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C. Year 3: Core Drugs > Diuretics - Loop > Flashcards

Diuretics - Loop Flashcards

1
Q

Where in the kidneys is blood filtered to form the filtrate?

1 - efferent arteriole
2 - afferent arteriole
3 - glomerulus
4 - juxtaglomerular

A

3 - glomerulus

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2
Q

Once the filtrate is formed from the glomerulus, what happens to the fluid as it move through the tubules and out of the collecting duct as urine?

1 - only glucose is reabsorbed
2 - Na+ and K+ only are reabsorbed
3 - lots of ions and fluids are reabsorbed

A

3 - lots of ions and fluids are reabsorbed

  • H2O, ions (K+, Na+, Cl-)
  • what is left is urine
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3
Q

Labels the parts of the renal tubules using the labels below:

1 - loop of henle
2 - distal convoluted tubule
3 - proximal tubule
4 - collecting duct

A

1 - proximal tubule
2 - loop of henle
3 - distal convoluted tubule
4 - collecting duct

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4
Q

Where are ions mainly re-absorbed in the renal system?

1 - loop of henle
2 - distal convoluted tubule
3 - proximal tubule
4 - collecting duct

A

3 - proximal tubule

  • glucose, amino acids, ions, uric acid
  • excretion of phosphate and H+
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5
Q

Water passively follows ion re-absorption in the distal tubules of the renal system, which ion specifically does it follow?

1 - Na+
2 - K+
3 -Cl-
4 - HCO3-

A

1 - Na+
- due to osmosis (H2O dilutes Na+ in blood)

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6
Q

What are diuretics?

1 - drugs that increase water, Na+ and Cl- excretion
2 - drugs that decrease water, Na+ and Cl- excretion
3 - drugs that increase water, K+ excretion
4 -drugs that decrease water, K+ excretion

A

1 - drugs that increase water, Na+ and Cl- excretion

  • reduce fluid retention
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7
Q

Which of the following is not part of the loop of henle?

1 - thin descending loop of henle
2 - u-bend of henle
3 - thin ascending loop of henle
4 - thick ascending loop of henle

A

2 - u-bend of henle

  • does not exist
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8
Q

Loop diuretic have their action by affecting the loop of henle. Specifically which part of the loop of henle do they have have their greatest effect?

1 - thin descending loop of henle
2 - thin ascending loop of henle
3 - thick ascending loop of henle

A

3 - thick ascending loop of henle

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9
Q

The thick ascending loop of henle is impermeable to what?

1 - Na+
2 - K+
3 - Cl-
4 - H2O

A

4 - H2O

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10
Q

The thick ascending loop of henle is impermeable to H2O. What type of channel is on the apical surface (closer to the lumen)?

1 - Na+/K+ ATPase
2 - Na+/K+/2Cl-
3 - Na+
4 - K+/Cl-

A

2 - Na+/K+/2Cl-

  • moves 1 Na+ and K+ and 2 Cl- into the cells down the concentration gradient
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11
Q

The thick ascending loop of henle is impermeable to H2O. Na+/K+/2Cl- channels are present on the apical surface (closer to the lumen) that move 1 Na+ and K+ and 2 Cl-. On the basolateral side of the tubules there is a Na+/K+ ATPase. What does this do?

1 - exchanges 1 Na+ for 1K+
2 - exchanges 2 Na for K+ and 2Cl-
3 - exchanges 3 Na+ for 2 K+
4 - exchanges 2 Cl- for 1 Na+

A

3 - exchanges 3 Na+ for 2 K+

  • requires ATP
  • K+ and Cl- are able to leak back to into the lumen via leak channels
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12
Q

Through the reabsorption of Na+, K+ and Cl- an electrical gradient is generated allowing paracellular reabsorption of which 2 ions?

1 - Ca2+
2 - Cl-
3 - Mg2+
4 - Zinc

A

1 - Ca2+

3 - Mg2+

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13
Q

Which 2 of the following are the loop diuretics that we need to be aware of?

1 - Bumetanide
2 - Furosemide
3 - Indapamide
4 - Bendroflumethiazide

A

1 - Bumetanide
2 - Furosemide

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14
Q

Bumetanide and Furosemide are the loop diuretics that we need to be aware of. What is the mechanism of action of these drugs?

1 - inhibit Na+/K+ ATPase
2 - inhibit leaky K+/Cl- channels
3 - inhibit Na+ channels on arteries
4 - inhibit Na+/K+/2Cl- channels

A

4 - inhibit Na+/K+/2Cl- channels

  • Na+, K+ and Cl- are excreted
  • Ca2+ and Mg2+ are also excreted
  • H2O follows the Na+
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15
Q

Which of the following is NOT increased in the excretion found in the urine?

1 - Na+
2 - K+
3 - Ca2+ and Mg2+
4 - glucose
5 - Cl-

A

4 - glucose

  • remember ‘Loops Loose Calcium’
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16
Q

In addition to inhibiting the Na+/K+/2Cl- channels in the thick ascending loop of henle, loop diuretics Bumetanide and Furosemide have a second mechanism, what is this?

1 - vasoconstrict the efferent arteriole via prostaglandin release
2 - vasoconstrict the afferent arteriole via prostaglandin release
3 - vasoconstrict the efferent arteriole via prostaglandin release
4 - vasodilate the efferent arteriole via prostaglandin release

A

4 - vasodilate the efferent arteriole via prostaglandin release

  • increases renal plasma flow
  • increases eGFR
  • this increases further loss of - Na+, K+, Cl-, Ca2+, Mg2+ and H2O
17
Q

Loop diuretics, Bumetanide and Furosemide, have 2 mechanisms:

  • inhibiting the Na+/K+/2Cl-
  • vasodilate the efferent arteriole via prostaglandin release

Which drug class can cause a dampening of this prostaglandin release, and this attenuate the effect of loop diuretcis?

1 - Antiarrhythmics
2 - NSAIDs
3 - anti-hypertensives
4 - Anticoagulants

A

2 - NSAIDs

18
Q

Which of the following is indicated alongside oxygen and nitrates in the treatment breathlessness in acute pulmonary oedema?

1 - Bumetanide or Furosemide
2 - Doxazosin
3 - Amlodipine
4 - Ramipril

A

1 - Bumetanide or Furosemide

  • also though to dilate capacitance veins, reducing preload and improving cardiac function
19
Q

Loop diuretics, Bumetanide and Furosemide are indicated in 2 of the following, which 2?

1 - chronic heart failure
2 - 1st line anti-hypertension
3 - adrenal insufficiency
4 - renal and/or liver failure

A

1 - chronic heart failure
4 - renal and/or liver failure

  • BOTH can cause fluid overload
20
Q

Which of the following is NOT an adverse effect of loop diuretics?

1 - hypotension
2 - low electrolyte state
3 - hyponatraemia
4 - hearing loss/tinnitus
5 - cardiac arrhythmias

A

5 - cardiac arrhythmias

  • hypotension and low electrolyte state due to excretion
  • hyponatraemia is most common, but if too much water is lost it can lead to hypernatraemia
21
Q

Loop diuretics, Bumetanide and Furosemide are contradicted in which 2 of the following:

1 - severe hypovolemia
2 - severe dehydration
3 - peripheral oedema
4 - nephrotic syndrome

A

1 - severe hypovolemia
2 - severe dehydration

22
Q

Loop diuretics, Bumetanide and Furosemide should be used with caution with all of the following except?

1 - hypokalaemia
2 - hyponatraemia
3 - glaucoma
4 - hepatic encephalopathy

A

3 - glaucoma

  • low K+ can worsen hepatic encephalopathy and induce a coma
23
Q

Patients with gout should avoid the chronic use of loop diuretics, Bumetanide and Furosemide, why?

1 - K+ inhibits uric acid formation
2 - K+ inhibits crystal formation
3 - low H2O increases concentration of uric acid
4 - increased uric acid reabsorption

A

4 - increased uric acid reabsorption
- low circulating fluids can increase uric acid re-absorption in proximal tubules
- hypovolaemic patients can therefore have gout attacks due to increased uric acid re- absorption

24
Q

Can loop diuretics, Bumetanide and Furosemide, increase or decrease lithium levels?

A
  • increases
  • due to reduced excretion
25
Q

Can loop diuretics, Bumetanide and Furosemide, increase or decrease the risk of toxicity of digoxin?

A
  • increase risk of toxicity
  • less is filtered out of the kidneys
26
Q

Loop diuretics, Bumetanide and Furosemide, can increase ototoxicity and nephrotoxitiy of which drug due to lower excretion levels?

1 - Gentamicin
2 - Co-Amoxiclav
3 - Amlodipine
4 - Spironolactone

A

1 - Gentamicin

  • common side effect of this drug, so if it is not being excreted then more will increase the risk of side effects
27
Q

What is the most important to monitor in patients who are prescribed loop diuretics, Bumetanide and Furosemide?

1 - U&Es
2 - FBC
3 - eGFR
4 - LFTs

A

1 - U&Es

  • important to monitor Na+, K+, Cl-, Ca2+ and Mg2+ levels

C. Year 3: Core Drugs (125 decks)

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