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Pharmacology > Chap 15 - Diuretics > Flashcards

Chap 15 - Diuretics Flashcards

1
Q

In which part of the nephron do carbonic anhydrase inhibitors work?

A

Proximal convoluted tube

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2
Q

Where in the nephron do loop diuretics work? Be specific.

A

Thick ascending loop of Henle

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3
Q

Where in the nephron do thiazides work?

A

Distal convoluted tubule. (Early segment)

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4
Q

Where in the nephron do potassium sparing diuretics work?

A

Cortical collecting ducts.

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5
Q

Most diuretics work in the luminal side of the membrane with the exception of which?

A

Aldosterone receptor antagonist - these enter the collecting tubule cell from the basolateral side.

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6
Q

Which part of nephron is responsible for 60-70% of total sodium reabsorption?

A

Proximal convoluted tube

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7
Q

A hypokalemic state has what effect on pH? And a hyperchloremic state?

A

Increases and decreases respectively.

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8
Q

What is the difference between primary and nephrogenic diabetes insipidous?

A

N: can’t concentrate urine b/c kidneys not responding to ADH. P: can’t concentrate urine b/c not making ADH.

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9
Q

What is the class of diuretics that increase uric acid excretion, usually by inhibiting uric acid reabsorption? Example is ethacrynic acid.

A

Uricosuric diuretic.

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10
Q

What is the prototypic agent for the carbonic anhydrase inhibitors class of diuretics?

A

Acetazolamide

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11
Q

Which of the loop diuretics will make you acidotic? Alkalotic?( 2 each )

A

Carbonic anhydrase inhibitors and k+sparing drugs; loops and thiazides

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12
Q

Which of the diuretics gets rid of the most NaCl in urine? Of the most NaHCO3?

A

Loops and carbonic anhydrase inhibitors respectively.

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13
Q

Which of the diuretics has the dual effect of reducing intraocular pressure?

A

Carbonic anhydrase inhibitors hence they are used to treat severe acute glaucoma.

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14
Q

Which diuretic does the following: creates acidosis in CSF which results in hyperventilation which protects against high altitude sickness.

A

Carbonic anhydrase inhibitors.

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15
Q

Under what conditions will acetazolamide be used as a diuretic?

A

If edema and metabolic alkalosis is present.

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16
Q

Drowsiness, paresthesia, and formation of renal stones are common signs of toxicity for which class of diuretics?

A

CAi

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17
Q

At its most severe toxicity, this can lead to hepatic encephalopathy.

A

CAi, esp in pts with hepatic disease.

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18
Q

Which carrier is the target of loop diuretics?

A

Na+K+2Cl- carrier.

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19
Q

Approx what percent of sodium reabsorption is done in the TAL?

A

20 to 30

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20
Q

What is the prototypical loop agent?

A

Furosemide

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21
Q

Ethacrynic acid acts most like which of the diuretics?

A

Loops.

22
Q

Diuresis of CAi is self-limiting and usually lasts how long? And what about the loops?

A

2 to 3 days. Short acting 4 hours done.

23
Q

This class of diuretics is mainly used in tx of edematous states such as ascities and heart failure.

A

Loops

24
Q

Why are loops no good for tx of HTN?

A

Too short acting

25
Q

Otototoxicity is an important toxic effect of which agent?

A

Loops

26
Q

The Na+Cl- transporter is the target for which agents?

A

Thiazides.

27
Q

What is the prototype for thiazide diuretics?

A

Hydrochlorothiazide.

28
Q

Is the duration of action of thiazides longer or shorter than loops?

A

Longer at 6-12 hours

29
Q

What happens to urine calcium content with loop diuretics? With thiazides?

A

Increased. Decreased.

30
Q

Thiazides plus what other diuretic will produce a synergistic effect with marked diuresis?

A

Loop

31
Q

What is he major clinical application of use for thiazides?

A

HTN

32
Q

The final segment of the nephron is the last site of Na+ reabsorption and is controlled by what?

A

Steroid hormone aldosterone.

33
Q

The part of the nephron where reabsorption occurs via channels (ENaC) NOT a transporter.

A

Cortical collecting ducts

34
Q

What is the primary site of acidification of the urine?

A

Cortical collecting duct.

35
Q

To what class of drug does amiloride and triamterene belong?

A

Potassium sparing drugs

36
Q

Aldosteronism is an important indication for which of the diuretics?

A

Spironolactone

37
Q

Which diuretics should never be given with K+ supplements?

A

Potassium sparring diuretics.

38
Q

Which of the diuretics can cause gynecomastia and anti-adrenergic effects?

A

K+ sparring (spironolactone)

39
Q

What is the prototype for osmotic diuretics?

A

Mannitol

40
Q

How exactly does mannitol work as a drug?

A

It is poorly reabsorbed (although freely filtered) and as a result it stays in the lumen and keeps water there with it. Remember, these work in the proximal tubule.

41
Q

Which of the diuretics can also reduce brain volume and ITC pressure by osmotically extracting water from tissue in blood?

A

Mannitol. Note that a similar effect also happens in the eye and is used in treating glaucoma.

42
Q

Which class of diuretics are mainly used to maintain high urine flow?

A

Osmotic drugs

43
Q

Which class of diuretics are used to treat reduced BF?

A

Osmotic drugs.

44
Q

Which class of diuretics does desmopressin belong to?

A

ADH agonists

45
Q

Which class of drugs do conivaptan and tolvaptan belong to?

A

ADH antagonists

46
Q

Which drug facilitates water reabsorption by activation of v2 recpetors?

A

ADH. Note that this action increases cAMP which leads to insertion of AQP2 water channels into luminal membrane.

47
Q

Which diuretic drugs are used to treat pituitary diabetes insipidus?

A

ADH agonists

48
Q

True or false: ADH agonists are useful in the treatment of nephrogenic diabetes insipidus.

A

False.

49
Q

Which class of diuretics should be used to treat SIADH secretion?

A

ADH antagonists such as demeclocycline and conivaptan

50
Q

What is the risk of toxicity with ADH?

A

In presence of large water load may cause hyponatremia.

51
Q

What is the most toxic side effect of lithium?

A

Nephrogenic diabetes insipidus. FOR THIS REASON, NEVER USE TO TX SIADH. remember, lithium is an ADH antagonist.

Pharmacology (15 decks)

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