Diuretic agents

Question 1

Prototype carbonic anhydrase inhibitor

Answer 1

acetazolamide

Question 2

MOA of CAIs

Answer 2

inhibits carbonic anhydrases which results in lower concentration of H+ in the epithelial cell. This removes the driving force for transport of Na+ into the cell

Question 3

Site of action of CAIs

Answer 3

proximal tubule

Question 4

Therapeutic use of CAIs

Answer 4

rarely as a diuretic,
wide angle glaucoma
Altitude sickness
Epilepsy

Question 5

Adverse effects of CAIs

Answer 5

hypokalemia,
urinary alkinization and metabolic acidosis
renal stone formation
Toxicity similar to sulfonamides

Question 6

Site of action for the NA+-K+-2Cl- symport inhibitors

Answer 6

ascending limb of henle

Question 7

Prototype of Loop diuretics

Answer 7

furosemide

Question 8

MOA of loop diuretics

Answer 8

blocks the NA+-K+-2Cl- syporter

Question 9

Therapeutic use of loop diuretics

Answer 9

acute pulmonary edema, used for rapid IV action

CHF - used orally

Question 10

Adverse effects of loop diuretics

Answer 10

hyponatremia and hypokalemia
hypocalcemia
Reversible ototoxicity 
hyperuricemia
hyperglycemia

Question 11

Drug interactions with loop diuretics

Answer 11

NSAIDS reduce efficacy

Question 12

Prototype Na+-Cl- inhibitor prototype

Answer 12

hydrochlorothiazide, chlorothiazide

Question 13

Site of action of thiazides

Answer 13

distal convoluted tubule

Question 14

MOA of thiazides

Answer 14

inhibits Na+-Cl- symporter, so inhibition of carbonic anhydrase

Question 15

Thereapeutic uses of thiazides

Answer 15

hypertension
Mild edema
nephrogenic diabetes insipidus- paradoxical effect
calcium nephrolithiasis and osteoperosis

Question 16

Side effects of inhibiting Na+-Cl-

Answer 16

Hypokalemia, hyponatremia
Hyperuricemia
hyperglycemia and hyperlipidemia
Erectile dysfunction

Question 17

Drug interactions with thiazides

Answer 17

NSAIDs reduce diuretic efficacy

Quinidine- hypokalemia increases torsades de pointes

Question 18

Potassium-sparing diuretics

Answer 18

ENaC and aldosterone antagonists

Question 19

ENaC prototypes

Answer 19

triamterene, amiloride

Question 20

Aldosterone antagonist prototypes

Answer 20

spironolactone

Question 21

Site of action of potassium sparing diuretics

Answer 21

late distal tubule and collecting duct

Question 22

MOA of ENaC inhibitors

Answer 22

block epithelial Na+ channels on the apical membrane

Question 23

Aldosterone antagonist MOA

Answer 23

block cytosolic mineralocorticoid receptors, reduce expression of aldosterone-induced proteins (all of which promote Na+ reabsorption by multiple mechanisms)

Question 24

Adverse effects of potassium sparing diuretics

Answer 24

kyperkalemia, caution with ACE inhibitors and NSAIDs

Question 25

Adverse effects of spironolactone

Answer 25

steroid receptors can produce gynecomastia, impotence, hirsutism, decreased libido, epelernone reduces progestrone related effects.

Question 26

Therapeutic use of both K+ sparing diuretics

Answer 26

prevent hypokalemia

Question 27

Therapeutic use of ENaC inhibitors

Answer 27

liddle syndrome and systic fibrosis

Question 28

Therapeutic uses of aldosterone antagonists

Answer 28

primary hyperaldosteronism, hepatic cirrhosis, CHF

Question 29

Prototype osmotic diuretics

Answer 29

mannitol

Question 30

Site of action of osmotic diuretics

Answer 30

loop of henle, renal tubules

Question 31

MOA of osmotic diuretics

Answer 31

increases osmolarity of tubular fluid and plasma

Question 32

Therapeutic uses of osmotic diuretics

Answer 32

dialysis disequilibrium syndrome

reduces pre- and postoperative CSF and intraocular pressure

Question 33

Adverse effects of osmotic diuretics

Answer 33

contraindicated in heart failure and active cranial bleeding