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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
Q

Active NaCl reabsorption occurs in ascending limb via the _____.

A

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

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22
Q

Name 3 Carbonic Anhydrase Inhibitors.

A
  1. Acetazolamide (Diamox) 2. Dorzolamide 3. Brinzolamide
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23
Q

What is the consequence of hyperkalemia?

A

conduction block disorders

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23
Q

Aldosterone antagonists tend to be _____.

A

K+ sparing

23
Q

Anti-remodeling occurs by decreasing ____, ____, and _____.

A

hypertrophy, fibrosis, apoptosis

24
Q

When can furosemide be started?

A

either acutely or chronically

25
Q

Which 2 classes of drugs have anti-remodeling action and are assoc. with decreases in morbidity/mortality?

A
  1. Beta-blockers (beta-1 receptor) 2. ARBs (angiotensin-II receptor)
26
Q

Which diuretic has a SE of ototoxicity?

A

ethacrynic acid

27
Q

What is the most common s/s for diuretic OD?

A

dizziness upon standing

28
Q

The _____ decrease Na+ reabsorption, so increased Na+ and water enter the urine.

A

diuretic agents

29
Q

Almost all of _____, _____, _____, and _____ are reabsorbed in the proximal convoluted tubule.

A

glucose; amino acids; NaHCO3; other metabolites

31
Q

Sometimes loop diuretics are augmented with a _____.

A

thiazide diuretic

32
Q

What is the common name for furosemide?

A

Lasix

33
Q

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

A

mild alkaline diuresis

33
Q

How is congestion reduced?

A

diuretics

35
Q

____ works via osmotic effects that prevent water reabsorption.

A

Mannitol

36
Q

Are diuretics used chronically or acutely?

A

both

36
Q

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

A

hypertonic osmotic forces

37
Q

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++.

A

intracellular K+

39
Q

_____ tend to be K+ sparing.

A

Aldosterone antagonists

40
Q

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

A

descending limb

42
Q

ACE inhibitors indirectly block the release of aldosterone, so they are _____.

A

K+ sparing

43
Q

What are the K+ sparing diuretics?

A

Na+ channel blockers and aldosterone antagonists

44
Q

Name 3 goals of heart failure management with pharmacotherapy.

A
  1. reduction of congestion 2. modulate neurohormonal regulation 3. improve flow
45
Q

What are K+ sparing diuretics used for?

A

anti-fibrotics

46
Q

A true synergistic effect may be achieved with a ____ and a ____ in refractory edema.

A

thiazide; loop diuretic

48
Q

What diuretic works by inhibiting Na+-K+-ATPase?

A

none

50
Q

Thiazides increase reabsorption of ____, but loop diuretics decrease serum _____ levels.

A

Ca++; Ca++

51
Q

Nearly all diuretic agents exert their effects at luminal (urine) surface of _____.

A

renal tubule cells

52
Q

What is often the first tx for HF?

A

Furosemide

53
Q

How is flow improved?

A

vasodilators (difficult- usu req mechanical devices or transplantation)

54
Q

_____increase reabsorption of Ca++, but _____ decrease serum Ca++ levels.

A

Thiazides; loop diuretics

55
Q

Most Na+ comes back in at the _____, and diuretics don’t affect that.

A

proximal convoluted tubule

56
Q

What is another name for loop diuretics and why?

A

high ceiling bc they give the maximum efficacy of all diuretics

57
Q

ACE inhibitors indirectly block the release of _____, so they are K+ sparing.

A

aldosterone

59
Q

Inhibition of the carbonic anhydrase enzyme depresses ______ in proximal tubule.

A

NaHCO3 reabsorption

60
Q

Nearly all _____ agents exert their effects at luminal (urine) surface of renal tubule cells.

A

diuretic

61
Q

The diuretic agents decrease ______, so increased Na+ and water enter the urine.

A

Na+ reabsorption

62
Q

Active ____ reabsorption occurs in ascending limb via the Na+-K+-2Cl- cotransporter (NKCC2).

A

NaCl

63
Q

What is the major use of _____ in HF, even though they are diuretics, is as an anti-remodeling agent?

A

aldosterone antagonists

64
Q

____ and ____, both diuretics, work by interacting with membrane transport proteins.

A

Thiazides; furosemide

66
Q

Carbonic Anhydrase Inhibitors are used to treat?

A

Glaucoma, acute mountain sickness

67
Q

What are some SEs for the thiazides?

A

hypokalemia hyperglycemia gout hyperlipidemia 2a hyperaldosteronism allergic rxns

68
Q

Loop diuretic efficacy is increased with ____.

A

dietary salt restriction (

CVPR Exam I (29 decks)

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