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Diuretics Flashcards

1
Q

What drug is a competitive antagonist to aldosterone?

A

spironolactone

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2
Q

What does the inhibition of carbonic anhydrase do?

A

prevents the conversion of CO2 and H2O to H2CO3

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3
Q

How do thiazide diuretics exert their effects?

A

inhibit Na/Cl cotransporter

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4
Q

Which diuretics cause the most NaHCO3 to be excreted?

A

carbonic anhydrase inhibitors

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5
Q

Which drugs are osmotic diuretics?

A

Mannitol

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6
Q

Effects of eplerenone may be prolonged with which drugs?

A

CYP3A4 inhibitors: ketoconazole and verapamil

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7
Q

What type of drugs do you want to use cautiously with loop diuretics?

A

sulfonamides

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8
Q

Which receptors do dopamine receptor agonists exert their effects?

A

dopamine 1 receptors

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9
Q

Where does the highest rate of O2 consumption occur?

A

proximal convoluted tubule

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10
Q

what segment of the kidney do carbonic anhydrase inhibitors work?

A

proximal convoluted tubule

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11
Q

What is the onset and duration of furosemide?

A

5-10 minute onset
peak in 30 minutes
2-6h duration

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12
Q

Which drug results in nantruresis and increased renal blood flow?

A

dopamine

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13
Q

which diuretic reduced mortality in HF patients with poor EF?

A

spironolactone

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16
Q

Which drugs are vasopressin receptor antagonists?

A

tolvaptan

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17
Q

What are some uses for acetazolamide?

A

Glaucoma, altitude sickness, central sleep apnea, intercranial HTN, familial periodic paralysis

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18
Q

Which diuretics cause the most NaCl excretion?

A

Loop diuretics and Loop agents with thiazides

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19
Q

Renal vasodilation and Na excretion is caused by what mechanisms?

A

prostaglandins, ANP, kinins

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20
Q

The inhibition of Na/Cl cotransporter in thiazide diuretics leads to what effects? (2)

A

increased excretion of Na, Cl and K

stimulates reabsorption of Ca

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21
Q

How to aldosterone antagonists work?

A

prevents synthesis and activation of the aldosterone dependent basal cell Na/K ATPase pump

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23
Q

Pteridines in combination therapy with ACEI’s, ARBs, or NSAIDs can cause what?

A

hyperkalemia

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24
Q

How does acetazolamide reverse hypoventilation?

A

by causing metabolic acidosis. Metabolic acidosis will cause hyperventilation as a compensatory response.

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25
Q

Where do the osmotic diuretics work?

A

proximal convoluted tubule and descending loop of henley

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26
Q

Which medication is used to treat hyponatremia seen with SIADH, CHF, or cirrhosis

A

tolvaptan

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27
Q

Which class of diuretics promotes lithium reabsorption leading to potential toxicity?

A

thiazide diuretics

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28
What segment of the kidney is highly permeable to water, making osmolality constant with interstitial fluid
proximal convoluted tubule
29
What are side effects of thiazide diuretics?
hypoK, hypochloremia, metabolic alkalosis, gout.
30
What type of antagonists compete for receptors in the kidney causing diuresis?
aldosterone
31
NSAIDS decrease effectiveness of which diuretic classes
loop diuretics, thiazide diuretics,
33
What influences GFR?
MAP, CO, SNS
35
What is the threshold concentration in the renal tubule for glucose to leak into the urine?
225 mg/min
36
Which class of diuretics bind to mineralocorticoid receptors?
aldosterone antagonists
37
Which medication is used for renal protection after cardiac or major vascular surgeries?
dopamine or fenoldopam
38
What are the adverse effects of aldosterone antagonists
hyperkalemia, gynecomastia
39
What is the final site of NaCl absorption and K secretion?
collecting duct
40
Which class of diuretics potentiates NMBs?
Loop Diuretics, thiazide diuretics
41
The inhibition of carbonic anhydrase leads to what?
decreased reabsorption of Na, HCO3 and water
42
How do loop diuretics exert their effect?
blocking the Na/K 2Cl cotransporter, reducing the reabsorption of NaCl
43
What part of the kidney are most glucose, bicarb, amino acids, and other metabolites reabsorbed?
Proximal convoluted tubule
44
Which diuretic class is used off label to treat polycystic ovarian syndrome?
aldosterone antagonists
45
What does the stimulation of aldosterone do in the body?
promote reabsorption of Na from the distal convoluted tubule and collecting duct
46
GFR is mainly affected by what?
Cardiac output
47
Which diuretic is a selective D1 agonist with moderate affinity for alpha 2 receptors?
fenoldopam
48
What makes acetazolamide a weak diuretic?
causes water loss in the proximal convoluted tubule. Water can be reclaimed further downstream .
49
Which diuretic can cause cerebral edema if the BBB is not intact?
mannitol
50
Which class of diuretics may result in tolerance to their diuretic effect?
loop diuretics (braking phenomenon)
53
Where is the primary site of action of loop diuretics?
thick ascending limb of the loop of henley.
54
Where do aldosterone antagonists exert their effects?
aldosterone receptor of TUBULAR CELL from the plasma
56
Which loop diuretic is metabolized by the liver, 2x potency of furosemide, and longer duration?
torsemide
57
What drugs are in the class of loop diuretics?
Furosemide, bumetanide, torsemide, ethacrynic acid
58
How do dopamine agonists work?
increase cAMP, resulting in inhibition of the Na-H exchange and the Na/K ATPase pump
59
What are the only diuretics that do not need to reach the renal tubule to exert their effects? What is their class?
spironolactone and eplerenone (aldosterone antagonists)
60
Prostaglandins, ANP, and kinins leads to renal dilation leading to increased...
blood flow, GFR, urine output, and Na excretion
61
What are side effects of loop diuretics?
hypoK, ototoxicity, metabolic alkalosis. | Also: hypoNa, hypoCl, hypoMg, dehydration, gout,
62
What are the side effects of acetazolamide?
hypokalemia, hyphosphatemia, metabolic acidosis, fatigue, depression, paresthesias, hepatic encephalopathy
63
Which drugs are pteridine analogs?
triamterene, amiloride
64
What do potassium sparing diuretics do?
decrease Na reabsorption without increasing K excretion
65
What is the dose of furosemide?
0. 5-1mg/kg IV | 0. 1-0.3 if used with mannitol
66
What regulates calcium reabsorption in the distal convoluted tubule?
Parathyroid Hormone
66
What is the volume of collective filtrate formed over time
GFR
67
What autoregulates the afferent and efferent arterioles to either dilate or constrict
Macula Densa cells in the distal convoluted tubules
68
What are the most potent diuretics?
loop diuretics
69
What are the two types of potassium sparing diuretics?
pteridine analogs | aldosterone antagonists
71
How do pteridine analogs work?
prevent Na reabsorption in the cortical collecting duct by blocking epithelial Na channels
72
Which loop diuretic has extensive protein binding?
furosemide
73
What is the primary sites for Na, K and water transport
principle cell of the collecting duct
74
Which diuretics cause alkalosis?
Loop diuretics, thiazides
75
Which diuretics cause acidosis?
carbonic anhydrase inhibitors, K sparing diuretics
76
Which pteridine is more potent?
amiloride
77
Where do potassium sparing diuretics work?
collecting duct
79
What type of electrolytes do loop diuretics increase excretion of?
Mg, Ca, NaCl
80
Furosemide causes nephrotoxicity when given with which drugs?
aminoglycoside antibiotics (gentamicin, streptomycin, amikacin, neomycin)
81
How do vasopressin receptor antagonists work?
inhibit V2 receptors in the collecting ducts leading to decreased water reabsorption
82
Aldosterone regulates what type of channels in the collecting duct?
epithelial Na channel
83
Which class of diuretics are used for long term treatment of HTN by producing vasodilation?
thiazide diuretics
84
Osmotic diuretics cause higher osmolality of tubular fluid leading to what effects?
inhibits water reabsorption, promoting diuresis
85
what is the primary site for H and bicarb secretion?
intercalated cells of the collecting duct
85
What stimulates the release of aldosterone?
ACTH
86
Which type of patients should mannitol be avoided in, due to adverse effects causing the same thing?
heart failure, and pulmonary edema
87
Thiazide diuretics, paired with Beta antagonists leads to what?
hyperglycemia
88
How do osmotic diuretics lead to diuresis?
increase plasma osmolality; pulling fluid from the extracellular fluid into the intravascular space
89
How much of cardiac output do the kidneys receive?
20-25%, 90% to the cortex, 10% to the medulla
89
Where do thiazide diuretics exert their effects?
distal convoluted tubule | ascending loop of henley
90
Which diuretic class is used to treat Calcium containing renal calculi?
thiazide diuretics
91
where is 65% of filtered Na and water reabsorbed
proximal convoluted tubule
92
What effects does Mannitol have?
decrease ICP and IOP | increase RBF and UO
93
Where do Thiazide diuretics work?
distal convoluted tubule
93
SNS activation decreases what factors related to the kidney?
blood flow, GFR, urine output, and Na retention
93
What is the most important mineralocorticoid in the body
aldosterone
93
Where do carbonic anhydrase inhibitors work?
proximal convoluted tubule
93
What loop diuretic is ok to be used with sulfonamides?
ethacrynic acid
93
Which loop diuretic is 40x more potent than furosemide with less K excretion?
bumetanide
93
What drugs are in the class of thiazide diuretics?
Hydrochlorothiazide, chlorothiazide, chlorthalidone, metolazone
94
What are the carbonic anhydrase inhibitors?
Acetazolamide
95
What is the dose of mannitol?
0.25-1 g/kg
96
Which type of allergy has cross sensitivity to thiazide diuretics?
sulfa allergy - sulfonamide antibiotics
97
Stressors activate the SNS leading to what effects on the kidney?
renal vasoconstriction and Na retention
98
The NaCl exchange by the Na/K 2Cl cotransporter is blocked by which class of diuretics?
Loop Diuretics
99
How do ANP and BNP promote diuresis?
block the basal Na/K ATPase channel in the collecting duct
100
What are uses for loop diuretics?
fluid retention in CHF, pulmonary edema, intraop diuresis
100
Which potassium sparing diuretic has extensive metabolism in the liver and its metabolites potentiates its diuretic effect?
triamterene
100
Where do dopamine agonists work in the kidney?
proximal convoluted tubule and loop of henley
101
which drugs are aldosterone antagonists
spironolactone and epletenone
102
which diuretic is given before aortic clamping above the renal arteries
mannitol

Pharmacology (6 decks)

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