05.12 - Diuretics, Aquaretics (Bahouth) Flashcards
(145 cards)
1
Q
CA Inhibitor
A
Acetazolamide
2
Q
___ may be effective in patients w/ impaired renal function when class 1 thiazides are not
A
Metolazone, Indapamide (class 2 thiazides)
3
Q
2 main conditions that cause ADH release
A
Elevation in plasma osmolarity >280; Depletion of ECV
4
Q
2 Organic Base K-Sparing Diuretics
A
Triametrene, Amiloride
5
Q
2 Types of Na Channels in IMCD
A
(1) CNG: Amiloride-sensitive, cyclic nucleotide gated cation channel; (2) Low-conductance highly-selective Na ENaC channel
6
Q
3 Clinical uses of Osmotic Diuretics
A
Intra-cranial pressure, Intra-ocular pressure, Dialysis disequilibrium syndrome
7
Q
3 Drugs classes associated with SIADH
A
Psychotropics, Sulfonylureas, Vinca Alkyloids
8
Q
3 Net Effects of Loop Diuretics
A
(1) Significant NaCl loss; (2) Increase excretion of K, H; (3) Increase excretion of Ca, Mg
9
Q
4 Clinical uses of CA inhibitors
A
Cysteinurea, Intra-ocular pressure, Seizures, Mountain sickness
10
Q
4 Therapeutic Uses of Loop Diuretics
A
(1) Edema of cardiac, hepatic, or renal origin; (2) Pulmonary edema; (3) Hypercalcemia; (4) Protect against renal failure
11
Q
A poor response to Thiazides may reflect
A
Either an overwhelming load of dietary Na, or impairted renal capacity to excrete Na
12
Q
Action of ANP
A
Binds NP receptor-A, activates GC and increases cGMP
13
Q
Action of BNP
A
Binds NP receptor-A, activates GC and increases cGMP
14
Q
Action of CNP
A
Binds NPR-B in vascular SM cells –> Relaxation
15
Q
Action of Demeclocycline
A
Antagonizes ADH at V2R’s
16
Q
Activation of V1 receptor activates
A
Gq-PLC-IP3 pathway –> Mobilizes Ca –> Vasoconstriction
17
Q
Advantages of Torsemide
A
Also lowers BP; Longer Half Life
18
Q
Best tolerated drug classes for monotherapy in HTN
A
Diuretics, ACEi’s
19
Q
Bindin of ADH to V2 receptor activates
A
Gs-cAMP, PKA –> Insertion of AP-2, p-lation of urea transporter
20
Q
Bumetanide vs Furosemide
A
Bum is 40x more potent
21
Q
Class 2 Thiazides
A
Metolazone, Indapamide
22
Q
Clinical effects of Nesiritide
A
(1) Increase Na excretion; (2) Useful in CHF
23
Q
Clinical Uses of Spironolactone
A
Diuretic in combo with HCTZ; CHF, Cirrhosis
24
Q
Clinical Uses of Triametrene, Amiloride
A
Combined with HCTZ to decrease K excretion
25
Common preventable cause of diuretic resistance
Co-administration of NSAID with Loop
26
Concentration of urine in Mannitol use
Hypoosmotic (losing free water)
27
DDAVP is also used in
Bleeding disorders, Nocturnal Enurisis
28
Desmopressin
Highly selective V2R agonist
29
Difference between Loop and Osmotic
Loop have high [Na] in urine
30
Diuretic of choice in Cirrhosis
Spironolactone
31
Diuretic to use in Chronic Renal Failure
Loop
32
Diuretic to use in Mild CHF
Thiazide, Loop
33
Diuretic to use in Moderate or Severe CHF
Loop
34
Diuretic to use in Nephrotic Syndrome
Loop
35
Do PG's increase or decrease with Loop Diuretics?
Increase
36
Drug interactions of Furosemide
Li, Indomethacin, Probenecid, Warfarin
37
Effect of ADH on urea transport
V2 --\> PKA p-lates urea transporter --\> inc. permeability of CD to urea
38
Effect of Furosemide on K, H, Ca, Mg
Increases secretion of all
39
Effect of Furosemide on Renal PG's and Venous capacitance
Increases both
40
Effect of Osmotic Diuretics on PCT
Osmotically inhibit Na/H2O reabsorption
41
Effect of Thiazides on Ca, Mg
Decrease excretion of Ca, Increase secretion of Mg
42
Effect of Thiazides on Na, K, Cl
Loss of all three --\> Hypokalemia
43
Effect of Triametrene, Amiloride on Na, K, H
Weak excretion of Na; Inhibit secretion of K, H
44
Eplerenone vs Spironolactone
Lower affinity for AR's so less side effects
45
Found in urine, paracrine regulator of Na transport
Urodilantin
46
Furosemide vs Indomethacin
NSAIDs inhibit PG effect of Furosemide
47
Furosemide vs Probenecid
Compete for secretion by Organic Acid Transporter
48
Furosemide vs Warfarin
Compete for protein binding
49
General MOA Acetazolamide
CA Inhibitor
50
General MOA Mannitol
Osmotic Diuretic
51
General MOA of AVP, DDVAP
V2R Agonism, Collecting Duct
52
General MOA of Conivaptan, Tolvaptan
V2R Antagonism, Collecting Duct
53
Given in large doses, Osmotic Diuretics
increase osmolarity of plasma
54
Highly selective V2R agonist
Desmopressin
55
How are Loop diuretics administered
IV in hypertensive crisis or in Acute Pulmonary Edema
56
How are Thiazides unlike Loops
Thiazides decrease secretion of Ca
57
How do Load-Dependent Principal cells work
The more Na is delivered, the more is absorbed in exchange for K secretion
58
How do Loop Diuretics affect Macula Densa
MD thinks very little Na, so it secretes PG's --\> Increase RBF and FF
59
How do PG's affect actions of Loops
Reduce Na re-absorption in distal nephron, antagonize ADH, distribute renal blood from cortex to JG
60
How does Furosemide reach the luminal symporter
Secreted by Organic Acid Transporter
61
How does Furosemide travel in blood
Extensively protein bound
62
How does Hypovolemia lead to Hyponatremia
Hypovolemia stimulates ADH-mediate retention of H20
63
How does Nesiritide increase Na excretion
Inhibits CNG\_nonspecific cation channel in IMCD; Inhibits RAAS
64
How will V2R agonist affect Central vs Nephrogenic DI
Increase urine osmolarity in central by not nephrogenic
65
In CHF, Cirrhosis, or Nephrotic Syndrome, hypovolemia is exacerbated by
Diuretics
66
In what condition is Mannitol contraindicated
CHF
67
Indications for Vaptans
Significant Hypervolemic and Euvolemic Hyponatremia (including patients with HF, Cirrhosis, SIADH)
68
Inhibiting CA results in loss of what in urine
Bicarbonate
69
K-Sparing Diuretics are useful in what patients
At risk of K depletion; Hyperuricemia
70
Late DCT, CD Principal cells are involved in __ re-absorption and __ secretion
Na reabsorption, K secretion
71
Like Loops, Thiazides require
secretion into tubular fluid to exert effect
72
Loop Diuretics
Furosemide, Bumetanide, Torsemide
73
Loop that also lowers BP
Torsemide
74
MOA of Loop Diuretics
Inhibit Na-K-2Cl symporter in TALH
75
MOA of Thiazide Diuretics
Inhibit NaCl reabsorption in the Na-K Aldosterone-independent sement of distal tubule
76
MOA of Triametrene, Amiloride
Inhibit Na re-absorption in late distal tubule (sodium load segment)
77
MOA of Vaptans
Selective V2R antagonists
78
Most popular drug for HTN
HCTZ
79
Most potent class of diuretics in mobilizing NaCl
Loop
80
Most Thiazides are ineffective when
GFR \< 30-40 mL/minute
81
Net Effect of Aldosterone Antagonists
Increase excretion of Na; Inhibit secretion of K, H
82
Net effect of Osmotic Diuretics
Significantly increase urine
83
On which part of nephron do Triametrene, Amiloride act
Late Distal Tubule, Sodium Load segment
84
On which part of nephron does Furosemide act
TALH
85
Osmolarity of urine with ADH present
1200
86
Osmolarity of urine without ADH
50
87
Osmotic Diuretic
Mannitol
88
Patients with what type of HTN show better responses to Thiazides
Volume-dependent HTN (low renin)
89
Pharmacokinetics of Furosemide
Short half-life; Extensively protein-bound
90
Pharmacokinetics of Vaptans
CYP3
91
Physiological effects of Aldosterone
NaCl transport enhanced; Increased secretion of K, H+
92
Retention phenomena of Thiazides
Hyperuricemia, Hypercalcemia
93
Role of Renin in Loop Diuretic use
Potently increased
94
Route of Acetazolamide
Oral
95
Route of HCTZ
Oral
96
Route of Mannitol
Injection
97
Selective V2R antagonists
MOA of Vaptans
98
SIADH Tx:
Water restriction, Loops, Demeclocycline, Vaptans
99
Side effects of Acetazolamide
Metabolic Acidosis, K loss (hypokalemia)
100
Side effects of Furosemide
Hypokalemia, Ototoxicity; Elevated BUN, Hyperglycemia, Hyperuricemia
101
Side effects of Mannitol
Volume overload (don't use in CHF)
102
Side effects of Nesiritide are related to
its narrow therapeutic index
103
Side effects of Spironolactone
Hyperkalemia; AR: Gynecomastia, Hirsutism, Uterine Bleeding
104
Side effects of Triametrene, Amiloride
Hyperkalemia, Megaloblastic Anemia in cirrhosis
105
Side effects of Vaptans
Hyperglycemia, GI disturbances, Clotting probs
106
Sodium loss in Thiazides results in chronic
Reduced GFR
107
Spironolactone vs Canrenone
Sp is a pro-drug that is extensively metabolized; Can is active metabolite with longer half-life
108
T/F: Diuretics only reduce mortality from HTN when used with BB's
False, effective alone or in combo
109
T/F: Nesiritide reduces mortality in CHF
FALSE
110
Therapeutic Uses of Thiazides
Edema, Hypercalciurea, Essential HTN, Osteoporosis, Nephrogenic Diabetes Insipidus
111
Thiazides are widely used to treat
Mild or Moderate HTN
112
Tx of Central DI
Selective V2R agonists
113
Tx of Nephrogenic DI
Thiazide Diuretics
114
Type A Principal cells are regulated by
Hormone: Aldosterone
115
Type B Principal cells are regulated by
Load dependent
116
Type of channel in Aldosterone Sensitive Channel
Aldosterone-Sensitive ENaC Channel: Na-K/H
117
Type of channel in Na-K Aldosterone-independent segment
Na-Cl symporter
118
Type of Channel in Sodium Load Segment
ENaC Channel: Na-K/H
119
Type of channels affected by Aldosterone in DCT
Epithelial Sodium Channels (ENaC) are increased
120
Urine with Acetazolamide use
Alkaline, bicarbonate loss into it
121
Urodilatin arises from same precursor as
ANP
122
Use of Loop Diuretics for Non-Pulmonary edema
Oral use in Cardiac, Hepatic, or renal origin edema (GFR\<30)
123
Uses of V1R agonists
Post-op Ileus; Esophageal varices; Acute Hem Gastritis
124
V2R agonism
Arginine Vasopressin, Desmopressin (DDAVP)
125
V2R Ant-agonism
Conivaptan, Tolvaptan
126
What causes acidosis with CA inhibitors
Enhanced chloride reabsorption
127
What is substituted for Furosemide in patients receiving Warfarin
Bumetanide
128
When are class 1 Thiazides perferably used
When GFR \>50
129
When are class 2 Thiazides used
More potent, so when GFR\<50 but greater than 30
130
When are K-Sparing Diuretics contraindicated
Significant Renal Insufficiency (GFR\<75); Other K-retaining conditions
131
When are Loop used over Thiazides
Severe Htn unresponsive to Thiazides, especially w/ renal insufficiency, cardiac failure, cirrhosis
132
Where do CA inhibitors mostly act
Proximal Tubule (90%), Distal (10%)
133
Where do CNP's originate
Endothelium and Kidneys
134
Where do Loop Diuretics act
Inhibit Na-K-2Cl symporter in TALH
135
Where do Vasopressin and Desmopressin act
Collecting duct, V2R agoism
136
Where is V1 receptor found
Vascular SM
137
Where is V2 receptor found
Principal Cells in Renal CD
138
Which are more potent anti-hypertensives: Thiazides or K-Sparing
Equipotent
139
Which class of drugs creates largest volume of urine
Osmotic Diuretics
140
Which is preferred: Terlipressin or 8-arg vasopressin
Terlipressin has less side effects
141
Which parts of nephron have Aquaporin-1
Proximal Convoluted Tubule, Descending Limb
142
Which parts of nephron have Aquaporin-2
Collecting Duct
143
Why are Thiazides only mild diuretics
Act on distal tubule, which only absorbs 5% of Na
144
Why is Nesiritide useful in CHF
Decreases SVR, Decreases LVP, Increases CO
145
Wide margin of safety; Dose-response curve influence by renal disease
Furosemide
