ADH hormone and diuretics (Trachte) - W2 Flashcards
Where do loop diuretics work and what are 2 examples?
- thick acending limb of loop of Henle
- furosemide, bumetanide
What is the MOA of loop diuretics and how do they effect urine NaCL, K+, blood pH, calcium?
- inhibit the Na, K, 2Cl pump
- prevents decrease in osmolarity
- Increase NaCl - hyponatremia
- increase K+ excretion - hypokalemia
- increases Ca2+ excretion - hypocalemia
- increases pH
What are the side effects of loop diuretics?
- impaired hearing
*
What is the site of action of thiazides?
what are some examples?
- act in distal convoluted tubule
- chlorthalidone
- hydrocholorthiazide
- metalazone
MOA of thiazides.
Effect on urine NaCl, K, pH, Ca
- inhibit Na/Cl symporter
- increase NaCL excretion
- increase K+ excretion - decrease K+ reabsorption - acts in collecting tubule
- decreases Ca excretion - enhanced reabsorption in DCT through TRPV5.
- increases pH
What are some uses of thiazides?
- hypertension
- HF
- nephrolithiasis
- diabetes insipidus
What are side effects of thiazides?
- Hyperglycemia
- hyperuricemia - gout
- hypokalemia
- hyperlipidemia
- hyponatremia
- sulfur allergy
What drug class has a major effect as a vasodilator?
- Thiazides
- reduce calcium influx, reduce contraction.
Where do potassium sparing diuretics work and what are some examples?
- Cortical collecting tubule
- amiloride, triamterene
- Spironolactone, Eplerenone
What is the MOA of K+ sparing diuretics?
Effect on urine NaCl, K, pH, Ca
- Block ENAC or block aldosterone (spironolactone)
- Increase NaCl excretion.
- Decrease K+ excretion.
- Decreases pH
What are the major uses of K+ sparing diuretics?
- hyperaldosteronism
- prevent potassium wasting
What are side effects of K+ sparing diuretics?
- Hyperkalemia – arrythmias
- hyperchloremic metabolic acidosis
- gynecomastia
- acute renal failure
- kidney stones
Where does ADH act?
Examples?
Mechanism?
- Vasopression = natural. Desmopressin = synthetic.
- Site = collecting duct
- MOA = stimulation of G-protein coupled receptors in collecting duct to recruit aquaporin channels
- enhances water reabsorption.
Drug that is an ADH antagonist
convaptan
Drug that is an antibiotic with some activity as an ADH antagonist
Demecocycline
What is used as an osmotic diuretic?
Where does it act?
- mannitol
- acts in proximal tubule and/or descending limb of loop of henle
MOA of manntiol
Use
How does it affect sodium and potassium?
- not reabsorbed in the nephron - exerts an osmotic effect to reduce water reabsorption
- USe
- reduce body water
- reduce intracranial pressure
- decreases excretion of NaCl and K
Side effects of mannitol
- EC volume expansion
- dehydration
Sodium glucose tranporter inhibitors
MOA
Effects
Examples
- inhibit SGLT-2 in proximal tubule
- increase loss of glucose in the urine, reduce blood sugar, cause weight loss
- many side effects - UTI
- Examples
- canigliflozin
- dapagliflozin
- gliflozin
Carbonic anhydrase inhibitors
example
MOA
site of action
effect on PH
- Acetazolamide
- inhibit carbonic acid to decrease body stores of bicarbonate in proximal tubule
-
decreases pH
- metabolic acidosis
What is acetazolamide used for?
- glaucoma
- urinary alkalization
- metabolic acidosis
- tx of acute mountain sickness
What do probenicid and sulfinpyrazone do
inhibit a renal organic acid transporter to faciliate excretion.
microtubule inhibitor with antiinflammatory properties
Colchicine
How do thiazides increase glucose?
- bind to SUR on ATP sensitive K+ channel
- allow the channel to open and K+ to flow out
- hyperpolarizes so Calcium can’t come into cell
- prevents insulin release from granules
