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Renal Pharm > Diuretics > Flashcards

Diuretics Flashcards

1
Q

i. Acute mountain sickness ii. Restore acid-base balance in heart failure patients with metabolic alkalosis caused by loop diuretics

A

Acetazolamide

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2
Q

i. Heart failure ii. Treatment of ascites and edema secondary to hepatic failure iii. Hypokalemic alkalosis secondary to mineralcorticoid excess associated with diminished aldosterone metabolism iv. Effective in secondary hypertension due to hyperaldosteronism a. Potentiate the action of more proximally acting diuretics b. Counteract the potassium wasting of thiazide and loop diuretics

A

Spironolactone

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3
Q

a. Potentiate the action of more proximally acting diuretics b. Counteract the potassium wasting of thiazide and loop diuretics

A

Potassium sparing diuretics

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4
Q

About 67% of sodium reabsorption occurs here

A

Proximal tubule

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5
Q

Acute mountain sickness

A

acetazolamide

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6
Q

Aminoglycosides (ototoxicity) NSAIDs (decreases efficacy) Oral hypoglycemics (efficacy decreased)

A

Ethacrynic acid and Furosemide; loop diuretics

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7
Q

Carbonic anhydrase inhibitors site of action

A

Proximal tubule

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8
Q

Carbonic anhydrase inhibitors inhibit Na+ reabsorption by noncompetitively and reversibly inhibiting proximal tubule cytoplasmic carbonic anhydrase II and luminal carbonic anhydrase IV

A

Dorzolamide; Acetazolamide

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9
Q

Cirrhosis associated edema treatment

A

Diuretics include Spironolactone, loop diuretics and thiazides

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10
Q

Concurrent use with other potassium-sparing diuretics, potassium supplements, ARBs, or ACEIs (hyperkalemia) NSAIDs (decreases efficacy) Anuria

A

Spironolactone; Triamterene; Amiloride

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11
Q

Counteract hyperkalemia caused by potassium-retaining drugs or renal insufficiency with impaired K+ excretion

A

Loop diuretics; Thiazides

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12
Q

Counteract the potassium wasting of thiazide and loop diuretics

A

Potassium sparing diuretics

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13
Q

Glaucoma

A

dorzolamide

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14
Q

Heart failure associated edema treatment

A

spironolactone which competitively antagonizes aldosterone binding to its receptor; Furosemide is used in the acute setting to reduce the extent of pulmonary edema

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15
Q

How do carbonic anhydrase inhibitors cause metabolic acidosis?

A

i. Inhibition of H+ secretion ii. Inhibition of CA acid secreting-intercalated cells of the collecting duct

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16
Q

Hypercalcemia treatment–> inc excretion of Calcium

A

Loop diuretic

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17
Q

Adverse effect Hyperkalemia Metabolic acidosis

A

Triamterene; Amiloride

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18
Q

Hypertension (first line)

A

Thiazides

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19
Q

AE Hypokalemia Impaired glucose tolerance/hyperglycemia Hyperuricemia Hyperlipidemia*

A

Hydrochlorothiazide and indapamide

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20
Q

Treatment: Hyponatremia (administered with hypertonic saline)

A

Loop diuretics

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21
Q

i. Hypernatremia and dehydration due to water loss in excess of sodium excretion ii. Increases plasma osmolality leading to hyponatremia manifested as headache, nausea and vomiting due to the movement of fluid into the extracellular compartments

A

Mannitol

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22
Q

AE i. Hypocalcemia ii. Hypomagnesemia iii. Hypokalemia; predisposes patient to cardiac arrythmias iv. Metabolic alkalosis Decreased glucose tolerance Reversible ototoxicity

A

Furosemide;

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23
Q

AE Impotence and gynecomastia Hyperkalemia Metabolic acidosis

A

Spironolactone

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24
Q

increased extracellular volume can cause pulmonary edema leading to?

A

pulmonary congestion and heart failure (contraindications of mannitol)

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25
Treatment Lithium-induced nephrogenic diabetes insipidus
amiloride
26
Loop diuretics site of action
Thick Ascending Limb of the Loop of Henle
27
AE Metabolic acidosis
Dorzolamide; Acetazolamide and Potassium sparing diuretics
28
Treatment Nephrogenic diabetes insipidus
Thiazides
29
Treatment Nephrolithiasis
Thiazides
30
Nephrotic syndrome associated edema treatment
Diuretics include Spironolactone, loop diuretics and thiazides
31
Osmotic diuretics small molecules that are filtered at the glomerulus but not subsequently reabsorbed in the nephron constitute an intraluminal osmotic force limiting reabsorption of water across water-permeable nephron segments
Mannitol
32
Potassium Sparing site of action
Collecting duct
33
Potassium-Sparing Diuretics blockade of aldosterone receptor in collecting ducts inhibits synthesis of new Na+ channels (and new Na+/K+ ATPase) in the principal cells by binding to and preventing nuclear translocation of the mineralcorticoid (aldosterone) receptor decrease potassium and proton secretion
Spironolactone
34
Potassium-Sparing Diuretics competitive inhibitors of the apical membrane Na+ channel decrease potassium and proton secretion
Triamterene
35
Potassium-Sparing Diuretics competitive inhibitors of the apical membrane Na+ channel decrease potassium and proton secretion blocks the uptake of lithium by the Na+ channel in the collecting duct
Amiloride
36
principle site of action for the carbonic anhydrase inhibitors (CAIs) (Acetazolamide and dorzolamide) and the osmotic diuretics (mannitol)
Proximal tubule
37
principle site of action for the loop diuretics (ethacrynic acid and furosemide).
thick ascending limb (TAL) of loop of henle
38
principle site of action for the potassium sparing diuretics (Amiloride, spironolactone, and triamterene).
Collecting duct
39
TREATMENT Pulmonary and peripheral edema Edema associated with hypoalbuminemia (caused by liver disease or nephrotic proteinuria) Hypercalcemia (caused by malignancy or hyperparathyroidism) Hyperkalemia (caused by potassium-retaining drugs or renal insufficiency) Hyponatremia
Ethacrynic acid
40
TREATMENT Pulmonary and peripheral edema Edema associated with hypoalbuminemia (caused by liver disease or nephrotic proteinuria) Hypercalcemia (caused by malignancy or hyperparathyroidism) Hyperkalemia (caused by potassium-retaining drugs or renal insufficiency) Hyponatremia HTN (this is the only one not a clinical use for the other loop diuretic)
Furosemide
41
Contraindication: Pulmonary congestion Heart failure Severe renal disease
Mannitol
42
Rank carbonic anhydrase inhibitors, loop diuretics, thiazides, osmotic diuretics, and potassium sparing diuretics on the basis of relative efficacy
loop diuretics; thiazides and osmotic diuretics; carbonic anhydrase inhibitors; potassium sparing diuretics
43
reabsorbs between 25% and 35% of the filtered Na+ load
thick ascending limb (TAL)
44
reabsorbs NaCl without accompanying water, diluting the tubular fluid
thick ascending limb (TAL)
45
Reduce intracranial pressure in neurological conditions
Osmotic diuretics
46
Reduce intracranial pressure in neurological conditions
Mannitol
47
Reduces formation of aqueous humor and thus lowers intraocular pressure in treating open angle glaucoma
Dorzolamide
48
Restore acid-base balance in heart failure patients with metabolic alkalosis caused by loop diuretics
acetazolamide
49
retain their function in patient’s with very low creatinine clearance
loop diuretics
50
reversibly and competitively inhibit the Na+/K+/2Cl cotransporter in thick ascending limb of Henle thus inhibiting Na+ reabsorption, increasing excretion of cations, particularly Mg++ and Ca++, and increasing K+ secretion
Furosemide
51
Solute absorption is iso-osmotic—water accompanies reabsorbed ions to maintain ionic balance
Proximal tubule
52
Contraindication: Sulfonamide allergies Oral hypoglycemics (efficacy decreased) NSAIDs (decreases efficacy) Anuria
Hydrochlorothiazide and indapamide
53
Contraindication: Sulfonamide allergies COPD
Dorzolamide; Acetazolamide
54
CI: Sulfonamide allergies Aminoglycosides (ototoxicity) NSAIDs (decreases efficacy) Oral hypoglycemics (efficacy decreased)
Furosemide
55
The diuretics directly target renal ion transporter or channel function or expression to increase renal (1) excretion and thereby decrease (2)
1. Na+ 2. extracellular fluid volume
56
The modest diuresis caused by the (1) is due to the fact that 90% of sodium reabsorption occurs before reaching the distal tubule
thiazides
57
The principal cells of the proximal portions of the _________ reabsorb between 1% and 5% of the filtered Na+ load
Collecting duct
58
the principle site of action for the thiazide diuretics (hydrochlorothiazide and indapamide).
Distal convoluted tubule
59
The reabsorption of Na+ is dependent upon plasma aldosterone levels (aldosterone increases Na+ reabsorption and water retention).
Collecting duct
60
The tubular fluid emerging from the thin ascending limb is (1) and has an (2) concentration
1. hypertonic 2. elevated NaCl
61
used in combination with loop diuretics in heart failure a. Diminish hypercalciuria in patients at risk for nephrolithiasis b. Hypertension (first-line drugs) c. Heart failure d. Nephrogenic diabetes insipidus
Hydrochlorothiazide and indapamide
62
Thiazide diuretics competitive antagonists of the Na+/Cl cotransporter in distal tubule promote transcellular reabsorption of calcium
Hydrochlorothiazide and indapamide
63
Thiazides site of action
Distal tubule
64
This continuation of the diluting segment reabsorbs between 2% and 10% of the filtered Na+ load, while remaining impermeable to water
Distal convoluted tubule
65
This effect is most pronounced in the loop of Henle and the proximal tubule where most iso-osmotic water reabsorption takes place
Osmotic diuretics (Mannitol)
66
Unlike the sodium channel inhibitors, the effects of (1) are a function of the endogenous levels of aldosterone. The higher the levels of aldosterone, the greater the effects of (1)
spironolactone
67
used in treating lithium-induced nephrogenic diabetes insipidus a. Potentiate the action of more proximally acting diuretics b. Counteract the potassium wasting of thiazide and loop diuretics
Amiloride
68
* Ethacrynic acid vs. Furosemide * BOTH are Loop diuretics; * Furosemide is CONTRAINDICATED for ____ (use Ethacrynic acid) * Similar clinical uses BUT Furosemide also used for \_\_\_\_\_ * Ethacrynic acid causes _____ ototoxicity; Furosemide causes \_\_\_\_\_ototoxicity;
SULFA ALLERGIES; HYPERTENSION; IRREVERSIBLE; REVERSIBLE

Renal Pharm (14 decks)

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