9 - Diuretics

Question 1

In the nephron, where do the 5 drugs go in order (descending, loop, ascending, collecting)?

4, 1, 3, 2, 5

Answer 1

1. CAI Duretics
2. Osmotic Diuretics
3. Loop Diuretics
4. Thiazide Diuretics
5. K+ Sparing Diuretics

Question 2

Osmoitics

What do these drugs do?

Answer 2

1. Freely enter renal tubule through glomerulus
2. Exert high osmotic force

Question 3

Osmotics

How do these drugs lead to diuresis?

Answer 3

Float through bloodstream, encourage fluid to follow them.

Question 4

Osmotics

What is the 1 osmotic drug to recall?

Answer 4

Mannitol

Question 5

Mannitol

What does it do?

Answer 5

Sucks fluid from extravascular space into intravascular space, takes water with it.

Question 6

Mannitol

How can this drug be helpful in someone suffering from head injury with increased ICP?

Answer 6

Helps get rid of fluid in that area to decrease pressure.

Question 7

Mannitol

How is it used in a secondary way?

Answer 7

Rules out hyper-responsiveness

Question 8

What is the Na+ Reabsorption in kidneys?

Answer 8

• 5% in distal convoluted tubule
• 70% in proximal convoluted Tubule
• 20% in Loop of Henle

Question 9

If we wanted to increase urine production by focusing on Na+ in distal convoluted tubule, what can we do?

Answer 9

Block Na+ from being reabsorbed

Question 10

Thiazide Diuretics

What is their function?

Answer 10

Block Na+ from being reabsorbed (at distal tubule)

Question 11

Thiazide Diuretics

How can blocking Na+ from reabsorption lead to diuresis?

Answer 11

1. More H2O goes with urine if Na+ concentration is increased
2. More urine produced with more H2O

Question 12

Thiazide

What is the drug for this category?

Answer 12

Hydrochlorothiazide

Question 13

Hydrochlorothiazide

How does it work, and what is it ideal for?

Answer 13

Works: Block Na+ Reabsorption in distal convoluted tubule

Ideal for: Treating ongoing mild problems (Hypertension + edema)

Question 14

Hydrochlorothiazide

What is this drug usually associated with?

Answer 14

• Heart Failure
• Renal Failure
• Decreased Efficiency

Question 15

Loop Diuretics

How does a loop diuretic work?

Answer 15

Blocks Na+ reabsorption into thick ascending limb, so water not absorbed by blood from descending limb.

Question 16

Loop Diuretics

What do these drugs block?

Answer 16

Reabsorption of Na+, K+, and Cl- at Loop of Henle

Question 17

Loop Diuretics

Why would preventing reabsorption of these lead to diuresis?

Answer 17

1. More Na+ in urine = more H2O out
2. More urine produced
3. Can go into hypokelemia and cause issues

Question 18

Loop Diuretics

What is the drug here?

Answer 18

Lasix (Furosemide)

Question 19

Lasix (Furosemide)

Which area of care is it most used and what method does it run on?

Answer 19

Used most in acute care settings.

• Ceiling effect is the method.

Question 20

Lasix (Furesomide)

What effects can we see with…
a) Electrolyte Status?
b) Cardiovascular Status?

Answer 20

a) Electrolyte imbalances, leads to things like hypokelemia

b) Arrythmia +hypo/hypertension + low perfusion + low BP + High HR

Question 21

CAIs

What is the CAI chem reaction?

Answer 21

CO2 + H2O <—> H2CO3 <—> HCO3 + H+

Question 22

CAIs

What do they do?

Answer 22

Orevebt the reaction from further occuring.

Question 23

CAIs

Why do these drug lead to diuresis?

Answer 23

1. Reaction stops
2. Less H+ available to exchange for Na+
3. Na+ stays in tubule = More Urine

Question 24

CAIs

What is the drug to recall?

Answer 24

Diamox (Acetazolamide)

Question 25

# Diamox (Acetazolamide) If you have a patient on lasix for a week, and notice their pH going up, what do you do?

Answer 25

Put them back on mechanical ventilator, and give diamox.

Question 26

# K+ Sparing Diuretics What is the drug?

Answer 26

Aldactone (Spironolactone)

Question 27

# Aldactone (Spironolactone) What does it do?

Answer 27

- Used in distases of hyperaldosteronism - Combines with other diuretics to offset hypokelemia that occurs with other diuretics ## Footnote This helps keep K+ in the body

Question 28

Which would work most at the PCT?

Answer 28

Class: Carbonic Anahydrase Inhibitor Diuretics. Drug: Acetazolamide (diamox)

Question 29

Which would work most at the loop of Henle?

Answer 29

Class: Loop diuretics Drug: Furosemide (Lasix)

Question 30

Which two would work mostly at the Distal Convoluted Tubule?

Answer 30

Classes: Thiazide Diuretics + Potassium-Sparing Diuretics Drugs: Hydrochlorothiazide + Spironolactone (Aldactone)

Question 31

Which would work by leaving the kidneys and taking H2O with it?

Answer 31

Class: Osmotic Diuretics Drug: Mannitol

Question 32

What are 3 side effects that are common with diuretics?

Answer 32

1. Electrolyte Imbalance 2. pH imbalances 3. Fluid imbalances

Question 33

# Electrolyte imbalances Almost all diuretics prevent reabsorption of Na+. What will the body do to get it back?

Answer 33

- Exchange other ions for Na+ ones - Other ions --> K+ + Ca(2+) + Mg(2+)

Question 34

# Hypokelemia When can it occur for 1 way?

Answer 34

When trying to prevent Na+ loss over time

Question 35

# hypokelemia What is the other way?

Answer 35

Too much water loss and aldosterone occurs. - K+ sacrificed for Na+ here

Question 36

# Hypokelemia What is one way to replace K+?

Answer 36

Through foods (avacadoes + bananas)

Question 37

What are 4 things hypovolemia (net volume loss) leads to?

Answer 37

1. Increased aldosterone 2. Decreased pre-load 3. Increased HR 4. Increased vasoconstriction + afterload