Diuretics and RAAS antagonists of HF

Question 1

Diuretics act on ___ surface

Answer 1

Luminal

Question 2

___ interact with membrane transport proteins

Answer 2

Thiazides, Furosemides, Triamterene

Question 3

___ interact with enzyme and ___ interact with hormone receptors

Answer 3

acetazolamide, apironolactone

Question 4

___ osmotic effect

Answer 4

Mannitol

Question 5

___ is a carbonic anhydrase inhibitor

Answer 5

acetazolamide

Question 6

CA inhibitors causes ____ in ____ (what and where)

Answer 6

decrease NaHCO3 reabsorption

PCT

Question 7

Loop of henle water removal in ___ limb and Na ___ in ___limb

Answer 7

descending

NaCl Reabsorption in accending

Question 8

Na reabsorpted in ascending limb via ______?

Answer 8

NKCC2 (NaK2Cl co transporter

Question 9

Loop diuretics do what?

Answer 9

inhibit NKCC2
Mg/Ca excretion (K intracell high, difuse back to lumen (K channel) drives Mg/Ca reabsorption)
Increase RBF

Question 10

Uses of Loop Diuretics

Answer 10

CHF (volume overload)
Refractory edema (+thiazide, aldosterone antagonists)
Hypercalceimia
Acute Pul Edema

Question 11

HF have ___ diuretic response due to:?

Answer 11

decreased

Decrease drug delivery to kidney, decrease RBF, hypoperfusion activatoin of RAS/SNS

Question 12

Loop diuretic adverse effects

Answer 12

hypokalemic metabolic alkalosis (increase K/H secretion)
Ototoxicity
Hyperuricemia/hyperglycemia
Hypomagnesemia
Hypotension (overdose)

Question 13

Hypokalemia predisposes pt to ___?

Answer 13

ectopic pacemakers/arrhythmias

Question 14

Loop diuretics includes?

Answer 14

Furosemide (most common)

Bumetanide, torsemide (higher F and longer t1/2)

Question 15

DCT is _____ to H2O

Answer 15

impermeable

Question 16

Na is reabsorpted in DCT via ___?

Answer 16

NCC (NaCl co transporter)

Question 17

Ca reabsorption occurs via ___?

Answer 17

Na/Ca exchanger

Question 18

NCX in DCT is regulated by

Answer 18

PTH (Parathyroid hormone)

Question 19

Thiazides inhibits ___

Answer 19

NCC (increase NaCl excretion)

Question 20

Thiazides _______ Ca

Answer 20

increase reabsorption of Ca

low Na intracellular, activates NCX, decrease Ca intracell, Ca reasborbed from urine

Question 21

Thiazides drugs include ___?

Answer 21

hydrochlorothiazide (prototype 2x/day)

chlorthalidone/metolazone - longer duration

Question 22

Thiazide adverse efects

Answer 22

Hypokalemia
hyperaldosteronism (volume decrease)
hyperglycemia/glycosuria
Hyperuricemia (precipitate gout attack)
hyperlipidemia (HTN risks)
Allergic - sulfonamide

Question 23

Thiazide acts in ___

Answer 23

DCT

Question 24

Aldosterone acts on __

Answer 24

collecting tubules

Question 25

K excretion is ____ to Na ______ in CT

Answer 25

coupled, | Na reabsorption

Question 26

Aldosterone acts on CT by ____?

Answer 26

gene transcription - increase number/activity of Na/K-atpase

Question 27

Trimaterne, amiloride diuretics acts by ___ at __

Answer 27

direct Na Channel block CT (less Na reabsorb = less K excreted

Question 28

Apironolactone/eplerenone act by ____ at __

Answer 28

competitive antagonist at aldosterone receptor CT - decrease Na reabsorption, decrease K excretion

Question 29

Uses of potassium sparing diuretics

Answer 29

CHF - aldosterone antag (also at heart) Hyperaldosteronism PCOS Hirustism - block androgens HTN

Question 30

Aldosterone antagonists important actions ____?

Answer 30

anti-remoding (less hypertrophy/fibrosis) | Increase K serum = less arrhythmias

Question 31

Potassium sparing diuretics include?

Answer 31

spironolactone/eplerenone (aldosterone receptor) | Triamterene/amiloride (diuretcs Na)

Question 32

Potassium sparing diuretics include?

Answer 32

``` Hyperkalemia EKG changes (Avoid NSAID) Endocrine abn (spiro - gynescomastia) ```

Question 33

ACEI includes

Answer 33

lisinopril, captopril, enalapril, moexipril, benazepril

Question 34

ACEI mechanism of action

Answer 34

``` block ATII induced vasoconstriction (decrease pre/afterload) block ATII myocardial hypertrophy/remodeling (aldosterone) Increase BK (block inactivatio - vasodilates) Increase endothelial function - NO Reduce SNS ```

Question 35

ACEI uses

Answer 35

HTN CHF Delay progression of diabetic enphropathy

Question 36

ACEI are ___ (except) converted to ____ by ___

Answer 36

prodrugs (lisinopril, captopril) Active metabolite by de-esterification in liver

Question 37

ACEI Eliminated by:

Answer 37

renal (except Moexi + Fosino)

Question 38

ACEI Adverse effect

Answer 38

``` dry cough, hyperkalemia HTN/acute renal failure (RA stenosis), angioedema Neurtropenia/proteinuria NOT FOR PREGNANCY ```

Question 39

Angiotensin II receptor antagonists acts on

Answer 39

AT1 receptor

Question 40

ARB are ACEI without ____

Answer 40

cough and less angioedema