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RUSVM Pharmacology Spring 2017 > Diuretics > Flashcards

Diuretics Flashcards

1
Q

T/F: Diuretics cause urination.

A

False. They increase urine volume/urine flow.

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2
Q

How is sodium excreted from the body due to diuretics?

A

as NaCl

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3
Q

Are cardiovascular and physiological diuretics true diuretics?

A

No, they just have a diuretic effect.

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4
Q

T/F: the action of cardiovascular diuretics on the kidneys is secondary.

A

True. Their diuretic effect is primarily because of their action on the heart.

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5
Q

When is dopamine considered a diuretic?

A

at low doses only. Acts on the cholinergic receptors and increases renal blood flow.

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6
Q

What is the therapeutic use of cardiovascular diuretics?

A

To treat edema associated with congestive heart failure.

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7
Q

What is the site of action of ADH?

A

The collecting ducts.

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8
Q

What are the 2 physiologic diuretics?

A

Water and sodium chloride.

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9
Q

When is sodium chloride used as a diuretic?

A

In urolithiasis in calves, cats, and sheep

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10
Q

T/F: carbonic anhydrase inhibitors are used as diuretics.

A

False.

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11
Q

What is the most commonly used osmotic diuretic?

A

Mannitol

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12
Q

T/F: Mannitol will act as a diuretic when given IV and PO.

A

False. It will not act as a diuretic when given PO.

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13
Q

What is the most effective class of diuretics and where do they act?

A

loop diuretics, act on the thick ascending loop of henle.

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14
Q

How much tubular reabsorption of Na occurs in the TAL?

A

25%

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15
Q

What is the second most effective class of diuretics and where do they act?

A

Thiazide diuretics, act on the early distal tubules.

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16
Q

How much Na reabsorption occurs in the early distal tubules?

A

5%

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17
Q

What are the third most effective class of diuretics?

A

osmotic diuretics and carbonic anhydrase inhibitors (but carbonic anhydrase inhibitors are not used as diuretics)

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18
Q

What is the mechanism of action of Mannitol?

A

acts in the loop of Henle and in the proximal tubule (secondary) pulling water along with it into the interstitial space.

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19
Q

What is mannitol used to treat?

A

localized edema or acute glaucoma. Can also be used to treat acute renal failure.

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20
Q

When is mannitol contraindicated?

A

in generalized edema or when there is cerebral hemorrhage.

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21
Q

T/F: Mannitol crosses the eye barrier and the blood brain barrier.

A

False

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22
Q

Why can mannitol also be used to treat acute renal failure?

A

because it increases renal blood flow and renal medullary blood flow by several mechanisms.

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23
Q

T/F: mannitol is metabolized and then eliminated rapidly by the kidneys.

A

False. mannitol is not metabolized.

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24
Q

T/F: all loop diuretics are weak acids

A

True

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25
Q

With the exception of ____, diuretics are given orally. ___ diuretics are oral and injectable.

A

Mannitol, loop diuretics.

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26
Q

What is the most common loop diuretic?

A

furosemide.

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27
Q

what is the primary mechanism of action of loop diuretics?

A

inhibit the Na+/K+/2Cl- symporter at the luminal membrane in the thick ascending limb of the loop of Henle.

28
Q

What 3 drugs can you use to treat acute renal failure?

A

mannitol, loop diuretics (furosemide), and dopamine.

29
Q

What is the secondary mechanism of action of loop diuretics and why is it important?

A

Causes more secretion of Ca+ and K+. It is important because the secretion of potassium can cause hypokalemia, leading to tachycardia, tachyarrhythmias, and death. The added excretion of Ca2+ can be used to treat hypercalcemia.

30
Q

T/F: loop diuretics lower blood pressure via vasodilation.

A

True

31
Q

What gives loop diuretics their ability to vasodilate?

A

the increase they cause in systemic venous capacitance.

32
Q

Loop diuretics are used as an adjunct to saline to treat this condition.

A

hypercalcemia.

33
Q

What is the most efficacious agent to treat exercise induced pulmonary hemorrhage?

A

furosemide.

34
Q

Why do you not use aminoglycosides with loop diuretics?

A

because of ototoxicity

35
Q

What is the most serious adverse effect of loop diuretics?

A

hypokalemia.

36
Q

What is the most important adverse effect of using loop diuretics on diabetic patients?

A

hyperglycemia

37
Q

Why don’t thiazide diuretics help in acute renal failure?

A

because they do not reach the site of action.

38
Q

Where do thiazide diuretics act?

A

on the early distal tubules

39
Q

T/F: thiazide diuretics have both oral and injectable forms.

A

False. only oral.

40
Q

What is the main mechanism of action of thiazide diuretics?

A

they inhibit the Na+/Cl- symporter in the early distal convoluted tubules resulting in inhibition of reabsorption of Na+, Cl-, and diuresis.

41
Q

What diuretics can be used to prevent kidney stones (uroliths)?

A

thiazide diuretics.

42
Q

With which diuretics is the electrolyte imbalance more severe, thiazide or loop diuretics?

A

loop diuretics

43
Q

T/F: thiazide diuretics can be used to treat localized or generalized edema of CHF.

A

True.

44
Q

When are thiazide diuretics contraindicated?

A

in patients with hypercalcemia.

45
Q

Where do potassium sparing diuretics act?

A

on the late distal tubule and collecting duct.

46
Q

What other uses are there for potassium-sparing diuretics?

A

treatment of hypokalemia

47
Q

Which potassium sparing diuretic is a steroid hormone?

A

Spironolactone.

48
Q

What is the mechanism of action of spironolactone?

A

it competitively blocks aldoserone binding to the aldosterone-receptor in the late distal tubule and collecting duct. This results in excretion of NaCl and diuresis, as well as retention of K+ and H+.

49
Q

What are one of the adverse effects of spironolactone?

A

Can cause systemic acidosis due to H+ retention.

50
Q

T/F: spironolactone is not suitable for emergency use.

A

True. It takes about a day or 2 to take effect.

51
Q

Why is the diuretic efficacy of spironolactone mild?

A

Because only 2% of Na+ reabsorption occurs in the late distal tubule and collecting duct.

52
Q

What are the 2 theraputic uses of spironolactone?

A

diuretic and tx of primary and secondary hyperaldosteronism.

53
Q

What is the mechanism of action of triamterene and amiloride?

A

they block epithelial Na+ channels in the luminal membrane of the principal cells in the late distal tubule and collecting duct. This results in the excretion ofNa+ and diuresis, as well as retention fo K+ and H+

54
Q

What are the therapeutic uses of triamterene and amiloride?

A

tx of hypokalemia and hypomagnesemia.

55
Q

T/F: triamterene is metabolized by the liver, resulting in an active metabolite.

A

True

56
Q

Which carbonic anhydrase inhibitor is used to control mountain sickness?

A

acetazolamide

57
Q

Which 2 carbonic anhydrase inhibitors are more likely to cause systemic acidosis?

A

acetazolamide and methazolamide

58
Q

What carbonic anhydrase inhibitor is used to treat for onpen angle glaucoma and is good for the long term management of glaucoma?

A

dorzolamide and brinzolamide

59
Q

What is the MOA for CAIs?

A

They reversibly inhibit CA at the proximal tubules (primary) and at the collecting ducts (secondary). This inhibits the exchange of H+ for Na.

60
Q

How do CAIs affect intraocular pressure?

A

They lower intraocular pressure by unhibiting carbonic anhydrase in the eye, decreasing the formation of aqueous humor.

61
Q

How are dorzolamide and brinzolamide administered?

A

Topically on the eye.

62
Q

What is the drug of choice to treat central diabetes insipidus?

A

desmopressin.

63
Q

What is the drug of choice to treat nephrogenic diabetes insipidus?

A

thiazide diuretics

64
Q

What is the difference between central diabetes insipidus and nephrogenic diabetes insipidus?

A

central diabetes insipidus completely lacks ADH.

65
Q

How can you diagnose whether a patient is suffering from central diabetes insipidus vs. nephrogenic diabetes insipidus?

A

Using ADH. If you see improvement, it is central.

RUSVM Pharmacology Spring 2017 (10 decks)

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