Ch. 20- Volume Regulation

Question 1

Renin Inhibitor: inhibits renin–> decreses conversion of Angiotensinogen to angiotensin I–> decreased ACE & decreased NaCl reabsorption

Answer 1

Aliskiren

Question 2

ACE Inhibitors- inhibits conversion of AT I to AT II

Answer 2

Captopril (active drug), Enalapril (prodrug), Ramipril (prodrug), Benazepril, Fosinopril, Moexipril, Perindopril, Quinapril, Trandolapril, Lisinopril (excreted unchanged)

Question 3

AR & Contraindication of ACE inhbitors

Answer 3

angioedema, cough, hyperkalemia, Pregnancy

Question 4

Angiotensin II Receptor Antagonist- Antag. Angiotensin II at AT1 receptor

Answer 4

Candesartan, Irbesartan, Losartan, Telmisartan, Valsartan

Question 5

B-Type Natriuretic Peptide (BNP)- increases intracellular concentrations of cGMP by binding Guanylyl cyclase receptor NPR-A of vascular smooth muscle–>sm. Muscle relaxation

Answer 5

Nesiritide (BNP)

Question 6

Use of BNP

Answer 6

Acute decompensated Heart failure

Question 7

Vasopressin Receptor 2 (V2) antagonists (@ collecting duct)- prevents vasopressin-stimulated water reabsorption via V2-aquaporin channels in CD

Answer 7

Convaptan (IV), Tolvaptan (Oral)

Question 8

Use of V2 antagonist

Answer 8

SIADH, cirrhotic asciteds, ADPKD

Question 9

Carbonic Anhydrase Inhbitors- Inhib. Na & HCO3- reabsorption by inhib. Prox.-tubule carbonic anhydrase II and luminal IV

Answer 9

Acetazolamide

Question 10

Use for Carbonic Anhydrase Inhibitors

Answer 10

High altitude sickness, Heart Failure, Glaucoma, Epilepsy

Question 11

considerations of Acetazolamide

Answer 11

Metabolic Acidosis; ASA increases Acetazolamide= CNS toxicity

Question 12

Osmotic Diuretics- filters and NOT reabsorbed= osmotic force pulling H2O out

Answer 12

Mannitol

Question 13

Uses for osmotic diuretics

Answer 13

Cerebral Edema,

Question 14

consideration for mannitol

Answer 14

careful monitoring of volume status

Question 15

Loop Diuretics- Inhbit Na reabsorption by inhbiiting NKCC2 in luminal membrane of cells in TAL of loop of henle

Answer 15

Furosemide, Bumetanide, Torsemide, Ethacrynic Acid (use for allergy to sulfa; Toxic: cuase hyperuricemia)

Question 16

Considerations for Loop Diuretics

Answer 16

Bumetanide- 40x more potent, Loops are first line for acute relief of pulm. Edema in CHF

Question 17

Uses for loops

Answer 17

HTN, Acute pulm. Edema, CHF associated edema, Hypercalcemia, Hyperkalemia

Question 18

AR of loops

Answer 18

Ototoxicity, hypokalemia, dehydration, allergy (sulfa), Nephritis, Gout, Hypocalcemia, met. alkalosis, arrhythmias, low K+

Question 19

Inhib. NaCl reabsorption by acting as antagonist at NCC co-transport in distal convoluted tubule; promotes increased Ca reabsorption

Answer 19

HCTZ, Bendroflumethiazide, Hydroflumethiazide, Polythiazide, Chlorthalidone, Metolazone, Indapamide

Question 20

Uses/considerations/AR for thiazides

Answer 20

HTN, CHF edema; can unmask DM; hypokalemic met. alkalosis, hyperglycemia, hyperlipidemia, hyperuricemia, hypercalcemia, sulfa allergy

Question 21

Collecting duct (K+ sparing)- inhib. Aldosterone by binding to and preventing translocation of mineralcorticoid receptor; competitively inhib. Principal cell apical membrane on ENaC sodium channel

Answer 21

Spironolactone, Eplerenone, Amiloride, Triamterene

Question 22

Use for K+ sparing diuretics

Answer 22

HTN, CHF edema, liver cirrhosis; HTN, Liddle’s syndrome (mendelian form of HTN)

Question 23

AR of K+ sparing

Answer 23

Hyperkalemia (lead to arrhythmia), gynecomastia (antiandrogen effects)