical structure relate to its function?

Accepted Answer

The sulfonamide group (-SO₂NH₂) coordinates with zinc in carbonic anhydrase's active site, blocking the enzyme. The thiadiazole ring provides additional binding affinity, while the molecule's moderate lipid solubility allows penetration into eyes, kidneys, and brain.

Question 3

Why does acetazolamide cause tingling in fingers and toes?

Accepted Answer

The metabolic acidosis alters ionized calcium levels and affects nerve membrane potential. Additionally, reduced bicarbonate may affect peripheral nerve function. This paraesthesia is usually mild, temporary, and indicates the drug is working.

Question 4

How does acetazolamide differ from other diuretics?

Accepted Answer

Unlike loop or thiazide diuretics that work on sodium channels, acetazolamide inhibits carbonic anhydrase, causing bicarbonate loss with accompanying sodium and potassium. It's a weaker diuretic but uniquely creates metabolic acidosis for altitude adaptation.