3. Diuretics

Question 1

The following drug is what kind of diuretic? (maintains urine flow, pull water from cells for excretion)
Mannitol

Answer 1

Osmotic diuretic

Question 2

The following drug is what kind of diuretic? (urinary alkalinization, mountain sickness, glaucoma)
acetazolamide

Answer 2

Carbonic anhydrase inhibitor

Question 3

The following drug are what kind of diuretic? (edema, HTN)
amiloride
triamterene
spironolactone
eplerenone

Answer 3

K+ sparing diuretics

Question 4

The following drug are what kind of diuretic? (hyponatremia)
conivaptan
tolvaptan

Answer 4

Aquaretics

Question 5

The following drug are what kind of diuretic? (HTN, edema)
hydrocholorthiazide
metolazone
chlorthalidone

Answer 5

Thiazide diuretics

Question 6

The following drug are what kind of diuretic? (edema,HTN)
furosemide
torsemide
bumetanide
ethacrynic acid

Answer 6

Loop diuretics

Question 7

Where do osmotic diuretics and carbonic anhydrase inhibitors work?

Answer 7

CA inhibitors: PCT

Osmotic: mainly PCT and some thin descending loop henle

Question 8

Where do vaptans work in the kidney?

Answer 8

Collecting duct (block ADH regulated water absorption)

Question 9

What are the K losing diuretics?

Answer 9

everything but K sparing diuretics (anything that acts before collecting duct)

Question 10

Hyperkalemia causes tall T waves and bradycardia while hypokalemia causes flattened T waves and?

Answer 10

U waves

Question 11

Drug:
Characteristics: blocks NaKCCl cotransporter, used for edema, decreases preload, decreases EC volume, rapid dyspnea, tx HTN, WORKS in pts with low GFR (which diuretic doesnt?), lots of toxicities, otoxicity, hypochloremic metabolic alkalosis, hypokalemia/natremia/calcemia/mg, hyperglycemia/uricemia, sulfur drug

Answer 11

Furosemide

Question 12

Drug:
Characteristics: same as furosemide, longer 1/2 life, better oral absorption, better for HF

Answer 12

Torsemide

Question 13

Drug:
Characteristics: same as furosemide but more predictable oral absorption

Answer 13

bumetanide

Question 14

Drug:
Characteristics: same as furosemide but NON SULFUR

Answer 14

ethacrynic acid

Question 15

What drugs dont work when there is low GFR?

Answer 15

Thiazides (note: loop diuretics work)

Question 16

Loop diuretics are for rapid and massive fluid removal such as acute pulmonary edema or ?

Answer 16

hypertension

Question 17

Drug:
Characteristics: blocks NaCl cotransport in distal tubules, K losing, used in mod HTN, not effective in patients with low GFR, used in calcium nephrolithiasis/nephrogenic diabetes insiputus, causes hypokalemia/mg/natremia, hypochloremic metabolic alkalosis, hypercalcemia /glycemia/uricemia and is a sulfur drug

Answer 17

Hydrochlorothiazide (HCTZ)

Question 18

Drug:
Characteristics: same as HCTZ but poor oral absorption

Answer 18

chlorothiazide

Question 19

Drug:
Characteristics: same as HCTZ but 1/2 life of 40-60 hrs, preferred by HTN specialists

Answer 19

chlorthalidone

Question 20

Drug:
Characteristics: sames as HCTZ, long acting, fav for cardiologist used as adjunct diuretic in tx of CHF

Answer 20

metolazone

Question 21

Drug:
Characteristics: blocks epithelial sodium channels ENaC in collecting ducts, counteracts K+ loss, causes hyperkalemia

Answer 21

amiloride

Question 22

Drug:
Characteristics: same as amiloride, used for edema and off label HTN, quickly absorbed, 6-9hr duration

Answer 22

tramterene

Question 23

Drug:
Characteristics: competitive antagonist of aldosterone receptors with side effects due to partial agonist at androgen receptors, K sparing diuretic, reduces fibrosis post MI heart failure (reverses cardiac remodeling), slow on and slow off (2-3day effect), causes hyperkalemia, amenorrhea, hirsutism, gynecomastia, impotence

Answer 23

Spironolactone

Question 24

Drug:
Characteristics: same as spironolactone but more selective (lacks sulfur), approved for post mi HF, less gynecomastia, 10x more expensive

Answer 24

Eplerenone

Question 25

Drug:
Characteristics: nonpeptide arginine vasopressin receptor antagonist (anti ADH), affinity for V1A and V2, promotes excretion of free water, tx of euvolemic and hypervolemic, hyponatremia in pts who are hospitalized, symptomatic, not responsive to fluid restriction, monitor closely cause too rapid serum sodium correction can lead to seizures, osmotic demyelination, coma or death

Answer 25

conivaptan

Question 26

Drug:
Characteristics: same as conivaptan but selective V2 receptor antagonist *oral(Not IV), only in hospital where plasma sodium is monitored, use less than 30 days for hyponatremia, longer use = hepatotoxicity, used to slow progression of adult polycystic kidney dz

Answer 26

Tolvaptan

Question 27

Drug:
Characteristics: carbonic anhydrase inhibitor, inhibit Na/H exchange, sodium bicarb diuresis = hyperchloremic acidosis, only used in urinary alkalinization, metabolic alkalosis, glaucoma, mountain sickness, can cause K wasting, renal stones

Answer 27

Acetazolamide (not used anymore)

Question 28

Drug:
Characteristics: eliminate excess intracellular volume, inability to reabsorb keeps water in the PCT, which is excreted, pulls water out of cells, IV, used in prophylaxis of renal failure, reduction ICP, reduction intraocular pressure

Answer 28

Mannitol