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IP1 > E2: Diuretics > Flashcards

E2: Diuretics Flashcards

1
Q

What drug class(s) acts in proximal tubule reabsorption

A

Carbonic anhydrase inhibitors

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2
Q

what drug class(s) acts in loop of Henle reabsorption

A

Loop diuretics

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3
Q

what drug class(s) acts in distal tubule reabsorption

A

Thiazide and related diuretics

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4
Q

what drug class(s) acts in collecting duct reabsorption

A

Potassium sparing diuretics
Antidiuretic hormone regulation

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5
Q

4 mechanisms of ion absorption in tubule cell

A

Na+/H+ exchange
Na+/K+/2Cl- co-transport
Na+/Cl- co-transport
Na+ entry through Na+ channels

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6
Q

Compare and contrast the acute and chronic effect of diuretics as antihypertensive therapy

A

Acutely, diuretics act to
-↓BP by causing diuresis
-↓ plasma vol & SV - ↓ CO & BP
-initial ↓ CO causes a compensatory ↑ in PVR
Over time,
-ECF and plasma vol returns to pretreatment levels and PVR falls below baseline
-↓PVR is responsible for LT hypotensive effects
-thiazides mobilize Na+/water from arteriolar walls to ↓ PVR and ↓BP

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7
Q

Which drug class is a derivative of sulfonamides

A

True thiazide diuretics (hydrochlorthiazide)

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8
Q

what drug class contains quinazolines or indoline structures

A

thiazide-like drugs (chlorthalidone, metolazone & indapamide)

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9
Q

Thiazide diuretics MOA, pharm effects (hydrochlorothiazide), indications

A
  1. inhibit Na+/Cl- cotransporter at distal tubule to increase excretion of Na+ and Cl- in urine
  2. ↑Ca2+ reabsorption in proximal tubule by increasing passive reabsorption and in distal tubule by decreasing Na+ which increases Na+/Ca2+ exchange in basolateral membrane
  3. induce expression of apical Ca2+ channels

↑ NaCl excretion, K+ wasting, ↓ urine Ca2+

HTN, mild HF, nephrolithiasis, nephrogenic diabetes insipidus

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10
Q

Thiazide diuretics uses

A
  1. HTN
  2. Nephrolithiasis (renal calculi, ↓ Ca2+ excretion aka kidney stones)
  3. nephrogenic diabetes insipidus
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11
Q

Thiazide diuretics ADR
Specific ADR of hydrochlorothiazide

A

electrolyte imbalances
CNS (dizziness, confusion, irritability)
Hyperuricemia
sexual dysfunction

HYPERURICEMIA, HYPERGLYCEMIA, hypoatremia

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12
Q

thiazide diuretic DI

A

combo w/other anti-HTN, monitor BP
NSAIDS ↑Na+ retention which antagonizes therapeutic effect of thiazides
Topiramate (↓K,↓Cl)
Digitalis: ↑arrhythmias
Lithium:↓ renal excretion of Li+, toxic
Allopurinol: ↑ allergic response

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13
Q

What patients are loop diuretics preferred over thiazides

A

CKD when est GFR is <30ml,min.1.73m2 and edema is present

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14
Q

Loop diuretics MOA

A

Inhibit Na+/K+/2Cl- cotransporter on the apical membrane of cells in the loop of Henle

Result in ↓ reabsorption of Na+ & Cl- –> ↑excretion in urine

↓ the positive transepithelial potential- causes marked ↑ in Ca2+ & Mg2+ secretion –> hypocalcemia & hypomagnesemia

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15
Q

Loop diuretics ADR

A

Hypotension & volume depletion
Hypokalemia
Alkalosis – due to enhanced H+ secretion
Mg+ wasting
Dose-related ototoxicity – caution w/aminoglycosides
Ethacrynic acid produces GI disturbances

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16
Q

Loop diuretics uses

A

-Pulmonary & peripheral edema associated w/CHF
-Other edematous conditions: liver cirrhosis and nephrotic syndrome
-Hypercalcemia: enhance Ca2+ excretion
-Hyperkalemia: enhance K+ excretion
-Less useful in treating htn
-Limited efficacy & short t1/2
-Availability more effective & better tolerated antihypertensive agents

17
Q

Furosemide (Lasix)
Class
MOA
Uses
ADR

A

-Loop diuretic
-MOA: inhibit reabsorption of Na+ and Cl- by attaching to Cl- binding site of the Na+/K+/2Cl- cotransporters in TAL of Henle

Uses:
-HTN
-HF
-Acites
-Hypercalcemia
-Pulmonary edema

ADR
-Volume depletion
-↓ Na+, ↓Ca2+, ↓K+
-Hyperglycemia
↓-Mg–> ↓Ca2+ & tetany
-Hyperuricemia
-Metabolic alkalosis

18
Q

Potassium sparing diuretics MOA and MOA of Aldosterone Antagonist

A

-Block epithelial Na+ channels (ENaC) in the principal cells of DCT & collecting ducts
-Na+ reabsorption is coupled w/K+ secretion – inhibition of Na+ reabsorption —> ↓K+ excretion
-K+ sparing diuretic – poor antihypertensive monotherapy; combination w/thiazides antagonize
-K+ loss –> ↓ risk of ventricular arrythmias

Aldosterone inhibitors ↓biosynthesis of new Na+ channels in principal cells via blockeing aldosterone receptors –> inhibition of Na+ reabsorption

19
Q

Potassium sparing diuretic drugs and aldosterone antagonist drugs

A

Amiloride
Amiloride/HCTZ
Triamterene
Triamterene/HCTZ

Spironolactone and eplerenone

20
Q

Use of potassium-sparing diuretics and use of aldosterone antagonists

A

adjunct w/thiazides or loop diuretics to prevent hypokalemia

  1. Adjunct w/thiazides/loop diuretics to
  2. prevent hypokalemia
  3. Heart failure
  4. Ascites in cirrhosis
  5. Acne & hair loss in women
  6. Male baldness – topical
  7. Diagnosis of primary hyperaldosteronism
21
Q

ADR of potassium sparing diuretics and of aldosterone antagonists

A

Hyper kalemia: arrhythmias, metabolic acidosis & acute renal failure
Hyperchloremic metabolic acidosis-inhibit H+ secretion in parallel w/K+ secretion
Kidney stones: triamterene- slightly soluble & may precipitate in the urine

Aldosterone inhibitors also have:
Endocrine abnormalities: spironolactone may cause gynecomastia, breast tenderness…

22
Q

Acetazolamide
Class
Use
MOA
ADR
CI

A

carbonic anhydrase inhibitors
Use: glaucoma, petit mal seizure (adjuvants), alkalinization of urine, acute mountain sickness
MOA: Reduce HCO3- reabsorption & Na+ uptake in PT
-Inhibit excretion of H+ and coupled Na+ uptake
-Prolonged use –> more alkaline urine & more acidic blood

ADR: monitor electrolyte disturbances, Severe K+ wasting, N, V, sedation, HA, renal calculi, metabolic acidosis

CI: Hepatic cirrhosis

RARELY used today

23
Q

Mannitol
Class
Use
MOA
ADR

A

Class: osmotic diuretic
Use: prophylaxis of acute renal failure
MOA: agents are easily filtered, poorly reabsorbed; alter the diffusion of the water relative to Na+ by “binding water”; ↓Net reabsorption of Na+
ADR: headache, nausea

24
Q

Mannitol and Urea
Class
Use
MOA
ADR

A

Class: osmotic diuretic
Use: prophylaxis of acute renal failure, reduction of intracranial & intraocular pressure
MOA: agents are easily filtered, poorly reabsorbed; alter the diffusion of the water relative to Na+ by “binding water”; ↓Net reabsorption of Na+
ADR: headache, nausea

IP1 (23 decks)

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