Exam 2: Diuretics

Question 1

What are the conditions that promote the development of edema?

Answer 1

• Altered blood circulation
• Altered blood composition
• inadequate lymphatic drainage

Question 2

Where does potassium reabsorption occur?

Secretion?

Answer 2

Reabsorption at the proximal tubule

Secretion at the distal tubule and collecting duct

Question 3

How do thiazide diuretics affect calcium reabsorption?

Answer 3

Increased calcium reabsorption

Question 4

How do loop diuretics affect calcium and Mg excretion?

Answer 4

Increase calcium and magnesium excretion

Question 5

Acidic drugs compete for ** excretion, leading to a ** attack.

Answer 5

Uric acid

Gouty

Question 6

What 3 drugs are carbonic anhydrase inhibitors?

Answer 6

Acetazolamide, Dorzolamide, and Brinzolamide

Question 7

What is the MOA of Carbonic anhydrase inhibitors?

Answer 7

-Inhibits the CA enzyme and blocks Bicarb production. This leads a decreased availability of H+ for exchange with Na+, resulting in increased Na+ loss

Question 8

What are the indications for CA inhibitors?

Answer 8

• Glaucoma
• Alkaline urine
• Alkalosis

Question 9

What are the adverse effects of CA inhibitors?

Answer 9

• Hyperchloremic metabolic acidosis
• Hypokalemia
• Hyperuricemia
• Renal stones

Question 10

What are the contraindications with CA inhibitors?

Answer 10

• Hepatic cirrhosis

- sulfa hypersensitivity

Question 11

What are the two loop diuretics?

Answer 11

Furosemide and Ethacrynic acid

Question 12

What is the MOA of loop diuretics?

Answer 12

• Block the NCKK2 transporters, impairing the concentration and diluting function of the kidney.
• Induce kidney PGs, to decrease salt transport and to Vasodilate

Question 13

What are the indications for loop diuretics?

Answer 13

• HF
• Pulmonary edema
• Hypercalcemia
• Works well at low GFR

Question 14

How do loop diuretics relieve pulmonary edema?

Answer 14

Relieve pulmonary congestion by increasing systemic venous capacitance

Question 15

How do loop diuretics treat hypercalcemia?

Answer 15

Loops decrease reabsorption of Mg and Ca by reducing the K+ gradient

Question 16

What are the adverse effects of loop diuretics?

Answer 16

• Hypokalemia metabolic alkalosis
• Hypochloremia
• Hypocalcemia and Hypomagnesemia
• Hyperuricemia
• Irreversible ototoxicity

Question 17

What are the contraindications of loop diuretics?

Answer 17

• Sulfa hypersensitivity
• Aminoglycosides (enhanced ototoxicity)
• Digoxin (loss of K increases toxicity)

Question 18

What is the main difference between furosemide and ethancrynic acid?

Answer 18

Ethacrynic acid is not a sulfa derivative and can be used in people allergic to sulfa
-Also has the highest risk of ototoxicity

Question 19

What drug us a thiazide diuretic and what drugs are compounds related to thiazides?

Answer 19

• Thiazide (HCTZ)

- Related compounds: Metalazone and indapamide

Question 20

What is the MOA of thiazide diuretics?

Answer 20

Inhibition of sodium reabsorption at the early distal tubule by inhibiting the Na/Cl co transporter

Question 21

What are the indications for thiazide diuretics?

Answer 21

• HTN (causes relaxation of smooth muscle and vasodilation)
• HF
• Nephrolithiasis
• Nephrogenic DI

Question 22

What are the adverse effects of thiazide diuretics?

Answer 22

Reduced insulin secretion, Hypokalemia metabolic alkalosis, Hyperuricemia, magnesium loss, hyperglycemia, and elevated serum lipids

Question 23

How do Thiazide diuretics decrease calcium secretion?

Answer 23

• Increase activity of PTH dependent Ca channels
• Not due to PTH, but due to increased luminal Na which leads to increase in cell membrane potential and increased Ca reabsorption

Question 24

What is different about Indapamide compared to the other thiazides?

Answer 24

Indapamide is excreted by biliary system and is useful in patients with renal insuffiency

• Does not cause increased plasma lipids
• Vasodilation

Question 25

What are the contraindications for thiazides?

Answer 25

- Sulfa hypersensitivity - Hypokalemia can precipitate digitalis toxicity - diabetics, hyperglycemia and carbohydrate intolerance may occur - Lithium toxicity

Question 26

Which thiazide diuretic works with a reduced GFR?

Answer 26

Metalazone

Question 27

What are the two classes of Potassium sparing diuretics?

Answer 27

- Aldosterone antagonists | - Direct inhibitors of Na+ flux

Question 28

What kind of drug is spironolactone?

Answer 28

Aldosterone antagonists

Question 29

What is the MOA of aldosterone antagonists?

Answer 29

1) competitive inhibitor of aldosterone, which promotes the excretion of N and retention of K at the late distal tubule and collecting duct

Question 30

What are the indications for spironolactone?

Answer 30

- edema associated with HF, cirrhosis, and nephrotic syndrome - Most effective drug for treating hyperaldosteronism

Question 31

What are the adverse effects of spironolactone?

Answer 31

- Relatively few, occasional GI upset, nausea, vomiting - Gynecomastia (androgen receptor antagonist - Occasional hyperkalemia

Question 32

What are the contraindications for spironolactone?

Answer 32

Hyperkalemia, chronic renal insuffiency, and liver damage

Question 33

What kind of drug is eplerenone?

Answer 33

Aldosterone antagonist

Question 34

What is the MOA of eplerenone?

Answer 34

-Same as spironolactone effects at the aldosterone receptor, but less incidence of endocrine related side effects

Question 35

What kind of drugs are amiloride and triamterene?

Answer 35

Potassium sparing diuretics that are direct inhibitors of Na flux

Question 36

What is the MOA of Amiloride and triamterene?

Answer 36

-Inhibit the Na/K ion exchange independently of aldosterone, leading to decreased K excretion

Question 37

What is the main use of potassium sparing diuretics?

Answer 37

Combination with K losing diuretics

Question 38

What is the DOC or Li+ induced DI?

Answer 38

amiloride

Question 39

What are the adverse effects of potassium sparing diuretics?

Answer 39

- Hyperkalemia | - nausea, vomiting, leg cramps, dizziness

Question 40

What are the 4 osmotic diuretics?

Answer 40

Mannitol, isosorbide, Glycerin, and urea

Question 41

What are the indications for osmotic diuretics?

Answer 41

- prophylaxis of acute renal failure - decrease IOP - decreased ICP - Protect kidney

Question 42

What is the contraindication for osmotic diuretics?

Answer 42

HF

Question 43

What is desmopressin and what is it used for?

Answer 43

Synthetic ADH used to treat central DI

Question 44

What kind of drug is conivaptan?

Answer 44

ADH antagonist

Question 45

What are the indications for conivaptan?

Answer 45

-treatment of euvolemic or hypervolemic hyponatremia in hospitalized patients (increases Na concentrations and increases free H20 clearance)

Question 46

Wha are the adverse effects of Conivaptan?

Answer 46

Hypokalemia - injection site reactions - orthostatic hypotension

Question 47

What is the contraindication to conivaptan?

Answer 47

Hyponatremia associated with hypovolemia

Question 48

What kind of drug is tolvaptan?

Answer 48

ADH antagonist that is similar to conivaptan, but it is a non-peptide V2 vasopressin receptor antagonist

Question 49

Why do CA inhibitors cause Hyperchloremia?

Answer 49

Na+ loss is in the form of NaHCO3 instead of NaCl

Question 50

Why are CA inhibitors not used for long term therapy?

Answer 50

The effectiveness of the drug decreases in a few days because accumulation of H+ within the tubule from normal metabolic processes allows the Na/H exchange to take place again, preventing the diuretic effect

Question 51

What is the MOA of osmotic diuretics?

Answer 51

Filtered, but not reabsorbed by the kidney. Keeps water in the tubules and produces diuresis

Question 52

What is the MOA of Conivaptan?

Answer 52

Non-peptide V1a and V2 receptor antagonist