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Pharmacology Exam II > Diuretics > Flashcards

Diuretics Flashcards

1
Q

Proximal Tubule important for reabsorption of

A

Na-HCO3

NaCl

H2O

as well as AA’s, glucose, etc.

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2
Q

Where are the two main sites of K reabsorption?

A

Proximal convoluated tubule (65%) - compulsory

Distal convoluted tubule - regulated

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3
Q

Carbonic Anhydrase Inhibitors used for?

A

Used to be diuretic but now more for metabolic

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4
Q

Carbonic Anhydrase Inhibitors MOA

A

inhibit CA

decreased HCO3- reasorption in PCT

decreased HCO3- formation in kidney/RBC’s

Inhibition of titratable acid and NH4+ secretion

Ultimately leads to increased HCO3- excretion which pulls NaCl and H2O with it resulting in DIURESIS

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5
Q

Clinical indication of Carbonic anhydrase inhibitors

A

Glaucoma
Acute mountain sickness
Induce urinary alkalinization
Edema (combined with NKCC and NCC inhibitors)

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6
Q

Adverse Effects of Carbonic Anhydrase Inhibitors

Contraindicated in?

A

hyperchloremia metabolic acidosis

renal stones

renal loss of K

Cirrhosis (d/t increased NH4)

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7
Q

Osmotic Diuretic MOA

Main site of action?

A

freely filtered/poorly reabsobred

Increases tubular osmotic pressure = pulling water into tubule and keeping it there

Thin loop of Henle

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8
Q

Clinical Applications of Osmotic Diuretics (4)

A

Prophylaxis of acute renal failure

Cerebral edema

Dialysis dysequilibrium syndrome

Acute glaucoma attacks

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9
Q

Adverse effects of osmotic diuretics

A

ECV expansion - risk of pulmonary edema w/CHF

Hyponatremia/hypernatremia

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10
Q

Contraindications of Osmotic Diuretics

A

anuria - d/t kidney disease

impaired liver function

active cranial bleed

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11
Q

Osmotic Diuretics

A

MANNITOL
glycerin
isosorbide
urea

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12
Q

Carboinic ANhydrase Inhibitors

A

ACETAZOLAMIDE
dichlrophenamide
methazolamide

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13
Q

Loop Diuretics (NKCC Inhibitors)

A

FUROSEMIDE
bumetanide
ethacrynic acid

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14
Q

NKCC Inhibitors MOA

A

inhibit Na/K/2Cl cotransporter

inhibits reabsorption of solute from Thick Ascending Limb

Venodilation occurs - decreases RA and PCW pressures within minutes

Increase fractional Ca and Mg excretion - both through paracellular route

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15
Q

Clinical Indications of NKCC Inhibitors

A

Pulmonary edema

CHF

Acute Renal Failure

Hypercalcemia - (saline + loop diuretics)

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16
Q

MAJOR adverse effect of NKCC Inhibitors

A

HYPOKALEMIA

used extensively in CHF patients along with digoxin and other potassium sensitive drugs

17
Q

NCC Inhibitors (Thiazides and Sulfonamides)

A

CHLORTHALIDONE
hydrochlorothiazide
metolazone
indapamide

18
Q

NCC inhibitors MOA

A

Inhibit Distal convoluted tubule Na/Cl co-transporter

Decreases Ca excretion

Causes vasorelaxation

19
Q

Clinical Applications of NCC INhibitors (thiazides/sulfonamides)

A

Hypertension

Edema control

Hypercalciuria

Nephrolithiasis

Nephrogenic diabetes insipidus

20
Q

Inhibitors of renal epithelial Na channels

A

AMILORIDE

triamterene

21
Q

Renal Epithelial Na Channel Inhibitors MOA

A

block Na channels in late distal convoluted tubule and cortical collecting ducts

causes MODEST natriuresis and prevention of K LOSS

22
Q

Clinical indications of Renal Epithelial Na Channel Inhibitors

A

K-sparing agents in HYPOKALEMIC ALKALOSIS

in combo with thiazides/sulfonamides

23
Q

Aldosterone receptor antagonists

A

SPIRONOLACTONE

eplerenone

24
Q

Aldosterone antagonist MOA

A

antagonize aldosterone receptor

decrease Na reabsorption - natriuresis

decrease loss of K in exchange for Na

25
Q

Spironolactone Therapeutic Effects (4)

A

Prevention of LV remodeling and cardiac fibrosis

Prevention of sudden cardiac death

Hemodynamic effects

Vascular effects - decreased NADPH oxidase actiity

26
Q

Clinical Applications of Spironolactone

A

Edema/Hypertension

Standard therapy of heart failure

Primary hyperaldosteronism

Refractory edema associated with secondary hyperaldosteronism

27
Q

Adverse Effects of Spironolactone

A

HYPERKALEMIA

metabolic acidosis

Effects d/t binding to other steroid receptors (gynecomastia, impotence, hirsutism)

Pharmacology Exam II (5 decks)

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