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3b_Boards - SketchyPharm > (2) CV & Renal: Diuretics (2.1-2.4) > Flashcards

(2) CV & Renal: Diuretics (2.1-2.4) Flashcards

1
Q

What part of the nephron do Acetazolamide and Mannitol act on?

A

PCT

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2
Q

Is the renal tubule Na+/K+ ATPase located on the apical or basolateral membrane?

A

Basolateral

(Yellow tract is tubular lumen, gray track is intracellular compartment)

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3
Q

Is the renal tubule Na+/H+ exchanger located on the apical or basolateral membrane?

A

Apical

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4
Q

What reaction does carbonic anhydrase in the renal tubule catalyze?

A

HCO3- + H+ → H2O + CO2

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5
Q

What reaction does intracellular carbonic anhydrase catalyze in the renal tubule?

A

H2O + CO2 → H+ + HCO3-

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6
Q

MOA: Acetazolamide

A

Inhibits carbonic anhydrase

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7
Q

Name 3 effects Acetazolamide has on renal electrolyte concentrations

A

(1) ↑ HCO3-
(2) ↑ Na+
(3) ↑ K+
* (↓ CA ⇒ ↓ Intracellular H+ ⇒ Inhibition of Na+/H+ exchanger ⇒ ↑ lumenal [Na+])*

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8
Q

What acid/base disorder does Acetazolamide cause?

A

Normal anion gap metabolic acidosis

(Remember, anion gap acidosis is due to the production of volatile organic acids such as in diabetic ketoacidosis)

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9
Q

Indications - Non-diuretic (3) : Acetazolamide

A

(1) Glaucoma
(2) Idiopathic intracranial hypertension
(3) Mountain sickness
* (Alkalinization of urine also treats gout and cystinuria by ↑ crystal solubility)*

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10
Q

What type of renal tubular acidosis does Acetazolamide cause?

A

Type II

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11
Q

Acetazolamide promotes the precipitation of what type of kidney stone?

A

Calcium phosphate

(Tubular alkalinization shifts the HPO42- ↔ PO43- + H+ to the right ∴ ↑ [PO43-] ∴ ↑ Ca3(PO4)2 solubility product ⇒ Precipitation)

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12
Q

Which diuretics are Sulfa drugs?

A

(1) Acetazolamide
(2) Loop diuretics
(3) Thiazide diuretics
* (Note: Ethacrynic acid is a loop diuretic but NOT a Sulfa drug)*

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13
Q

MOA: Mannitol

A

Osmotic diuretic

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14
Q

Indications (2) : Mannitol

A

(1) ↑ Intracranial pressure
(2) ↑ Intraocular pressure

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15
Q

Adverse Effects (3) : Mannitol

A

(1) Pulmonary edema
(2) Exacerbate heart failure
(3) Altered Na+ levels
* (↑ Serum osmolarity draws fluid from CSF/eyes, but this can dilute serum sodium and increase cardiac afterload)*

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16
Q

Does Mannitol cause hyper or hyponatremia?

A

Either, depending on the situation

  • (↑ Solute in serum ⇒ ↑ Osmotic draw from ECF ⇒ Dilution and hyponatremia)*
  • (↑ Solute in urine ⇒ ↑ Osmotic draw in tubular fluid ⇒ ↑ Water excretion ⇒ Concentration and hypernatremia)*
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17
Q

Which segment of the nephron is most impermeable to water?

A

Thick ascending loop of Henle

(Note: DCT is relatively impermeable to water as well)

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18
Q

What transporter do loop diuretics inhibit?

A

Na+/K+/2Cl- Cotransporter

(On the lumenal membrane)

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19
Q

MOA: Furosemide

A

Inhibits Na+/K+/2Cl- Cotransporter

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20
Q

MOA: Ethacrynic acid

A

Inhibits Na+/K+/2Cl- Cotransporter

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21
Q

What ions do loop diuretics promote excretion of indirectly?

A

(1) Mg2+
(2) Ca2+

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22
Q

Do loop diuretics have a larger effect on serum Mg2+ or Ca2+?

A

Mg2+

(Ca2+ levels are corrected by ↑ intestinal absorption due to Vitamin D, ↑ renal absorption due to PTH)

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23
Q

Which class of diuretics induce the expression of COX-2?

A

Loop diuretics

24
Q

Which class of pain medication can interfere with loop diuretics?

A

NSAIDs

25
Q

Indications (3) : Loop diuretics

A

(1) Pulmonary edema/CHF
(2) Ascites
(3) Hypertension
* (Also useful in hypercalcemia)*

26
Q

Which class of diuretics are the first-line treatment for pulmonary edema secondary to heart failure?

A

Loop diuretics

(∵ They are the most efficacious. Also note the #1 on the balloon)

27
Q

Are loop diuretics potassium wasting?

A

Yes

(Inhibition of Na+/K+/2Cl- cotransporter ⇒ ↑ lumenal Na+ concentration and ∴ increased activity of Na+/K+ ATPase)

28
Q

Adverse Effects (5) : Loop diuretics

A

(1) Ototoxicity
(2) Sulfa allergy
(3) Interstitial nephritis
(4) Hyperuricemia
(5) Contraction alkalosis

29
Q

Name a loop diuretic that is NOT a Sulfa drug

A

Ethacrynic acid

30
Q

Where do thiazide diuretics act?

A

Distal convoluted tubule

31
Q

MOA: Thiazide diuretics

A

Inhibits NaCl cotransporter

(In DCT)

32
Q

What is the difference in the mechanism of Ca2+ reabsorption in DCT vs. TAL?

A

(1) DCT: Active transport
(2) TAL: Driven by (+) lumenal voltage

33
Q

What effect do thiazide diuretics have on Ca2+ reabsorption?

A

Increase

(Contrast with loop diuretics)

34
Q

Indications (5) : Thiazides

A

(1) Hypertension
(2) Heart failure
(3) Nephrogenic diabetes insipidus
(4) Ca2+ stones
(5) Osteoporosis

35
Q

Adverse Effects (7) : Thiazides

A

(1) Hypercalcemia
(2) Hyperglycemia
(3) Hyperlipidemia
(4) Hyperuricemia
(5) ↑ Serum Li+
(6) Hyponatremia
(7) Hypokalemia
* (“Hydrochlorothiazide at the high dive makes a lot of labs high!”)*

36
Q

Which part of the renal tubule do K+ sparing diuretics act on?

A

Collecting duct

37
Q

What part of the renal tubule does Aldosterone act on?

A

Collecting duct

38
Q

Which cell regulates Na+/K+/H2O reabsorption in the collecting duct?

A

Principal cell

39
Q

Where is ENaC located?

A

Apical collecting duct membrane

40
Q

What drives K+ secretion in the collecting duct?

A

(-) Lumenal voltage

(Na+ reabsorption ⇒ (-) Lumenal voltage ⇒ Pulls K+ through channels)

41
Q

What cell is responsible for H+ secretion in the collecting duct?

A

α-intercalated cells

(α for αcid)

42
Q

Name 4 ion transporters in the collecting duct upregulated by Aldosterone

A

(1) K+ channels
(2) ENaC
(3) Na+/K+ ATPase
(4) H+ ATPase

43
Q

Which K+ sparing diuretics directly inhibit Na+ channels?

A

(1) Amiloride
(2) Triamterene

44
Q

MOA (2) : K+ sparing diuretics

A

(1) Inhibit ENaC
(2) Antagonize aldosterone receptor
* (∴ Prevents generation of negative lumenal potential and ∴ K+ wasting)*

45
Q

What ENZYME does Spironolactone inhibit?

A

17α-hydroxylase

46
Q

Name 2 mineralcorticoid receptor antagonists

A

(1) Eplerenone
(2) Spironolactone

47
Q

Other than Spironolactone, what can be used to treat the symptoms of Conn’s syndrome?

A

Eplerenone

48
Q

What are two classes of diuretics which prevent cardiac remodeling and improve outcomes in heart failure?

A

(1) Aldosterone receptor antagonists
(2) ACE Inhibitors
* (Theme: ↓ Aldosterone Fx ⇒ ↑ Survival)*

49
Q

Which class of antidiuretics are useful in Liddle’s syndrome?

A

K+ sparing diuretics

  • (Specifically, ones that target ENaC)*
  • Recall: Liddle’s syndrome is overactive ENaCs*
50
Q

Adverse Effects (2) : K+ sparing diuretics

A

(1) Hyperkalemia
(2) Normal anion gap metabolic acidosis

51
Q

What type of renal tubular acidosis do K+ sparing diuretics cause?

A

Type 4

52
Q

What is the only cause of type 4 renal tubular acidosis associated with hyperkalemia?

A

K+ sparing diuretics

53
Q

Name 4 side effects of Spironolactone which distinguish it from other K+ sparing diuretics

A

(1) Inhibits 17α-hydroxylase
(2) Inhibits androgen receptor
(3) ⇒ Gynecomastia
(4) ⇒ Impotence

54
Q

What diuretic can be used to treat polycystic ovarian syndrome (PCOS)?

A

Spironolactone

55
Q
A

3b_Boards - SketchyPharm (32 decks)

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