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Renal Pharm > Diuretics > Flashcards

Diuretics Flashcards

1
Q

i. Acute mountain sickness ii. Restore acid-base balance in heart failure patients with metabolic alkalosis caused by loop diuretics

A

Acetazolamide

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2
Q

i. Heart failure ii. Treatment of ascites and edema secondary to hepatic failure iii. Hypokalemic alkalosis secondary to mineralcorticoid excess associated with diminished aldosterone metabolism iv. Effective in secondary hypertension due to hyperaldosteronism a. Potentiate the action of more proximally acting diuretics b. Counteract the potassium wasting of thiazide and loop diuretics

A

Spironolactone

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3
Q

a. Potentiate the action of more proximally acting diuretics b. Counteract the potassium wasting of thiazide and loop diuretics

A

Potassium sparing diuretics

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4
Q

About 67% of sodium reabsorption occurs here

A

Proximal tubule

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5
Q

Acute mountain sickness

A

acetazolamide

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6
Q

Aminoglycosides (ototoxicity) NSAIDs (decreases efficacy) Oral hypoglycemics (efficacy decreased)

A

Ethacrynic acid and Furosemide; loop diuretics

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7
Q

Carbonic anhydrase inhibitors site of action

A

Proximal tubule

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8
Q

Carbonic anhydrase inhibitors inhibit Na+ reabsorption by noncompetitively and reversibly inhibiting proximal tubule cytoplasmic carbonic anhydrase II and luminal carbonic anhydrase IV

A

Dorzolamide; Acetazolamide

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9
Q

Cirrhosis associated edema treatment

A

Diuretics include Spironolactone, loop diuretics and thiazides

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10
Q

Concurrent use with other potassium-sparing diuretics, potassium supplements, ARBs, or ACEIs (hyperkalemia) NSAIDs (decreases efficacy) Anuria

A

Spironolactone; Triamterene; Amiloride

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11
Q

Counteract hyperkalemia caused by potassium-retaining drugs or renal insufficiency with impaired K+ excretion

A

Loop diuretics; Thiazides

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12
Q

Counteract the potassium wasting of thiazide and loop diuretics

A

Potassium sparing diuretics

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13
Q

Glaucoma

A

dorzolamide

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14
Q

Heart failure associated edema treatment

A

spironolactone which competitively antagonizes aldosterone binding to its receptor; Furosemide is used in the acute setting to reduce the extent of pulmonary edema

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15
Q

How do carbonic anhydrase inhibitors cause metabolic acidosis?

A

i. Inhibition of H+ secretion ii. Inhibition of CA acid secreting-intercalated cells of the collecting duct

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16
Q

Hypercalcemia treatment–> inc excretion of Calcium

A

Loop diuretic

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17
Q

Adverse effect Hyperkalemia Metabolic acidosis

A

Triamterene; Amiloride

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18
Q

Hypertension (first line)

A

Thiazides

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19
Q

AE Hypokalemia Impaired glucose tolerance/hyperglycemia Hyperuricemia Hyperlipidemia*

A

Hydrochlorothiazide and indapamide

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20
Q

Treatment: Hyponatremia (administered with hypertonic saline)

A

Loop diuretics

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21
Q

i. Hypernatremia and dehydration due to water loss in excess of sodium excretion ii. Increases plasma osmolality leading to hyponatremia manifested as headache, nausea and vomiting due to the movement of fluid into the extracellular compartments

A

Mannitol

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22
Q

AE i. Hypocalcemia ii. Hypomagnesemia iii. Hypokalemia; predisposes patient to cardiac arrythmias iv. Metabolic alkalosis Decreased glucose tolerance Reversible ototoxicity

A

Furosemide;

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23
Q

AE Impotence and gynecomastia Hyperkalemia Metabolic acidosis

A

Spironolactone

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24
Q

increased extracellular volume can cause pulmonary edema leading to?

A

pulmonary congestion and heart failure (contraindications of mannitol)

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25
Q

Treatment Lithium-induced nephrogenic diabetes insipidus

A

amiloride

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26
Q

Loop diuretics site of action

A

Thick Ascending Limb of the Loop of Henle

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27
Q

AE Metabolic acidosis

A

Dorzolamide; Acetazolamide and Potassium sparing diuretics

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28
Q

Treatment Nephrogenic diabetes insipidus

A

Thiazides

29
Q

Treatment Nephrolithiasis

A

Thiazides

30
Q

Nephrotic syndrome associated edema treatment

A

Diuretics include Spironolactone, loop diuretics and thiazides

31
Q

Osmotic diuretics small molecules that are filtered at the glomerulus but not subsequently reabsorbed in the nephron constitute an intraluminal osmotic force limiting reabsorption of water across water-permeable nephron segments

A

Mannitol

32
Q

Potassium Sparing site of action

A

Collecting duct

33
Q

Potassium-Sparing Diuretics blockade of aldosterone receptor in collecting ducts inhibits synthesis of new Na+ channels (and new Na+/K+ ATPase) in the principal cells by binding to and preventing nuclear translocation of the mineralcorticoid (aldosterone) receptor decrease potassium and proton secretion

A

Spironolactone

34
Q

Potassium-Sparing Diuretics competitive inhibitors of the apical membrane Na+ channel decrease potassium and proton secretion

A

Triamterene

35
Q

Potassium-Sparing Diuretics competitive inhibitors of the apical membrane Na+ channel decrease potassium and proton secretion blocks the uptake of lithium by the Na+ channel in the collecting duct

A

Amiloride

36
Q

principle site of action for the carbonic anhydrase inhibitors (CAIs) (Acetazolamide and dorzolamide) and the osmotic diuretics (mannitol)

A

Proximal tubule

37
Q

principle site of action for the loop diuretics (ethacrynic acid and furosemide).

A

thick ascending limb (TAL) of loop of henle

38
Q

principle site of action for the potassium sparing diuretics (Amiloride, spironolactone, and triamterene).

A

Collecting duct

39
Q

TREATMENT Pulmonary and peripheral edema Edema associated with hypoalbuminemia (caused by liver disease or nephrotic proteinuria) Hypercalcemia (caused by malignancy or hyperparathyroidism) Hyperkalemia (caused by potassium-retaining drugs or renal insufficiency) Hyponatremia

A

Ethacrynic acid

40
Q

TREATMENT Pulmonary and peripheral edema Edema associated with hypoalbuminemia (caused by liver disease or nephrotic proteinuria) Hypercalcemia (caused by malignancy or hyperparathyroidism) Hyperkalemia (caused by potassium-retaining drugs or renal insufficiency) Hyponatremia HTN (this is the only one not a clinical use for the other loop diuretic)

A

Furosemide

41
Q

Contraindication:

Pulmonary congestion Heart failure Severe renal disease

A

Mannitol

42
Q

Rank carbonic anhydrase inhibitors, loop diuretics, thiazides, osmotic diuretics, and potassium sparing diuretics on the basis of relative efficacy

A

loop diuretics; thiazides and osmotic diuretics; carbonic anhydrase inhibitors; potassium sparing diuretics

43
Q

reabsorbs between 25% and 35% of the filtered Na+ load

A

thick ascending limb (TAL)

44
Q

reabsorbs NaCl without accompanying water, diluting the tubular fluid

A

thick ascending limb (TAL)

45
Q

Reduce intracranial pressure in neurological conditions

A

Osmotic diuretics

46
Q

Reduce intracranial pressure in neurological conditions

A

Mannitol

47
Q

Reduces formation of aqueous humor and thus lowers intraocular pressure in treating open angle glaucoma

A

Dorzolamide

48
Q

Restore acid-base balance in heart failure patients with metabolic alkalosis caused by loop diuretics

A

acetazolamide

49
Q

retain their function in patient’s with very low creatinine clearance

A

loop diuretics

50
Q

reversibly and competitively inhibit the Na+/K+/2Cl cotransporter in thick ascending limb of Henle thus inhibiting Na+ reabsorption, increasing excretion of cations, particularly Mg++ and Ca++, and increasing K+ secretion

A

Furosemide

51
Q

Solute absorption is iso-osmotic—water accompanies reabsorbed ions to maintain ionic balance

A

Proximal tubule

52
Q

Contraindication: Sulfonamide allergies Oral hypoglycemics (efficacy decreased) NSAIDs (decreases efficacy) Anuria

A

Hydrochlorothiazide and indapamide

53
Q

Contraindication: Sulfonamide allergies COPD

A

Dorzolamide; Acetazolamide

54
Q

CI: Sulfonamide allergies Aminoglycosides (ototoxicity) NSAIDs (decreases efficacy) Oral hypoglycemics (efficacy decreased)

A

Furosemide

55
Q

The diuretics directly target renal ion transporter or channel function or expression to increase renal (1) excretion and thereby decrease (2)

A
  1. Na+ 2. extracellular fluid volume
56
Q

The modest diuresis caused by the (1) is due to the fact that 90% of sodium reabsorption occurs before reaching the distal tubule

A

thiazides

57
Q

The principal cells of the proximal portions of the _________ reabsorb between 1% and 5% of the filtered Na+ load

A

Collecting duct

58
Q

the principle site of action for the thiazide diuretics (hydrochlorothiazide and indapamide).

A

Distal convoluted tubule

59
Q

The reabsorption of Na+ is dependent upon plasma aldosterone levels (aldosterone increases Na+ reabsorption and water retention).

A

Collecting duct

60
Q

The tubular fluid emerging from the thin ascending limb is (1) and has an (2) concentration

A
  1. hypertonic 2. elevated NaCl
61
Q

used in combination with loop diuretics in heart failure a. Diminish hypercalciuria in patients at risk for nephrolithiasis b. Hypertension (first-line drugs) c. Heart failure d. Nephrogenic diabetes insipidus

A

Hydrochlorothiazide and indapamide

62
Q

Thiazide diuretics competitive antagonists of the Na+/Cl cotransporter in distal tubule promote transcellular reabsorption of calcium

A

Hydrochlorothiazide and indapamide

63
Q

Thiazides site of action

A

Distal tubule

64
Q

This continuation of the diluting segment reabsorbs between 2% and 10% of the filtered Na+ load, while remaining impermeable to water

A

Distal convoluted tubule

65
Q

This effect is most pronounced in the loop of Henle and the proximal tubule where most iso-osmotic water reabsorption takes place

A

Osmotic diuretics (Mannitol)

66
Q

Unlike the sodium channel inhibitors, the effects of (1) are a function of the endogenous levels of aldosterone. The higher the levels of aldosterone, the greater the effects of (1)

A

spironolactone

67
Q

used in treating lithium-induced nephrogenic diabetes insipidus a. Potentiate the action of more proximally acting diuretics b. Counteract the potassium wasting of thiazide and loop diuretics

A

Amiloride

68
Q
  • Ethacrynic acid vs. Furosemide
  • BOTH are Loop diuretics;
  • Furosemide is CONTRAINDICATED for ____ (use Ethacrynic acid)
  • Similar clinical uses BUT Furosemide also used for _____
  • Ethacrynic acid causes _____ ototoxicity; Furosemide causes _____ototoxicity;
A

SULFA ALLERGIES;

HYPERTENSION;

IRREVERSIBLE;

REVERSIBLE

Renal Pharm (14 decks)

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