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CVPR Exam I > 21. Diuretics & RAAS Antagonists > Flashcards

21. Diuretics & RAAS Antagonists Flashcards

1
Q

Almost all of glucose, amino acids, NaHCO3, and other metabolites are reabsorbed in the _____.

A

proximal convoluted tubule

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1
Q

Although the Na+-K+-2Cl- cotransporter (NKCC2) is electrically neutral, its action leads to excess intracellular K+ which then back diffuses into lumen creating a lumen positive potential. This potential then drives the reabsorption of _____.

A

cations Mg++ and Ca++

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2
Q

What is aldosterone?

A

major mineralocorticoid- Na+ sparing, K+ wasting

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3
Q

Inhibition of CA by ______ results in retention of HCO3- in lumen (urine) with mild alkaline diuresis.

A

acetazolamide

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4
Q

_____ diuretics are the most efficacious.

A

Loop

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5
Q

Water removal (from lumen) occurs in descending limb as a result of _____ generated in interstitial spaces.

A

hypertonic osmotic forces

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6
Q

What are some important SEs for spironolactone?

A

gynocomastia, hyperkalemia

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7
Q

Water removal (from lumen) occurs in the _____ as a result of hypertonic osmotic forces generated in interstitial spaces.

A

descending limb

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7
Q

Although the _____ is electrically neutral, its action leads to excess intracellular K+ which then back diffuses into lumen creating a lumen positive potential. This potential then drives the reabsorption of cations Mg++ and Ca++.

A

Na+-K+-2Cl- cotransporter (NKCC2)

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7
Q

Tx with loop diuretics and thiazides causes increased plasma concentrations of uric acid, possibly leading to ____.

A

gout

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7
Q

_____ inhibit the Na+/Cl- cotransporter, causing increased urinary secretion of NaCl.

A

Thiazide diuretics

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9
Q

How are neurohormones modulated?

A

RAAS antagonists and Beta-blockers

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9
Q

Most Na+ comes back in at the proximal convoluted tubule, and ____ don’t affect that.

A

diuretics

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10
Q

Thiazide diuretics inhibit the Na+/Cl- cotransporter, causing increased urinary secretion of _____.

A

NaCl

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11
Q

Inhibition of the carbonic anhydrase enzyme depresses NaHCO3 reabsorption in the _____.

A

proximal tubule

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11
Q

Thiazide diuretics inhibit the _____, causing increased urinary secretion of NaCl.

A

Na+/Cl- cotransporter

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12
Q

Inhibition of the _____ enzyme depresses NaHCO3 reabsorption in proximal tubule.

A

carbonic anhydrase

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13
Q

What is the major extracellular cation?

A

Na+

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13
Q

What is the consequence of hypokalemia?

A

more ectopic pacemakers

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15
Q

_____, a diuretic, works by interacting with hormone receptors.

A

Spironolactone

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16
Q

Nearly all diuretic agents exert their effects at _____ surface of renal tubule cells.

A

luminal (urine)

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16
Q

The major use of aldosterone antagonists in HF, even though they are diuretics, is as ____.

A

an anti-remodeling agent

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18
Q

Name a diuretic used to treat HF.

A

Furosemide

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19
Q

Active NaCl reabsorption occurs in the _____ via the Na+-K+-2Cl- cotransporter (NKCC2).

A

ascending limb

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20
Active NaCl reabsorption occurs in ascending limb via the \_\_\_\_\_.
Na+-K+-2Cl- cotransporter (NKCC2)
22
Name 3 Carbonic Anhydrase Inhibitors.
1. Acetazolamide (Diamox) 2. Dorzolamide 3. Brinzolamide
23
What is the consequence of hyperkalemia?
conduction block disorders
23
Aldosterone antagonists tend to be \_\_\_\_\_.
K+ sparing
23
Anti-remodeling occurs by decreasing \_\_\_\_, \_\_\_\_, and \_\_\_\_\_.
hypertrophy, fibrosis, apoptosis
24
When can furosemide be started?
either acutely or chronically
25
Which 2 classes of drugs have anti-remodeling action and are assoc. with decreases in morbidity/mortality?
1. Beta-blockers (beta-1 receptor) 2. ARBs (angiotensin-II receptor)
26
Which diuretic has a SE of ototoxicity?
ethacrynic acid
27
What is the most common s/s for diuretic OD?
dizziness upon standing
28
The _____ decrease Na+ reabsorption, so increased Na+ and water enter the urine.
diuretic agents
29
Almost all of \_\_\_\_\_, \_\_\_\_\_, \_\_\_\_\_, and _____ are reabsorbed in the proximal convoluted tubule.
glucose; amino acids; NaHCO3; other metabolites
31
Sometimes loop diuretics are augmented with a \_\_\_\_\_.
thiazide diuretic
32
What is the common name for furosemide?
Lasix
33
Inhibition of CA by acetazolamide results in retention of HCO3- in lumen (urine) with \_\_\_\_\_\_.
mild alkaline diuresis
33
How is congestion reduced?
diuretics
35
\_\_\_\_ works via osmotic effects that prevent water reabsorption.
Mannitol
36
Are diuretics used chronically or acutely?
both
36
Water removal (from lumen) occurs in descending limb as a result of _____ generated in interstitial spaces.
hypertonic osmotic forces
37
Although the Na+-K+-2Cl- cotransporter (NKCC2) is electrically neutral, its action leads to excess _____ which then back diffuses into the lumen, creating a lumen positive potential. This potential then drives the reabsorption of cations Mg++ and Ca++.
intracellular K+
39
\_\_\_\_\_ tend to be K+ sparing.
Aldosterone antagonists
40
Water removal (from lumen) occurs in the _____ as a result of hypertonic osmotic forces generated in interstitial spaces.
descending limb
42
ACE inhibitors indirectly block the release of aldosterone, so they are \_\_\_\_\_.
K+ sparing
43
What are the K+ sparing diuretics?
Na+ channel blockers and aldosterone antagonists
44
Name 3 goals of heart failure management with pharmacotherapy.
1. reduction of congestion 2. modulate neurohormonal regulation 3. improve flow
45
What are K+ sparing diuretics used for?
anti-fibrotics
46
A true synergistic effect may be achieved with a ____ and a ____ in refractory edema.
thiazide; loop diuretic
48
What diuretic works by inhibiting Na+-K+-ATPase?
none
50
Thiazides increase reabsorption of \_\_\_\_, but loop diuretics decrease serum _____ levels.
Ca++; Ca++
51
Nearly all diuretic agents exert their effects at luminal (urine) surface of \_\_\_\_\_.
renal tubule cells
52
What is often the first tx for HF?
Furosemide
53
How is flow improved?
vasodilators (difficult- usu req mechanical devices or transplantation)
54
\_\_\_\_\_increase reabsorption of Ca++, but _____ decrease serum Ca++ levels.
Thiazides; loop diuretics
55
Most Na+ comes back in at the \_\_\_\_\_, and diuretics don't affect that.
proximal convoluted tubule
56
What is another name for loop diuretics and why?
high ceiling bc they give the maximum efficacy of all diuretics
57
ACE inhibitors indirectly block the release of \_\_\_\_\_, so they are K+ sparing.
aldosterone
59
Inhibition of the carbonic anhydrase enzyme depresses ______ in proximal tubule.
NaHCO3 reabsorption
60
Nearly all _____ agents exert their effects at luminal (urine) surface of renal tubule cells.
diuretic
61
The diuretic agents decrease \_\_\_\_\_\_, so increased Na+ and water enter the urine.
Na+ reabsorption
62
Active ____ reabsorption occurs in ascending limb via the Na+-K+-2Cl- cotransporter (NKCC2).
NaCl
63
What is the major use of _____ in HF, even though they are diuretics, is as an anti-remodeling agent?
aldosterone antagonists
64
\_\_\_\_ and \_\_\_\_, both diuretics, work by interacting with membrane transport proteins.
Thiazides; furosemide
66
Carbonic Anhydrase Inhibitors are used to treat?
Glaucoma, acute mountain sickness
67
What are some SEs for the thiazides?
hypokalemia hyperglycemia gout hyperlipidemia 2a hyperaldosteronism allergic rxns
68
Loop diuretic efficacy is increased with \_\_\_\_.
dietary salt restriction (

CVPR Exam I (29 decks)

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