Diuretics

Question 1

what are the two main toxicities of acetazolamide?

Answer 1

metabolic acidosis and hypokalemia

Question 2

what is the MoA of acetazolamide?

Answer 2

blocks action of carbonic anhydrase in the PCT and therefore you get less reabsoprtion of Na and secretion of H+

Question 3

name the two most common toxicities of loop diuretics?

Answer 3

hypokal

met alk

Question 4

name the four loop diuretics

Answer 4

furosemide
torsemide
bumetanide
ethacrynic acid

Question 5

what is another toxicity that loop diuretics cause in the loop?

Answer 5

hypocalcemia or hypercalciuria

Question 6

why do loop diuretics lead to hypercalciuria?

Answer 6

in the loop…potassium usually leaks into lumen through ROMK but since it is blocked the potassium does not…and this doesnt create the gradient for calcium to flow back in paracellulary

Question 7

how do loop diuretics cause gout? or hyperuricemia?

Answer 7

the diuretics are cleared using the same channels that pump urea out basolaterally and the same channels that pump urea in the epithelial surface…so not as much urea out and more urea in

Question 8

name the three thiazide diuretics

Answer 8

chlorthalidone
hydrochlorothiazide
metolazone

Question 9

what are the two common toxicities caused by thiazides

Answer 9

hypokal

met alk

Question 10

name the three other toxicities associated with thiazide?

Answer 10

hypercalcemia or hypocacliuria
hyperuricemia/gout
hyperglycemia

Question 11

how do thiazides cause hyperglycemia?

Answer 11

increased K+ secretion and less insulin release so higher blood sugar levels

Question 12

how do thiazides cause hyperuricemia and gout?

Answer 12

thiazides compete with urea export channels for clearance in kidneys

Question 13

how do thiazides cause hypercalcemia?

Answer 13

there is a calcium channel that works more in the DCT when the NCC channel is blocked by the thiazides

Question 14

what are the two ENaC blockers?

Answer 14

triamterene and amiloride

Question 15

what are the two aldosterone receptor blockers?

Answer 15

spironolactone and epleronone

Question 16

what are the two toxicities associated with ENaC blocker and also receptor blockers?

Answer 16

hyperkalemia and metabolic acidosis

Question 17

what is a random toxicity associated with spironolactone?

Answer 17

gynecomastia

Question 18

how does mannitol work as a diuretic?

Answer 18

it just gets filtered into the lumen and is increasing the luminal osmolality so it pulls a ton of water out…pretty much solute diuresis

Question 19

what are two toxicities of mannitol administration?

Answer 19

hypokalemia and metabolic alkalosis

Question 20

why does mannitol cause hypokal and met alk?

Answer 20

because of the huge amount of H2O pulled into lumen…lowers conc of H+ and K+ in the lumen and this leads to a favorable excretion gradient for these two ions

Question 21

what two classes of diuretics cause metabolic acidosis?

Answer 21

K+ sparing and carbonic anhydrase inhibitors