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Diuretics pharm 2 test 2 Flashcards

1
Q

Where does this act on the renal tubule- acetazolamide?

A

acts on the proximal convoluted tubule

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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

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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

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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

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5
Q

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

A

these act in the collecting duct

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6
Q

Where does this act on the renal tubule- ADH antagonists

A

these also act in the collecting duct

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7
Q

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

A

70-75%

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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

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9
Q

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

A

fully passive

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10
Q

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

A

no it is not

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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.

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12
Q

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

A

this reabsorbs these two

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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.

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14
Q

What do thiazides do to the distal diluting site?

A

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

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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

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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)

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17
Q

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

A

this occurs in the proximal tubule

no drugs affect this

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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+

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19
Q

How do thiazides affect Ca2+?

A

these increase Ca2+ reabsorption in the renal tubules

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20
Q

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

A

these increase excretion at the thick ascending limb

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21
Q

What does Acetazolamide do?

A

this is a carbonic anhydrase inhibitor

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22
Q

what does dorzolamide do?

A

this is a carbonic anhydrase inhibitor- topical

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23
Q

what does brinzolamide do?

A

this is a carbonic anhydrase inhibitor -Topical

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24
Q

what is the ending for carbonic anhydrase inhibitors?

A

NAME?

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25
How do carbonic anhydrase inhibitors work?
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
26
How does the content of the urine change when on carbonic anhydrase inhibitors? (-zolamides)
this increases bicarbonate in urine akalinization due to increase bicarb
27
What do carbonic anhydrase inhibitors do to the body?
reduced body total bicarb metabolic acidosis (due to low bicarb- and high Cl)
28
how do carbonic anhydrase inhibitors affect the eye?
these reduce the production of aqueous humor and CSF
29
how are carbonic anhydrase inhibitors taken?
these have good oral absorption, with effects in about 30 min
30
What are the toxic effects of carbonic anhydrase inhibitors?
hyperchloremic metabolic acidosis renal stones renal potassium wasting
31
what are the two contraindication for carbonic anhydrase inhibitor use?
hepatic cirrhosis sulfonamide hypersensitivity
32
What are carbonic anhydrase inhibitors used to treated? (5 things)
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
33
What type of diuretics are the most effective at increasing sodium excretion?
loop diuretics
34
how much sodium can loop diuretics cause excretion of?
these can have 20-25% of filtered Na be excreted
35
what are furosemide, bumetanide, and torsemide derived from?
sulfonamide, important for allergy questions
36
what is ethacrynic acid derived from?
aryloxyacetic acid
37
what is the prototype drug for loop diuretics?
furosemide (a sulfonamide derivative)
38
How do loop diuretics work?
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
39
what is the normal role of the 1 sodium 1 potassium 2 chloride transported that gets blocked by loop diruetics?
this normally reabsorbs Na and Cl
40
How do loop diuretics affect the concentrating abilities of the kidney?
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
How do loop diuretics effect Mg and Ca?
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
how do loop diuretics affect the pH and salt balance of the body?
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
What are the 3 major hypo's that loop diuretics cause?
hypokalemic metabolic alkalosis hypocalcemia hypomagnesemia
44
what is the 1 hyper that loop diuretics cause?
hyperuricemia
45
What happens when you combine loop diuretics with aminoglycosides?
ototoxicity
46
what happens when you combine lithium and loop diuretics?
these increase Li+ retention, toxic (due to Na+ loss)
47
what happens when you combine digoxin and loop diruetics?
toxicity, due to low potassium
48
What do you give loop diuretics to treat? 4 main things
CHF Pulmonary edema Impaired renal function (and the edema associated with it) Pulmonary congestion follownig MI
49
How does the dose of bumetanide compare to that of furosemide (the prototype drug)
bumetanide is 40X more potent, and needs a 40X smaller dose to achieve the same effect
50
What are the two newer loop diruetics?
bumetanide and torsemide
51
How quickly do loop diuretics reach peak effect?
60-90 min
52
what is the half life of loop diuretics?
1.5 hours
53
What drug is Ethacrynic acid like? and what are its two differences?
this works with the same method of action as furosemide but it is not a sulfonamide derivative (for allergies) but is more ototoxic
54
what is the prototype drug for thiazides?
hydrochlorothiazide
55
what is the mechanism of action for thiazides?
these inhibit sodium resorption at he cortical dilution site
56
What are the 6 negative effects of thiazide use? (will go over mechanisms next, just list)
``` Hypokalemia Hyperuricemia decreased Ca2+ excretion Magnesium loss Iodide and Bromide Loss Hyperglycemia ```
57
How do thiazides cause hypokalemia? (non aldosterone way)
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
how do thiazides cause hypokalemia thru aldosterone?
thiazides cause a plasma volume contraction. | this stimulates aldosterone secretion, which favors K+ loss
59
how do thiazides cause hyperuricemia?
thiazides decrease the excretion of uric acid- by inhibition of tubular uric acid secretion
60
how do thiazides cause a decrease in calcium excretion?
parathyroid hormone dependent Gs posphorylates Ca2+ channels, increasing calcium reabsorption
61
How do thaizides cause hyperglycemia?
these decrease insulin release, and increase glucose intolerance. this is important in type 2 diabeties
62
what do thiazides compete with in the renal tubule?
these compete with uric acid for excretion- (this is how you get hyperuricemia)
63
how are thiazides given?
orally
64
what type of thiazide is given to pts with renal insufficiency? why?
Indapamide - because it is excreted by the biliary system, and there for is useful in pts with renal insufficiency
65
How do thiazides affect lipid levels?
they increase serum lipid levels
66
What thiazide does NOT affect lipid levels?
only Indapamide (the biliary excretion one)
67
How do thiazides affect the blood?
they lead to a whole host of Blood Dyscrasia- leukopenia, anemia, thrombocytopenia, purpura, hemolytic anemia, agranulocytosis, hypersensitivity rxns'
68
What do thiazides do to blood vessels? what pt group?
this can cause Necrotizing Vasculitis of skin and kidney in Elderly pts.
69
what type of thiazide is given to pts with renal insufficiency? why?
Indapamide - because it is excreted by the biliary system, and there for is useful in pts with renal insufficiency
70
How do thiazides affect lipid levels?
they increase serum lipid levels
71
What thiazide does NOT affect lipid levels?
only Indapamide (the biliary excretion one)
72
How do thiazides affect the blood?
they lead to a whole host of Blood Dyscrasia- leukopenia, anemia, thrombocytopenia, purpura, hemolytic anemia, agranulocytosis, hypersensitivity rxns'
73
What do thiazides do to blood vessels? what pt group?
this can cause Necrotizing Vasculitis of skin and kidney in Elderly pts.
74
how do thiazides affect lithium?
these increase lithium toxicity, by limiting lithium clearance
75
How do thiazies affect infants?
the can aggravate jaundice in infants
76
How does Metalazone work? why is it special?
this works like a thiazide- inhibits sodium ion transport. special because it produces diuresis in pts with reduced GFR
77
How is Indapamide metabolized?
it has hepatic metabolism
78
how long is the half life of Indapamide?
14-18 hours
79
What does Indapamide do?
diuresis relaxes BV's reduces LVH
80
What does Spironolactone do?
this is a competitive inhibitor of aldosterone | this promotes excretion of sodium and retention of potassium @ collecting tubule level
81
What are the toxicities of spironolactone?
this causes GI upset, gynecomastia and sometimes hyperkalemia
82
What is Spironolactone used to treat?
edema from CHF Hyperaldostreonism Works with thiazides to help conserve K+
83
What does Eplerenone do?
this is a selective aldosterone receptor antagonist (SARA)
84
Why is Eplerenone different than spironolactone?
this has a lower incidence of endocrine related side effects, because it is selective for the receptor
85
Why does Eplerenone have many drug interactions?
because it is metabolized by CYP3A4
86
what does Eplerenone do for Post MI pts?
it reduces all-cause mortality post MI (with LV dysfunction)
87
What two drugs directly inhibit sodium flux, and are potassium sparing diuretics?
Triamterene Amiloride
88
what is the main serious side effect of potassium sparing diuretics?
hyperkalemia
89
How is mannitol given?
IV
90
what does mannitol do?
this is an osmotic diuretic. freely filtered by the kidney, and sucks up water
91
Why is mannitol given? (5 reasons)
``` 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
What does Vasopressin do?
this is exogenous ADH (anitdiruetic hormone) | used to prevent dehydration
93
what drug can substitute for Epi in pts with cardiac arrest and asystole/pulseless? (according to ACLS)
IV Vasopressin
94
What receptor does Desmopressin work on?
V2 only!
95
What diseases is Desmopressin used to treat?
this treats pts with Hemophilia A (by increasing plasma factor VIII) and von Willebrand disease (by increasign vWF)
96
What can excess ADH cause?
hyponatremia
97
What does Conivaptan do?
this is a V1/V2 vasopressin receptor antagonist. increases urine output, decreases water uptake
98
What is demeclocycline?
this is a tetracycline antibiotic, that happens to produce nephorgenic diabetes insipidus (by uncoupling V2 from its adenylyl cyclase enzyme)
99
what does lithium do?
this produces nephorgenic diabetes insipidus by uncoupling the V2 receptor for adenylyl cyclase enzyme

Pharm test II (6 decks)

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