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Pharmacology > Diuretics > Flashcards

Diuretics Flashcards

1
Q

How does the kidney regulate extracellular fluid volume?

A

by changing ionic concentrations and water levels in the body

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2
Q

What percentage of Na, K, Ca, Mg, Cl, bicarbonate, and water are resorbed by the kidney?

A

greater than 95%

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3
Q

How many liters does the kidney filter per day?

A

180

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4
Q

How often does the total blood volume get filtered through the kidney?

A

every 40 minutes

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5
Q

What does the kidney eliminate?

A

urea, creatinine, drugs, and toxicants

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6
Q

Urine is _____ of plasma.

A

ultrafiltrate

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7
Q

What are some other functions of the kdiney?

A

production of renin, erythropoietin, and glycogen storage

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8
Q

What is occurring at step 1?

A

Active transport coupled to ATP hydrolysis

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9
Q

What is happening at steps 2 and 3?

A

simple diffusion

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10
Q

What is happening during steps 4-7?

A

movement via ion channels

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11
Q

What is happening in step 8?

A

counter-transport (antiport)

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12
Q

What is happening in steps 9-10?

A

co-transport (symport)

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13
Q

Some of these transporter sites (in the renal tubule cells) serve as ______ of various class of diuretic drugs.

A

pharmacological targets

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14
Q

Generally, what do diuretics do?

A

increase the water and salt elimination rate in urine

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15
Q

Diuretics ______ renal excretion of mainly Na+ and water.

A

incrrease

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16
Q

Diuretics ______ extracellular fluid volume.

A

decrease

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17
Q

Diuretics ______ blood pressure and ______ cardiac function.

A

normalize, improve

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18
Q

Diuretics _____ normal tissue perfusion and organ function.

A

restore

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19
Q

Diuretics _____ the clearance of poisons, drug, and metabolites.

A

enhance

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20
Q

Diuretics ______ clearance of debris from the nephrons.

A

increase

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21
Q

What are the indications for diuretic use?

A

edema, hypertension, and ‘others’ (will address others in another card)

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22
Q

What is edema?

A

an increase in interstitial fluid volume

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23
Q

What are three causes of generalized edema?

A

congestive heart failure, nephrotic syndrome, and hepatic diseases

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24
Q

How does congestive heart failure cause generalized edema?

A

Decreased cardiac output -> renal hypofunction -> RAS activation -> Na and H20 retention -> edema

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25
Q

How does nephrotic syndrome cause generalized edema?

A

Protein loss in urine → decreased plasma oncotic pressure → increased interstitial fluid → edema

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26
Q

How do hepatic diseases cause edema?

A

Decreased aldosterone or protein synthesis -> increased Na and H20 retention -> edema

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27
Q

What some types of local edema?

A

cardiogenic pulmonary edema, cerebral edema, ocular edema, and udder edema

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28
Q

What can cause cardiogenic pulmonary edema?

A

cardiomyopathy, valve and septal defects

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29
Q

What are the ‘other’ indications for diuretics?

A

glaucoma, Ca urolithiasis, hypercalcemia, hypo and hyperkalemia, metabolic acidosis/alkalosis, nephrogenic diabetes insipidus

30
Q

What are the 5 major classes of diuretics?

A

osmotic diuretics, loop diuretics, thiazides diuretics, K+ sparing diuretics, and ‘others’

31
Q

What are the ‘others’ diuretics?

A

Carbonic anhydrase inhibitors: Methylxanthines, acidifying salts

32
Q

The site of action of diuretics can ______ the efficacy of the specific class of diuretics?

A

influence

33
Q

What is the primary site of action of osmotic diuretics?

A

proximal tubule and descending loop

34
Q

What is the mechanism of action of osmotic diuretics?

A

Osmotic diuretics are filtered into the nephron at the glomerulus but cannot be reabsorbed therefore forming an osmotic gradient. - the osmotic activity of these agents prevents water and ion reabsorption

35
Q

What are the osmotic diuretics we discussed in class?

A

mannitol, glycerin, and isosorbide

36
Q

How and when is mannitol used?

A

They are most commonly used by IV route only; used in short-term and emergency situations

37
Q

How is glycerin given and at what percentage?

A

orally, used up to 50% solution

38
Q

How is isosorbide given and at what percentage?

A

orally, used up to 50% solution

39
Q

What are the therapeutic uses for osmotic diuretics?

A

cerebral edema, acute glaucoma, renal failure, and poisonings

40
Q

What specific osmotic diuretic is used to treat cerebral edema?

A

Mannitol - it is very effective for reducing intracranial pressure

41
Q

What osmotic diuretics are used to treat acute glaucoma?

A

mannitol and glycerin

42
Q

When is mannitol and glycerin used in acute glaucoma cases?

A

For acute glaucoma attacks before and after opthalamic surgery

43
Q

If you have a diabetic patient with acute glaucoma and chose to use an osmotic diuretic, what is your drug of choice?

A

isosorbide

44
Q

What is the choice osmotic diuretic to be used in the case of renal failure and why?

A

Mannitol (with furosemide) to increase glomerular filtration volume and maintain urine flow - also used to treat ischemia or nephrotoxin

45
Q

What is the choice osmotic diuretic for poisonings?

A

Mannitol

46
Q

What patients is mannitol not recommended for?

A

patients with pulmonary edema or with cerebral hemorrhage

47
Q

Why is mannitol not recommended for patients with pulmonary edema?

A

because it can extract water from intracellular compartments and expand in the extracellular fluid in the lung

48
Q

Why is mannitol not recommended in animals with cerebral hemorrhage?

A

because it can increase fluid buildup resulting in intracranial pressure

49
Q

What should be monitored when using osmotic diuretics?

A

fluid and electrolyte balance

50
Q

What is the most powerful and widely used diuretic?

A

loop diuretics

51
Q

What are the mechanisms of action of loop diuretics?

A

Reduce ion reabsorption by inhibiting the Na/K/2Cl cotransporter in the luminal membrane of the thick ascending loop of Henle

Also inhibit Ca and Mg reabsorption due to change in luminal positive potential

52
Q

What is the ancillary action of loop diuretics?

A

increase prostaglandin (PGE2) release

53
Q

What does increased prostaglandin do?

A

increased renal blood flow, decreased left ventricular pressure, decreased pulmonary edema

54
Q

What are the loop diuretics we discussed in class?

A

furosemide (Lasix), torsemide, bumetanide, and ethacrynic acid

55
Q

Furosemide causes Na and water excretion by __-fold in dogs.

A

17

56
Q

Torsemide is ____ as potent as furosemide.

A

twice

57
Q

Bumetanide is _____ times more potent than furosemide.

A

25-40

58
Q

True or False: Ethacrynic acid is the most commonly used loop diuretic in animals.

A

False - it is not used in animals

59
Q

How are loop diuretics metabolized?

A

They are strongly bound to plasma proteins and do not pass into the glomerular filtrate. They reach the site of action by being secreted into convulated tubule by organic acid transport.

Rapid onset - IV route w/in 5 minutes and within 1hr after oral dosing. diuresis 3-6 hour

Excretion: 80% of unmetabolized drug is excreted in urine; 20% as glucuronide

60
Q

What are the therapeutic uses of loop diuretics?

A

edema, heart failure, antihypertensive, acute renal failure, hypercalcemia of malignancy, vitamin D toxicosis, hyperkalemic state, treatment of post-parturient udder edema, exercise-indused pulmonary hemorrhage

61
Q

In cases of acute renal failure, what is furosemide paired with?

A

mannitol

62
Q

How do loop diuretics help treat hypercalcemia?

A

increased urinary Ca secretion

63
Q

When are loop diuretics used in the case of hyperkalemia?

A

if mannitol is ineffective

64
Q

What are the adverse effects of loop diuretics?

A

fluid and electrolyte imbalance, oxotoxicity, dehydration, hyperuriemia, hypocalcemia, muscle weakness, metabolic alkalosis, CNS depression

65
Q

What are symptoms associated with hypokalemia?

A

dizziness, muscular weakness, cardiac arrhythmias, tetany, respiratory arrest, and coma

66
Q

How can loop diuretics cause ototoxicity?

A

they can cause deafness due to electrolyte imbalances in the endolymph of the inner ear

67
Q

Loop diuretics exacerbate ototoxicity and nephrotoxicity of _________ antibiotics and cisplatin.

A

aminoglycoside

68
Q

What do loop diuretics cause when combined with corticosteroids or amphotericin B?

A

increased hypokalemia

69
Q

What reduces the diuretic response of loop diuretics?

A

NSAIDS

70
Q

How does furosemide interact with probenecid or sulfinpyrazone?

A

it inhibits the uricosuric effects

71
Q

What are the contraindications for using loop diuretics?

A

hepatic dysfunction, gout, and diabetes mellitus

Pharmacology (16 decks)

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