Diuretics

Question 0

Furosemide Adverse Effects

Answer 0

Loop, NKCC2
**Ototoxicity**
Hyperuricemia
Acute Hypovolemia
**Hypokalemia**
Hypomagnesemia
Allergies (Sulfa)

Question 1

Furosemide Indications

Answer 1

Loop
NKCC2
DOC for acute pulmonary edema with heart failure
Hypercalcemia
Hyperkalemia
Ethacrynic acid is non-sulfa but more ototoxic

Question 2

Torsemide indications

Answer 2

Loop, NKCC2
DOC for acute pulmonary edema with heart failure
Hypercalcemia
Hyperkalemia

Question 3

Torsemide adverse effects

Answer 3

Loop, NKCC2
**Ototoxicity**
Hyperuricemia
Acute hypovolemia
**Hypokalemia**
Hypomagnesemia
Allergies (sulfa)

Question 4

Loop Diuretics Mechanism

Answer 4

NKCC2
Site-ascending LOH
Blocks Na/Cl/K co transporter
Increased prostaglandin synthesis (COX2)
Ethacrynic acid is non sulfa but more ototoxic, furosemide and torsemide are sulfa

Question 5

Loop Diuretic Urine Composition

Answer 5

Increased calcium, sodium, potassium, magnesium

Increased volume

Question 6

Thiazides Mechanism

Answer 6

NCCT
Site - DCT
Block Na/Cl co transporter
ceiling-saturates at low dose

Question 7

Loop Effects

Answer 7

NKCC2
Ascending LOH Na/Cl/K cotransporter
Most effective DOC for acute pulmonary edema with heart failure
Produces a lot of urine
Increases renal blood flow via decreased resistance

Question 8

Thiazide Effects

Answer 8

NKCC2
Site - DCT
Decreases PVR and BP even after volume recovery

Question 9

Thiazide Indication

Answer 9

HTN
Mild heart failure
Hypercalciuria
Diabetes Insipidus

Question 10

Thiazide Urine composition

Answer 10

Increased sodium, potassium, Chloride, Magnesium
Decreased Calcium
Increased volume

Question 11

Thiazide Adverse effects

Answer 11

Give oral only 
NKCC2 
Hypokalemia
Hyponatremia
Hyperuricemia
Volume depletion
**Hyperglycemia**
**Hyperlipidemia**

Takes 1-3 week to obtain stable effects

Question 12

Thiazides

Answer 12

Chlorthalidone
Hydrchlorothiazide
Metolazone
(Sulfa derivatives)

Question 13

Loops

Answer 13

Furosemide
Torsemide
Ethacrynic Acid

Question 14

Aldosterone Agonists

Answer 14

Spironolactone

Eplerenone

Question 15

Aldosterone Agonist Mechanism

Answer 15

Antagonizes aldosterone at cytoplasmic receptors (preventing translocation)
Acts at collecting duct
Used in combination with other diuretics

Question 16

Aldosterone Antagonist Indication

Answer 16

Primary hyperaldosteronism

Edema

Question 17

Aldosterone Antagonist PK

Answer 17

Oral and strongly protein bound

Induces CYP450

Question 18

Aldosterone Antagonist Adverse Effects

Answer 18

GI upset and peptic ulcers
**Endocrine->irregular menstrual cycles, gynecomastia, impotence**
Hyperkalemia
Nausea, Lethargy
Mental Confusion

Question 19

ENaC K sparing Drugs

Answer 19

Amiloride

Triamterene

Question 20

ENaC K Sparing Mechanism

Answer 20

Blocks Na transport channels
Decreases sodium/potassium exchange
Acts at collecting duct

Question 21

ENaC K sparing indications

Answer 21

Primary hyperaldosteronism
Heart failure
Hypokalemia

Question 22

ENaC K sparing Adverse effects

Answer 22

Same as spironolactone -GI upset and peptic ulcers, Endocrine issues (gynecomastia, impotence, irregular menstrual), Hyperkalemia, nausea, lethargy, mental confusion
Plus leg cramps**
Increased BUN, uric acid

Question 23

CAH inhibitor Drug

Answer 23

Acetazolamide

Question 24

CAH inhibitor Mechanism

Answer 24

Acts mainly in the PT | Prevents formation of H+ needed for Na+ reabsorption in the PT

Question 25

CAH inhibitor Indication

Answer 25

Glaucoma (decreases production of aqueous humor) Treat metabolic alkalosis Mountain sickness prophylaxis Epilepsy

Question 26

CAH inhibitor Adverse effects

Answer 26

**Metabolic acidosis** K depletion (rare) Renal stones **Contraindicated in hepatic cirrhosis due to decreased NH4+ excretion**

Question 27

Osmotic Drug

Answer 27

Mannitol

Question 28

Osmotic Effect

Answer 28

Does not affect sodium excretion

Question 29

Osmotic drug mechanism

Answer 29

Filtered into glomerulus, draws H2O into tubular fluid

Question 30

Osmotic drug indications

Answer 30

Increased ICP Acute renal failure (shock) Drug toxicity Trauma (maintain urine)

Question 31

Osmotic PK

Answer 31

IV only

Question 32

Osmotic Adverse

Answer 32

Extracellular H2O expansion ->Dehydration Hypo or hypernatremia Oral->osmotic diarrhea

Question 33

ADH antagonist

Answer 33

Conivaptan

Question 34

Conivaptan

Answer 34

Inhibits CYP3A4

Question 35

ADH antagonist Effect

Answer 35

Renders CT impermeable to H2O

Question 36

ADH antagonist mechanism

Answer 36

Inhibit ADH | Decrease aquaporins in the collecting duct

Question 37

ADH antagonist indication

Answer 37

SIADH | Hyponatremia

Question 38

ADH antagonist Urine composition

Answer 38

Increased plasma Na | Decreased H2O reabsorption ->dilute urine

Question 39

ADH antagonist PK

Answer 39

IV only

Question 40

ADH antagonist adverse

Answer 40

Nephrogenic diabetes insipidus | Renal failure

Question 41

Diuretic main uses

Answer 41

Management of edema and hypertension