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Pharm Block 11 > Diuertics > Flashcards

Diuertics Flashcards

1
Q

What is a more appropriate name for diuretics

A

Natriuretics

-actually implies that you are losing Na, water follows

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2
Q

What works at the proximal convoluted tubule

A

Acetaxoalmide

CAI

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3
Q

What works at the descending loop of Henle

A

Nothing, no drugs target this specific area

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4
Q

What drugs target the ascending loop of henle

A

Loop diuretics

Furosemide

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5
Q

What drugs target the distal convoluted tubule

A

Thiazides

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6
Q

What drugs target the collecting ducts

A

K+ sparing diuretics

Spironolactone, amiloride

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7
Q

How does acetazolamide (CAI) work at the proximal convoluted tubule

A

Inhibits reabsorption of HCO3- in the proximal convoluted tubule

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8
Q

How do loop diuretics work int he ascending loop of henle

A

Inhibit the Na/K/Cl cotransporter , resulting in the retention of Na, Cl, and water

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9
Q

How do thiazides work in the distal convoluted tubule

A

Inhibits reabsoprtion of Na and Cl in distal tubule, resulting in retention of water

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10
Q

What is the most commonly used diuretics

A

Thiazides

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11
Q

What is the most efficious diuretics

A

Loop

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12
Q

How do K+ sparing diuretics like spinronolactone and amiloride work in the collecting duct

A

Spironolactone is an aldosterone antagonsit, mediates reabsorption of Na and secretion of K

Amiloride block Na channels

Prevent loss of K

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13
Q

Where does most bicarbonate get reabsorbed

A

Proximal convoluted tubule

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14
Q

Where does most water get reabsorbed (and Na)

A

Proximal convoluted tubule

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15
Q

As you move through the nephron, how is Na reabsorbed

A

Less and less. Most reabsoprtion in the proximal convoluted tubule

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16
Q

How do you want to stop water reabsoprtion in the proximal convoluted tubule

A

Block H to indirectly block luminal Na pump

  • H comes from bicarbonate in urine
  • CA breaks down HCO3- into CO2 and water
  • now can move into cell
  • more CA in cell puts it back together to get HCO3-
  • HCO3- can one get reabsorbed into the blood

Use Carbonic anhydrase inhibitor to block the H

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17
Q

Luminal pump in the proximal convoluted tubule

A

Na/H pump

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18
Q

Basolateral membrane pump in proximal convoluted tubule

A

Na/K pump

-puts the Na back in the blood

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19
Q

How does carbonic anhydrase inhibitor work in the proximal convoluted tubule?

A
  • if CA is inhibited, can no longer break down HCO3-
  • H20 and CO2 cant move into the cell and cant form H inside the cell
  • Na stays in the urine (along with water), this is how it works as a diuretic

also not reabsorbing any bicarbonate
-results in metabolic acidosis, peeing out bicarbonate

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20
Q

What is a side effect of CAI used systemically

A

Metabolic acidosis. Not reabsorbing any bicarbonate, peeing it out

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21
Q

What what do we use CAI in order to not get the side effect of metabolic acidosis

A

Used topically for glaucoma

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22
Q

What part of the loop of henle do we target with drugs

A

Thick ascending limb

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23
Q

What do loop diuretics do to calcium

A

Lose calcium

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24
Q

What kind of luminal pump does the loop of henle have

A

Na/K/Cl pump

-all get into the cell

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25
Q

In the loop of henle, what does the influx of K do through the Na/K/Cl pump?

A

Increases intracellular K, which is already high. There is another channel for the cell to just leak it back out into the urine.

  • this changes membrane potential and causes the cells to separate from each other a little bit
  • when this happens, Mg and Ca2+ can get reabsorbed
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26
Q

How does Ca and Mg get reabsorbed in the nephron

A

In the ascending loop of henle, K is pumped into the cell via Na/K/CL pump. Since intracellular K is already high, the cell leaks the K back out into the urine. This causes a membrane potential change which then separates the cells a little bit. When this happens, Mg and Ca can get reabsorbed through that space between the cells

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27
Q

What happens if K does not come in and then leak out in the ascending limb of henle?

A

Do not reabsorb Mg and Ca

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28
Q

How do loop diuretics work

A

Block the Na/K/Cl transporter

  • can reabsorb Na (or water)
  • decrease K into the cell, no membrane potential change, no reabsorbtion of Mg to Ca, pee it out.
  • loops stop all 5 of these ions from reabsorbing
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29
Q

Which kind of drug will prevent Ca or Mg reabsoprtion

A

Loop diuretics like furosemide

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30
Q

What kind of drugs save calcium

A

Thiazides

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31
Q

What do thiazides do to Ca

A

Save it

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32
Q

What is the luminal transporter in the distal convoluted tubule?

A

Na/Cl transporter

Also has a Ca2+ channel in it too

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33
Q

Ca2+ channel and the Na/Cl transporter in the distal convoluted tubule

A
  • pathway for Ca to be reabsorbed
  • PTH regulates this
  • takes calcium out of urine and puts it into blood
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34
Q

What do thiazides block?

A

The Na/Cl transporter in the distal convoluted tubule

35
Q

How do thiazides work in the distal convoluted tubule

A

Block the Na/Cl transporter

-Na stays in the urine=diuretics

36
Q

How does blocking the Na/Cl transporter in the distal convoluted tubule effect Ca

A

Leaders to increased Ca2+ reabsorption
-if you block the Na/Cl pump, it will increase the activity of the Na/Ca pump that is present on the basolateral membrane to make up for the lack of Na being brought in, causing more Ca2+ reabsoprtion

37
Q

Postmenapausal women and diuretics

A

Give thiazides to decrease risk of osteoporosis

38
Q

What direction should you give to increase blood Ca?

A

Thiazides

39
Q

What diuretics will decrease urinary Ca?

A

Thiazides

40
Q

What regulates Ca2+ being absorbed

A

PTH

41
Q

Where are the principal and intercalated cells found in the nephron

A

In the collecting tubule

42
Q

What are the transporter on the lunminal side of the collecting tubule?

A

Principle cells

  • Na channel
  • K channel

Intercalated cell
-H transporter

43
Q

why are most diuretics K wasting?

A

The collecting duct doesn’t see much Na because it is the last place for Na to be reabsorbed

  • but if on a diuretic, more Na here
  • leads to increased K loss
44
Q

Na and K in the principle cells of the collecting tubules

A

Na comes in and K goes out, it is a coupled process

45
Q

When the principal cells of the collecting tubule secretes K, what do the intercalated cells do

A

Secrete H+ back into the urine along with it

46
Q

K loss in the collecting duct equals what

A

H loss

47
Q

If something is K wasting, what else is it?

A

H wasting

Hypokalemia=alkalosis

48
Q

If something is K sparing, what else is it

A

H sparing

Hyperkalemia=acidosis

49
Q

How does amiloride work in the collecting tubule

A

Blocks the Na pump

  • K+ sparing because now K+ not leaving
  • also H sparing too
  • acidosis and hyperkalemia
50
Q

Which drug that works in the collecting tubule will cause acidosis and hyperkaleima?

A

Amiloride

  • blocks the Na pump
  • K+ sparing because now K not coming in either
  • this also means that H is being spared
51
Q

How does aldosterone work in the collecting tubule

A
  • retains Na/H20 by binding its receptors there
  • increases Na reabsorption which increases water reabsorption
  • wastes H and K
52
Q

What is a problem in the collecting tubule that can lead to hypokalemia and alkalosis?

A

Hyperaldosteronism

53
Q

How do spironolactone and eplerenone work in the collecting tubule

A
  • block the aldosterone receptors

- does not increase Na, so not wasting K or H

54
Q

What is the exception to the rule for K and H being lost together when things work on K in the collecting duct?

A

Carbonic Anhydrase Inhibitors

  • cause K loss
  • but cause acidosis
  • cant reabsorb bicarbonate
55
Q

What is the name of the Carbonic Anhydrase Inhibitor used

A

Acetazolamide

56
Q

What are CAI most commonly used for

A

Eyedrops for glaucoma

57
Q

MOA of CAI in the eye

A

Inhibits CA in the ciliary body of the eye where it decreases the rate of aqueous humor formation (and decreases IPO)

58
Q

MOA of CAI

A

Can’t break down HCO3

  • stays in the urine
  • water and CO2 can’t move into the cell
  • cant form H inside the cell
  • Na and water stay in the urine as well.

Need H to make the Na/H pump work, otherwise, cant get Na into the cell

59
Q

Therapeutic uses of CAI (acetazolamide)

A
  • glaucoma: closed angle glaucoma
  • acute mountain sickness: above 10,000. Prevents weakness, breathlessness, dizziness, nausea, and cerebral and pulmonary edem by inducing acidosis before you go into the mountains
60
Q

Adverse effects of CAI (acetazolamide)

A

Metabolic acidosis (2-3 days of use) if used systemically

61
Q

What is a common name for CAIs

A

Anything that ends in -zolamide

62
Q

MOA of loop diuretics (furosemide, “-semide”)

A

Blocks the Na/K/Cl transporter

  • cant reabsorb Na or water
  • decreased K into cell, decreases Mg, and Ca reabsorbtion as well
63
Q

Therapeutic uses of loop diuretics (furosemide)

A
  • acute pulmonary edema
  • CHF (thiazides better choice, but loop used acutely if waking up with swollen feet)
  • edema
64
Q

Pharmacokinetics of loop diuretics

A

Short half life

Duration of action is 1-4 hours

65
Q

Adverse effects of loop diuretics (furosemide)

A

Ototoxicity: tinnitus, hearing impairment, sense of fullness in ears
-occurs due to inhibition of Na/K/Cl cotransporter in the inner ear

Hypokalemia alkalosis
-wastes K and H

66
Q

MOA of thiazides

A

Block the Na/Cl transporter in the distal convoluted tubule

  • Na stays in the urine
  • increased Ca reabsoprtion
67
Q

What are the thiazides most commonly used

A

HCTZ and chlorthalidone

68
Q

Therapeutic uses of thiazides

A
  • HTN
  • CHF
  • Hypercalciuria: good for patients with calcium stones in the urinary tract. Pull Ca2+ out of urine and put back into blood.
  • nephrogeniic diabetes insipidus
69
Q

How does a diuretic like thiazides work for diabetes insipidus

A

Pt has trouble repsponding to ADH receptor and loses a lot of water without Na

  • give diuretic
  • will lose Na now, along with the water
  • plasma vol decreases, which causes increased RAAS
  • ANGII on the PCT will cause reabsoprtion of more Na and now water too
70
Q

Adverse effects of thiazides

A

Hypokalemia alkalosis
Hypercalcemia
Hyperglycemia and hyperlipidemia

71
Q

Why do thiazides cause hyperglycemia and hyperlipidemia

A

Inhibiting insulin release from beta cells

72
Q

Which K sparing drugs are used for heart failure

A

Spironolactone and eplerenone

73
Q

How do spironolactone and eplerenone treat heart failure

A

Block aldosterone

74
Q

What are the weakest diuretics

A

K sparing

  • spironolactone
  • eplerenone
  • amiloride
75
Q

When do we use K sparing drugs

A

In combo with other diurites

76
Q

Which K sparing drug is not used for heart failure

A

Amiloride

77
Q

MOA of spironolactone and eplerenone

A

Aldosterone receptor antagonists

78
Q

Therapeutic uses of spironolactone and eplerenone

A
  • diuretics
  • hyperaldosteronism
  • heart failure
  • female hirsutism (only spironolactoen)
79
Q

Which K sparing drug works well for female hirsutism

A

Spironolactone because it also blocks the androgen receptor

80
Q

Adverse effects of spironolactone and eplerenone

A

Spironolactone may cause hynecomastia in males and irregular menstrual cycle in females
Hyperkalemia

81
Q

MOA of amiloride

A

Block the Na channels in collecting tubules

82
Q

Actions of amiloride

A

Used in combo with other diuretics to maintain normal K levels

83
Q

Adverse effects of amiloride

A

Hyperkalemia

Pharm Block 11 (7 decks)

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