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Year 2 > Diuretics > Flashcards

Diuretics Flashcards

1
Q

Where to Carbonic Anhydrase Inhibitors act?

A

Proximal convoluted tubule.

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2
Q

Where to osmotic diuretics act?

A

PCT, Thin descending loop, and the collecting duct.

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3
Q

Where do Loop diuretics act?

A

Thick ascending duct.

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4
Q

Where to Thiazides and Thiazide-like analogs act?

A

Distal convoluted tubule.

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5
Q

Where do Potassium sparing drugs and vasopressin receptor antagonists act?

A

Collecting duct.

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6
Q

Where in the nephron is Na reabsorbed?

A

Every portion of the nephron except the thin limbs of the Loop of Henle.

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7
Q

Is movement of Na from the lumen to the tubular cell an active or passive process?

A

Always passive.

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8
Q

Is movement of Na from the cell to the the blood active or passive?

A

Always active, requiring Na/K ATPase.

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9
Q

Do most diuretics block the active step or the passive step of Na reabsorption?

A

The passive step.

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10
Q

Where is the MAJORITY of Na reabsorbed.

A

PCT

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11
Q

Which diuretics block the active step of Na reabsorption?

A

None.

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12
Q

What are the two routes by which diuretics reach they site of action in the nephron?

A

1) Blood to site. 2) Tubular Fluid (lumen) to site.

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13
Q

Which route do Aldosterone antagonists act on?

A

Blood to site.

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14
Q

What is the function to the organic acid secretory system?

A

To transfer large substances from the blood into the renal tubules.

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15
Q

How can diuretics negatively effect gout patients.

A

They can compete for transfer with uric acid, leading to less uric acid excretion.

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16
Q

What are the 4 loop diuretics that act on the Thick Ascending Loop?

A

Furosemide, Torsemide, Bumetanide, Ethacrynic acid.

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17
Q

What is the transporter site of action for Furosemide, Torsemide, Bumetanide, and Ethacrynic acid?

A

NaK/2Cl transporter on luminal membrane of Thick ascending limb.

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18
Q

How to Furosemide, Torsemide, Bumetanide, and Ethacrynic acid reach their site of action?

A

Via the OASS in the Proximal Convoluted Tubule.

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19
Q

There is excess K+ accumulation inside cells. What effect does this have on Ca and Mg?

A

It will cause Ca and Mg to be driven out of the lumen and into the blood. Excessive K is a major reason for Ca and Mg reabsorption at the Thick Ascending Limb.

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20
Q

What is the effect of Furosemide, Torsemide, Bumetanide, and Ethacrynic acid on water, Na, Cl, Ca, Mg, and K reabsorption?

A

It DECREASES reabsorption for all of them.

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21
Q

What is the effect of renal prostaglandins (PGE2) on loop diuretics?

A

They contribute to the diuretic effects of loop diuretic drugs.

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22
Q

What is the effect of NSAIDs on loop diuretics?

A

They decrease the effects of loop diuretic drugs.

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23
Q

What are possible adverse effects of loop diuretics?

A

Severe decrease in BP, risk of hypokalemia, increased gout risk, hypovolemia.

24
Q

Can loop diuretics be used to treat acute pulmonary edema caused by heart failure?

A

Yes, because they have a very rapid onset.

25
Q

What are the two Thiazide diuretics?

A

Chlorothiazide and Hydrochlorothiazide.

26
Q

What are the three Thiazide-like diuretics?

A

Chlorthalidone, Metolazone, Indapamine.

27
Q

Where do the Thiazide and Thiazide-like drugs act?

A

DCT.

28
Q

What is the transporter site of action for Thiazides?

A

NaCl transporter on the luminal membrane of DCT.

29
Q

What is the effect of Thiazide diuretics on Ca reabsorption?

A

They increase Ca reabsorption, causing a net rise in blood Ca levels.

30
Q

What is the effect of NSAIDs on Thiazide diuretics?

A

NSAIDs decrease overall efficacy of Thiazide diuretics.

31
Q

What is the speed of action of Thiazide diuretics?

A

They have a slow onset. 1-3 weeks before effects fully seen.

32
Q

What are the two classes of potassium sparing drugs?

A

Na channel blockers and Aldosterone antagonists.

33
Q

What are the two potassium sparing drugs that are Na channel blockers?

A

Amiloride and Triamterene.

34
Q

What are the three potassium sparing drugs that are aldosterone antagonists?

A

Spironolactone, Canrenone, Eplerenone.

35
Q

Where in the nephron do potassium sparing drugs act?

A

Collecting ducts.

36
Q

What are the three major effects of aldosterone in the collecting duct?

A

Decreases K reabsorption. Increases Na and water reabsorption.

37
Q

What are the effects of Amiloride and Triamterene?

A

Decrease Na reabsorption (slight), increase K reabsorption (major), decrease water reabsorption.

38
Q

What are the effects of Spironolactone, Canrenone, and Eplerenone?

A

Decrease Na reabsorption (slight), increase K reabsorption (major), decrease water reabsorption.

39
Q

What are the effects of aldosterone antagonists?

A

Decrease in Na channel expression and Na channel activity. Decrease in K channel expression.

40
Q

What is the most common side effect of potassium sparing drugs?

A

Hyperkalemia

41
Q

Explain the reaction of aldosterone antagonists with steroid receptors.

A

These drugs are synthetic steroids and can interact with steroid receptors in cells other than the kidney. Can cause impotence, gynecomastia, menstrual irregularities.

42
Q

True or false: Aldosterone antagonists can treat excess hair growth in women.

A

True.

43
Q

What is the advantage of using Eplerenone vs Spironolactone?

A

It has little or no affinity for non-aldosterone receptors. Thus, no unpleasant hormone side effects occur.

44
Q

What are the two classes of Vasopressin Receptor Antagonists?

A

Tetracyclines and Vaptans

45
Q

What are the Tetracycline class Vasopressin Receptor Antagonists?

A

Demeclocycline.

46
Q

What are the Vaptan class Vasopressin Receptor Antagonists?

A

Tolvaptan, Conivaptan, Lixivaptan.

47
Q

What is the major effect of Vasopressin receptors being activated by ADH?

A

Increase in water reabsorption via insertion of water channels into the luminal membrane of the collecting ducts.

48
Q

What is the major effect of Vasopressin Receptor Antagonists?

A

Decrease in water reabsorption.

49
Q

What are Vasopressin receptor antagonists used to treat?

A

Hypoatremia.

50
Q

What is the most common osmotic diuretic?

A

Mannitol.

51
Q

What are the two sites of action of osmotic diuretics?

A

PCT and Thin Descending Limb.

52
Q

How to osmotic diuretics reach their site of action?

A

They are freely filtered at the glomerulus.

53
Q

What are the three carbonic anhydrase inhibitors?

A

Acetozolamide, Dorzolamide, Brinzolamide.

54
Q

What are the renal sites of action of carbonic anhydrase inhibitors?

A

PCT and collecting duct.

55
Q

What are carbonic anhydrase inhibitors most used for?

A

To decrease the elevated intraocular pressure caused by glaucoma.

Year 2 (9 decks)

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