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Renal > Diuretics > Flashcards

Diuretics Flashcards

1
Q

What are diuretics

A

Drugs that increase rate of urine flow

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2
Q

What are natriuresis

A

Drugs that increase excretion of sodium

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3
Q

Main effect of diuretics

A

Decrease reabsorption of sodium and chloride

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4
Q

Clinical application of diuretic

A

Reduce extracellular fluid volume

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5
Q

Type of diuretics

A 
Carbonic anhydride inhibitors
Loop diuretics 
Thiazide diuretics
Potassium sparing diuretics
Osmotic diuretics
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6
Q

Site of action of carbonic anhydrase inhibitors

A

Proximal convoluted tubule

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7
Q

Site of action of osmotic diuretics

A

Proximal convoluted tubule

Thin descending limb

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8
Q

Site of action of loop diuretics

A

Thick ascending limb

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9
Q

Sites of action of thiazide diuretics

A

Distal convoluted tubule

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10
Q

Site of action of potassium sparing diuretics

A

Cortical collecting tubule

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11
Q

Why is the enzyme carbonic anhydrase important

A

key role in sodium bicarbonate reabsorption and H+ secretion

breakdown of H2 CO3 -> co2 H2O in the lumen

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12
Q

What is the action of the carbonate anhydrase inhibitors

A

Inhibit both luminal and Cytoplasmic carbonic anhydrase Decreasing the absorption of sodium bicarbonate in the proximal tubule

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13
Q

Examples of carbonic anhydrase inhibitors

A

Acetazolamide
Dichlorphenamide
Methazolamide

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14
Q

How are carbonic Anhydraseinhibitors administered

A

Per os

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15
Q

In which segment of the proximal convoluted table are carbonic anhydrase inhibitors excreted

A

S2

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16
Q

Time needed for a change in urine pH after carbonic anhydrase inhibitors administration and time of action

A

Requires 30 to 120 minutes and persist for two hours

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17
Q

Should you reduce carbonic anhydrase inhibitors dose when there is renal insufficiency

A

Yes

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18
Q

Clinical uses of carbonic anhydrase inhibitors

A

Urine alkalinization
Glaucoma
Metabolic alkalosis

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19
Q

Carbonic anhydrase inhibitors unwanted effect

A

Metabolic acidosis due to chronic low bicarbonate
Potassium wasting
Paresthesia ,drowsiness, hypersensitivity reactions

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20
Q

Contra indication of carbonic anhydrase inhibitors

A

Patients with cirrhosis because of risk of. Hyperammonemia and. Hepatic encephalopathy

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21
Q

Mode of action of loop diuretics

A

Inhibition of sodium potassium chloride symporter at the thick ascending limb Preventing reabsorption of sodium potassium and chloride andWhich
also inhibit calcium and magnesium reabsorption

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22
Q

Loop diuretics examples

A 
Furosemide 
Bumetanide 
Etacrynic acid 
 torsemide
Piretanide
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23
Q

furosemide metabolism

A

65% Excreted unchanged in urine

Rest conjugated to glucuronic acid

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24
Q

Metabolism of bumetanide and torse I de

A

Hepatic metabolism

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25
Q

Loop diuretics have long or short half life

A

Short

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26
Q

What is the postdiuretic sodium retention effects

A

When there is decline of concentration of the loop diuretic there’s direct reabsorption of sodium occurring

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27
Q

Clinical uses of loop diuretics

A 
Acute pulmonary edema 
chronic congestive heart failure
Management of hypertension 
nephritic syndrome 
edema treatments associated with chronic renal insufficiency 
edema treatments
Treatment of hepatic cirrhosis
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28
Q

Unwanted effects of loop diuretics

A 
Hypokalemia
Hypomagnesemia
Hypocalcemia
Ototoxicity
Hyperuricemia
Hyponatremia
29
Q

Which of the loop diuretics mostly close ototoxicityf

A

Etacrynic acid

30
Q

Loop diuretics contraindications

A

Patient allergic to sulfonamides should avoid loop diuretics with a sulfonamide base

31
Q

Action of thiazide diuretics

A

Inhibits the sodium chloride symporter other distal convoluted tubule’s
Increases excretion of sodium chloride and water

32
Q

Examples of thiazide diuretics

A 
Bendroflumethiazide
Chlorothiazide
Trichlormethiazide
Hydrochlorothiazide
Hydroflumethiazide
Polythiazide
33
Q

Examples of thiazides like diuretics

A

Indapamide
Metolazone
Quinethazone
Chlorthalidone

34
Q

Can you administer all thiazide per os

A

Yes

35
Q

With which compound do thiazide diuretics compete with for secretion

A

Uric acid

36
Q

Clinical uses of thiazide diuretics

A

Edema treatments in cases of. Congestive heart failure ,cirrhosis,nephritic syndrome

37
Q

Unwanted effects of thiazide diuretics

A

Fatal Hyponatremia

38
Q

thiazide diuretics contraindications

A

Patience hypersensitive to sulfonamides or congeners should avoid

39
Q

What of action of potassium sparing diuretics

A

Reduced sodium reabsorption in the distal convoluted table and collecting tubules by antagonizing aldosterone and blocking sodium channels

40
Q

Potassium sparing diuretics responsible for antagonizing aldosterone

A

Spironolactone

Eplerone

41
Q

Potassium sparing diuretics responsible for blocking sodium channels

A

Amiloride

triamterene

42
Q

Action of spironolactone

A

Block binding of aldosterone to its Cytoplasmic receptor -> Increases sodium excretion with chloride and water and decrees potassium secretion

43
Q

Is spironolactone a strong or a weak diarrhetic

A

A weak diuretic

44
Q

Amiloride and triamterene action

A

Decrease luminal membrane sodium permeability -> Increase excretion of sodium chloride and water , decreases potassium secretion

45
Q

Where is s spironolactone absorbed

A

In the G.I. tract

46
Q

Metabolism of spironolactone

A

Metabolized in the liver

47
Q

What is Canrenone

A

An active metabolites of spironolactone with a long half-life of 16.5 hours

48
Q

Is Amiloride poorly or well absorbed

A

Poorly

49
Q

How is Amiloride excreted

A

By urinary excretion of unchanged drug

50
Q

Time of action of Amiloride

A

Peaks at six hours

Duration of 24 hours

51
Q

Is triamterene well or poorly absorbed in git

A

Well

52
Q

Triamterene metabolism

A

Metabolized to active form 4hydroxytriamterene sulfate and excreted in urine

53
Q

Action time of triamterene

A

Onset within two hours

duration of 12 to 16 hours

54
Q

Clinical uses of potassium sparing diuretics

A 
Hertz failure 
primary hyperaldosteronism( conns syndrome)
Secondary hyperaldosteronism
55
Q

Unwanted effects of potassium sparing diuretics

A

Hyperkalemia

Effect on steroid receptor causing gynecomastia ,impotence ,libido, menstrual irregularities

56
Q

Contraindication of potassium sparing diuretics

A

Hyperkalemia patient

57
Q

Osmotic diuretics mode of action

A

Retain water in luminal fluid and increased osmolarity of blood and renal filtrate

58
Q

Osmotic diuretics examples

A

Glycerin
isosorbide
Mannitol
urea

59
Q

Murder of administration of osmotic diuretics

A

Parenterally

60
Q

Is there a metabolism of osmotic diuretics

A

No

61
Q

How long does it take to eliminate osmotic diuretics

A

30 to 60 minutes

62
Q

Can you call uses of osmotic diuretics

A

Prophylaxis against acute renal failure
treatment of raised intracranial pressure or cerebral edema
raised intraocular pressure or glaucoma

63
Q

Unwanted effects of osmotic diuretics

A

Increased extracellular fluid volume
hyponatremia
Dehydration
Nausea headache vomiting

64
Q

Why is there diuretics resistance

A

Increased sodium chlorite reabsorption downstream of segments of diuretic action

Retention of sodium until next dose of diuretic when there is decline of diuretic concentration

Compensatory mechanism through renin-angiotensin aldosterone system and SNS

Decreased GI absorption and secretion into TUBULAR SITE leading to failure of drug to reach tubular sites

65
Q

How do you manage diuretics resistance

A

Rule out diuretics noncompliance
Reduce salt intake
Increase diuretics dosage
Inhibits different nephron sites through combination therapy
Optimize treatment of underlying disorder
Consider IV administration

66
Q

What type of combination of diuretic it’s possible

A

Loop diuretics and thiazide

Potassium sparing + loop + thiazides

67
Q

Which thiazides it is mostly used in combination with loop agents

A

Metolazone

68
Q

Do you need potassium supplement Tatian in combination of metolazone with loop diuretics

A

Yes because of hypokalemia

69
Q

When can you give a combination of potassium sparing plus loop and thiazide diuretics
When should you avoid it

A

To prevent hypokalemia

To avoid impatient with renal insufficiency

Renal (16 decks)

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