Diuretics

Question 1

T/F: Water will follow Na during resorption/secretion.

Answer 1

True

Question 2

What happens to water if you block Na resorption into the blood?

Answer 2

More water will leave in the urine

Question 3

How will the resorption of less Na effect blood pressure?

Answer 3

Less Na resorbed = less H2O resorbed.

If less H2O in the blood -> blood volume decreases

Decrease in blood volume = decrease in blood pressure

Question 4

T/F: Most of the filtered plasma gets excreted as urine.

Answer 4

False

Out of 180 liters only 1.5 is excreted per day

Question 5

Where do carbonic anhydrase inhibitors act?

Answer 5

Proximal convoluted tubule

Question 6

What is the goal of carbonic anhydrase?

Answer 6

To facilitate the shuttling of Na+ from the lumen back into the blood.

(Bicarbonate comes with it as well)

Question 7

What is the overall effect of CA inhibitors?

Answer 7

Inhibits Na+ resorption -> enhances fluid loss -> lowers blood volume/pressure

Question 8

Where do osmotic diuretics work?

Answer 8

Proximal convoluted tubule and proximal straight tubule

Question 9

____________ diuretics work by increasing the osmolarity of blood and renal filtrate.

Answer 9

Osmotic

Question 10

Mannitol is an example of a ___________ diuretic. It is not well resorbed back into the blood, and thus water will stick with it and not be resorbed.

Answer 10

Osmotic

Question 11

Where do loop diuretics act?

Answer 11

Thick ascending limb

Question 12

T/F: Loop diuretics are most effective in patients with impaired kidney function.

Answer 12

True

Question 13

How do loop diuretics work?

Answer 13

Block a transporter that brings Na+, Cl-, and K+ in from the lumen.

Question 14

What are some possible side effects from loop diuretics?

Answer 14

Mg and Ca imbalances

Question 15

________________ are sulfonamide derivatives, and therefor could cause allergic reactions.

Answer 15

Loop diuretics

Question 16

Where do thiazides diuretics work?

Answer 16

Distal convoluted tubule

Question 17

_________ diuretics inhibit a Na+ Cl- symporter from the lumen to tubular cells.

Answer 17

Thiazide

Question 18

Which two types of diuretics can cause K+ loss and lead to ion imbalances?

Answer 18

Thiazides and loop diuretics

Question 19

Where do K+ sparing diuretics work?

Answer 19

Cortical collecting tubule

Question 20

In what two ways do K+ sparing diuretics work?

Answer 20

1. Na+ channel from lumen into cell

2. Aldosterone receptor antagonist

Question 21

______________ are used as adjunctive therapy, together with other drugs, in the treatment of hypertension and management of CHF.

Answer 21

K+ sparing diuretics

Question 22

T/F: Diuretics make you pee more.

Answer 22

True

Question 23

What are the two blood pressure regulatory system?

Answer 23

Short term = sympathetic nervous system

Long term = renal system

Question 24

Describe the baroreflex regulation of blood pressure.

Answer 24

Baroreceptors send BP info to medulla -> symp nerves adjust to regulate vasoconstriction, heart beat, cardiac output

Question 25

Where are baroreceptors found in the kidney?

Answer 25

JG cells

Question 26

What is released from the juxtaglomerular apparatus when blood pressure decreases?

Answer 26

Renin

Question 27

What is the role of renin in regulating BP?

Answer 27

Renin turns angiotensinogen into angiotensin I Angiotensin I is then converted into angiotensin II by ACE

Question 28

Where is angiotensinogen secreted?

Answer 28

Liver

Question 29

Where is angiotensin I converted to angiotensin II?

Answer 29

In the lung capillaries by ACE

Question 30

What are the effects of angiotensin II?

Answer 30

Direct and indirect vasoconstriction, sodium resorption and water retention Long term: can produce structural remodeling INCREASE BP

Question 31

Which angiotensin II receptor is important for pharm intervention?

Answer 31

AT1 receptor (GPCR)

Question 32

T/F: Angiotensin II stimulates aldosterone release.

Answer 32

True

Question 33

What are the four classes of drugs used to treat hypertension?

Answer 33

1. Diuretics - reduce blood volume 2. Sympathoplegic - reduce vascular resistance and CO 3. Direct vasodilators - relax smooth muscle 4. Block angiotensin II - reduce vascular resistance and blood volume

Question 34

___________ diuretics are favored for patients with mild to moderate hypertension and normal renal and cardiac function.

Answer 34

Thiazide

Question 35

Which type of diuretics are used with more severe hypertension?

Answer 35

Loop

Question 36

What is the most common side effect of diuretics for hypertension?

Answer 36

K+ depletion

Question 37

What are the three ways sympathoplegic agents work?

Answer 37

1. Act on CNS 2. Reduce epinephrine release 3. Block adrenoreceptors Use diuretics in conjunction to prevent Na retention

Question 38

Sympathoplegic agents that act on the CNS activate _____ receptors, reducing cardiac output.

Answer 38

alpha2

Question 39

Sympathoplegic drugs that selectively block adrenoreceptors are aiming to block beta1 receptors having what effect?

Answer 39

Diminish CO and renin production

Question 40

What are the four methods that direct vasodilators use to treat hypertension?

Answer 40

1. NO drugs 2. Reduce Ca+ influx 3. Hyperpolarize (activate K+ channel) 4. Activate dopamine

Question 41

What is one of the negative aspects of direct vasodilators?

Answer 41

The body senses the changes and tries to compensate Often have to take more drugs to oppose compensation

Question 42

Which dopamine receptor do some direct vasodilators effect?

Answer 42

D1

Question 43

T/F: ACE inhibitors would inhibit angiotensin I production.

Answer 43

False Angiotensin II

Question 44

How do ACE inhibitors promote vasodilation?

Answer 44

ACE normally degrades bradykinin which is a vasodilator Inhibit ACE -> more bradykinin, more vasodilation

Question 45

What class of drugs end in -pril?

Answer 45

ACE inhibitors

Question 46

T/F: Lisinopril is a prodrug.

Answer 46

False

Question 47

T/F: ACE inhibitors decrease cardiac output and heart rate.

Answer 47

False Decrease peripheral vascular resistance No effect on heart Useful if kidney is compromised

Question 48

What class of drugs end in -sartan?

Answer 48

Antagonists for angiotensin receptor

Question 49

Angiotensin antagonists bind to _____ receptors.

Answer 49

AT1

Question 50

T/F: Angiotensin antagonists affect bradykinin metabolism.

Answer 50

False ACE inhibitors do