Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Nephrology > Diuretics > Flashcards

Diuretics Flashcards

1
Q

Rate the Diuretic classes from least to greatest in terms of efficacy

A

Least - Carbonic Anhydrase Inhibitors
Middle - aldosterone antagonists and Na channel blockers, thiazides, loop diuretics
Most - Loop of henle (not counting the double whammy of loop + thiazide)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What do the 5 different diuretic classes do to potassium levels?

A

Most Wasting = Loop + Thiazide combination
Wasting (least-greatest) = thiazides, carbonic anhydrase inhibitors, loop of henle agents
SAVING = aldosterone antagonists and sodium channel blockers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What do the 5 different diuretic classes do in terms of H+ handling?

A

The carbonic anhydrase inhibitors and aldosterone antagonists/Na channel blockers have no H+ effect
H+ decrease (least-greatest) = thiazides, loop agents, combo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What diuretic agents mess with calcium levels?

A

Loop of henle agents sharply DECREASE calcium levels
Thiazides sharply INCREASE calcium levels
Loop + thiazide combo keeps things about equal in/out

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Which diuretic classes affect magnesium levels?

A

Only loop of henle agents have an appreciable effect on magnesium levels in the serum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Which diuretics function by inhibiting processes in the proximal convoluted tubule?

A

Mannitol (osmotic) and Acetazolamide (CA inhibitor)

*they also work in proximal straight tubule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Which diuretics function by inhibiting cells in the TALH?

A

TALH = thick ascending loop of henle

  • Furosemide
  • Bumetanide
  • ethacrynic Acid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

which diuretics work after the loop of henle in the proximal portion of the distal convoluted tubule?

A
  • thiazides

* metolazone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Which diuretics act at the level of the cortical collecting duct?

A

Amiloride (sodium channel blocker), spironolactone (aldosterone inhibitor), Triamterene

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the job of the proximal convoluted tubule?

A

70-80% of the reabsorption of water, electrolytes, short peptides and small molecules in plasma filtrate

  • there is secretion of orgainic acids and bases here, which is how diuretics get to their site of action
  • bicarb is re-generated and reabsorbed here
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How does mannitol work?

A

Mannitol is an osmotic diuretic that is not metabolized or reabsorped in the proximal tubule

  • end result is osmotic retention of water in the urine and stuff that freely flows with the water
  • induces diuresis by elevating the osmolarity of the glomerular filtrate
  • excretion of sodium and chloride is increased
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the pharmacokinetics of mannitol?

A

Administered IV, distributes in ECF, excreted by glomerular filtration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

When do you use mannitol?

A

Prevention of acute kidney injury secondary to major vascular surgery
Glaucoma (decrease intraocular pressure)
Preservation of renal function in rhabdomyolysis
Elevated intracranial pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the adverse effects of mannitol?

A

acute increase in ECF volume, nausea/headache, in prolonged use, can cause severe water loss and hypernatremia, heart failure (volume expansion)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What does Acetazolamide do?

A

It inhibits tubular Carbonic Anhydrase, which messes with the tubular reabsorption of bicarbonate

  • causes a metabolic acidosis, so it loses effectiveness if a pt is already acidotic
  • because of lack of bicarb, lack of sodium reabsorption, leads to a tiny bit of diuresis
  • mostly used to prevent HACE and HAPE now
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is Acetazolamide used for?

A

Glaucoma, Metabolic alkalosis, Mountain sickness/altitude sickness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the adverse effects of Acetazolamide?

A

metabolic acidosis, drowsiness, fatigue, CNS depression, parasthesias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the 4 Loop diuretics we talked about?

A

Furosemide, bumetanide, torsemide, ethacrynic acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the different absorbance percentages through the nephron for water?

A

Proximal convoluted tubule = 70%
Loop of Henle = 15%
Distal convoluted tubule and collecting duct = 14%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the different absorbance percentages for sodium through the nephron?

A

proximal convoluted tubule = 70%
Loop of Henle = 25%
Distal convoluted tubule and collecting duct = 4.5%

21
Q

What channel do loop diuretics inhibit?

A

Na/K/2Cl co-transporter in the TALH

  • decreases tonicity of medullary interstitium and therefore inhibits reabsorption of water in collecting duct
  • 15-25% excretion of filtered sodium
22
Q

How is Furosemide administered?

A

can be administered oral or IV. It binds well to plasma proteins and has a rapid onset of action
*both metabolized and renally eliminated

23
Q

How is ethacrynic acid administered?

A

IV. It binds plasma proteins extensively, is metabolized AND renally eliminated. Rapid onset of action

24
Q

What are loop diuretics used for?

A

HTN, edema by CV, renal or hepatic diseases.
*also used in hypercalcemia and pulmonary edema
DO NOT USE when there is edema caused by calcium channel blockers

25
Q

What are the adverse effects of loop diuretics?

A

Hearing loss (ototoxicity), Rapid onset of action, Hypokalemia, metabolic alkalosis (by way of potassium), Hyponatremia, Hypocalcemia, uric acid retention, sulfa allergy

26
Q

What are the 4 thiazide diuretics we talked about?

A

Hydrochlorothiazide, chlorthalidone, metolazone, indapamide

27
Q

What do the thiazide diuretics do?

A

Inhibit Na/Cl co-transporter in proximal part of distal convoluted tubule
*only moderate diuresis because of max 5% sodium affect

28
Q

What is the more potent thiazide?

A

Metolazone can increase sodium excretion even with lowered GFR (less than 30ml/min)
*used in combo with furosemide for lots of diuresis

29
Q

How are thiazides administered?

A

orally. they are secreted into proximal tubule and NOT metabolized

30
Q

What are thiazides used for?

A

HTN, edema (metolazone)

31
Q

What are the adverse effects of the thiazides?

A

Hypokalemia, hypomagnesemia, uric acid retention (gout), hyponatremia, hypochloremia, hyperglycemia and lipid abnormalities, hypercalcemia, sexual dysfunction, sulfa allergy

32
Q

What are the two aldosterone antagonists we talked about?

A

spironolactone and eplerenone (this is the selective one)

33
Q

What do aldosterone antagonists do?

A

antagonise the binding of aldosterone receptors at the aldosterone-dependent sodium-potassium exchange sites in the distal convoluted renal tubule

  • reduces reabsorption of sodium and secretion/excretion of potassium
  • also inhibits free testosterone from binding to androgen receptors in the cytoplasm of breast cells
  • eplerenone is the mineralocorticoid selective antagonist
34
Q

How are the aldosterone antagonists administered?

A

orally. Metabolized to active state, renal and biliary excretion. Slow onset of action and long half-life

35
Q

What are aldosterone antagonists used for?

A

Resistant HTN, Heart Failure, Hyperaldosteronism (but adminster with other diuretics that act on water as this is a potassium saver)

36
Q

What are the adverse effects of the aldosterone antagonists?

A

Hyperkalemia (don’t use in proggessive renal failure like under 30ml/min GFR), Gynecomastia (not eplerenone), Amenorrhea

37
Q

What does the AT1 angiotensin II receptor do?

A

Vasoconstriction, hypertrophy, proliferation.

Increases: norepinephrine, thirst, sodium retention, PAI-I, oxidation

38
Q

What does AT2 angiotensin II receptor do?

A

releases NO, sends an antiproliferation signal, vasodilates

39
Q

What do ARB’s block?

A

They block angiotensin II from binding its receptor. They also block the action of the AT1 receptor (which is an angiotensin II receptor)

40
Q

What do MRAs block?

A

MRAs block Aldosterone binding to the mineralocorticoid receptor.

  • KIDNEY = blocks mineralocorticoid (aldosterone)-dependent sodium retention, potassium depletion, and lastly blocks increased microalbuminuria
  • VESSELS/HEART = blocks increased NADPH, ROS, NF-kB and AP1 (eventually blocks inflammation and fibrosis)
  • CNS/ANS = blocks central sympathetic drive hypertension, blocks the decreased heart rate variability, decreases myocardial NE uptake
41
Q

What do MRAs do in the CNS/ANS?

A

*CNS/ANS = blocks central sympathetic drive hypertension, blocks the decreased heart rate variability, decreases myocardial NE uptake

42
Q

What do MRAs do in the vessels/heart?

A

*VESSELS/HEART = blocks increased NADPH, ROS, NF-kB and AP1 (eventually blocks inflammation and fibrosis)

43
Q

what do MRAs do in the kidney?

A

*KIDNEY = blocks mineralocorticoid (aldosterone)-dependent sodium retention, potassium depletion, and lastly blocks increased microalbuminuria

44
Q

What are the two sodium channel blockers we talked about?

A

Triamterene and Amiloride

45
Q

How does Amiloride work?

A

blocks luminal sodium channels and decreases the driving force for potassium secretion/excretion
*indirectly decreases hydrogen ion secretion

46
Q

How are sodium channel blockers (kidney) administered?

A

Orally. secreted as organic bases. Metabolized in liver and both renal and biliary excretion

47
Q

When do you use sodium channel blockers (kidney)?

A

In combo with other diuretics. They are synergistic with others and help spare some potassium

48
Q

What are the adverse effects of sodium channel blocker use (kidney)?

A

Hyperkalemia, hyperuricemia, glucos intolerance in diabetes (amiloride in particular)

49
Q

In diabetic patients, what diuretic are you concerned about using?

A

Amiloride, as it can make diabetic patients glucose intolerant

Nephrology (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions