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Pharm Unit 1 > 6. Diuretics > Flashcards

6. Diuretics Flashcards

1
Q

Uses of diuretics?

A

HTN & edema (CV, renal or endocrine)

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2
Q

Normal GFR? Amount that ends up in urine? Amount that is reabsorbed?

A

125ml/min
1ml/min
124ml/min

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3
Q

What is the most important pump throughout the kidney for Na reabsorption?

A

Basal Na-K ATPase –> causes electronegatively & low intracellular [Na] –> gradient for Na absorption from lumen

It is always present. The luminal pump changes depending where you are

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4
Q

What does Carbonic Anhydrase (CA) do?

A

Convert CO2 + H2O into carbonic acid/H2CO3 (in lumen) & the reverse of this same reaction (within renal cell)

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5
Q

What is the overall “goal” of CA actions with regard to Na absorption?

A

Lumenal pump brings Na into the cell & pumps H into the lumen

The overall goal of CA is to use bicarb absorption cycle to provide Hs for the Na pump

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6
Q

How is bicarb & H movement tied to Na absorption in the proximal tubule?

A

H is pumped out of the renal cell (into the lumen) while Na is pumped inside the cell

H is then attached to bicarb (HCO3-) to form carbonic acid (H2CO3)

Carbonic Anhydrase converts carbonic acid into CO2 & H2O in the lumen

CO2 & H2O diffuse into cell

CA converts CO2 & H2O back into carbonic acid

Carbonic acid donates it H (to the Na pump) & then is pumped out of the basal bicarb pump

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7
Q

How much of Na absorption happens in the proximal tubule? TAL of Loop of Henle? Distal Convoluted Tubule? Collecting Duct?

A

50%
25%
10%
5%

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8
Q

What is Acetazolamine?

A

CA inhibitor that acts in the proximal tubule to decrease Na absorption

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9
Q

What diuretic acts on the proximal tubule?

A

Acetazolamine

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10
Q

What is the adverse side effet that limits current usage of Acetazolamine? What is an “unconventional” use of the drug?

A

Acidosis (no longer pumping out H in exchange for Na)

Treat altitude sickness (acidosis increases Hb release of O2)

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11
Q

What pump is involved with Na absorption in the TAL?

A

A lumenal pump which pumps Na & K (and 2 Cl which isn’t really important) into the cell

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12
Q

How is Na absorption in the TAL related to Mg & Ca absorption? How do loop diuretics cause Mg & Ca loss?

A

K is pumped into the cell with Na

High intracellular K causes K to move back into the lumen via K leak channels

This movement of K back into the lumen creates a + charge which drives Mg & Ca to be absorbed via paracellular routes

If block Na absorption –> block K movmement through leak channel –> no driving force for Mg or Ca –> Ca & Mg stay in lumen & are excreted

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13
Q

What diuretic acts on the TAL of the loop of henle?

A

Furosemide

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14
Q

What is Furosemide?

A

Diuretic which blocks action of Na/K/Cl pump in TAL of loop of henle

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15
Q

What is the most powerful diuretic?

A

Furosemide

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16
Q

What is the loop diuretic?

A

Furosemide

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17
Q

What are the uses of Furosemide?

A

Pulmonary edema
CHF
Renal disease (increase RBF & increase urine output in acute renal failure)
Hypercalcemia

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18
Q

Adverse effects of furosemide?

A 
Hypocalcemia
Hypomagnesium
Hypokalemia
Hypovolemia
Hearing loss
19
Q

What type of diuretic increases Ca & Mg secretion? Which increases Ca absorption?

A

Furosemide (Loop diuretic)

Thiazides (DCT)

20
Q

What diuretic acts on the DCT?

A

Thiazides

21
Q

What are thiazides?

A

Diuretic which blocks Na-Cl pump in the DCT

22
Q

How is Ca flow related to Na reabsorption in the DCT? How do thiazides cause increase Ca in the body?

A

If block Na pump on lumen with thiazides –> no Na coming into cell, but Na is still leaving the cell due to basal pump –> very low Na inside cell –> causes Na to move back into the cell via a basal Ca-Na pump

In this way, Na is “uselessly” cycled from inside the cell to outside via the Na-K & Na-Ca pumps. Every time Na goes through this cycle a Ca is reabsorbed

23
Q

Which type of diuretic is moderately powerful?

A

Thiazides

24
Q

Uses of thiazides?

A

HTN
Hypercalciuria & renal stones
Osteoporosis
DI (decrease polyuria)

NOT effective for renal disease

25
Q

How is Na reabsorbed in the CD?

A

Na brought into the cell without an accompanying anion –> increase + charge within cell –> causes K to be secreted

26
Q

What are the NON-Potassium sparring diuretics? How do they cause K loss?

A

Acetazolamine
Furosemide
Thiazide

All increase the amount of Na in urine. CD tries (& fails) to off set this by absorbing more Na which is linked to K secretion

27
Q

What are the Potassium sparring diuretics? How do they prevent K loss?

A

Spironolactone
Triamterene & Amiloride

Na aborption is coupled to K secretion. Both are inhibited

28
Q

What is natriuresis?

A

Na excretion

29
Q

What are the natriuretic effects of non-K sparring diurectics transient?

A

Compensation mechanisms (Ang, aldosterone, ADH) compensate after 2 weeks

30
Q

If somebody has Hyokalemia, what is/are the diuretic(s) that will correct the problem fastest?

A

Amiloride & Triamterene

31
Q

What are Amiloride & Triamterene? How do they work?

A

Diuretics that block Na transporter in CD

32
Q

What is Spironolactone? How does it work?

A

Diuretic that blacks the action of aldosterone in CD –> decreased activity of aldo transcription factor –> less creation of Na-K pump & Na transporter

33
Q

Which diuretics work in the CD?

A

Spironolactone

Amiloride & Triamterene

34
Q

What is the lumenal Na tansporter in the CD called?

A

ENaC (epithelial Na channel) in the principal cell

35
Q

Which diuretics are weak?

A

CD diuretics

36
Q

What are the uses of the CD diuretics?

A

Used in conjunction with other diuretics to prevent K loss (too weak to work by themselves for HTN)

Spironolcatone is used for Conn’s syndrome (primary hyperaldosteronism) & hepatic cirrhosis (secondary hyperaldosteronism)

37
Q

Which diuretic has a slow onset of action? Why?

A

Spironolactone

Is effecting protein expression, not the transporters directly

38
Q

What are the adverse effects of CD diuretics?

A

Hyperkalemia (especially if in combo with beta blockers or ACE inhibitors)

39
Q

What is the osmotic diuretic?

A

Mannitol

40
Q

What is mannitol? How does it work?

A

Osmotic diuretic

Increase plasma osmolarity –> increase fluid extraction from bodies interstitial space
Increase osmolarity in the kidney lumen (mannitol filtered & not absorbed) –> less of a driving force for water absorption –> water loss

41
Q

Uses of manitol?

A

Reduce ICP in cerebral edema
Reduce intraocular pressure in glaucoma
Maintain renal function in acute renal failure

42
Q

Adverse events with manitol?

A

Expansion of ECF volume –> pulmonary congestion or heart failure

43
Q

Which drug can cause gynecomastia in males & menstrual abnormalities in females? How?

A

Spironolactone

Cross reactivity with other steroid receptors

Pharm Unit 1 (7 decks)

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