Diuretics

Question 1

What are one of the early signs of diabetes?

Answer 1

• Polyurea

- Too much urination

Question 2

What do diuretics do?

Answer 2

Control the direction of sodium

Question 3

Why is controlling sodium important?

Answer 3

• Because where sodium goes, water follows
• Useful for controlling urine output
• Drugs block sodium

Question 4

Describe diabetes mellitus

Answer 4

• Elevates glucose
• Glucose can be used to move water- diuretic
• Elevated sugar = polyurea
• Acts as an osmotic
• High plasma glucose blocks glucose reabsorption

Question 5

Describe diabetes insipidus

Answer 5

• Sodium issue
• Plasma hypernatremia reduced by diuretic on Na+ reabsorption
• With a sodium problem, diuretics can be used

Question 6

What are the functions of kidney?

Answer 6

• Water volume- ADH
• Acid/balance- carbonic anhydrase
• Regulates BP- RAS
• Filtration, reabsorption and excretion
• Oxygen sensing- part of regulating BP

Question 7

What is the main purpose of diuretics?

Answer 7

• Helps rid body of sodium and water

- Reduces oedema

Question 8

What are the uses of diuretics?

Answer 8

• Diabetes insipidus
• Kidney disorders (Stones)
• Oedema
• Polycystic ovary syndrome
• Osteoporosis- regulates Ca
• Female hirsutism
• High BP
• Congestive heart failure
• Cirrhosis (ascites)

Question 9

What are some non-pharmacologic treatments?

Answer 9

• Lifestyle changes
• NSAID restriction
• Salt restriction
• Caffeine
• Diet/exercise/alcohol/smokng

Question 10

How can NSAID restriction be helpful?

Answer 10

• Cyclooxygenase blocks production of prostaglandins
• E.g. inhibiting prostaglandins blood flow to kidney is reduced
• Stimulates compensatory

Question 11

How is salt restriction important?

Answer 11

• Plasma sodium is important for the regulation of water

Question 12

How is caffeine important?

Answer 12

• Causes increase in strength of heartbeat- increases perfusion to kidney

Question 13

Why are diet/exercise/alcohol and smoking important?

Answer 13

• Central obesity
• Drinking alcohol over time
• Stop responding to increase in fluid- retains

Question 14

What are the different types of diuretics?

Answer 14

• Loop
• Thiazide
• Potassium sparing
• Carbonic anhydrase
• Osmotic
• Xanthines
• Glucose

Question 15

Give examples of loop diuretics

Answer 15

• Furosemide

- Bumetanide

Question 16

When might loop diuretics be used?

Answer 16

• Peripheral and pulmonary oedema
• Congestive heart failure
• Effective in diminished renal function

Question 17

How do loop diuretics work?

Answer 17

• Inhibit Na/Cl/K reabsorption in the thick ascending loop on Henle
• High capacity so potent

Question 18

What are the adverse effects of loop diuretics?

Answer 18

• Can cause osteoporosis- due to Ca loss
• Electrolyte imbalance (might cause deafness)
  Hypokalaemia- blocks reuptake

Question 19

Give examples of thiazide diuretics

Answer 19

• Bendroflumethiazide, metolazone, chlortalidone

- Similar to carbonic anhydrase- developed from them

Question 20

What are the uses of thiazide diuretics?

Answer 20

• Mild heart failure
• Hypertension- shown to reduce stroke
• Oedema
• Ascites in cirrhosis
• Retention of calcium- may help in osteoporosis

Question 21

How do thiazide diuretics diuretics work?

Answer 21

• Only blocks sodium and chloride
• Excess sodium in the lumen
• Water goes into the lumen
• Water loss this way
• Not as potent as loop, don\t affect potassium
• Excretion of Na/Cl and water increased

Question 22

What are the adverse effects of thiazide diuretics?

Answer 22

• Weakness, impotence, postural hypotension about regulating dose
• Hypokalaemia- arrhythmias, supplement with potassium
• Hyperuricaemia, nitrogenous waste, secretion of thiazides competes with uric acid secretion- can precipitate gout