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Urinary Exam 2 > Diuretics I > Flashcards

Diuretics I Flashcards

1
Q

Which ion transporter do the most effective diuretics and natriuretics work upon?

A

NKCC2 in the TAL

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2
Q

Broad mechanism of action for osmotic diuretics?

A
  1. ) Freely filtered by glomerulus
  2. ) No reabsorption from urine
  3. ) Must be pharmacologically-inert
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3
Q

Natriuresis vs diuresis:

A

Natriuresis: sodium excretion causing urination, large amounts of sodium in the urine
Diuresis: urination due to excretion of water, dilute urine

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4
Q

Administration of osmotic diuretics:

A

IV only, oral use laxative

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5
Q

Natriuretics:

A

Aldosterone antagonists

Diuretics

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6
Q

Aldosterone antagonists:

A

Spironolactone

Eplerenone

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7
Q

Three general diuretic categories:

A

Potassium sparing
Thiazide diuretics
Loop diuretics

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8
Q

Potassium sparing diuretics:

A

Amiloride

Triamterene

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9
Q

Thiazide diuretics:

A

Hydrochlorothiazide

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10
Q

Loop diuretics:

A

Furosemide

Torsemide

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11
Q

What occurs with inhibition of carbonic anhydrase?

A

You get reduced plasma bicarbonate levels

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12
Q

With reduced bicarbonate levels in the plasma what do you get?

A

It is replaced by chloride leading to hypercholoremic acidosis

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13
Q

What is refractoriness?

A

Natriuresis being reduced by bicarbonate depletion

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14
Q

Carbonic anhydrase inhibitor:

A

Acetazolamide (it’s a sulfonamide)

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15
Q

What competes with uric acid for secretion and can lead to inhibition of uric acid secretion?

A

Diuretics
Penicillins
Low-dose aspirin

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16
Q

Thiazide diuretic affect on calcium?

A

Reduce urinary calcium excretion
Reduce renal calculus formation
Positive calcium balance

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17
Q

Loop diuretic effect on calcium?

A

Increased urinary calcium excretion
Support renal calculus formation
Negative calcium balance

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18
Q

What occurs with sodium delivery into the DCT?

A

Any intervention increasing sodium delivery to DCT stimulates potassium excretion (Na in K out to lumen)

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19
Q

What is the active substrate for renin in plasma?

A

Alpha-2-globulin angiotensinogen

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20
Q

What increases plasma angiotensinogen levels?

A

Glucocorticoids

Estrogens

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21
Q

Alternative pathway for angiotensin I conversion?

A

Angiotensin I -> Angiotensin 1-9 via ACE II -> Angiotensin 1-7 via ACE

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22
Q

What receptor does angiotensin I work on?

A

ATR-1

23
Q

What receptors does angiotensin II work on?

A

ATR-1

ATR-2

24
Q

What receptors does angiotensin III work on?

A

ATR-1

ATR-2

25
Q

What receptor does angiotensin 1-7 work on?

A

MAS receptor

26
Q

Action of ATR-1 when stimulated?

A

Vasoconstriction
Pro-inflammatory
Pro-mitotic

27
Q

Action of ATR-2 and MAS receptors when stimulated?

A

Oppose:
Vasoconstriction
Pro-inflammatory
Pro-mitotic

28
Q

Aldosterone action on kidneys:

A

Sodium reabsorption
Sodium potassium exchange in DCT
Sodium hydrogen exchange in DCT

29
Q

Aldosterone action on CNS:

A

Increased BP

30
Q

Aldosterone action on heart:

A

Cardiac hypertrophy

31
Q

ACE inhibitor SE:

A 
Hyperkalemia
Fetal death 2/3 trimester
Teratogenic 1st trimester
Decreased proteinuria in diabetics
ANGIOEDEMA
32
Q

Angiotensin receptor antagonists SE:

A

Hyperkalemia
Fetal death 2/3 trimester
Teratogenic 1st trimester
Decreased proteinuria in diabetics

33
Q

What causes angioedema?

A

Inactivation of ACE which is responsible for the breakdown of bradykinin to inactive bradykinin

34
Q

What does bradykinin cause?

A

NO formation
Hypotension
Prostacyclin formation
Angioedema

35
Q

How do you treat angioedema?

A

As anaphylaxis

36
Q

ACE has polymorphisms in different patients, how is this done?

A

Insertion deletion variants for intron 16

37
Q

What are the three ways can ACE have polymorphisms in intron 16?

A
  1. ) Insertion/insertion (I/I)
  2. ) Insertion/deletion (I/D)
  3. ) Deletion/deletion (D/D)
38
Q

What do each of the three ACE polymorphisms cause?

A 
I/I= normal A-II levels
I/D= mild increase in A-II levels
D/D= large increase in A-II levels
39
Q

How do potassium sparing diuretics work?

A

By inhibiting sodium input channel aka sodium reabsorption (Na in/K out to lumen)

40
Q

What effect do potassium sparing diuretics have on bicarbonate levels?

A

Reduces NHE therefore increasing bicarbonate ion excretion in urine

41
Q

Which drug alkalizes urine?

A

Acetazolamide

42
Q

Which drugs do you treat hypertension with?

A

Renin inhibitors
ACE inhibitors
AT-1 receptor blockers
Thiazide diuretics

43
Q

Which drugs mobilize edema?

A

Loop diuretics

Thiazide diuretics

44
Q

Which drugs cause diuresis (flow only)?

A

Loop diuretics

Mannitol

45
Q

Which drugs treat altitude sickness?

A

Acetazolamide

46
Q

Which drugs treat hypercalcemia?

A

Loop diuretics

47
Q

Which drugs treat osteoporosis?

A

Thiazide diuretics

48
Q

Which drugs combinations are for acute exacerbation of edema?

A

IV hydrochlorothiazide
IV acetazolamide
Oral thiazide/thiazide like drugs

49
Q

Who is at risk for renal carcinoma?

A

Patients taking thiazide and loop diuretics chronically; ACE inhibitors

50
Q

OTC diuretics:

A

Ammonium chloride

Caffeine

51
Q

Ammonium chloride mechanism:

A

Metabolized to urea + chloride ion

Sodium passively follows chloride ion excretion

52
Q

Caffeine mechanism:

A

Blocks adenosine receptor mediated sodium reabsorption (inhibition of sodium reabsorption)

53
Q

What do uricosurics do?

A

Block tubular diuretic secretion

Urinary Exam 2 (16 decks)

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