Diuretics

Question 1

What are the three renal dilators?

Answer 1

Dopamine, Fenoldopam, and Atriopeptin

Question 2

How do renal dilators work?

Answer 2

Decreases filter fraction and GFR stays the same. There is increased blood flow in the peritubular capillaries, which has less oncotic pressure, causing less Na/H20 to be reabsorbed and more to be “leaked” back into the tubule. Weak diuretic.

Question 3

What is the diuretic used to treat edema in an inpatient setting?

Answer 3

Mannitol.

Question 4

What kind of diuretic is Mannitol and how does it work?

Answer 4

Osmotic Diuretic. Freely Filtered, prevents reabsorption of water from the tubule.
Uses are for edema, acute renal failure, and glaucoma. Can cause volume overload in the vasculature.

Question 5

What diuretic works in the proximal tubule and what kind is it?

Answer 5

Acetazolomide - Carbonic Anhydrase Inhibitor

Question 6

What is the mode of function of a carbonic anhydrase inhibitor?

Answer 6

Prevents the production of carbonic acid from CO2 and H20, which produces a H+ ion that is used to convert Bicarbonate into Carbonic acid in the lumen. Causes decrease reabsorption of bicarb due to rest of tubule unable to compensate. Increased Na+, K+, Bicarb, and H20 excetion.

Question 7

What are therapeutic uses of Acetazolamide?

Answer 7

Alkalizes urine, helping with toxicity. Altitude sickness. Reduces aqueous humor formation

Question 8

What kind of diuretics are the most potent and fastest acting with short duration?

Answer 8

Loop Diuretics. Furosemide. Bumetanide, and Ethacrynic Acid.

Question 9

What type of transporter is targeted with loop diuretics?

Answer 9

Na-K-2Cl Symporter in the ascending loop.

Question 10

What are extra effects of loop diuretics?

Answer 10

Increases renal blood flow and GFR, enhances Calcium excretion, and causes increased urate absorption.

Question 11

What are the main therapeutic uses for loop diuretics?

Answer 11

Treating edema due to cardiac, hepatic, or renal disease. Acute pulmonary edema. HTN

Question 12

What is unique about Furosemide adverse effects?

Answer 12

Can cause hyperglycemia.

Question 13

What are possible side effects of loop diuretics?

Answer 13

Hypokalemia, Alkalosis, Hypovalemia, and Ototoxicity.

Question 14

Where do thiazide diuretics work and name them?

Answer 14

Chlorothiazide, Hydrochlorothiazide, and Metolazone. Distal Tubule, inhibiting the Na+/Cl- co-transporter.

Question 15

What are the effects of a thiazide diuretic?

Answer 15

Moderate potency, long duration/fast acting, increases excretion of K+ and decreases calcium excretion. Causes hypertonic urine.

Question 16

What are therapeutic uses for thiazide diuretics?

Answer 16

First line for HTN treatment, CHF, and used to treat renal calculi (increases absorption of Ca+2).

Question 17

What are adverse side effects from thiazide diuretics?

Answer 17

Hypokalemia, Alkalosis, Too much urate in blood, and HYPERGLYCEMIA, and Lowered GFR.

Question 18

What are the two types of potassium sparing diuretics and what are they?

Answer 18

Aldosterone Antagonist: Spironolactone, Eplerenone

Sodium Channel Inhibitors: Amiloride and Triamterene

Question 19

Where do potassium sparing diuretics work?

Answer 19

Collecting tube, either inhibiting the channels or the aldosterone receptors.

Question 20

How are potassium sparing diuretics used?

Answer 20

They are always used with unison with another diuretic to prevent hyperkalemia. Used to treat HTN, Edema, and used with CHF to increase survival. Also treats aldosteronemia.

Question 21

What is a unique side effect of aldosterone inhibitors?

Answer 21

Gynecomastia due to Spironolactone»Eplerenone

Weak progesterone agonist

Question 22

What can a high dose of Triamterene cause?

Answer 22

Decreased Renal blood flow and GFR

Question 23

What diuretics work the fastest?

Answer 23

Loop Diuretics - Furosemide, Bumetanide, and Ethacrynic Acid

Question 24

What type of diuretics are the cheapest?

Answer 24

Thiazide Diuretics: Chlorothiazide, Hydrochlorothiaze, Metolazone

Question 25

What type of diuretics have the greatest effect?

Answer 25

Loop Diuretics: Furosemide, Bumetanide, Ethacrynic Acid

Question 26

What is ceiling dose and how is it effected by renal disease?

Answer 26

Ceiling effect is the dose at which there is no further effect in the kidney, the more diseased state the higher the dose to have the same effect.

Question 27

What body compartment do diuretics act the most slowly on?

Answer 27

Intracellular Fluid - Body Compartment

Diuretics act directly on vascular compartment

Question 28

What is a consideration when treating HTN with diuretics?

Answer 28

When treating with diuretics, due to the fluid loss there is an increase in renin, so helpful to prescribe ACE inhibitor as well.

Question 29

What is the main purpose of CHF therapy?

Answer 29

Decrease fluid volume - thus lower preload. Prevent hypertrophy, maintain stroke volume. Improve survival by using Spironolactone and Eplerenone.

Question 30

What are two ways Thiazide diuretics can help hypertension?

Answer 30

Reduces fluid volume and has a mild effect on arterial smooth muscle relaxation decreasing peripheral resistance.