Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharm test II > Diuretics pharm 2 test 2 > Flashcards

Diuretics pharm 2 test 2 Flashcards

1
Q

Where does this act on the renal tubule- acetazolamide?

A

acts on the proximal convoluted tubule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Where does this act on the renal tubule- osmotic agents like mannitol?

A

these act on the thin descending limb of loop of henle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Where does this act on the renal tubule- loop agents (like flurosemide)

A

these act on the thick ascending limb, both in the cortex and medullary segments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Where does this act on the renal tubule- thiazides

A

these act between the thick ascending limb and the distal convoluted tubule, within the cortex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Where does this act on the renal tubule- aldosterone antagonists?

A

these act in the collecting duct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Where does this act on the renal tubule- ADH antagonists

A

these also act in the collecting duct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What percent of glomerular filtrate is absorbed in the proximal tubule?

A

70-75%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How is glomerular filtrate absorbed in the proximal tubule?

A

active Na uptake

Na+ cotransport with glucose, AA’s, organic acids

H+ / Na+ exchange with carbonic anhydrase

Passive h2o

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How does the thin descending and thin ascending limb of loop of henle transport water and electrolytes?

A

fully passive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

In the thick ascending loop of henle, is it permeable to water?

A

no it is not

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what does the thick ascending loop of henle do to salts? how?

A

this actively co-transports Na+, K+, and 2Cl- out of the loop into the interstitium.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what does the thick ascending loop of henle do to Ca2+ and Mg2+?

A

this reabsorbs these two

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What happens at the distal diluting site?

A

here excess Na+ and Cl+ are pumped out of the tube, and into the cortex.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What do thiazides do to the distal diluting site?

A

these inhibit Na+ transport…keeping the salt in the loop, causing diuresis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What two mechanisms exist to transport Na+ in the distal tubules and collecting ducts?

A

Na+ and K+ exchange

Na+ and H+ is catalyzed by carbonic anhydrase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what does ADH do the to collecting ducts?

A

ADH increases the permeability of the collecting ducts to water, allowing more water into the interstitum, concentrating the urine (water out of the tube, into the medulla)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Where does most K+ reabsorption occur? do drugs affect it?

A

this occurs in the proximal tubule

no drugs affect this

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Where does secretion of K+ occur? do drugs affect it?

A

secretion of K+ occurs in the distal tubules.

Na/K exchange

Aldosterone-antagonists and K sparing diuretics affect secretion of K+

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How do thiazides affect Ca2+?

A

these increase Ca2+ reabsorption in the renal tubules

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

how does loop diuretics effect Ca2+ and Mg+2?

A

these increase excretion at the thick ascending limb

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What does Acetazolamide do?

A

this is a carbonic anhydrase inhibitor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what does dorzolamide do?

A

this is a carbonic anhydrase inhibitor- topical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what does brinzolamide do?

A

this is a carbonic anhydrase inhibitor -Topical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what is the ending for carbonic anhydrase inhibitors?

A

NAME?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How do carbonic anhydrase inhibitors work?

A

these prevent the reputake of H2CO3.

Without H2CO3 in the cell, there is no H+ reservoir inside the cell for Na+/H- exchange. This leaves Na+ out in the tube lumen.

Increased Na+ in the tubules activates Na+/K+ exhangers- this attempts to draw Na+ from inside the cell (very low currently due to H+/Na+ exhanger blockage), while pushing K+ into the lumen of the tube.

So promotes K+ loss by secondary effect

and Promotes Na+ loss by inhibiting its resorption into the cell via Na+/H+ exhange

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

How does the content of the urine change when on carbonic anhydrase inhibitors? (-zolamides)

A

this increases bicarbonate in urine

akalinization due to increase bicarb

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What do carbonic anhydrase inhibitors do to the body?

A

reduced body total bicarb

metabolic acidosis (due to low bicarb- and high Cl)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

how do carbonic anhydrase inhibitors affect the eye?

A

these reduce the production of aqueous humor and CSF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

how are carbonic anhydrase inhibitors taken?

A

these have good oral absorption, with effects in about 30 min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are the toxic effects of carbonic anhydrase inhibitors?

A

hyperchloremic metabolic acidosis

renal stones

renal potassium wasting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

what are the two contraindication for carbonic anhydrase inhibitor use?

A

hepatic cirrhosis

sulfonamide hypersensitivity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What are carbonic anhydrase inhibitors used to treated? (5 things)

A

Glaucoma

used to Alkalinize the urine (via too much bicarbonate)

used to combat metabloc alkalosis (by inducing hyperchloremic metabolic acidosis)

acute mountain sickness

and epilepsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What type of diuretics are the most effective at increasing sodium excretion?

A

loop diuretics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

how much sodium can loop diuretics cause excretion of?

A

these can have 20-25% of filtered Na be excreted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

what are furosemide, bumetanide, and torsemide derived from?

A

sulfonamide, important for allergy questions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

what is ethacrynic acid derived from?

A

aryloxyacetic acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

what is the prototype drug for loop diuretics?

A

furosemide (a sulfonamide derivative)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

How do loop diuretics work?

A

these ALL block the 1 sodium, 1 potassium, 2 Cl- co transporter found in the medullary (deeper) portion of the thick ascending limb of loop of henle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

what is the normal role of the 1 sodium 1 potassium 2 chloride transported that gets blocked by loop diruetics?

A

this normally reabsorbs Na and Cl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

How do loop diuretics affect the concentrating abilities of the kidney?

A

by blocking the 1 Na 1 K 2 Cl co transporter, you cannot increase the saltiness of the medulla (and thus its osmotic water drawing powers)- so the kidney loses some osmotic power in the medulla, and gains osmotic power in the tube (by leaving all that salt in it)

41
Q

How do loop diuretics effect Mg and Ca?

A

this causes their excretion (due to less K+ inside the cell, which was originally used to create an electrical gradient that would push Mg and Ca back into the medulla)

42
Q

how do loop diuretics affect the pH and salt balance of the body?

A

this induces hypokalemia and alkalosis

  • due to increased K+ loss both locally, and in the distal K+/Na+ exchange sites (where the body wants more Na+, so it dumps K)

loss of H+ via the Na+/H+ exchanger, also in the distal tubule (once more, body wants to retain that Na+ at all costs)

43
Q

What are the 3 major hypo’s that loop diuretics cause?

A

hypokalemic metabolic alkalosis

hypocalcemia

hypomagnesemia

44
Q

what is the 1 hyper that loop diuretics cause?

A

hyperuricemia

45
Q

What happens when you combine loop diuretics with aminoglycosides?

A

ototoxicity

46
Q

what happens when you combine lithium and loop diuretics?

A

these increase Li+ retention, toxic (due to Na+ loss)

47
Q

what happens when you combine digoxin and loop diruetics?

A

toxicity, due to low potassium

48
Q

What do you give loop diuretics to treat? 4 main things

A

CHF

Pulmonary edema

Impaired renal function (and the edema associated with it)

Pulmonary congestion follownig MI

49
Q

How does the dose of bumetanide compare to that of furosemide (the prototype drug)

A

bumetanide is 40X more potent, and needs a 40X smaller dose to achieve the same effect

50
Q

What are the two newer loop diruetics?

A

bumetanide and torsemide

51
Q

How quickly do loop diuretics reach peak effect?

A

60-90 min

52
Q

what is the half life of loop diuretics?

A

1.5 hours

53
Q

What drug is Ethacrynic acid like? and what are its two differences?

A

this works with the same method of action as furosemide

but it is not a sulfonamide derivative (for allergies)

but is more ototoxic

54
Q

what is the prototype drug for thiazides?

A

hydrochlorothiazide

55
Q

what is the mechanism of action for thiazides?

A

these inhibit sodium resorption at he cortical dilution site

56
Q

What are the 6 negative effects of thiazide use? (will go over mechanisms next, just list)

A 
Hypokalemia
Hyperuricemia
decreased Ca2+ excretion
Magnesium loss
Iodide and Bromide Loss
Hyperglycemia
57
Q

How do thiazides cause hypokalemia? (non aldosterone way)

A

thazides act at the cortical diluting site (just shy of the distal convoluted tubule)- and they cause Na+ retention in the tube.

this excess Na+ reaches the distal exchange sites, where Na+ is traded for K+. And the body loves Na+, so it dumps tons of K trying to suck up all the Na+ it can

58
Q

how do thiazides cause hypokalemia thru aldosterone?

A

thiazides cause a plasma volume contraction.

this stimulates aldosterone secretion, which favors K+ loss

59
Q

how do thiazides cause hyperuricemia?

A

thiazides decrease the excretion of uric acid- by inhibition of tubular uric acid secretion

60
Q

how do thiazides cause a decrease in calcium excretion?

A

parathyroid hormone dependent Gs posphorylates Ca2+ channels, increasing calcium reabsorption

61
Q

How do thaizides cause hyperglycemia?

A

these decrease insulin release, and increase glucose intolerance. this is important in type 2 diabeties

62
Q

what do thiazides compete with in the renal tubule?

A

these compete with uric acid for excretion- (this is how you get hyperuricemia)

63
Q

how are thiazides given?

A

orally

64
Q

what type of thiazide is given to pts with renal insufficiency? why?

A

Indapamide - because it is excreted by the biliary system, and there for is useful in pts with renal insufficiency

65
Q

How do thiazides affect lipid levels?

A

they increase serum lipid levels

66
Q

What thiazide does NOT affect lipid levels?

A

only Indapamide (the biliary excretion one)

67
Q

How do thiazides affect the blood?

A

they lead to a whole host of Blood Dyscrasia- leukopenia, anemia, thrombocytopenia, purpura, hemolytic anemia, agranulocytosis, hypersensitivity rxns’

68
Q

What do thiazides do to blood vessels? what pt group?

A

this can cause Necrotizing Vasculitis of skin and kidney in Elderly pts.

69
Q

what type of thiazide is given to pts with renal insufficiency? why?

A

Indapamide - because it is excreted by the biliary system, and there for is useful in pts with renal insufficiency

70
Q

How do thiazides affect lipid levels?

A

they increase serum lipid levels

71
Q

What thiazide does NOT affect lipid levels?

A

only Indapamide (the biliary excretion one)

72
Q

How do thiazides affect the blood?

A

they lead to a whole host of Blood Dyscrasia- leukopenia, anemia, thrombocytopenia, purpura, hemolytic anemia, agranulocytosis, hypersensitivity rxns’

73
Q

What do thiazides do to blood vessels? what pt group?

A

this can cause Necrotizing Vasculitis of skin and kidney in Elderly pts.

74
Q

how do thiazides affect lithium?

A

these increase lithium toxicity, by limiting lithium clearance

75
Q

How do thiazies affect infants?

A

the can aggravate jaundice in infants

76
Q

How does Metalazone work? why is it special?

A

this works like a thiazide- inhibits sodium ion transport.

special because it produces diuresis in pts with reduced GFR

77
Q

How is Indapamide metabolized?

A

it has hepatic metabolism

78
Q

how long is the half life of Indapamide?

A

14-18 hours

79
Q

What does Indapamide do?

A

diuresis
relaxes BV’s
reduces LVH

80
Q

What does Spironolactone do?

A

this is a competitive inhibitor of aldosterone

this promotes excretion of sodium and retention of potassium @ collecting tubule level

81
Q

What are the toxicities of spironolactone?

A

this causes GI upset,
gynecomastia
and sometimes hyperkalemia

82
Q

What is Spironolactone used to treat?

A

edema from CHF

Hyperaldostreonism

Works with thiazides to help conserve K+

83
Q

What does Eplerenone do?

A

this is a selective aldosterone receptor antagonist (SARA)

84
Q

Why is Eplerenone different than spironolactone?

A

this has a lower incidence of endocrine related side effects, because it is selective for the receptor

85
Q

Why does Eplerenone have many drug interactions?

A

because it is metabolized by CYP3A4

86
Q

what does Eplerenone do for Post MI pts?

A

it reduces all-cause mortality post MI (with LV dysfunction)

87
Q

What two drugs directly inhibit sodium flux, and are potassium sparing diuretics?

A

Triamterene

Amiloride

88
Q

what is the main serious side effect of potassium sparing diuretics?

A

hyperkalemia

89
Q

How is mannitol given?

A

IV

90
Q

what does mannitol do?

A

this is an osmotic diuretic. freely filtered by the kidney, and sucks up water

91
Q

Why is mannitol given? (5 reasons)

A 
prophylaxis of acute renal failure
reduce intraocular pressure
reduce intracrainal pressure
reduce CSF volume
protect kidney against things that are nephortoxic in high concentrations
92
Q

What does Vasopressin do?

A

this is exogenous ADH (anitdiruetic hormone)

used to prevent dehydration

93
Q

what drug can substitute for Epi in pts with cardiac arrest and asystole/pulseless? (according to ACLS)

A

IV Vasopressin

94
Q

What receptor does Desmopressin work on?

A

V2 only!

95
Q

What diseases is Desmopressin used to treat?

A

this treats pts with Hemophilia A (by increasing plasma factor VIII)

and von Willebrand disease (by increasign vWF)

96
Q

What can excess ADH cause?

A

hyponatremia

97
Q

What does Conivaptan do?

A

this is a V1/V2 vasopressin receptor antagonist.

increases urine output, decreases water uptake

98
Q

What is demeclocycline?

A

this is a tetracycline antibiotic, that happens to produce nephorgenic diabetes insipidus
(by uncoupling V2 from its adenylyl cyclase enzyme)

99
Q

what does lithium do?

A

this produces nephorgenic diabetes insipidus by uncoupling the V2 receptor for adenylyl cyclase enzyme

Pharm test II (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions