Diuretics and Antidiuretics

Question 1

Carbonic anhydrase (CAse) inhibitors

Answer 1

Acetazolamide

Question 2

Acetazolamide

Answer 2

Inhibits carbonic anhydrase in PCT

Cause alkaline diuresis

Hpehloei etaoli aidosis

Question 3

Ciliary body of eye

Answer 3

Secrets HCO3- into the aqueous humor (CAse is required)

Question 4

Choroid plexus

Answer 4

Secrets HCO3- into the CSF (CAse is required)

Question 5

Carbonic anhydrase (CAse) inhibitors Indications

Answer 5

Glaucoma
** dorzolamide & brinzolamide **

Acute mountain sickness

Urinary alkalization

Metabolic alkalosis

Question 6

Carbonic anhydrase (CAse) inhibitors Adverse Effects

Answer 6

Hyperchloremic metabolic acidosis

• Renal stones
• Hypokalemia

Hypersensitivity reactions

Question 7

Carbonic anhydrase (CAse) inhibitors Contraindications

Answer 7

*hepatic cirrhosis

Question 8

Loop diuretics (High ceiling diuretics)

Answer 8

Furosemide

Question 9

Furosemide

Answer 9

inhibit Na+/K+/2Cl- co-transport in the thick ascending limb of loop of Henle ->
abolition of lumen positive potential

Most efficacious diuretics

*** increase renal blood flow (due to PG synthesis)

↑ loss of Mg++ & Ca++

Question 10

Loop diuretics (High ceiling diuretics) Indications

Answer 10

Acute pulmonary edema

Edema due to acute left ventricular failure

Acute renal failure

Hypercalcemia

Anion overdose

Question 11

Loop diuretics (High ceiling diuretics) Side Effects

Answer 11

Hypokalemic metabolic alkalosis

Ototoxicity

Hyperuricemia

Hypocalcemia

Hypomagnesemia

Allergic reactions (skin rash, eosinophilia, interstitial nephritis)

Other toxicities

• severe dehydration
• hyponatremia

Question 12

Thiazides

Answer 12

Hydrochlorothiazide, chlorothiazide

Question 13

Hydrochlorothiazide, chlorothiazide

Answer 13

Block Na+/Cl- co-transport in DCT

↑ Ca++ reabsorption

↑ uric acid level

Question 14

Thiazides Indications

Answer 14

Hypertension

Heart failure

Nephrolithiasis (due to idiopathic hypercalciuria)

Nephrogenic diabetes insipidus

Question 15

Thiazides Adverse Effects

Answer 15

Hypokalemic metabolic alkalosis

Hyperuricemia

Impaired carbohydrate tolerance- *hyperglycemia

*Hyperlipidemia

Allergic reactions- photosensitivity, hemolytic anemia, thrombocytopenia 7.

weakness, fatigability & parasthesia

Question 16

Potassium sparing diuretics

Answer 16

Antagonize the effects of aldosterone at distal and cortical collecting tubule

antagonism: spironolactone & eplerenone

inhibits Na influx: amiloride & triamterene

Question 17

Spironolactone

Answer 17

synthetic steroid

competitive antagonist of aldostereone

Question 18

Eplerenone

Answer 18

spironolactone analog with greater selectivity for the aldosterone receptor

** used for treatment of HTN

Question 19

Triamterene and amiloride

Answer 19

Do not block aldosterone receptor instead they directly interfere with Na+ entry

Question 20

Indications of K+ sparing diuretics

Answer 20

• Mineralocorticoid (aldosterone) excess
• Hypertension (along with thiazides)
• Edematous conditions (heart failure, hepatic cirrhosis)

Question 21

Side effects of K+ sparing diuretics

Answer 21

• Hyperkalemia
• Metabolic acidosis
• Gynecomastia (only with spironolactone)

Question 22

Osmotic diuretics

Answer 22

mannitol

Question 23

mannitol

Answer 23

Proximal tubule and descending limb of loop of Henle

NOT ABSORBED ORALLY

↓ intracranial pressure

Question 24

Osmotic diuretics Indications

Answer 24

reduce intracranial (in cerebral edema) & intraocular pressure (in glaucoma)

increase urine volume

Question 25

Osmotic diuretics Side effects

Answer 25

can complicate heart failure, may produce pulmonary edema (mannitol is contraindicated in pulmonary edema and edema due to heart failure) dehydration and hypernatremia

Question 26

Vasopressin

Answer 26

luminal water channel, AQP2

Question 27

ADH agonists

Answer 27

Desmopressin (V2 selective), Vasopressin, Terlipressin, Lypressin (PRESSIN)

Question 28

ADH antagonists

Answer 28

Conivaptan, Tolvaptan Demeclocycline & Lithium

Question 29

V1a receptors

Answer 29

blood vessels vasoconstrictor GPCR -> IP3/DAG

Question 30

V2 receptors

Answer 30

GPCR -> adenylyl cyclase vasodilator ↑water permeability in distal kidney tubules

Question 31

___ receptors are more sensitive to ADH

Answer 31

V2

Question 32

vasopressin on platelet agregation

Answer 32

release of coagulation factor VIII & von Willebrand factor (V2 action)

Question 33

V1 receptor uses

Answer 33

Bleeding esophageal varices- vasopressin

Question 34

V2 receptor uses

Answer 34

Diabetes insipidus (DI) Hemophilia, von Willebrand disease

Question 35

Vasopressin antagonists (DLC)

Answer 35

demeclocyline lithium conivaptan in hyponatremia, used to treat: liver cirrhosis SIADH