diuretics 3

Question 1

Diuretics that block ____Na+ reabsorption receptor, which leads to _____

Answer 1

collecting tubule

decrease in K+ excretion (hyperkalemia K+-sparing)

Question 2

Spironolactone

acts to

Answer 2

Competitive antagonist at aldosterone receptor, leads to blocks synthesis of Na+ and K+ channels - Na+-K+-ATPase

Question 3

Triamterene / Amiloride acts as a

Answer 3

1. Direct effect to block the Na+-channels on collecting duct lumen and decrease Na+ reabsorption
2. No utility in HF - do not block pro-fibrotic actions of aldosterone

Question 4

Triamterene metabolized in

Answer 4

liver

Question 5

which drugs are K+ sparing diuretics

Answer 5

1. spironolactone
2. eplerenone
3. triamterene/amiloride

Question 6

Tx of HF by K+ sparing diuretics: Anti-remodeling action is to

Answer 6

block of aldosterone-mediated cardiac hypertrophy and fibrosis

Question 7

K+ sparing diuretics tx HF can benefit from raising serum

Answer 7

K+ leads to counter risk of hypokalemia-induced arrhythmias from K+-wasting diuretics

Question 8

K+ sparing diuretic adverse reactions

Answer 8

1. hyperkalemia
2. endocrine abnormalitiies (gynecomastia)
3. GI upset
4. drowsiness

Question 9

K+ sparing diuretic: hyperkalemia can cause

Answer 9

1. EKG changes
2. conduction abnormalities
3. arrhythmias

Question 10

hyperkalemia in K+ sparing diuretic risk is increased by

Answer 10

1. Increasing age
2. Underlying renal dysfunction
3. Higher doses
4. Combined use of ACEI or ARB
5. Use of NSAID analgesics

Question 11

gynecomastia by spironolactone is caused by?

Answer 11

block of androgen receptor

NOT seen with eplerenone, because it is selective for aldo receptors

Question 12

RAAS Antagonists

Answer 12

1. ACE Inhibitors

2. AT-1 Receptor Blockers

Question 13

ACEI action in HF

Answer 13

1. Inhibits ACE conversion of Ang I to Ang II, which blocks Ang II-induced vasoconstriction, which decreases preload and afterload
2. Vasodilators have less survival benefits than ACEIs

Question 14

ACEI primary mechanism

Answer 14

decrease Ang II-induced release of aldo and moderates myocardial hypertrophy and remodeling

Question 15

ACEI results in

Answer 15

1. Decreases bradykinin inactivation, increasing its vasodilator action
2. Improves endothelial function, which leads to enhancing NO action
3. Reduces sympathetic activity

Question 16

ACEI: prodrugs

Answer 16

are converted to the active metabolite by de-esterification in the liver

Question 17

ACEI excretion

Answer 17

Active metabolites are eliminated by the kidneys - renal dosing required