Diuretics I

Question 1

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

Answer 1

NKCC2 in the TAL

Question 2

Broad mechanism of action for osmotic diuretics?

Answer 2

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

Question 3

Natriuresis vs diuresis:

Answer 3

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

Question 4

Administration of osmotic diuretics:

Answer 4

IV only, oral use laxative

Question 5

Natriuretics:

Answer 5

Aldosterone antagonists

Diuretics

Question 6

Aldosterone antagonists:

Answer 6

Spironolactone

Eplerenone

Question 7

Three general diuretic categories:

Answer 7

Potassium sparing
Thiazide diuretics
Loop diuretics

Question 8

Potassium sparing diuretics:

Answer 8

Amiloride

Triamterene

Question 9

Thiazide diuretics:

Answer 9

Hydrochlorothiazide

Question 10

Loop diuretics:

Answer 10

Furosemide

Torsemide

Question 11

What occurs with inhibition of carbonic anhydrase?

Answer 11

You get reduced plasma bicarbonate levels

Question 12

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

Answer 12

It is replaced by chloride leading to hypercholoremic acidosis

Question 13

What is refractoriness?

Answer 13

Natriuresis being reduced by bicarbonate depletion

Question 14

Carbonic anhydrase inhibitor:

Answer 14

Acetazolamide (it’s a sulfonamide)

Question 15

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

Answer 15

Diuretics
Penicillins
Low-dose aspirin

Question 16

Thiazide diuretic affect on calcium?

Answer 16

Reduce urinary calcium excretion
Reduce renal calculus formation
Positive calcium balance

Question 17

Loop diuretic effect on calcium?

Answer 17

Increased urinary calcium excretion
Support renal calculus formation
Negative calcium balance

Question 18

What occurs with sodium delivery into the DCT?

Answer 18

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

Question 19

What is the active substrate for renin in plasma?

Answer 19

Alpha-2-globulin angiotensinogen

Question 20

What increases plasma angiotensinogen levels?

Answer 20

Glucocorticoids

Estrogens

Question 21

Alternative pathway for angiotensin I conversion?

Answer 21

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

Question 22

What receptor does angiotensin I work on?

Answer 22

ATR-1

Question 23

What receptors does angiotensin II work on?

Answer 23

ATR-1

ATR-2

Question 24

What receptors does angiotensin III work on?

Answer 24

ATR-1

ATR-2

Question 25

What receptor does angiotensin 1-7 work on?

Answer 25

MAS receptor

Question 26

Action of ATR-1 when stimulated?

Answer 26

Vasoconstriction Pro-inflammatory Pro-mitotic

Question 27

Action of ATR-2 and MAS receptors when stimulated?

Answer 27

Oppose: Vasoconstriction Pro-inflammatory Pro-mitotic

Question 28

Aldosterone action on kidneys:

Answer 28

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

Question 29

Aldosterone action on CNS:

Answer 29

Increased BP

Question 30

Aldosterone action on heart:

Answer 30

Cardiac hypertrophy

Question 31

ACE inhibitor SE:

Answer 31

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

Question 32

Angiotensin receptor antagonists SE:

Answer 32

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

Question 33

What causes angioedema?

Answer 33

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

Question 34

What does bradykinin cause?

Answer 34

NO formation Hypotension Prostacyclin formation Angioedema

Question 35

How do you treat angioedema?

Answer 35

As anaphylaxis

Question 36

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

Answer 36

Insertion deletion variants for intron 16

Question 37

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

Answer 37

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

Question 38

What do each of the three ACE polymorphisms cause?

Answer 38

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

Question 39

How do potassium sparing diuretics work?

Answer 39

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

Question 40

What effect do potassium sparing diuretics have on bicarbonate levels?

Answer 40

Reduces NHE therefore increasing bicarbonate ion excretion in urine

Question 41

Which drug alkalizes urine?

Answer 41

Acetazolamide

Question 42

Which drugs do you treat hypertension with?

Answer 42

Renin inhibitors ACE inhibitors AT-1 receptor blockers Thiazide diuretics

Question 43

Which drugs mobilize edema?

Answer 43

Loop diuretics | Thiazide diuretics

Question 44

Which drugs cause diuresis (flow only)?

Answer 44

Loop diuretics | Mannitol

Question 45

Which drugs treat altitude sickness?

Answer 45

Acetazolamide

Question 46

Which drugs treat hypercalcemia?

Answer 46

Loop diuretics

Question 47

Which drugs treat osteoporosis?

Answer 47

Thiazide diuretics

Question 48

Which drugs combinations are for acute exacerbation of edema?

Answer 48

IV hydrochlorothiazide IV acetazolamide Oral thiazide/thiazide like drugs

Question 49

Who is at risk for renal carcinoma?

Answer 49

Patients taking thiazide and loop diuretics chronically; ACE inhibitors

Question 50

OTC diuretics:

Answer 50

Ammonium chloride | Caffeine

Question 51

Ammonium chloride mechanism:

Answer 51

Metabolized to urea + chloride ion | Sodium passively follows chloride ion excretion

Question 52

Caffeine mechanism:

Answer 52

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

Question 53

What do uricosurics do?

Answer 53

Block tubular diuretic secretion