Diuretics

Question 1

Most diuretics work by

Answer 1

Increasing Na excretion

Question 2

Osmotic diuretics

Answer 2

The only non-natriuretic drug–they just truly increase urine volume

Question 3

Clinical uses for diuretics

Answer 3

hypertension, CHF, edema, electrolyte abnormalities

Question 4

Where do carbonic anyhydrase inhibitors work

Answer 4

Proximal tubule of kidney

Question 5

Where do loop diuretics work

Answer 5

Thick ascending loop of Henle

Question 6

Where do thiazides work

Answer 6

Distal tubule

Question 7

Where do K+ sparing diuretics work

Answer 7

Collecting ducts

Question 8

Example of osmotic diuretic

Answer 8

Mannitol

present throughout tubule

Question 9

Therapeutic uses for mannitol

Answer 9

Decrease ICP in cerebral edema
Decrease IOP in glaucoma
Preserve urine volume in acute oliguric renal failure
Increase clearance of toxins

Question 10

Adverse effects of mannitol

Answer 10

Acute hypovolemia

Question 11

Mannitol is contraindicated in

Answer 11

CHF and pulmonary edema due to initial increase in ECF volume

Question 12

Carbonic anhydrase inhibitors

Answer 12

“-zolamide”
Block reabsorption of HCO3- in proximal tubule, which decreases Na reabsorption
Can cause metabolic acidosis and severe hypokalemia
Most commonly used in glaucoma and mountain sickness

Question 13

Most widely used loop diuretics

Answer 13

Furosemide

Question 14

Loop diuretics

Answer 14

Inhibits Na/K/Cl cotransporter and increases Na in the lumen causing diuresis
Causes increased excretion of K+, Mg, and Ca
Induces expression of COX-2 and prostaglandins causing vasodilation

Question 15

Therapeutic uses of loop diuretics

Answer 15

acute pulmonary edema and CHF, other edematous states, hypercalcemia and hyperkalemia, hypertension

Question 16

Adverse effects of loop diuretics

Answer 16

Hypokalemia, metabolic acidosis, hypomagnesia and hypocalcemia, ototoxicity, sulfa allergy

Question 17

Most common thiazides

Answer 17

Hydrochlorothiazide

Question 18

Thiazides

Answer 18

Inhibit Na/Cl cotransporter in distal tubule causing increases Na and Cl excretion
Increased Ca reabsorption–decreased risk of Calcium renal stones

Question 19

Therapeutic uses for thiazides

Answer 19

Hypertension, CHF, calcium renal stones, nephrogenic DI

Question 20

Adverse effects of thiazides

Answer 20

Hypokalemia, metabolic alkalosis, hypercalcemia, decreased insulin

Question 21

Potassium sparing diuretics

Answer 21

Not good by themselves
Used in adjunct to other diuretics
Block aldosterone mainly: decreased Na reabsorption and decreased K+ secretion

Question 22

Ungated Na channel blockers

Answer 22

Amiloride and Triamterene

Inhibits Na channels in collecting ducts causing less Na to go in and less K to go out–K sparing

Question 23

Aldosterone receptor antagonists

Answer 23

Spironolactone
Competitive antagonist of aldosterone receptors
Can cause hyperkalemia

Question 24

Spironolactone negatively interacts with

Answer 24

digoxin, ACEI, ARBs, and NSAIDs

Question 25

Acetazolamide

Answer 25

Works in the proximal tubule; inhibits carbonic anhydrase which causes decreased reabsorptions of bicarb, pulls Na in the tubule and causes diuresis Causes metabolic acidosis

Question 26

Acetazolamide uses

Answer 26

Decrease CSF in intracranial hypertension, decrease aqueous humor in glaucoma, and mountain sickness

Question 27

Examples of loop diuretics

Answer 27

Furosemide and ethacrynic acid

Question 28

1st line diuretic for hypertension

Answer 28

thiazide

Question 29

First line diuretic for HF

Answer 29

Loop diuretics

Question 30

Thiazide effect on insulin

Answer 30

Can decrease insulin and cause hyperglycemia

Question 31

Side effects of spirinolactone

Answer 31

Decreased testosterone, increased gynecomastia, increased impotence and decreased libido

Question 32

Potassium sparing diuretics and HF

Answer 32

Can be helpful to decrease cardiac remodeling