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Pharm Block 11 > Diuertics > Flashcards

Diuertics Flashcards

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1
Q

What is a more appropriate name for diuretics

A

Natriuretics

-actually implies that you are losing Na, water follows

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2
Q

What works at the proximal convoluted tubule

A

Acetaxoalmide

CAI

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3
Q

What works at the descending loop of Henle

A

Nothing, no drugs target this specific area

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4
Q

What drugs target the ascending loop of henle

A

Loop diuretics

Furosemide

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5
Q

What drugs target the distal convoluted tubule

A

Thiazides

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6
Q

What drugs target the collecting ducts

A

K+ sparing diuretics

Spironolactone, amiloride

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7
Q

How does acetazolamide (CAI) work at the proximal convoluted tubule

A

Inhibits reabsorption of HCO3- in the proximal convoluted tubule

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8
Q

How do loop diuretics work int he ascending loop of henle

A

Inhibit the Na/K/Cl cotransporter , resulting in the retention of Na, Cl, and water

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9
Q

How do thiazides work in the distal convoluted tubule

A

Inhibits reabsoprtion of Na and Cl in distal tubule, resulting in retention of water

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10
Q

What is the most commonly used diuretics

A

Thiazides

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11
Q

What is the most efficious diuretics

A

Loop

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12
Q

How do K+ sparing diuretics like spinronolactone and amiloride work in the collecting duct

A

Spironolactone is an aldosterone antagonsit, mediates reabsorption of Na and secretion of K

Amiloride block Na channels

Prevent loss of K

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13
Q

Where does most bicarbonate get reabsorbed

A

Proximal convoluted tubule

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14
Q

Where does most water get reabsorbed (and Na)

A

Proximal convoluted tubule

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15
Q

As you move through the nephron, how is Na reabsorbed

A

Less and less. Most reabsoprtion in the proximal convoluted tubule

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16
Q

How do you want to stop water reabsoprtion in the proximal convoluted tubule

A

Block H to indirectly block luminal Na pump

  • H comes from bicarbonate in urine
  • CA breaks down HCO3- into CO2 and water
  • now can move into cell
  • more CA in cell puts it back together to get HCO3-
  • HCO3- can one get reabsorbed into the blood

Use Carbonic anhydrase inhibitor to block the H

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17
Q

Luminal pump in the proximal convoluted tubule

A

Na/H pump

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18
Q

Basolateral membrane pump in proximal convoluted tubule

A

Na/K pump

-puts the Na back in the blood

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19
Q

How does carbonic anhydrase inhibitor work in the proximal convoluted tubule?

A
  • if CA is inhibited, can no longer break down HCO3-
  • H20 and CO2 cant move into the cell and cant form H inside the cell
  • Na stays in the urine (along with water), this is how it works as a diuretic

also not reabsorbing any bicarbonate
-results in metabolic acidosis, peeing out bicarbonate

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20
Q

What is a side effect of CAI used systemically

A

Metabolic acidosis. Not reabsorbing any bicarbonate, peeing it out

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21
Q

What what do we use CAI in order to not get the side effect of metabolic acidosis

A

Used topically for glaucoma

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22
Q

What part of the loop of henle do we target with drugs

A

Thick ascending limb

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23
Q

What do loop diuretics do to calcium

A

Lose calcium

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24
Q

What kind of luminal pump does the loop of henle have

A

Na/K/Cl pump

-all get into the cell

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25
In the loop of henle, what does the influx of K do through the Na/K/Cl pump?
Increases intracellular K, which is already high. There is another channel for the cell to just leak it back out into the urine. - this changes membrane potential and causes the cells to separate from each other a little bit - when this happens, Mg and Ca2+ can get reabsorbed
26
How does Ca and Mg get reabsorbed in the nephron
In the ascending loop of henle, K is pumped into the cell via Na/K/CL pump. Since intracellular K is already high, the cell leaks the K back out into the urine. This causes a membrane potential change which then separates the cells a little bit. When this happens, Mg and Ca can get reabsorbed through that space between the cells
27
What happens if K does not come in and then leak out in the ascending limb of henle?
Do not reabsorb Mg and Ca
28
How do loop diuretics work
Block the Na/K/Cl transporter - can reabsorb Na (or water) - decrease K into the cell, no membrane potential change, no reabsorbtion of Mg to Ca, pee it out. - loops stop all 5 of these ions from reabsorbing
29
Which kind of drug will prevent Ca or Mg reabsoprtion
Loop diuretics like furosemide
30
What kind of drugs save calcium
Thiazides
31
What do thiazides do to Ca
Save it
32
What is the luminal transporter in the distal convoluted tubule?
Na/Cl transporter Also has a Ca2+ channel in it too
33
Ca2+ channel and the Na/Cl transporter in the distal convoluted tubule
- pathway for Ca to be reabsorbed - PTH regulates this - takes calcium out of urine and puts it into blood
34
What do thiazides block?
The Na/Cl transporter in the distal convoluted tubule
35
How do thiazides work in the distal convoluted tubule
Block the Na/Cl transporter | -Na stays in the urine=diuretics
36
How does blocking the Na/Cl transporter in the distal convoluted tubule effect Ca
Leaders to increased Ca2+ reabsorption -if you block the Na/Cl pump, it will increase the activity of the Na/Ca pump that is present on the basolateral membrane to make up for the lack of Na being brought in, causing more Ca2+ reabsoprtion
37
Postmenapausal women and diuretics
Give thiazides to decrease risk of osteoporosis
38
What direction should you give to increase blood Ca?
Thiazides
39
What diuretics will decrease urinary Ca?
Thiazides
40
What regulates Ca2+ being absorbed
PTH
41
Where are the principal and intercalated cells found in the nephron
In the collecting tubule
42
What are the transporter on the lunminal side of the collecting tubule?
Principle cells - Na channel - K channel Intercalated cell -H transporter
43
why are most diuretics K wasting?
The collecting duct doesn’t see much Na because it is the last place for Na to be reabsorbed - but if on a diuretic, more Na here - leads to increased K loss
44
Na and K in the principle cells of the collecting tubules
Na comes in and K goes out, it is a coupled process
45
When the principal cells of the collecting tubule secretes K, what do the intercalated cells do
Secrete H+ back into the urine along with it
46
K loss in the collecting duct equals what
H loss
47
If something is K wasting, what else is it?
H wasting | Hypokalemia=alkalosis
48
If something is K sparing, what else is it
H sparing | Hyperkalemia=acidosis
49
How does amiloride work in the collecting tubule
Blocks the Na pump - K+ sparing because now K+ not leaving - also H sparing too - acidosis and hyperkalemia
50
Which drug that works in the collecting tubule will cause acidosis and hyperkaleima?
Amiloride - blocks the Na pump - K+ sparing because now K not coming in either - this also means that H is being spared
51
How does aldosterone work in the collecting tubule
- retains Na/H20 by binding its receptors there - increases Na reabsorption which increases water reabsorption - wastes H and K
52
What is a problem in the collecting tubule that can lead to hypokalemia and alkalosis?
Hyperaldosteronism
53
How do spironolactone and eplerenone work in the collecting tubule
- block the aldosterone receptors | - does not increase Na, so not wasting K or H
54
What is the exception to the rule for K and H being lost together when things work on K in the collecting duct?
Carbonic Anhydrase Inhibitors - cause K loss - but cause acidosis - cant reabsorb bicarbonate
55
What is the name of the Carbonic Anhydrase Inhibitor used
Acetazolamide
56
What are CAI most commonly used for
Eyedrops for glaucoma
57
MOA of CAI in the eye
Inhibits CA in the ciliary body of the eye where it decreases the rate of aqueous humor formation (and decreases IPO)
58
MOA of CAI
Can’t break down HCO3 - stays in the urine - water and CO2 can’t move into the cell - cant form H inside the cell - Na and water stay in the urine as well. Need H to make the Na/H pump work, otherwise, cant get Na into the cell
59
Therapeutic uses of CAI (acetazolamide)
- glaucoma: closed angle glaucoma - acute mountain sickness: above 10,000. Prevents weakness, breathlessness, dizziness, nausea, and cerebral and pulmonary edem by inducing acidosis before you go into the mountains
60
Adverse effects of CAI (acetazolamide)
Metabolic acidosis (2-3 days of use) if used systemically
61
What is a common name for CAIs
Anything that ends in -zolamide
62
MOA of loop diuretics (furosemide, “-semide”)
Blocks the Na/K/Cl transporter - cant reabsorb Na or water - decreased K into cell, decreases Mg, and Ca reabsorbtion as well
63
Therapeutic uses of loop diuretics (furosemide)
- acute pulmonary edema - CHF (thiazides better choice, but loop used acutely if waking up with swollen feet) - edema
64
Pharmacokinetics of loop diuretics
Short half life | Duration of action is 1-4 hours
65
Adverse effects of loop diuretics (furosemide)
Ototoxicity: tinnitus, hearing impairment, sense of fullness in ears -occurs due to inhibition of Na/K/Cl cotransporter in the inner ear Hypokalemia alkalosis -wastes K and H
66
MOA of thiazides
Block the Na/Cl transporter in the distal convoluted tubule - Na stays in the urine - increased Ca reabsoprtion
67
What are the thiazides most commonly used
HCTZ and chlorthalidone
68
Therapeutic uses of thiazides
- HTN - CHF - Hypercalciuria: good for patients with calcium stones in the urinary tract. Pull Ca2+ out of urine and put back into blood. - nephrogeniic diabetes insipidus
69
How does a diuretic like thiazides work for diabetes insipidus
Pt has trouble repsponding to ADH receptor and loses a lot of water without Na - give diuretic - will lose Na now, along with the water - plasma vol decreases, which causes increased RAAS - ANGII on the PCT will cause reabsoprtion of more Na and now water too
70
Adverse effects of thiazides
Hypokalemia alkalosis Hypercalcemia Hyperglycemia and hyperlipidemia
71
Why do thiazides cause hyperglycemia and hyperlipidemia
Inhibiting insulin release from beta cells
72
Which K sparing drugs are used for heart failure
Spironolactone and eplerenone
73
How do spironolactone and eplerenone treat heart failure
Block aldosterone
74
What are the weakest diuretics
K sparing - spironolactone - eplerenone - amiloride
75
When do we use K sparing drugs
In combo with other diurites
76
Which K sparing drug is not used for heart failure
Amiloride
77
MOA of spironolactone and eplerenone
Aldosterone receptor antagonists
78
Therapeutic uses of spironolactone and eplerenone
- diuretics - hyperaldosteronism - heart failure - female hirsutism (only spironolactoen)
79
Which K sparing drug works well for female hirsutism
Spironolactone because it also blocks the androgen receptor
80
Adverse effects of spironolactone and eplerenone
Spironolactone may cause hynecomastia in males and irregular menstrual cycle in females Hyperkalemia
81
MOA of amiloride
Block the Na channels in collecting tubules
82
Actions of amiloride
Used in combo with other diuretics to maintain normal K levels
83
Adverse effects of amiloride
Hyperkalemia

Pharm Block 11 (7 decks)

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