Diuretics

Question 1

What is anuria?

Answer 1

Failure for the kidneys to produce urine

Question 2

Why are diuretics used for anuria?

Answer 2

To help the kidneys make urine

Question 3

Why are diuretics used during HTN?

Answer 3

to decrease blood volume which will decrease BP

Question 4

What are diuretics used w/ CHF?

Answer 4

To decrease the amount of blood that is backing up in lungs or systemically

Question 5

Why are diuretics used during liver disease?

Answer 5

To increase albumin concentration to raise BCOP

Question 6

Why are diuretics used during glaucoma?

Answer 6

To decrease fluid that can increase IOP

Question 7

What are diuretics used for nephritis?

Answer 7

To help the kidney produce urine

Question 8

Why are diuretics used during encephalopathy?

Answer 8

To decrease fluid in brain

Question 9

How does liver disease cause edema?

Answer 9

Live makes albumin, when liver disease is happening no albumin is made and therefore on the venous end of blood return there is no BCOP to bring water back into the veins

Question 10

Where do osmotic diuretics work?

Answer 10

PCT and descending loop of henle

Question 11

Where do CA inhibitors work?

Answer 11

PCT

Question 12

Where do loop diuretics work?

Answer 12

Ascending loop of henle

Question 13

Where do thiazides work?

Answer 13

DCT

Question 14

Where do K-sparing diuretics work?

Answer 14

DCT and Collecting Duct

Question 15

What are the 7 classes of diuretics?

Answer 15

Osmotic agents
CA inhibitors
Loop diuretics
Thiazides/thiazides-like
Potassium sparing
ADH antagonist
SGLT2 inhibitors

Question 16

What is another name for loop diuretics?

Answer 16

Organic acids

Question 17

Are ostmotic diuretics filtered, reabsorbed or secreted?

Answer 17

Filtered

Question 18

What is mannitol(Osmitrol)? Route? What doesn’t it cross?

Answer 18

Osmotic diuretic

IV

Does not cross membranes, thus why it is given IV

Question 19

What are the indications for osmotic diuretics?

Answer 19

Increased intracranial pressure
Cerebral edema
Glaucoma

Question 20

What is the MOA of CA inhibitor?

Answer 20

CA is what turns HCO3 and H+ into H2CO3 and then into H20 and CO2. Thus bicarbonate isn’t able to be reabsorbed into the blood

Thus bicarbonate is peed out

Question 21

What is peed out when a pt takes CA inhibitors?

Answer 21

Na (and water because it follows the salt)

HCO3

Question 22

What is acetazolamide(Diamox)? Why is metabolic acidosis a ADR of this?

Answer 22

CA inhibitor

Causes metabolic acidosis because the pt is peeing out a lot of HCO3 because it is not getting reabsorbed

Question 23

Why is CA inhibitor used for glaucoma?

Answer 23

Because CA is used to increase aqueous humor which increases IOP

Question 24

Why is CA Inhibitor used for seizures?

Answer 24

Seizures occur when the body is too alkaline. In order to decrease alkaline, HCO3 needs to be peed out

Question 25

Why is CA inhibitor used for acute man sickness?

Answer 25

CA inhibitors increase RR to get of H+ in the form of CO2

Question 26

What is hydrochlorothiazide(esodrix,hydroDIURIL)?

Answer 26

Thiazide diuretic

Question 27

What is chlorothiazide(Diuril)?

Answer 27

Thiazide diuretic

Question 28

What is metolazone(mykrox, zaroxolyn)?

Answer 28

Thiazide-like diuretic

Question 29

What is chlorthalidone(Hydone, thalitone)

Answer 29

Thiazide like diuretic

Question 30

What is indapamide(Lozol)?

Answer 30

Thiazide like diuretic

Question 31

What is the MOA of thiazide and thiazide-like diuretics? What does it cause?

Answer 31

Blocks Na/Cl symporter on apical membrane Causes Na/Cl/K/H/H2O to be peed out

Question 32

What is the strongest diuretic?

Answer 32

Loop diuretics

Question 33

Why can thiazides cause hypercalcemia?

Answer 33

- Because Na/Cl symporter on apical membrane is blocked - increased Ca2+ is reabsorbed into blood through Na/Ca antiporter on basilar membrane to increase Na level in renal tubular cell

Question 34

What is the Ca channel that Ca2+ comes thru to be reabsorbed into the blood?

Answer 34

TRPV5 channel

Question 35

Why are thiazides indicated for kidney stones?

Answer 35

Because they help increase Ca2+ reabsorption instead of Ca2+ getting stuck in renal pelvis

Question 36

What are thiazides indicated for Osteoporosis?

Answer 36

Because of the reabsorption increase of Ca2+

Question 37

What are the blood levels of a pt on thiazides? | Na/K/Cl/H+

Answer 37

``` Hyponatremia Hypochloremia Hypokalemia Hypercalcemia Alkalosis ```

Question 38

Why is orthostatic hypotension a ADR of thiazides?

Answer 38

Because of the decrease in blood volume/decrease BP

Question 39

Why is hypokalemia a ADR of thiazides?

Answer 39

Because of Na/Cl symporter being blocked and pulling K+ into collecting duct

Question 40

Why is hypourecemia a ADR of thiazides(2)?

Answer 40

Because the inhibition of Na/Cl symporter inhibits uric acid from being excreted And Decrease in blood volume increases the uric acid concentration

Question 41

Why is hyperglycemia a ADR of thiazides?

Answer 41

Because a decrease in BP increases the sympathetic system which raises BGL

Question 42

What are the indications for loop diuretics?

Answer 42

Severe peripheral edema Pulmonary edema Liver cirrhosis Renal disease

Question 43

What is the MOA of loop diuretics? What does it cause to be secreted?

Answer 43

Blocks Na/2Cl/K symporter Causes H+,K+, Cl-, Na+, Mg2+ and H2O to enter collecting duct

Question 44

What are the lab values of a pt on loop diuretics?

Answer 44

Hyponatremia Hypochloremic alkalosis Hypokalemia

Question 45

Why is hypotension a ADR of loop diuretics?

Answer 45

Because of the decrease in blood volume which causes decrease BP

Question 46

Why is hyperuricemia a ADR of loop diuretics?

Answer 46

Because the MOA of loop diuretics blocks uric acid from being secreted into the collecting duct

Question 47

Why is hyperglycemia a ADR of loop diuretics?

Answer 47

Because decrease in BP causes and increase in sympathetic system which increase BGL

Question 48

What is ototoxocity?

Answer 48

Damaging in ear d/t toxic medication

Question 49

Why is ototoxicity a ADR of loop diuretics?

Answer 49

Because there are Na/K/Cl channels in the ears that get blocked

Question 50

What is the indications for K-sparing diuretics?

Answer 50

HTN Edema Hyperaldosteronism

Question 51

What is the MOA of K-sparing diuretics?

Answer 51

It blocks aldosterone receptors to prevent channels being made to allow K+ into the renal tubular cells

Question 52

What are the lab levels of K+ sparing diuretics? K+

Answer 52

Hyperkalemia

Question 53

What is gynecomastia?

Answer 53

Breast enlargement in males

Question 54

What is xanthene derivatives? What do they do? What is an example of one?

Answer 54

Diuretic Increase blood flow thru dilation do vessels to kidneys and GFR Caffeine is a diuretic

Question 55

How does ADH antagonist act as a diuretic?

Answer 55

Blocks the V-2 receptor on the basal membrane which causes a decrease in the production of aquaporin 2 channels on the apical membrane. Thus decreasing water reabsorption

Question 56

What values should be monitored when taking diuretics?

Answer 56

Electrolyte values Weight Vital signs Serum K+ levels

Question 57

Why should a pt take diuretics in the morning?

Answer 57

Because it can interfere w/ sleep...ie getting up to pee at night

Question 58

What are the Sx of hypokalemia? Why does it cause this?

Answer 58

Muscle weakness Constipation Irregular pulse Lethargy A decrease of K+ in body causes hyperpolarization of cells, making it difficult for them to depolarize

Question 59

What K+ supplement is taken for hypokalemia?

Answer 59

K-DUR

Question 60

What are food high in K+?

Answer 60

``` Bananas Dates Apricots Broccoli Green beans Legumes ```

Question 61

What diuretic should you not take K+ supplements?

Answer 61

K+ sparing diuretics

Question 62

DM pats taking thiazides or loop diuretics should watch what levels of their body?

Answer 62

BGL because they can lead to hyperglycemia