Class: Pharm: Antidiuretics

Question 1

What is the only place in nephron that diuretic drugs do not act?

Answer 1

Glomerulus -

Question 2

What is the trend: The further away from the Glomerulus a diuretic acts….

Answer 2

the less effective it is at excreting fluid

Question 3

Where do Carbonic Anhydrase inhibitors act?

Answer 3

PCT

Question 4

Where do osmotic diuretics act

Answer 4

PCT/loop

Question 5

Where do loop diuretics act

Answer 5

TAL

Question 6

Where do thiazides act

Answer 6

dct

Question 7

Where do K+-sparing diuretics act?

Answer 7

Cortical collecting tubule

Question 8

only class that causes K+ wasting and metabolic acidosis

Answer 8

CA inhibitors

Question 9

What ion is elevated in blood when using CA inhibitors?

Answer 9

hypercholremic

Question 10

Besides electrolyte disturbances, what is another important ADE of CA inhibitors and the MOA?

Answer 10

renal stones dt high lumen pH of urine–> Ca+ to crash out

Question 11

MAnnitol is what type of diuretic and where exaqctly does it act? (2 places)

Answer 11

osmotic diuretic

acts on PCT and thin ascending and descending loop

Question 12

MOA of mannitol

Answer 12

it is freely filtered –> increased osmolarity of tubule lumen–> rapid diuresis

Question 13

ADEs of mannitol

Answer 13

increased BF bc water flows into blood as well

problem in active bleeding

Question 14

Uses of mannitol (2)

Answer 14

1. Used to reduce intracranial Pressure, cerebral edema before/after neurosurgery
2. Used to reduce IOP for acute glaucoma or for surgery

Question 15

2 cix for mannitol

Answer 15

peripheral edema and active bleeding

Question 16

ADEs of loop diuretics (2)

Answer 16

ototoxicity

mtb alkalosis

Question 17

Loop diuretics cause low levels of what in serum

Answer 17

hypocalemia
hypomagnesemia
hypoklaemia

Question 18

What connection do loop diuretics have to uric acid and what implications

Answer 18

dt hypovolemia–> increased reabsorption of uric acid–> hyperuricemia –> GOUT!!!

Question 19

What type of stones are caused with loop diuretics and why

Answer 19

Ca++ stones becuase they stop reabsorption and increase lumen concentration of Ca –> stones

Question 20

What type of kidney function is needed for Loops

Answer 20

can work with low GFR - do not require good kidney fuinciton

Question 21

What condition are loops the 1st choice for

Answer 21

PE

Question 22

Loops Cix in what 3 conditions

Answer 22

sulfonamide allergies
CHF
Cirrhosis

Question 23

Thiazide: major and minor sites of action and trasporters affected

Answer 23

i. Inhibit NaCl symport in DCT- major

ii. Minor inhibiton of CA in PCT

Question 24

Thiazides enhance reabsortoin of what?

Answer 24

CALCIUM!!!!!!!!!!!!!

Question 25

Thiazides: ADEs (3)

Answer 25

hyperuricemia
intolerance of CHO (glucose)
hyperlipidemia

Question 26

what type of kideny function do thiaides require?

Answer 26

they need good GFR

Question 27

between loops and diuretics, which will have a more dramatic increase in function with small increase in dose

Answer 27

Loops

Question 28

name the 3 K= sparing diuretics

Answer 28

Amiloride, Triamterene

spironolactone

Question 29

MOA of Amiloride and triamterene

Answer 29

both block apical Na reabsoption channels

Question 30

what are Amiloride and triamterene specifically indicated for

Answer 30

treatment of polyuria and polydipsia dt long -term Lithium use

Question 31

ADE of triamterene

Answer 31

potentially nephrotoxic and can cause cast formation

Question 32

Spironolactone MOA

Answer 32

inhibits Aldosterone receptor –> inhibition of Na/K+ATPase on basolateral mb

Question 33

Spironolactone is preferred in what condition?

Answer 33

cirrhosis

Question 34

Spironolactone is specifically ix for what 2 consditions?

Answer 34

primary aldosteronism

HF

Question 35

Which Diuretics Can Exacerbate Gout? (2)

Answer 35

loop

thiazides