Diuretics

Question 1

Carbonic Anhydrase Inhibitors

Rx

Answer 1

Acetazolamide

PCT

Question 2

Osmotic Diuretics

Answer 2

Mannitol

*glycerin, isosorbide, urea
PCT

Question 3

Na/K/2Cl Blockers

Rx

Answer 3

• Furosemide
• Ethacrynic acid

*bumetanide

TALH

Question 4

Na/Cl Blockers
“thiazide-like diuretics”

Rx

Answer 4

HTCZ

*chlorthalidone, indapamide

DCT

Question 5

ENaC Inhibitors

Rx

Answer 5

Amiloride

triamterene

DCT

Question 6

Aldosterone blockers

Rx

Answer 6

• Spironolactone
• Eplerenone

CD

Question 7

Vasopressin (ADH) Blockers

Rx

Answer 7

*Tolvaptan

Conlvaptan

CD

Question 8

K wasting

Rx

Answer 8

• Furosemide
• ethacryinic acid
• HCTZ

Question 9

K Sparring

Rx

Answer 9

• Amiloride
• Spironolactone
• Eplerenone

Question 10

Best 1st choice HTN/?

Answer 10

HCTZ

Question 11

Best 1st choice Edema?

Answer 11

Loop Diuretic

Question 12

How to decrease extra-cellular fluid?

Answer 12

Increase sodium excretion

Question 13

CAI urine pH?

Answer 13

Alkaline (UP)

Question 14

CAI effect on glomerular filtration

Answer 14

• constrict afferent

* lessen constriction of efferent (lower renin/ang 2)

Question 15

CAI

Steady state

Answer 15

Lowered,, “diuretic braking”

Question 16

CAI

Effect on Cl

Answer 16

Serum Hyperchloremia (no bicarb for bicarb/Cl transporter in CD)

Question 17

Acetazolamide

• Site of action
• Mech
• Urine
• Plasma electrolytes
• Interactions

Answer 17

• renal PT, eye (aqueous h.)
• Blocks Carb. Anhydrase (UP tubular Na, Activates TGF)
• Alkaline Urine (pH 8) =>Renal Stones
• DOWN Bicarb, UP Cl-
• Cross-rxn w/ Sulfonamides

Question 18

CAI
Acetazolamide

Uses

Answer 18

• Metabolic Acidosis
• LOWER intraocular pressure
• Acute Mountain Sickness

Question 19

Which are best at lowering Blood volume?

Answer 19

Loop

NaK2Cl

Question 20

Loop Diuretics

Which channel?

Answer 20

TALH. NaK2Cl

Question 21

Loop diuretic braking (neg feedback)

Answer 21

macula not sensing Na cuz turned off, releasing renin

Question 22

Loop

Furosemide, Ethacrynic Acid

• Where
• Mech
• Urine
• Plasma
• S.E.

Answer 22

• TALH
• NaK2Cl block, abolish osmotic gradient, UP Renal BF, UP Renin = diuretic braking
• Excrete all ions
• hypoK
• HypoK = arrythmia, hypoTN, Ototoxicy, Hyperuricemea (gout)

Question 23

Loop

Furosemide, Ethacryinic acid

Uses

Answer 23

• Edema = peripheral, pulm

* HTN W/ CHF = 1st line

Question 24

Loops LOWER mortality/morbidity in

Answer 24

HF

Question 25

How do diuretics enter glomerulus ?

Answer 25

Secreted into PCT by anion transporters

Question 26

HCTZ * Where * Mech * Urine * Plasma * S.E.

Answer 26

* DCT * STOP Na/Cl co-transporter * DOWN Ca excretino * HypoK , Combine w/ ACEI! (Combat diuretic break) * HypoK, HyperCa, HyperUricemia, HypoTN, Hyperglycemia (DM!!), Hyperlipid

Question 27

HCTZ Uses

Answer 27

* HTN (simple essential) * Congestive HF * HyperCalciuria * Nephrogenic Diabetes Insipidus (ADH insensitivity)

Question 28

Thiazides LOWER mortality/morbidity in

Answer 28

HF | HTN

Question 29

Loops + thiazides both lead to loss of

Answer 29

* K+ (principle cell-CD) * H+ (a-intercalated cell-CD) HYPOK ALKALOSIS

Question 30

What is true for loops but not for thiazides

Answer 30

Loops can abolish corticomedullary osmotic gradient

Question 31

K sparing ENaC Amiloride , triamterene * Where * Mech * Urine * Plasma

Answer 31

* Late DCT + CD * ENaC * DOWN K/H excretion * HyperK

Question 32

K Sparring ENaC Amiloride + HCTZ LOWERS morbidity in

Answer 32

(Stroke) Elderly w/ HTN

Question 33

K sparring ENaC Amiloride, triamterene Uses

Answer 33

*ADJUNCT w/ Thiazide/Loop to prevent K LOSS

Question 34

K Sparring Spironolactone, Eplerenone * Where * Mech * Urine * Plasma * S.E.

Answer 34

* Late DCT + CD * Na/K aldosterone receptor, need adequate natural aldosterone level * DOWN K excretion * HyperK (Monitor!) * HyperK, Gynecomastia

Question 35

Spironolactone + loop/thiazide LOWERS mortality/morbidity in

Answer 35

HF

Question 36

K Sparing Spironolactone, Eplerenone Uses

Answer 36

ADJUNCT w/ thiazide/loop to prevent K LOSS

Question 37

Osmotic Mannitol, isosorbide * PK * Where * Mech * Urine * Plasma * S.E.

Answer 37

* NOT gi, IV ONLY, short t1/2 * Water permeable nephron sites (PCT, tDLH, CD) * UP plasma osmolality, UP ECFV (intravascular volume) , UP renal BF * UP Mg+ loss * HyperK

Question 38

Osmotic Mannitol, isosorbide Uses

Answer 38

Reduce intracranial or intraocular pressure b/f + after surgery

Question 39

Vasopressin ADH Blocker Tolvaptan, conivaptan * Where * Mech

Answer 39

* CD | * ADH antag at V2 ADH receptor

Question 40

Vasopressin Blocker tolvaptan conivaptan

Answer 40

*SIADH

Question 41

Combo therapy

Answer 41

* STRONG = Loop + thiazide | * NORMAL = K wasting (thiazide/loop) + K sparring (spironolactone)