Diuretics

Question 1

What effect do Carbonic anhydrase inhibitors have on the urine?

Answer 1

Alkalinize the urine…more bicarbonate is excreted

Question 2

What effect do carbonic anhydrase inhiitors have on chloride reabsorption?

Answer 2

Increase it…this can cause acidosis

Question 3

Specific example of carbonic anhydrase inh?

Answer 3

aetazolamide

Question 4

What does carbonic anhydrase normally do?

Answer 4

Converts H2CO3 to water and carbon dioxide to be reabsorbed

Question 5

What are osmotic diuretics?

Answer 5

They are small molecules that are filtered but not reabsorbed.

Question 6

What is their effect on the proximal convoluted tubule?

Answer 6

Inhibit Na and H20 reabsorption b/c they keep the osmolarity of the urine seo high that it needs to retain water.

Question 7

What are the net effects of osmotic diuretics?

Answer 7

Increase urine volume

Question 8

Specific osmotic diuretics?

Answer 8

Mannitol

Question 9

Do osmotic diuretics reduce intracranial and intraocular pressure?

Answer 9

Yes. Immediately

Question 10

What is the mechanism of action for loop diuretics?

Answer 10

They inhibit the Na-K-2Cl transporter,
Also inhibit the ability of the macula densa to sense NaCl, stimulate biosynthesis of prostaglandin, increase total renal blood flow

Question 11

Loop Diuretics do what?

Answer 11

They are the most potent class of diuretics in mobilizing NaCl, Increase urinary excretion of K and H. Increase excretion of Ca and Mg.

Question 12

Therapeutic uses of Loop Diuretics?

Answer 12

edema of cardiac, hepatoic, or renal origin
Also used in hypercalcemia to mobilize calcium
Protect against renal failure
Washout toxins
Antihypertensive

Question 13

How do loop diuretics effect pulmonary edema?

Answer 13

1) Decrease pulmonary wedge pressure
2) Increase compliance of pulmonary vessels
3) Increase peripheral venous capacitance
4) Reduce left ventricular filling pressure
5) cause brisk diuresis

Question 14

What is the most important thing the loop diuretics do?

Answer 14

Inhibit the macula densa

Question 15

How does furosemide work?

Answer 15

Inhibits NaCl reabsorption in Thick ascending Limb of Henle. MUST BE SECRETED. It has to come into the Proximal convoluted Tubule, travel to the thick ascending loop of henle, and then prevent NaCl reabsorption from the inside.

Question 16

How must you prescribe furosemide in people with renal diesase?

Answer 16

Must give larger doses b/c if they have kidney disease, their excretion mechanism is broken so you must give them more drug.

Question 17

What are the pharmacological effects of furosemide?

Answer 17

Urinary excretion of K and H
urinary excretion of calcium and magnesium
increase in renal prostaglandins
increase in Venous capacitance

Question 18

Side effects of furosemide?

Answer 18

warch for hypokalemia and pH disorders (mostly alkalosis)
Elevated BUN, hyperglycemia, hyperuricemia
Ototoxicity, sialadentitis (salivary gland inflammation)

Question 19

What drug interactions must be watched for?

Answer 19

interactions with Lithium
indomethacin
probenecid
warfarin

Question 20

What is significant about Bumetanide

Answer 20

forty times more potent than furosemide

Question 21

What are the three segments of the Distal convoluted Tubule and collecting Duct?

Answer 21

1) Na-K aldosterone independent segment (NaCl absorbed without water)
2) Aldosterone sensitive segment (Na exchanged for Potassium and Hydrogen)
3) Sodium load segment

Question 22

WHere do thiazide diuretics act?

Answer 22

DCT

Question 23

What is a big difference between thiazide and loop diuretics?

Answer 23

Thiazide diuretics decrease the urinary excretion of calcium.

Question 24

Uses of Thiazide diuretics?

Answer 24

reduction in edema due to CHF, cirrhosis, nephrotic syndrome
Hypercalciurea
Renal calcium stones
Reduction of bp in essential hypertension
osteoporosis
Diabetes insipidous

Question 25

When are class I thiazides used?

Answer 25

When GFR is above 50

Question 26

When are class II thiazides used?

Answer 26

When GFR is below 50

Question 27

Adverse effects of thiazides?

Answer 27

Depletion phenomena Retention phenomena Metabolic changes Hypersensitivity

Question 28

Two types of cells in DCT and CD?

Answer 28

Type A and Type B

Question 29

Type A cells are....

Answer 29

hormonally responsonsive (regulated by aldosterone) Na absorption and K secretion

Question 30

Type B cells are...

Answer 30

Load dependent. The more Na is delivered, the more is absorbed in exchange for K

Question 31

How do aldosterone antagonists work?

Answer 31

Bind to aldosterone receptors in the cytoplasm and prevent them from getting into the nucleus. Prevents NaCl cahnnels from being placed in cell membrance. Cuts down on sodium transport

Question 32

Toxicity of Carbonic Anhydrase Inhibitors?

Answer 32

Metabolic acidosis (more Cl- reabsorption), K+ loss

Question 33

Do osmotic diuretics interfere with urea absorption and impair cortico.... gradient?

Answer 33

Yes

Question 34

What would you use to treat dialysis disequilibrium syndrome and/or increased intraocular pressure?

Answer 34

Mannitol )osmotics)

Question 35

What is the mechanism behind the loops losing calcium?

Answer 35

Inhibition of the NK2C transporter in the thick ascending limb destroys the gradient between the lumen and the cell. Usually, NK2C works and then K moves back out through the potassium channel thus creating a positively charged lumen. This positive charge of the lumen with the negative charge of the cell draws in calcium and mg under physiologc conditions.

Question 36

Name the potassium sparing diuretics

Answer 36

The K STAys......Spironolactone, Triamterene, Amilioride

Question 37

How does spironolactone work?

Answer 37

Prevents ENac channels from being produced by binding to the aldo receptor in the cytoplasm and preventing its translocation to the nucleus. No Na taken in, no K released.

Question 38

The 3 class 1 thiazides are:

Answer 38

Hydrochlorothiazone, chlorothalidone, quinethazone

Question 39

The class II thiazides are

Answer 39

Metolazone, indepamide

Question 40

What loop can you give with warfarin?

Answer 40

Bumetanide