Theme 3 - Part III

Question 1

Diuretic use

Answer 1

Reduce Na+ reabsorption (filtrate) and Increase water loss

Nephron cells, modify filtrate

Question 2

Diuretic side effects [5]

Answer 2

Hypertension
Chronic HF
Liver Cirrhosis
Renal Disease Premenstrual/toxic oedema

Question 3

Carbonic anhydrase inhibitor

Answer 3

Proximal Tubule

Question 4

Osmotic diuretic

Answer 4

Desc LOH

Question 5

Loop diuretic

Answer 5

Asc LOH

Question 6

Thiazide (+ like) diuretic

Answer 6

Early DT

Question 7

Potassium-sparing aldosterone antagonist

Answer 7

Late DT

Question 8

Potassium-sparing non-aldosterone antagonist

Answer 8

Early collecting tubule

Question 9

Loop diuretic [3]

Answer 9

Inhibit Na+K+2Cl- cotransport in THICK ASC

Reduce reabsorption of Na+, K+ and Cl- (200->1,200ml over 3hr)

Oral 60 mins (4-6hrs)
IV 5mins (2 hrs)
IM 30mins

Question 10

Loop diuretic uses [6]

Answer 10

Acute PO 
Chronic HF
Liver Cirrhosis 
Resistant hypertension 
Nephrotic syndrome 
Acute renal failure

Question 11

Loop diuretic side effects [4]

Answer 11

Dehydration
Plasma K+ loss - Hypokalaemia
Deafness

Increase delivery of Na+ to DT for K+

Question 12

Thiazide diuretic use [4]

Answer 12

Act on distal tubule -> inhibit apical Na+/Cl- cotransporter

Hypertension
Oedema
Mild HF

Question 13

Thiazide diuretic side effect [4]

Answer 13

Plasma K+ depletion
Metabolic Alkalosis
Hyperglycaemia
Increase Plasma Cholesterol/uric acid

Question 14

Mild hypokalaemia [4]

Answer 14

Fatigue
Deafness
Dizziness
Muscle weakness

Question 15

Severe hypokalaemia [3]

Answer 15

Abnormal heart rhythm
Muscle paralysis
Death

Question 16

Potassium sparing [4]

Answer 16

Act on DT - inhibit reabsorption of Na+

Aldosterone antagonist: Eplerenone and spironolactone

Non-aldosterone antagonist:
Amiloride and triamterene

Question 17

Eplerenone and spironolactone uses

Answer 17

Metabolised to canrenone
Competitive antagonist of aldosterone
Reduce Na+ channel formation

• HF and oedema

Question 18

Eplerenone and spironolactone side effects [4]

Answer 18

Hyperkalaemia
Metabolic acidosis
GI upset
Gynaecomastia

Question 19

Amiloride and triamterene use

Answer 19

Distal tubule to inhibit Na+ reabsorption and decrease K+ excretion

Block luminal Na+ channel

Question 20

Amiloride and triamterene side effects [4]

Answer 20

Hyperkalaemia
Metabolic acidosis
GI disturbances
Skin rash

Question 21

Carbonic anhydrase inhibitor [3]

Answer 21

Acetozolamide block NaHCO3 reabsorption in PT

Gluacoma and epilepsy treatment

Metabolic acidosis and enhanced renal stone formation

Question 22

Osmotic diuretic [4]

Answer 22

Mannitol - solute undergoes glomerular filtration

30-60mins and persists 6-8hrs

Treat raised intercranial pressure and intraoccqular pressure

Hypertensive properties

Question 23

ADH antagonists

Answer 23

Two nonselective agents (orally active)

- Lithium (Li+) and demeclocycline. Also Amphotericin B

Question 24

ADH antagonist side effects

Answer 24

Can cause diabetes insipidus

Renal failure reported for both Li+ and demeclocycline

Li+ can cause tremors, mental confusion, cardiotoxicity, thyroid dysfunction and
leukocytosis

Demeclocycline shouldn’t be used in patients with liver disease

Question 25

Tolvaptan

Answer 25

V2 receptor antagonist, for treatment of hyponatriuraemia – decreased ECV leads to increased plasma [Na+]

Question 26

Xanthines [3]

Answer 26

Weak diuretic (Increase cardiac output)

Vasodilate glomerular afferent arteriole

Increased renal and glomerular blood flow