Diuretics Quiz Flashcards
A drug that increases urine volume by inhibiting the renal actions of vasopressin to increse free water clearance is most accurately referred to as a(n);
aquaretic
Substance that promotes the excretion of urine
diuretic
substance that promotes renal excretion of Na
Natriuretic
A nod to urologists, damage to any renal preglomerular blood vessel causes ischemia and death because these are lacking:
anastomoses
mannitol acts where?
acetazolamide acts where?
- PT and thin descending loop
- PT
Common reasons for administering a diuretic include all of the following EXCEPT:
- kidney failure
- heart failure
- primary (“essential”) hypertension
- central diabetes insipidus
- liver failure
- central diabetes insipidus
Hypokalemia causes which of the following at the excitable tissue cell membrane level?
hyperpolarization
Which of the following acid-base disturbances is associated with the use of loop and thiazide diuretics?
hypochloremic metabolic alkalosis
which diuretics can be used for acute pulmonary edema and why?
loop diuretics
removes massive amounts of fluid quickly
Diuretic class useful for treating HTN patients with low RBF and GFR (e.g., GFR < 30 ml/min):
loop diuretics
The excretion of this divalent cation is increased by loop diuretics and decreased by thiazide diuretics.
calcium
Besides contracting extracellular fluid volume, loop and thiazide diuretics inhibit organic anion transporters in the proximal tubule. This further increases the circulating level of a metabolic waste product, manifesting as:
hyperuricemia
Which of the following diuretics is most likely to cause hyperkalemia with hyperchloremic metabolic acidosis?
K+ sparring drugs:
Considering the mechanism of action of the following diuretics, which would be expected to take the longest for its effects to be observed?
spironolactone
What is a major concern when spironolactone is used at the same time as ACE inhibitors or ARBs in the treatment of heart failure?
hyperkalemia
Which of the following drugs is indicated if the goal is to hasten the elimination of toxic levels of a weak acid via urinary alkalinization?
acetazolamide
Which is a feared consequence of correcting hyponatremia too rapidly?
osmotic demyelination
what does licorice do?
What acid does it contain
- potentiates aldosterone affects => increases systolic BP => HTN
- glycyrrihizic
what is used to tx
central diabetes insipidus
nephrogenic diabetes insipidus due to Li+ toxicity
-desmopressin
-amilodrone
Na is less than 135 mEq; seen in 15-20% of hispitalized pts, most common electrolyte abnoralitiy seen in clinical practice
hyponatremia
predictable consequence of vaptan administration
polyuria
ability impaired in the kidney by loop diuretics, Bartter syndrome and hypokalemia (here presumably due to need for K+ by Na+-K+-2Cl- cotransporter) resulting in polyuria and nocturia (2 words)
concentrating
caused by loop and thiazide diuretics, increase the risk of gout
hyperuricemia
process employed by the TAL to make dilute tubular fluid and hypertonic medullary interstitium
countercurrent multiplier
potential adverse effect of spiranolactone in W;
hirtuism
amenorrhea
diuretic class that is a secondary choice for HTN unless GFR is low (e.g., GFR < 30 ml/min) since it will still work then while thiazides become ineffective
loop
first choice for HTN
thiazides
similar to hydrochlorothiazide but longer half-life, favored by some hypertension specialists in part because it is the only thiazide with proven cardiovascular benefits; doesn’t end in “thiazide”
chlorthalidone
- its blockade of carbonic anhydrase causes a Na/BICARB diuresis with hyperchloremic acidosis
- used for
- urinary alkalization to hasten eliination of weak acid toxins (aspirin),
- metabolic alkalosis,
- acute mountain sickness
- glaucoma
acetazolamide
occurs in liver disease due to impaired synthesis of plasma proteins and increased portal venous pressure; a reason to give a LOOP DIURETIC
ascites
selective non-peptide V2 receptor antagonist that can be administered orally to patients with hyponatermia despite water restriction; use > 30 days increases risk of hepatotoxicity
tolvaptan
prototype for the non-peptide V2 receptor antagonists that can be used judiciously to treat euvolemic and hypervolemic hyponatremia that does NOT respond to fluid restriction; causes water excretion without solute excretion
conivaptan
more selective than spiranolactone and more expensive
eplenerone
similar AE to foresemide; but better oral absorption
bumetadine
do not use diuretics for _____
lymphedema
Ca2+ kidney stones are more likely likely to develop due to which diuretics
loop, not thiazide
swelling of this organ by rapid onset hyponatremia or too-rapid correction of chronic hypernatremia can have catastrophic consequences
brain
best used to treat pulmonary edema due removal of exxcess extracellular fluid and in part by due to prostaglandin mediated vasodilation
loop diuiretics
+ inotrope used in inotrope whose toxicity is increased when we use loop diuretics d/t K+ loss
digoxin
