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Pharmacology II > CV & Renal: Diuretics > Flashcards

CV & Renal: Diuretics Flashcards

1
Q

Which type of diuretic?

  • steep slope on dose response curve
  • dose-dependent diuresis throughout therapeutic range
A

Loop diuretics

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2
Q

Which type of diuretic?

  • Flat dose-response curve
  • limited maximum response
A

Thiazide diuretics

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3
Q

Rank the 4 types of diuretics in terms of diuretic effect…

A

Loop&raquo_space; thiazide&raquo_space; CA Inhibitors > K+ Sparing

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4
Q

Which diuretics have greatest effect on increasing NaCl excretion?

A

Loop monotherapy

Loop + Thiazide

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5
Q

Which diuretics have the greatest effect on Sodium Bicarb excretion?

A

CA inhibitors

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6
Q

Which diuretics have the greatest effect on increasing excretion of potassium?

A

loops + thiazide

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7
Q

The arterial end of capillary bed favors shift of fluid…

A

out of vessels

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8
Q

The venous end of capillary bed favors shift of fluid…

A

into vessels

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9
Q

What three physiologic effects promote edema?

A

↑ hydrostatic P
↑ colloidal P
Inadequate lymphatic drainage

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10
Q

What causes an ↑ hydrostatic P which could favor edema?

A

↑ arterial or venous pressure

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11
Q

What causes an ↑ colloidal P that would favor edema?

A

↓ osmotic gradient via Na+ & H2O retention

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12
Q

The following conditions are associated with what physiologic process?

HF
Hepatic cirrhosis
Nephritis, nephrosis, renal damage from HTN
Diseases of steroid hormone secretion
Pre-eclampsia
Toxemia
Anaphylaxis and hypersensitivity reactions

A

Edema

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13
Q

Which section of the renal tubule?

Drugs:
Acetazolamide
Osmotic Agents

Reabsorbs:
NaHCO3
NaCl

A

PCT

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14
Q

Which section of the renal tubule?

Drugs:
Osmotic Agents

Reabsorbs:
H2O

A

Descending LOH

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15
Q

Which section of the renal tubule?

Drugs:
Loop Diuretics

Reabsorbs: 
2Cl-
K+
Na+
Mg2+
Ca2+
A

Thick Ascending LOH

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16
Q

Which section of the renal tubule?

Drugs:
Thiazides

Reabsorbs:
NaCl
Ca2+ (via PTH)

A

Early DCT

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17
Q

Which section of the renal tubule?

Drugs:
Osmotic Agents
Aldosterone Antagonists
ADH Antagonists

Reabsorbs:
NaCl (via Aldo)
Secretes:
K+
H+
H2O (via ADH)
A

Late DCT & CD

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18
Q

Osmotic agents act on what three parts of the renal tubule?

A

PCT, Desc. LOH, CD

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19
Q

Acetazolamide acts on what part of the renal tubule?

A

PCT

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20
Q

Loop diuretics act on what part of the renal tubule

A

Thick ascending limb of LOH

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21
Q

Thiazide diuretics act on what part of the renal tubule?

A

Early DCT

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22
Q

Aldosterone antagonists act on what part of the renal tubule?

A

Late DCT

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23
Q

ADH antagonists act on what part of the renal tubule?

A

CD

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24
Q

What effect do thiazide diuretics have on calcium?

A

↑ Ca Reabsorption

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25
Q

What effect do loop diuretics have on calcium and magnesium?

A

↑ Ca & Mg Excretion

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26
Q

Acidic drugs compete with ______ for excretion.

A

uric acid

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27
Q

The “–olamide” suffix refers to which class of diuretics?

A

CA inhibitors

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28
Q

Inhibition of carbonic anhydrase leads to a decreased production of what?

A

H2CO3

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29
Q

↓ H2CO3 Production from carbonic anhydrase inhibition affects what channel that leads to ↓ Na+/H2O reabsorption?

A

↓ H+/Na+ Exchange (lumen to PCT cells)

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30
Q

This diuretic is indicated for:

Glaucoma
Alkalizing Urine
Metabolic Alkalosis
Acute mountain sickness

A

CA inhibitors (–olamides)

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31
Q

What are two contraindications/precautions for CA inhibitors?

A

hepatic cirrhosis

sulfa

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32
Q

Which diuretics have the following adverse effects?

  • hyperchloremic metabolic acidosis
  • hypokalemia (acidosis = K ECF –> K ICF)
  • hyperuricemia
A

CA inhibitors (–olamide)

33
Q

describe the effectiveness of CA inhibitors over several days…

A

decreases

34
Q

Furosemide and Ethacrynic Acid are which type of diuretic?

A

Loop

35
Q

This class of diuretics blocks NKCC2 and ↑ Prostaglandin Production

A

Loop diuretics

36
Q

Which class of diuretics has the following indications?

HF
Pulmonary Edema
Hypercalcemia
Impaired renal fxn edema

A

Loop Diuretics

37
Q

What three drugs cannot be combined with loop diuretics?

A

NASAIDs/COX inhibitors (requires PGs), aminoglycosides (ototoxic), digoxin (decreased K –> digoxin toxicity)

38
Q

Overzealous use of loop diuretics is dangerous with what three conditions?

A

cirrhosis, borderline renal failure, HF

39
Q

Which loop diuretic is a sulfa drug?

A

furosemide

40
Q

The following adverse effects describe which class of diuretics?

  • hypokalemic metabolic acidosis
  • Hypocalcemia
  • hypomagnesemia
  • hyperuricemia
  • irreversible ototoxicity
A

Loop diuretics

41
Q

Ototoxicity is worse worse with ______ is combined with ______

A

ethacrynic acid + aminoglycosides

42
Q

Which 3 drugs are thiazide diuretics?

A

hydrochlorothiazide, metolazone, indapamide

43
Q

How do thiazide diuretics inhibit sodium reabsorption in the early distal tubule?

A

inhibit Na/Cl Cotransporter

44
Q

Thiazide diuretics depend on synthesis of…

A

prostaglandins

45
Q

Which class of diuretics has the following indications?

  • HTN
  • HF
  • Nephrolithiasis
  • Nephrogenic DI
A

Thiazides

46
Q

These diuretics…

  • contain sulfa
  • increase hyperglycemia
A

Thiazide diuretics

47
Q

What three drugs must be used with caution when administering thiazides?

A

digitalis (hypokalemia induced toxicity)

NSAIDs (decreased PGs)

Lithium (toxicity)

48
Q

Thiazide diuretics are acidic, meaning they should be used with caution in what condition?

A

hyperuricemia

49
Q

Thiazide diuretics hyperpolarize the cell, leading to relaxed smooth muscle and vasodilation.

What does thiazide act on to make this happen?

A

Increased potassium ATPase channel opening

50
Q

Thiazide diuretics have synergistic effects with which three drugs for HTN tx?

A

ACE, ARB, BB

51
Q

What effect does thiazide have on calcium excretion?

A

decreased calcium excretion due to increased calcium channel activity

52
Q

Thiazide diuretics increase calcium reabsorption by increasing PTH dependent calcium channel activity. Is this helpful in tx of osteoporosis?

A

no

53
Q

Which class of diuretics have the following adverse effects?

  • hyperglycemia
  • hypokalemic metabolic acidosis
  • hyperuricemia
  • hypomagnesemia
  • increased lipids
A

Thiazide diuretics

54
Q

The following mechanism describes which adverse effect of thiazide diuretics?

↑ K+ & H+ secretion at DCT → volume contraction → RAAS → ↑ Aldo → ↑ K+ secretion

A

hypokalemic metabolic acidosis

55
Q

What causes increased lipids with thiazide administration?

A

low insulin secretion

56
Q

This drug is indicated when GFR is < 20

A

metolazone (thiazide)

57
Q

This drug has pronounced vasodilation and doesn’t increase lipids… it is metabolized 50/50 in the liver and kidney

A

indapamideb (thiazide)

58
Q

This class of drugs interferes with sodium reabsorption in DCT without compromising potassium…

A

potassium sparing diuretics

59
Q

Which drug has the following mechanism?

Competitive Aldo. antagonism leading to:

↓ Na+ channels

↓ Na+ conductance → hyperpolarization → ↓ K+ Excretion

↓ Na+/K+ ATPase activity → ↓ K+ Excretion

A

spironolactone

60
Q

high doses of spironolactone lead to inhibition of what two receptor types?

A

glucocorticoid and sex hormone receptors

61
Q

This diuretic has the following unique indications:

Hyperaldosteronism
Hirsutism

A

Spironolactone

62
Q

What are two contraindications for spironolactone administration?

A

use with ACE/ARBs (hyperkalemia)

Gynecomastia

63
Q

Which potassium sparing diuretic has the following characteristics?

Selective Aldosterone Receptor Antagonist

P3A4 Metabolism

↓ Endocrine SFx, ↓ steroid receptor affinity

A

Eplerenone

64
Q

Which two diuretics have the following mechanism?

Directly inhibits aldosterone-sensitive Na+ channel → ↓ K+ excretion

A

Amiloride and Triamterene

65
Q

Which diuretic has the following indications?

  • DOC for lithium induced DI
  • non-acid diuretic safe in hyperuricemia
  • combo w/ K losing diuretics
A

amiloride and triamterene

66
Q

Amiloride and triamterene are contraindicated in what condition?

A

hyperkalemia (burn patients)

67
Q

The following are what class of diuretic?

Mannitol
Isosorbide
Glycerin
Urea

A

osmotic

68
Q

Which drugs have the following characteristics?

IV only
pharmacologically inert
Filtered, not absorbed

A

osmotic diuretics

69
Q

Which diuretic class has the following unique indications?

  • acute renal failure prophylaxis
  • ↓ IOP
  • ↓ Intracranial pressure in brain edema
  • Protect kidney from nephrotoxins
A

Osmotic diuretics

70
Q

Excessive administration of osmotic diuretics can have what effect?

A

ECF volume expansion

71
Q

Osmotic diuretics are contraindicated in what condition?

A

HF

72
Q

This drug is a synthetic ADH that primarily works on V2 receptors

A

Desmopressin

73
Q

What class of drug is desmopressin?

A

ADH agonist

74
Q

Desmopressin is used in what situation?

A

tx of central DI

↓ H2O Excretion

75
Q

“-vaptan”s are what drug class?

A

ADH Antagonists

76
Q

Which drug has the following mechanism?

Non-peptide V1a and V2 receptor antagonist

leads to increased sodium concentration and water clearance

A

Conivaptan

77
Q

Which drug class is indicated for euvolemic or hypervolemic hyponatremia?

A

ADH antagonists (vaptans)

78
Q

What are three characteristics that differentiate tolvaptan from conivaptan?

A
  1. non-peptide V2 antagonist
  2. PO admin
  3. can be continued outpatient

Pharmacology II (23 decks)

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