A patient with idiopathic intracranial hypertension is started on a drug that reduces CSF production. This drug inhibits the enzyme responsible for providing bicarbonate ions to the choroid plexus secretory process. The drug is:

• A Furosemide
• B Topiramate
• C Mannitol
• D Acetazolamide ✓

Explanation

CSF secretion depends on carbonic anhydrase within choroid plexus epithelial cells, which generates HCO3- that exchanges with Cl- entering the ventricle. Acetazolamide inhibits this enzyme and can reduce CSF production by roughly 40 to 60 percent, making it standard therapy for IIH. Mannitol is an osmotic diuretic that lowers brain water, not CSF formation, and furosemide acts on the kidney loop of Henle.

Reference: Ganong's Review of Medical Physiology, 26th ed.

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