Diuretics - Loop

Question 1

What is A?

Answer 1

Glomerulus

Question 2

What is B ?

Answer 2

Proximal convoluted tubule

Question 3

What is C?

Answer 3

Loop of Henle

Question 4

What is D?

Answer 4

Distal convoluted tubule

Question 5

What is E?

Answer 5

Collecting duct

Question 6

How much NA is absorbed in the loop of henle?

Answer 6

25%

Question 7

Which diuretic works by stimulating sodium secretion?

Answer 7

Mannitol

Question 8

How do Loop diuretics work ?

Answer 8

They act on the ascending limb of the loop of henle, where they inhibit the NA+/K+/2CL- protein.

Remember water follows NA +, so if NA+ is not reabsorbed into the body, neither is water and therefore has a diuretic effect (Increases urination).

Question 9

Which Diuretic works by inhibiting the NA+/K+/2CL- protein?

Answer 9

Loop Diuretics

Question 10

Name 2 x loop Diuetics

Answer 10

Fruesimide
Bumetanide

Question 11

What type of Diuretics are Fruesimide and Bumetanide?

Answer 11

Loop Diuretics

Question 12

What are the indications for Loop Diuretics ?

Answer 12

• Acute Pulmonary Odema
• Chronic Heart failure
• Other oedematous states, eg renal disease, or liver failure.

Question 13

What are some adverse effects of loop Diuretics ?

Answer 13

• Dehydration
• Hypotension
• Low electrolyte state (hyponatremia, hypomagnesaemia, and hypokalemia)
• Hearing Loss
  -Tinnitus

Question 14

Why can loop diuretics cause hearing loss and tinitus ?

Answer 14

A similar NA+/K+/2CL- co-transporter to the kidney is also present in the ear where it helps to convert sound into an electrical signal and loop diuretics may therefore induce a reversible form of deafness.

Question 15

Why may you need to switch from furosemide to bumetanide?

Answer 15

The proportion of frusemide absorbed by the gut is highly variable; it tends to be particularly low in severe fluid overload due to gut wall oedema.

• IV fruesimide may be appropriate.

-Bumetanide may be appropriate.

Question 16

What dose of bumetanide is equivalent to 40mg of frusemide?

Answer 16

1mg

Question 17

How do SGLT2 inhibitors work?

Answer 17

• Go to the Proximal Convoluted Tubule of the kidneys
• Block the SGLT2 (where 90% of glucose reabsorption occurs) and stop the SODIUM FROM BEING ABSOPRED.
• This then increases the osmolarity, causing more fluid to be excreted.

Question 18

What are some adverse effects of SGLT2 inhibators

Answer 18

• Increased risk of hypovolemia and electrolyte disturbance
• Thirst
  -Risk of UTI due to increase amount of glucose within the urine.
• Gangrene of the peritoneum
• Diabetic Ketoacidosissis
• Canagliflozin associated with LLA.