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Pharmacology > Diuretics > Flashcards

Diuretics Flashcards

1
Q

What drug is a competitive antagonist to aldosterone?

A

spironolactone

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2
Q

What does the inhibition of carbonic anhydrase do?

A

prevents the conversion of CO2 and H2O to H2CO3

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3
Q

How do thiazide diuretics exert their effects?

A

inhibit Na/Cl cotransporter

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4
Q

Which diuretics cause the most NaHCO3 to be excreted?

A

carbonic anhydrase inhibitors

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5
Q

Which drugs are osmotic diuretics?

A

Mannitol

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6
Q

Effects of eplerenone may be prolonged with which drugs?

A

CYP3A4 inhibitors: ketoconazole and verapamil

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7
Q

What type of drugs do you want to use cautiously with loop diuretics?

A

sulfonamides

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8
Q

Which receptors do dopamine receptor agonists exert their effects?

A

dopamine 1 receptors

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9
Q

Where does the highest rate of O2 consumption occur?

A

proximal convoluted tubule

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10
Q

what segment of the kidney do carbonic anhydrase inhibitors work?

A

proximal convoluted tubule

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11
Q

What is the onset and duration of furosemide?

A

5-10 minute onset
peak in 30 minutes
2-6h duration

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12
Q

Which drug results in nantruresis and increased renal blood flow?

A

dopamine

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13
Q

which diuretic reduced mortality in HF patients with poor EF?

A

spironolactone

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16
Q

Which drugs are vasopressin receptor antagonists?

A

tolvaptan

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17
Q

What are some uses for acetazolamide?

A

Glaucoma, altitude sickness, central sleep apnea, intercranial HTN, familial periodic paralysis

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18
Q

Which diuretics cause the most NaCl excretion?

A

Loop diuretics and Loop agents with thiazides

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19
Q

Renal vasodilation and Na excretion is caused by what mechanisms?

A

prostaglandins, ANP, kinins

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20
Q

The inhibition of Na/Cl cotransporter in thiazide diuretics leads to what effects? (2)

A

increased excretion of Na, Cl and K

stimulates reabsorption of Ca

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21
Q

How to aldosterone antagonists work?

A

prevents synthesis and activation of the aldosterone dependent basal cell Na/K ATPase pump

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23
Q

Pteridines in combination therapy with ACEI’s, ARBs, or NSAIDs can cause what?

A

hyperkalemia

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24
Q

How does acetazolamide reverse hypoventilation?

A

by causing metabolic acidosis. Metabolic acidosis will cause hyperventilation as a compensatory response.

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25
Q

Where do the osmotic diuretics work?

A

proximal convoluted tubule and descending loop of henley

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26
Q

Which medication is used to treat hyponatremia seen with SIADH, CHF, or cirrhosis

A

tolvaptan

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27
Q

Which class of diuretics promotes lithium reabsorption leading to potential toxicity?

A

thiazide diuretics

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28
Q

What segment of the kidney is highly permeable to water, making osmolality constant with interstitial fluid

A

proximal convoluted tubule

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29
Q

What are side effects of thiazide diuretics?

A

hypoK, hypochloremia, metabolic alkalosis, gout.

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30
Q

What type of antagonists compete for receptors in the kidney causing diuresis?

A

aldosterone

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31
Q

NSAIDS decrease effectiveness of which diuretic classes

A

loop diuretics, thiazide diuretics,

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33
Q

What influences GFR?

A

MAP, CO, SNS

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35
Q

What is the threshold concentration in the renal tubule for glucose to leak into the urine?

A

225 mg/min

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36
Q

Which class of diuretics bind to mineralocorticoid receptors?

A

aldosterone antagonists

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37
Q

Which medication is used for renal protection after cardiac or major vascular surgeries?

A

dopamine or fenoldopam

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38
Q

What are the adverse effects of aldosterone antagonists

A

hyperkalemia, gynecomastia

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39
Q

What is the final site of NaCl absorption and K secretion?

A

collecting duct

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40
Q

Which class of diuretics potentiates NMBs?

A

Loop Diuretics, thiazide diuretics

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41
Q

The inhibition of carbonic anhydrase leads to what?

A

decreased reabsorption of Na, HCO3 and water

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42
Q

How do loop diuretics exert their effect?

A

blocking the Na/K 2Cl cotransporter, reducing the reabsorption of NaCl

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43
Q

What part of the kidney are most glucose, bicarb, amino acids, and other metabolites reabsorbed?

A

Proximal convoluted tubule

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44
Q

Which diuretic class is used off label to treat polycystic ovarian syndrome?

A

aldosterone antagonists

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45
Q

What does the stimulation of aldosterone do in the body?

A

promote reabsorption of Na from the distal convoluted tubule and collecting duct

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46
Q

GFR is mainly affected by what?

A

Cardiac output

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47
Q

Which diuretic is a selective D1 agonist with moderate affinity for alpha 2 receptors?

A

fenoldopam

48
Q

What makes acetazolamide a weak diuretic?

A

causes water loss in the proximal convoluted tubule. Water can be reclaimed further downstream .

49
Q

Which diuretic can cause cerebral edema if the BBB is not intact?

A

mannitol

50
Q

Which class of diuretics may result in tolerance to their diuretic effect?

A

loop diuretics (braking phenomenon)

53
Q

Where is the primary site of action of loop diuretics?

A

thick ascending limb of the loop of henley.

54
Q

Where do aldosterone antagonists exert their effects?

A

aldosterone receptor of TUBULAR CELL from the plasma

56
Q

Which loop diuretic is metabolized by the liver, 2x potency of furosemide, and longer duration?

A

torsemide

57
Q

What drugs are in the class of loop diuretics?

A

Furosemide, bumetanide, torsemide, ethacrynic acid

58
Q

How do dopamine agonists work?

A

increase cAMP, resulting in inhibition of the Na-H exchange and the Na/K ATPase pump

59
Q

What are the only diuretics that do not need to reach the renal tubule to exert their effects? What is their class?

A

spironolactone and eplerenone (aldosterone antagonists)

60
Q

Prostaglandins, ANP, and kinins leads to renal dilation leading to increased…

A

blood flow, GFR, urine output, and Na excretion

61
Q

What are side effects of loop diuretics?

A

hypoK, ototoxicity, metabolic alkalosis.

Also: hypoNa, hypoCl, hypoMg, dehydration, gout,

62
Q

What are the side effects of acetazolamide?

A

hypokalemia, hyphosphatemia, metabolic acidosis, fatigue, depression, paresthesias, hepatic encephalopathy

63
Q

Which drugs are pteridine analogs?

A

triamterene, amiloride

64
Q

What do potassium sparing diuretics do?

A

decrease Na reabsorption without increasing K excretion

65
Q

What is the dose of furosemide?

A
  1. 5-1mg/kg IV

0. 1-0.3 if used with mannitol

66
Q

What regulates calcium reabsorption in the distal convoluted tubule?

A

Parathyroid Hormone

66
Q

What is the volume of collective filtrate formed over time

A

GFR

67
Q

What autoregulates the afferent and efferent arterioles to either dilate or constrict

A

Macula Densa cells in the distal convoluted tubules

68
Q

What are the most potent diuretics?

A

loop diuretics

69
Q

What are the two types of potassium sparing diuretics?

A

pteridine analogs

aldosterone antagonists

71
Q

How do pteridine analogs work?

A

prevent Na reabsorption in the cortical collecting duct by blocking epithelial Na channels

72
Q

Which loop diuretic has extensive protein binding?

A

furosemide

73
Q

What is the primary sites for Na, K and water transport

A

principle cell of the collecting duct

74
Q

Which diuretics cause alkalosis?

A

Loop diuretics, thiazides

75
Q

Which diuretics cause acidosis?

A

carbonic anhydrase inhibitors, K sparing diuretics

76
Q

Which pteridine is more potent?

A

amiloride

77
Q

Where do potassium sparing diuretics work?

A

collecting duct

79
Q

What type of electrolytes do loop diuretics increase excretion of?

A

Mg, Ca, NaCl

80
Q

Furosemide causes nephrotoxicity when given with which drugs?

A

aminoglycoside antibiotics (gentamicin, streptomycin, amikacin, neomycin)

81
Q

How do vasopressin receptor antagonists work?

A

inhibit V2 receptors in the collecting ducts leading to decreased water reabsorption

82
Q

Aldosterone regulates what type of channels in the collecting duct?

A

epithelial Na channel

83
Q

Which class of diuretics are used for long term treatment of HTN by producing vasodilation?

A

thiazide diuretics

84
Q

Osmotic diuretics cause higher osmolality of tubular fluid leading to what effects?

A

inhibits water reabsorption, promoting diuresis

85
Q

what is the primary site for H and bicarb secretion?

A

intercalated cells of the collecting duct

85
Q

What stimulates the release of aldosterone?

A

ACTH

86
Q

Which type of patients should mannitol be avoided in, due to adverse effects causing the same thing?

A

heart failure, and pulmonary edema

87
Q

Thiazide diuretics, paired with Beta antagonists leads to what?

A

hyperglycemia

88
Q

How do osmotic diuretics lead to diuresis?

A

increase plasma osmolality; pulling fluid from the extracellular fluid into the intravascular space

89
Q

How much of cardiac output do the kidneys receive?

A

20-25%, 90% to the cortex, 10% to the medulla

89
Q

Where do thiazide diuretics exert their effects?

A

distal convoluted tubule

ascending loop of henley

90
Q

Which diuretic class is used to treat Calcium containing renal calculi?

A

thiazide diuretics

91
Q

where is 65% of filtered Na and water reabsorbed

A

proximal convoluted tubule

92
Q

What effects does Mannitol have?

A

decrease ICP and IOP

increase RBF and UO

93
Q

Where do Thiazide diuretics work?

A

distal convoluted tubule

93
Q

SNS activation decreases what factors related to the kidney?

A

blood flow, GFR, urine output, and Na retention

93
Q

What is the most important mineralocorticoid in the body

A

aldosterone

93
Q

Where do carbonic anhydrase inhibitors work?

A

proximal convoluted tubule

93
Q

What loop diuretic is ok to be used with sulfonamides?

A

ethacrynic acid

93
Q

Which loop diuretic is 40x more potent than furosemide with less K excretion?

A

bumetanide

93
Q

What drugs are in the class of thiazide diuretics?

A

Hydrochlorothiazide, chlorothiazide, chlorthalidone, metolazone

94
Q

What are the carbonic anhydrase inhibitors?

A

Acetazolamide

95
Q

What is the dose of mannitol?

A

0.25-1 g/kg

96
Q

Which type of allergy has cross sensitivity to thiazide diuretics?

A

sulfa allergy - sulfonamide antibiotics

97
Q

Stressors activate the SNS leading to what effects on the kidney?

A

renal vasoconstriction and Na retention

98
Q

The NaCl exchange by the Na/K 2Cl cotransporter is blocked by which class of diuretics?

A

Loop Diuretics

99
Q

How do ANP and BNP promote diuresis?

A

block the basal Na/K ATPase channel in the collecting duct

100
Q

What are uses for loop diuretics?

A

fluid retention in CHF, pulmonary edema, intraop diuresis

100
Q

Which potassium sparing diuretic has extensive metabolism in the liver and its metabolites potentiates its diuretic effect?

A

triamterene

100
Q

Where do dopamine agonists work in the kidney?

A

proximal convoluted tubule and loop of henley

101
Q

which drugs are aldosterone antagonists

A

spironolactone and epletenone

102
Q

which diuretic is given before aortic clamping above the renal arteries

A

mannitol

Pharmacology (6 decks)

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