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PHRM 844 > EXAM 1 - DIURETICS > Flashcards

EXAM 1 - DIURETICS Flashcards

1
Q

What are the 7 classifications of diuretics

A

1.Inhibitors of carbonic anhydrase
2.Osmotic diuretics
3.inhibitors of NA, K, 2CL symport
4.Inhibitors of Na, Cl symport
5. inhibitors of renal epithelial Na channels
6. Mineralocorticoid receptor antagonists
7. vasopressin antagonists

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2
Q

where are inhibitors of carbonic anhydrase located

A

Proximal tubule (lumen surface)

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3
Q

Explain carbonic anhydrase inhibition

A

inhibit cytoplasmic CA and membrane-bound CA. By inhibiting it stops the reuptake of sodium bicarbonate

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4
Q

Why are CA inhibitors weak diuretics

A

These are weak diuretics because of the positioning of their target. Since these medications target the proximal tubule the water that is excreted is reabsorbed in distal parts of the nephron tube

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5
Q

Example of CA inhibitors

A

Acetazolamide (diamox)
Dichlorphenamide (daramide)
Methazolamide (Glauctabs)

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6
Q

Clinical use of CA inhibitors

A

Acute mountain sickness
metabolic alkalosis
Glaucoma
Urinary alkalinization

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7
Q

toxicities of CA inhibitors

A

Hyperchloremic metabolic acidosis
Renal stones
renal potassium wasting
Drowsiness/ paresthesia

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8
Q

Explain use and location of osmotic diuretics

A

Osmotic diuretics target the renal proximal tubule and descending limb because of their water permeable membranes. Theses diuretics shift the osmotic flow and blood flow which allows water to travel into the urine and lower the blood volume thus lowering blood pressure

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9
Q

Osmotic diuretics

A

IV
Mannitol
Urea
Oral
glucose
isosorbide
glycerine

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10
Q

explain the use and location of loop diuretics

A

these act on the luminal surface of the thick ascending limb on the Na, k, Cl symporter to block reuptake of sodium, potassium, chloride, and magnesium. These are the most powerful diuretics but also potassium wasting

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11
Q

Loop diuretics

A

Furosemide (lasix)
Bumetamide (Bumex)
Ethacrynic acid ( Edecrin) - must be metabolized first to be active
torsemide (Demadex)

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12
Q

Clinical use of loop diuretics

A

Edematous conditions
Acute pulmonary edema
Hypertension, heart failure
Acute hypercalcemia
Hyperkalemia
Acute renal failure
Anion overdose

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13
Q

Toxicities of loop diuretics

A

Dehydration
Hypokalemic metabolic
alkalosis
ototoxicity
hyperuricemia
hypomagnesemia

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14
Q

Explain use and location of thiazide and thiazide like diuretics

A

these target the sodium and chloride symport on the luminal surface on the distal convoluted tubule and it inhibit the reabsorption of potassium (potassium wasting)

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15
Q

Clinical use of thiazides

A

hypertension
heart failure
nephrolithiasis due to idiopathic hypercalciuria
nephrogenic diabetes insipidus

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16
Q

Toxicities of thiazides

A

hypokalemic metabolic alkalosis
hyperuricemia
impaired carbohydrates tolerance
hyperlipidemia
hyponatremia

17
Q

Thiazides

A

chlorothiazides (diuril)
hypochlorothiazides (hydrodiuril)
chlorthalidone (hygroton)
metolazone (mykrox)

18
Q

potassium-sparing diuretics use and location

A

Inhibit the renal epithelial sodium channel on the luminal surface of the late distal tubule and collecting duct
These are weaker diuretics and tend to be used in combination but they are potassium-sparing

19
Q

Examples of potassium-sparing diuretics

A

Amiloride (dyrenium)
Triamterene (midamor)

20
Q

Clinical use of potassium sparing

A

adjunctive treatment with thiazide or loop diuretics in heart failure or hypertension

21
Q

Toxicities and contraindications of Potassium sparing

A

Hyperkalemia
Hyperchloremic metabolic acidosis

Contraindications - K supplements, ACE inhibitors

22
Q

Mineralocorticoid receptor antagonists use and location

A

MRAs bind to the MR located in the late distal tubule and the collecting duct. When binding to MR it blocks the production on AIP which stops the reuptake of sodium thus reducing blood volume

23
Q

MRA examples

A

Spironolactone (aldactone)
Canrenone
Potassium canrenoate
Eplerenone

24
Q

MRAs clinical use and toxicities

A

Hypertension or HF w/other diuretics
mineralocorticoid excess
aldosteronism

toxicities - Hyperkalemia, hyperchloremic metabolic acidosis, gynecomastia,impotence, benign prostatic hyperplasia

25
Q

Vasopressin antagonists use and location

A

targets a receptor located on the interstitial surface of the collecting duct cell and blocks the binding of vasopressin to the V2 receptor which through multiple cycles produces CAMP which thus activates protein kinase A to phosphorylate aquaporin channels that collect water from the lumen collecting duct to add water into the blood. So vasopressin antagonists stop the movement of water to to the blood serum to lower blood volume

26
Q

Vasopressin examples

A

Conivaptan
tolvaptan

PHRM 844 (23 decks)

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