Diuretics

Question 1

What are 3 uses for diuretics

Answer 1

1. mobilize fluid
2. excrete fluid
3. excrete electrolytes

Question 2

name the prototype of drug for carbonic anhydrase inhibitor

Answer 2

Acetazolamide

Question 3

MOA for Acetazolamide (CAI)

Answer 3

inhibits carbonic anhydrase in proximal tubule

Question 4

what are 3 uses for Acetazolamide (CAI)

Answer 4

1. open-angle gluacoma
2. prophylaxis of acute mountain sickness
3. not used as much today

Question 5

how can Acetozolamide treat open-angle glaucoma

Answer 5

• decreases aqueous humor formation
• decreases intraocular pressure
• used for chronic treatment

Question 6

what are adverse effects of Acetozolamide

Answer 6

• metabolic acidosis
• hypokalemia
• drowsiness
• tingling of extremities (paresthesias)

Question 7

what is the main Benzothiadiazide used

Answer 7

Chlorothiazide

Question 8

name the related drugs of Benzothiazides

Answer 8

1. chlorthalidone
2. metalozone
3. indapamide

Question 9

MOA of benzothiazides

Answer 9

• inhibition of sodium chloride co-transporter on the luminal membrane of distal tubular cells
• less impact on proximal convoluted tubule

Question 10

what are benzothiazides effects on urine composition

Answer 10

• increase, Na, K, Cl, HCO3, H2O excretion

- decrease Ca excretion

Question 11

What are 5 therapeutic uses of Benzothiazides

Answer 11

1. hypertension
2. congestive heart failure, cirrhosis, other edemetous states
3. hypercalciuria
4. nephrogenic diabetes insipidus
5. nephrotic syndrome (+- Spironolactone)

Question 12

What are 7 adverse effects of benzothiazides

Answer 12

1. hypokalemia ( digitalis interaction)
2. hypovolemia
3. hypersensitivity

hyperGLUC
hyperGlycemia 
hyperLipidemia 
hyperUricemia (gout attacks)
hyperCalcemia

Question 13

When are thiazides ineffective as diuretics

Answer 13

GFR less than 30-40 ml/min

Question 14

What drugs are effective at lower GFR rates and can be used if GFR is less than 40 ml/min

Answer 14

Metolazone

Indapamide

Question 15

Name 4 Loop Diuretic drugs

Answer 15

Furosemide
Bumetanide
Torsemide
ethacrynic acid

Question 16

MOA of loop diuretics

Answer 16

inhibition of Na, K, 2Cl cotransporter in luminal membrane of ascending limb of the loop of henle

Question 17

what are loop diuretics impact on urine composition

Answer 17

• increase Na, K, Ca, Cl H2O excretion
• +/- HCO3 at low doses
• increase HCO3, PO4 at high doses

Question 18

what are 4 therapeutic uses for loop diuretics

Answer 18

1. acute pulmonary edema
2. edema of cardiac hepatic or renal origin
3. hypertension
4. hypercalcemia

Question 19

What are 3 adverse effects of loop diuretics

Answer 19

1. fluid and electrolyte imbalance
2. ototoxicity; hearing loss then vestibular effect may be additive with other ototoxic drugs
3. LDL, total cholesterol, total TG

Question 20

what are specific fluid and electrolyte imbalance for loop diuretics

Answer 20

• hypovolemia
• hyponatremia
• hyperglycemia
  OH DANG
  otoxocity
  hypokalemia
  dehyrdation
  Allergy sulfa
  nephritis
  Gout

Question 21

Name the potassium - sparing diuretics

Answer 21

Spironolactone
Eplerenone
Trimeterene
Amiloride

Question 22

MOA for Sprionolactone and Eplerenone

Answer 22

competitively inhibits the binding of aldosterone to mineralocorticoid receptor in late distal tubule and collecting duct cells

Question 23

what are Spironolactone and Eplerenone impact on urine composition

Answer 23

• increase Na, Cl, H2O excretion

- decrease K, and H

Question 24

what are therapeutic uses for Sprionolactone

Answer 24

1. primary hyperaldosteronism
2. prevent hypokalemia caused by thiazide or loop diuretics
3. drug of choice in hepatic cirrhosis patients

Question 25

what are therapeutic uses for Eplerenone

Answer 25

1. hyperkalemia | 2. CHF post-MI

Question 26

What are adverse effects of Spironolactone and Eplerenone

Answer 26

- hyperkalemia - gynecomastia in males - mestrual irregulars in females

Question 27

MOA of Trimeterene and amiloride

Answer 27

inhibit luminal Na channel in late distal tubule and collecting duct - inhibition can be either competitive or noncompetitive

Question 28

what are therapeutic uses for Trimeterene and amiloride

Answer 28

- secondary hyeraldosteronism | - prevent hypokalemia

Question 29

what are adverse effects of Trimeterene and Amiloride

Answer 29

hyperkalemia

Question 30

what is the mechanism of action for osmotic diuretics

Answer 30

- freely filtered at the glomerulus, poorly reabsorbed from luminal fluid - excreted in urine water associated with drug provides the diuresis

Question 31

name some osmotic diuretics

Answer 31

Mannitol, Urea

Question 32

therapeutic uses for Mannitol

Answer 32

1. maintain urine flow 2. oliguric acid renal failure 3. reduce intracranial or intraocular pressure 4. not useful for mobilizing edema

Question 33

adverse effects of Mannitol

Answer 33

1. over expression of the extracellular fluid | 2. alteration of Na, K, levels in blood

Question 34

what drug are used to treat hypertension

Answer 34

thiazide loop postaissium-sparing

Question 35

drug used for chronic congestive heart failure

Answer 35

thiazide | loop potassium- sparing

Question 36

durg used for acute pulmonary edem

Answer 36

loop

Question 37

drug used for nephrotic syndonme

Answer 37

loop or thiazide, often with spironolactone

Question 38

drug used for chronic renal failure

Answer 38

loop or loop w/ metolazone of indapamide

Question 39

drug used for acute renal failure

Answer 39

mannitol and furosemide

Question 40

drug used for cirrhosis with ascites

Answer 40

spironolactone Sprionoloactone and thiazide spirnonolactone and loop

Question 41

drug used for hypercalcemia

Answer 41

furosemide

Question 42

drug used for diabetes insipdidous

Answer 42

thiazide

Question 43

drug used for open-angle glaucoma

Answer 43

carbonic anhydrase inhibitors