Clinical use of diuretics

Question 1

What parts of the nephron are in the cortex of the kidney, medulla

Answer 1

glomerulus, proximal tubule, distal tubule/Loop of Henle, collecting ducts

Question 2

What are the arteries going to the glomerulus, what are the arteries leaving the glomerulus

Answer 2

Afferent arteriole, Efferent arteriole

Question 3

What is a standard amount of urine output

Answer 3

1.5 Liters per day

Question 4

What is the order (from most to least) of parts of the nephron that absorb Sodium

Answer 4

Proximal tubule, ascending limb, distal tubule, collecting ducts

Question 5

T/F: Other parts of tubules can make up for reabosorption that does not happen at other parts

Answer 5

True

Question 6

What is edema

Answer 6

swelling produced by expansion of the interstitial fluid volume

Question 7

What are causes of edema

Answer 7

liver failure and/or heart failure, hypoalbuminemia, increased capillary permeability, lymphedema

Question 8

What side of the nephron interacts with urine, which side interacts with cells of the body

Answer 8

luminal side, basolateral side

Question 9

What are the types of diuretics

Answer 9

carbonic anhydrase Inhibitors, Loop , thiazide , potassium sparing diuretics, osmotic

Question 10

What are the two carbonic anhydrase inhibitors, where do they work in the nephron

Answer 10

acetazolamide and methazolamide, proximal tubule

Question 11

Why is the diuresis from carbonic anhydrase inhibitors mild

Answer 11

the rest of the nephron compensates for increased tubular Na concentration, other transporters allow sodium to be reabsorbed in the proximal tubule

Question 12

What is a huge side effect of carbonic anhydrase inhibitors, why

Answer 12

metabolic acidosis, less bicarbonate reabsorbed leading to a loss of a buffer

Question 13

What are CAIs used for

Answer 13

Glaucoma, prophylaxis for acute altitude sickness

Question 14

What is the most potent class diuretic, what is the MOA and site of action

Answer 14

loop, inhibit Na-K-2Cl symporter located on the luminal side of the thick ascending Loop of Henle

Question 15

What are the loop diuretics

Answer 15

Furosemide, Bumetanide, Torsemide, and Ethacrinic Acid

Question 16

What can disease state can be caused through loop diuretic use, how

Answer 16

Gout, uric acid lead to gout and there is an accumulation because it competes with uric acid for transportand elimination in urine

Question 17

What can loop diuretics be used for

Answer 17

Edemea, severe hypercalcemia (though not 1st line therapy)

Question 18

T/F: Loop diuretics can be used in hypertension control

Answer 18

False: there is a lack of clinial trials to show that loop diuretics can reduce morbidity/mortality

Question 19

What is the bioavailabiltiy of furosemide by mouth in comparision to IV

Answer 19

50% (oral does is generally considered twice the IV dose)

Question 20

T/F: Bumetanide and Torsemide are generally given at the same dose for PO and IV

Answer 20

True

Question 21

T/F: As the dose of loop diuretics increases the effect increases until the fractional excretion of sodium is greater than or equal to 20

Answer 21

True

Question 22

What is the ceiling dose for furosemide and bumetanide

Answer 22

80mg, 1 mg

Question 23

What are side effects of loop diuretics

Answer 23

volume depletion, hypokalemia, hypocalcemia, hypomagnesia, ototoxicity

Question 24

Which diuretics have a MOA that blocks the Na+/Cl- symporter at the distal tubule

Answer 24

Thiazides

Question 25

What are the thiazide diuretics

Answer 25

hydrochlorothiazide, chlorthalidone, metolazone, indapamide

Question 26

What is the most used thiazide, which has high quality evidence for reducing morbidity and mortality for hypertension, which are generally only used with loop diuretics

Answer 26

hydrochlorothiazide, chlorthalidone, metolazone and indapamide

Question 27

What are thiazides used for

Answer 27

hypertension, potent diuresis if mixed with loop diuretics

Question 28

When can a patient not use hydrochlorothiazide

Answer 28

Cr/Cl less than 30

Question 29

What are the side effects of thiazides

Answer 29

hypokalemia, hypercalcemia, hyponatremia, hypomagnesemia

Question 30

What are the two categories for potassium sparing diuretics

Answer 30

sodium channel blockers of collecting ducts, aldosterone antagonists

Question 31

What are the potassium sparing sodium channel blocker diuretics

Answer 31

Amiloride and triamterene

Question 32

What are the potassium sparing aldosterone antagonist

Answer 32

spironolactone and eplerenone

Question 33

What the sodium channel blockers used for

Answer 33

combination with hydrochlorthiazide to prevent hypokalemia due to weak diuresis

Question 34

What is the MOA of aldosterone antagonists

Answer 34

block aldosterone binding that leads to gene expression of more Na+ channels therefore inhibition of Na channels leads to less Na reabsorption

Question 35

What are aldosterone antagonists used for

Answer 35

Combination with HCTZ to prevent hypokalemia, combination with furosemide (100:40) for patients who have ascites, emerging role in resistant hypertension, heart failure with reduced ejection fraction

Question 36

What are the side effects of potassium sparing diuretics

Answer 36

hyperkalemia (risk increases greatly with CrCl less than 50), gynecomastia (only when using spironolactone)

Question 37

What is the osmotic diuretic, when is it used

Answer 37

mannitol, elevated intracranial pressure

Question 38

What is the best way to control Edema

Answer 38

NaCl restriction of 2 grams a day for regular edema while less than 1 gram a day for severe edema

Question 39

What is the number one pharmacological therapy for edema, what should change if edema is unimproved, what is the last resort

Answer 39

Loop diuretics, increase daily dose or increase to BID, add thiazide