Diuretics And Renal Pharmacology

Question 1

On what part of the nephron do carbonic anhydrase inhibitors work?

Answer 1

Proximal convoluted tubule

Question 2

How do carbonic anhydrase inhibitors elicit their actions

Answer 2

They prevent reabsorption of bicarbonate from the renal tubule which results in decreased activity of apical sodium-hydrogen exchanger so causes diuretics due to retention f sodium in the renal tubules

Question 3

When are carbonic anhydrase inhibitors contraindicated

Answer 3

Hepatic cirrhosis

Question 4

Are carbonic anhydrase inhibitors Aquaretic, Natriuretic or Diuretic?

Answer 4

Diuretic

Question 5

What warnings are associated with carbonic anhydrase inhibitors?

Answer 5

Metabolic acidosis
Kidney stones due to alkaline urine
Hypokalaemia

Question 6

What is Mannitol?

Answer 6

An osmotic agent

Question 7

Where do osmotic agents elicit their actions?

Answer 7

PCT and decending loop of Henley

Question 8

How do osmotic agents such as mannitol work?

Answer 8

Inhibit resorption of water and sodium thus increasing the osmolarity of blood and renal filtrate

Question 9

What is risk of osmotic agents?

Answer 9

Hypernatraemia risk

Question 10

What are SGLT2 inhibitors

Answer 10

They inhibit sodium-glucose transport protein 2 to lower blood sugar

Question 11

Which diuretic drug class causes decreased body weight, decreased blood pressure, decreased plasma glucose, decreased plasma Uri acid and decreased glomerular hyperfiltration?

Answer 11

SGLT2 inhibitors

Question 12

SGLT2 inhibitors act on which part of the nephron?

Answer 12

Proximal tubular cells

Question 13

Where do loop diuretics act on the nephron?

Answer 13

Ascending limb of Henle

Question 14

Loop diuretics are better than thiazides in patients with what?

Answer 14

Impaired kidney function

Question 15

On what protein do loop diuretics act and to what effect?

Answer 15

They act on the NKCC2 ( Na+ K+, 2Cl-) symporter to inhibit reabsoprtion causing loss of water and sodium

Question 16

What electrolyte disturbance could be induced by a loop diuretic such as furosemide?

Answer 16

Hypokalaemia metabolic acidosis

Question 17

What are the Adverse drug reactions associated with the loop diuretic furosemide?

Answer 17

Ototoxicity
Alkalosis
Increased LDL and triglyceride
Gout

Question 18

Which transporter is the target of thiazides?

Answer 18

Sodium chloride transporter

Question 19

Where do thiazides act on the nephron?

Answer 19

Distal convoluted tubule

Question 20

How do thiazides work?

Answer 20

The inhibit the Na-Cl transporter.
The transporter usually pulls NaCl from the lumen of the DCT, but its inhibition means that NaCl and water remain in the lumen so more urine is made per day

Question 21

What electrolyte disturbance can be caused by thiazides?

Answer 21

Hypokalaemia metabolic acidosis

Question 22

Do thiazide increase or decrease calcium resorption?

Answer 22

Increase

Question 23

Which drug class is a competitive antagonist for aldosterone

Answer 23

Potassium sparing diuretic

Question 24

How do potassium diuretics work?

Answer 24

Competitive antagonist with aldosterone
Prevent sodium reabsorption
Prevent K+ and H+ ion secretion in the late distal tubule and collecting duct

Question 25

What ADRs are associated with thiazides?

Answer 25

``` Gout Hyperglycaemia Erectile dysfunction Increased LDL Increased triglyceride Hypercalcaemia ```

Question 26

Name a potassium sparing diuretic

Answer 26

Spironolactone

Question 27

What ADR’s are associated with potassium sparing diuretic?

Answer 27

Hyperkalaemia Impotence Painful gymaecomastia

Question 28

To what drug class does Tolvaptan belong?

Answer 28

An ADH antagonist - Aquaretic

Question 29

Which drug class is used to treat hyponatraemia and prevent cyst enlargement in adult polycystic kidney disease

Answer 29

ADH antagonists

Question 30

ADH antagonists word at which receptor?

Answer 30

V2 receptor - it blocks it

Question 31

Which metal has the same activity as ADH antagonists as a side effect?

Answer 31

Lithium

Question 32

How does alcohol act as a diuretic?

Answer 32

Inhibits ADH release

Question 33

How does caffeine act as a diuretic?

Answer 33

Increases GFR and decreased tubular Na+ reabsorption

Question 34

What is an ADR of Bumetanide

Answer 34

Myalgia

Question 35

Which diuretics would you use for hypertension?

Answer 35

Thiazide diuretics Spironolactone Loop diuretics

Question 36

Which drugs would traditionally be used in heart failure?

Answer 36

Loop diuretics | Spironolactone

Question 37

Which drugs would traditionally be used in decompensated liver disease?

Answer 37

Spironolactone | Loop diuretics

Question 38

Which drugs would traditionally be used in the treatment of nephrotic syndrome

Answer 38

Loop diuretics - big doses needed +/- thiazides +/- potassium sparing diuretics / potassium supplements

Question 39

Which drugs would be used in CKD

Answer 39

Loop diuretics

Question 40

What 3 things must be present for diuretics to be delivered to the renal tubule?

Answer 40

Blood flow to proximal tube Proximal tube must be functioning to transport furosemide across Thick ascending limb must be intact to respond to furosemide

Question 41

Decribe Barrters and Gitelmans syndromes

Answer 41

Autosomal recessive disorder Defect in thick ascending limb Causes alkalosis and hypokalaemia and results from no function

Question 42

How does bartters and gitelmans syndrome differ from Liddles syndrome

Answer 42

Bartters - reduced or no function | Liddles - increased function