Diuretics

Question 1

Oliguria

Answer 1

the production of abnormally small amounts of urine

Question 2

Polyuria

Answer 2

the production of abnormally large amounts of urine

Question 3

Mannitol MOA PO

Answer 3

poor lipid soluble, not well absorbed, acts as a cathartic drug, purgative, voids the intestines

Question 4

Mannitol MOA IV inj (acts at 2 sites)

Answer 4

thick ascending loop of Henle and proximal tubule

Question 5

the most effective diuretics are ____ diuretics, acting at

Answer 5

loop diuretics acting at the thick ascending loop of Henle, inhibiting sodium reabsorption

Question 6

the second most effective diuretics are ____ diuretics, acting at

Answer 6

thiazide diuretics acting at the early distal tubule

Question 7

the third most effective diuretics are carbonic anhydrase inhibitors and osmotic diuretics, acting at

Answer 7

act at proximal tubule

Question 8

the least effective are ____ diuretics, acting at

Answer 8

potassium-sparing diuretics, acting at the collecting duct and late distal tubule

Question 9

Mannitol is a ____ diuretic

Answer 9

moderate

Question 10

The effect on electrolyte imbalance is not significant with administration of mannitol. True or False

Answer 10

True

Question 11

______: Osmotic diuretics increase renal blood flow and perfusion, which can be useful in the treatment of oliguric renal failure; the most sensitive tissue to blood flow changes is the kidney - if the kidney does not get enough blood supply, it stops working (it is the first organ to shut down - ACUTE RENAL FAILURE).

Answer 11

Mannitol

Question 12

Mannitol is very ____philic.

Answer 12

hydro

Question 13

Mannitol leaves the vascular compartment via _____ in the endothelium of blood capillaries; fenestrations in the capillaries are wide allowing any free drug to pass out of the vascular compartment. Since the fenestrations in the GI tract are narrow, mannitol is not absorbed well.

Answer 13

fenestrations

Question 14

Mannitol cannot pass through fenestrations guarded by barriers; the strongest barrier using tight junctions in the body is the ____-____ barrier.

Answer 14

blood-brain

Question 15

Mannitol cannot cross the blood-brain barrier. True or False

Answer 15

True

Question 16

Both the vascular and interstitium are considered as one compartment. Mannitol is only used to treat ____ ____.

Answer 16

localized edema

Question 17

Mannitol can pull water from the brain and the eye; therefore in addition to local edema it is indicated in the treatment of glaucoma (chronic) to decrease ___. It does not cross the barrier of the eye, but pulls excess vitreous humor from the eye.

Answer 17

IOP (intraocular pressure)

Question 18

Mannitol MUST be given __.

Answer 18

IV

Question 19

Mannitol can also be used in cases of ______ and acute/chronic ______ failure.

Answer 19

toxicity; renal

Question 20

Mannitol is contraindicated in cases of _____ _____; it will exacerbate the condition.

Answer 20

generalized edema

Question 21

MANNITOL INDICATIONS (5)

Answer 21

1) CEREBRAL EDEMA 2) GLAUCOMA 3) ACUTE RENAL FAILURE 4) MOBILIZATION OF EDEMA FLUID 5) DRUG OVERDOSE PATIENTS

Question 22

MANNITOL CONTRAINDICATIONS

Answer 22

1) HEAD TRAUMA OR CEREBRAL HEMORRHAGE (DAMAGE TO THE BLOOD BRAIN BARRIER CAN ALLOW MANNITOL TO CROSS THE BARRIER AND EXACERBATE CEREBRAL EDEMA)

Question 23

loop diuretics are also called ____ ____ diuretics: act at the _____, are the ____ effective diuretics but also the ____ serious changes to electrolyte balance

Answer 23

high ceiling; thick ascending loop of Henle; most; most

Question 24

3 major loop diuretics (the “mides”): a patient that is allergic to one may be allergic to another: HYPERSENSITIVITY REACTIONS

Answer 24

furosemide (lasix/salix), bumetanide, ethacrynic acid

Question 25

the "mides" are all weak _____

Answer 25

acids

Question 26

excretion = filtration - reabsorption + secretion

Answer 26

finish later

Question 27

acids can compete; drug-drug interactions are possible; active tubular secretion

Answer 27

finish later

Question 28

Furosemide ADMIN

Answer 28

IV INJ or PO

Question 29

Furosemide MOA

Answer 29

next day

Question 30

osmotic diuretics and loop diuretics both increase renal blood flow and perfusion. true or false

Answer 30

true

Question 31

main MOA loop diuretics: inhibit the ________ in the thick ascending loop of Henle

Answer 31

Na+ K+ 2Cl symporter

Question 32

secondary MOA loop diuretics: inhibit paracellular reabsorption of 5 electrolytes

Answer 32

sodium, potassium, magnesium, chloride, calcium

Question 33

thus loop diuretics can be used to treat

Answer 33

hypercalcemia

Question 34

which diuretics cause the most significant electrolyte imbalance

Answer 34

loop

Question 35

the most severe electrolyte imbalance that can result is _____ with systemic alkalosis

Answer 35

potassium (hypokalemia); treat with a slow single IV injections as not to trigger a severe spike in K+

Question 36

systemic lifelong hypertension should not be treated with loop diuretics. true or false

Answer 36

true

Question 37

loop diuretics are often combined with _______ (normal) in order to treat hypercalcemia

Answer 37

saline; to compensate for the loss of electrolytes that will occur with the use of a loop diuretic

Question 38

blood from the nose of a horse after exercise can be indicative of exercise-induced _____ ______; loop diuretics can be used to treat this

Answer 38

pulmonary hemorrhage

Question 39

loop diuretics can be used to treat toxins because renal excretion will be increased. true or false

Answer 39

true

Question 40

never use a diuretic in an already dehydrated/hypovolemic patient. true or false

Answer 40

true

Question 41

acute poisoning leads to ______, ______

Answer 41

vomiting, diarrhea

Question 42

_______ or _______ are used in cases of poisoning

Answer 42

mannitol and furosemide

Question 43

mannitol is less efficacious and less likely to cause electrolyte imbalance than furosemide and is therefore the better choice for treatment of poison toxicity. true or false

Answer 43

true

Question 44

increased venous capacitance causes a _____ in blood pressure

Answer 44

decrease

Question 45

ototoxicity is ear damage to the extent of deafness due to electrolyte balance in the _______ of the inner ear

Answer 45

endolymph

Question 46

_________ are a class of antibiotics including streptomycin and gentamicin, can also cause ototoxicity; DO NOT USED aminoglycosides together with loop diuretics as the risk of ototoxicity is higher

Answer 46

aminoglycosides

Question 47

hyperurecemia can cause ______ when uric acid precipitates out and causes stone formation

Answer 47

uroliths

Question 48

loop diuretics given IV and PO with the exception of ____ which should only be given IV

Answer 48

mannitol

Question 49

thiazide diuretics act in the _____ _____ ____

Answer 49

early distal tubule

Question 50

thiazide diuretics are administered only

Answer 50

PO

Question 51

hydrochlorothiazide and chlorothiazide are examples of _______ diuretics

Answer 51

thiazide

Question 52

thiazide diuretics inhibit the ______ symporter in the distal convoluted tubule resulting in inhibition of tubular reaborption of sodium, chloride and diuresis

Answer 52

sodium-chloride

Question 53

one of the most common uroliths in animals is _____

Answer 53

calcium oxylate crystals form - high oxalic acid contant

Question 54

thiazide diuretics can be used to treat ______ edema

Answer 54

generalized

Question 55

one of the oldest used and most effective drugs used in hypertension in people is ______ because they are others such as calcium blockers and beta blockers cause greater electrolyte imbalances (ace inhibitors and beta blockers lower serum potassium), also because they are inexpensive in comparison

Answer 55

thiazide diuretics

Question 56

adverse effects for thiazide diuretics are similar to those of loop diuretics but less severe. true or false

Answer 56

true

Question 57

thiazide diuretics can cause __________ by increasing triglycerides in the plasma, increasing risk factors in hypertensive patients

Answer 57

hyperlipidemia

Question 58

only ______ diuretics can induce hyperlipidemia

Answer 58

thiazide

Question 59

glomerular filtration (mainly) and active tubular secretion by the kidney rids the body of thiazide diuretics. true or false

Answer 59

true

Question 60

thiazide diuretics DO NOT increase renal blood flow, causing issue when they cannot reach their site of action in patients with compromised renal blood flow, leading to significant decrease in efficacy. true or false

Answer 60

true

Question 61

spironolactone acts on aldosterone at the ________ and is therefore a potassium-sparing diuretic

Answer 61

mineralocorticoid receptors in the distal tubule and collecting duct

Question 62

addison's disease is characterized

Answer 62

sodium

Question 63

spironolactone is given

Answer 63

PO

Question 64

spironolactone MOA resulting in excretion of NaCl and diuresis as well as retention of potassium and proton

Answer 64

competitively blocks aldosterone binding to aldosterone receptors (MR, mineralocorticoid receptor)

Question 65

spironolactone are often combined with __________ or __________ diuretics in the treatment of congestive heart failure 1) even out potassium 2) manage high aldosterone caused by this condition

Answer 65

loop or thiazide

Question 66

spironolactone can also be used in primary or secondary

Answer 66

hyperaldosteronism

Question 67

loop diuretics may lead to systemic alkalosis where as potassium sparing diuretics such as spironolactone may lead to

Answer 67

systemic acidosis

Question 68

glucocorticoids, mineralocorticoids and sex hormones (both male and female) are all examples of ______ hormones

Answer 68

cholesterol

Question 69

_______ can decrease efficacy of endogenous estrogens and testosterones since they mimic cholesterol hormones

Answer 69

spironolactone

Question 70

spironolactone are well absorbed because they are steroids and therefore very ____ soluble

Answer 70

lipid

Question 71

the degree of metabolism of drugs is proportional to the lipid solubility of the drug. true or false

Answer 71

true

Question 72

triamterene and amiloride MOA unique

Answer 72

block sodium channels in the late distal tubule and collecting duct; these are unique sodium channels

Question 73

triamterene and amiloride can be used to counterbalance ______

Answer 73

hypokalemia

Question 74

most diuretics act on the ______ side

Answer 74

luminal

Question 75

receptors for triamterene and amiloride are found at the ______ side

Answer 75

opposite lumen (basolateral???)

Question 76

administer triamterene and amiloride

Answer 76

PO

Question 77

Carbonic anhydrase inhibitors are no longer used as diuretics, despite the fact that they have a diuretic effect, because they cause _____ _____.

Answer 77

systemic acidosis

Question 78

Acetazolamide, Brinzolamide, Dorzolamide and Methazolamide inhibit carbonic anhydrase primarily in the _____ _____ and secondarily in the _____ _____.

Answer 78

proximal tubule; collecting duct

Question 79

Brinzolamide and Dorzolamide are ophthalmic drugs used to inhibit carbonic anhydrase in the eye; lowers IOP by decreasing the formation of _____ _____.

Answer 79

aqueous humor

Question 80

Hypokalemia, hypoglycemia, mild systemic acidosis, all side effects of

Answer 80

the