Diuretics

Question 1

What is the primary function of diuretics?

Answer 1

Increase urine flow and Na(^+) and Cl(^-) excretion.

Question 2

What is the term for the excretion of Na(^+) in urine?

Answer 2

Natriuresis.

Question 3

What does diuresis refer to?

Answer 3

Increased urine flow rate.

Question 4

What are the two types of diuresis recognized in clinical medicine?

Answer 4

• Solute diuresis * Water diuresis

Question 5

What is solute diuresis caused by?

Answer 5

A decrease in renal tubular reabsorption of solute.

Question 6

What can promote water diuresis without solute diuresis?

Answer 6

Drugs that impair the action of antidiuretic hormone (ADH).

Question 7

What are vaptans classified as?

Answer 7

Aquaretics.

Question 8

How are diuretics classified?

Answer 8

According to their chemical structure and site of action.

Question 9

List the five groups of diuretics.

Answer 9

• Osmotic diuretics * Carbonic anhydrase inhibitors * Loop diuretics * Distal tubule diuretics * K(^+)-sparing diuretics

Question 10

What is the prototype drug for osmotic diuretics?

Answer 10

Mannitol.

Question 11

Where do loop diuretics mainly act?

Answer 11

Thick ascending Henle’s loop.

Question 12

What is the mechanism of action for loop diuretics?

Answer 12

Inhibit Na/K/2Cl cotransporter.

Question 13

What is the natriuretic potency of loop diuretics?

Answer 13

20–25%.

Question 14

What are the physiologic effects of diuretics on renal blood flow?

Answer 14

Changes in RBF vary by diuretic type.

Question 15

What effect do osmotic diuretics have on urine volume?

Answer 15

↑↑ urine volume.

Question 16

What is one clinical use of diuretics?

Answer 16

Treatment of generalized edema states.

Question 17

Which diuretic is commonly used for congestive heart failure?

Answer 17

Furosemide.

Question 18

What complication is most commonly associated with thiazide diuretics?

Answer 18

Hyponatremia.

Question 19

What phenomenon occurs when a diuretic loses effectiveness after several days?

Answer 19

Diuretic breaking phenomenon.

Question 20

What causes the diuretic breaking phenomenon?

Answer 20

Increased Na(^+) and water reabsorption in the proximal tubule.

Question 21

What is the urinary Na(^+)-to-K(^+) ratio indicative of?

Answer 21

Plasma aldosterone activity.

Question 22

What is Finerenone classified as?

Answer 22

A third-generation mineralocorticoid antagonist.

Question 23

What is the main effect of Sodium Glucose Cotransporter-2 (SGLT2) inhibitors?

Answer 23

Improve serum glucose levels in type 2 diabetes.

Question 24

Fill in the blank: The mechanism of action for carbonic anhydrase inhibitors is to inhibit _______.

Answer 24

carbonic anhydrase.

Question 25

True or False: K(^+)-sparing diuretics can cause hyperkalemia.

Answer 25

True.

Question 26

What is the effect of thiazide diuretics on Ca(^{2+}) excretion?

Answer 26

↓ Ca(^{2+}) excretion.

Question 27

What class of drugs includes canagliflozin, empagliflozin, luseogliflozin, and tofogliflozin?

Answer 27

SGLT2 inhibitors ## Footnote SGLT2 inhibitors are used for the treatment of type 2 diabetes.

Question 28

Which SGLT2 inhibitors have been approved in Japan for the treatment of type 1 diabetes?

Answer 28

Ipragliflozin and dapagliflozin ## Footnote These drugs are noted for their specific approval in Japan.

Question 29

What is the mechanism of action for SGLT2 inhibitors?

Answer 29

Inhibit Na(^+) and glucose transport in the proximal tubule ## Footnote This leads to increased excretion of glucose, Na(^+), and water.

Question 30

What clinical benefits have been observed with SGLT2 inhibitors in diabetic patients?

Answer 30

Lower glucose levels, improve albuminuria, kidney function, blood pressure, and cardiovascular disease ## Footnote Heart failure improvement has also been noted in nondiabetic patients.

Question 31

What adverse effects led to the use of angiotensin receptor blockers (ARBs) in heart failure management?

Answer 31

Some patients on ACE inhibitors had adverse effects ## Footnote This prompted the exploration of ARBs as an alternative.

Question 32

What is the role of neprilysin in the body?

Answer 32

Degrades endogenous vasoactive peptides ## Footnote These peptides include natriuretic peptides, bradykinin, and adrenomedullin.

Question 33

What is the effect of inhibiting neprilysin?

Answer 33

Increases levels of vasoactive peptides ## Footnote This counters neurohormonal overactivation contributing to vasoconstriction and Na(^+) retention.

Question 34

What is the combination of neprilysin inhibitor and ARB used for heart failure?

Answer 34

Sacubitril and valsartan (Entresto) ## Footnote This combination is extensively used in patients with heart failure.

Question 35

True or False: SGLT2 inhibitors have only been shown to lower glucose levels in diabetic patients.

Answer 35

False ## Footnote They also improve other health parameters such as kidney function and cardiovascular health.

Question 36

Fill in the blank: Neprilysin is a _______.

Answer 36

neutral endopeptidase ## Footnote It plays a crucial role in degrading vasoactive peptides.