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Pharmacology & Medical Chemistry II > Exam 1: Lecture 2 & 3: Diuretics > Flashcards

Exam 1: Lecture 2 & 3: Diuretics Flashcards

1
Q

Diuretics that work in the PCT

A

Carbonic Anhydrase Inhibitors
SGLT2 Inhibitors
Osmotic diuretics (not main site)

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2
Q

Diuretics that work in the Thin Descending Limb

A

Osmotic Diuretics (Main site of action)

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3
Q

Diuretics that work in the Thick Ascending Limb

A

Loop Diuretics

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4
Q

Diuretics that work in the DCT

A

Thiazide Diuretics

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5
Q

Diuretics that work in the Collecting Duct

A

Vasopressin Receptor Antagonists
ENaC Inhibitors, K+ Sparing Diuretics
Aldosterone Antagonists, K+ Sparing Diuretics

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6
Q

Carbonic Anhydrase Inhibitors: Prototype

A

Acetazolamide

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7
Q

Carbonic Anhydrase Inhibitors: MOA

A

Inhibition of Carbonic Anhydrase, preventing Sodium Bicarbonate reabsorption, leading to increased Sodium and Water excretion

Sodium stays in the Lumen since less moves through NHE3 and water goes where Sodium goes

Occurs mostly PCT

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8
Q

Carbonic Anhydrase Inhibitors: Applications

A 
Glaucoma
Urinary alkalinization
Metabolic alkalosis
epilepsy
CSF leakage
Respiratory Stimulant
Acute mountain sickness
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9
Q

Carbonic Anhydrase Inhibitors: Notables

A

Ineffective as a diuretic mono therapy due to effect on renal excretion are self limiting. Tolerance develops after 2-3 days

Risks associated are hyperchloremic & hypokalemic metabolic acidosis from Net lose of base in plasma and gain of CL-

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10
Q

Where does most potassium wasting occur?

A

Most occurs at the level of the collecting tubule

This is due to the ENaC, which when their is high Na+ in Lumen, will drive Na into cell causing K+ to be driven out. (causing hypokalemia)

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11
Q

Carbonic Anhydrase Inhibitors: Drugs

A

Acetazolamide = Prototype

Dorzolamide, Brinzolamide = eye drops

Dichlorophenamide, Methazolamide = oral

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12
Q

Carbonic Anhydrase Inhibitors: Glaucoma application

A

Block carbonic anhydrase, decreasing sodium and bicarbonate entry into cell. This reduces aqueous humor production which causes excess pressure causing glaucoma

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13
Q

Carbonic Anhydrase Inhibitors: Acute Mountain Sickness

A

Due to exposure to low oxygen lvls at high elevation

Preventing release of bicarbonate into CSF, which causes decrease in pH, and increase ventilation/oxygen delivery and decreasing the symptoms of acute mountain sickness

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14
Q

SLGT2 Inhibitors: Prototype

A

Dapagliflozin

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15
Q

SLGT2 Inhibitors: General MOA

A

Inhibition of SGLT2, preventing reabsorption of glucose in the PCT

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16
Q

SLGT2 Inhibitors: Applications

A

Diabetes mellitus, Type II Diabetes

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17
Q

SLGT2 Inhibitors: Notables

A

Side effects associated with non-specificity (bind to other SGLT), genetic and epigenetic variations

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18
Q

SLGT2 Inhibitors: Drugs

A

Dapagliflozin = Prototype (Farxiga)

Canagliflozin (Invokana)
Empagliflozin (Jardiance)

3rd line for type II Diabetes

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19
Q

SGLT2 Inhibitors: Steps

A

1st: SGLT2 inhibition, leading to increased conc of tubular fluid (more Glucose and Na excretion), reduction in extracellular fluid volume

Sensing of increased tubular Na leads to vasoconstriction (afferent)

Sensing increased tubular Na leads to inhibition of renin release, causing vasodilation (efferent)

This combo causes reduction in GFR, and intraglomerular hydrostatic pressure

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20
Q

What is the renal protective effect of SGLT2 inhibitors?

A

Reducing of GFR

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21
Q

SGLT2 Inhibitor: Clinical Application

A

Diabetes Mellitus, 3rd line therapy

Occurs when excess blood glucose, SGLT2 inhibitors will not allow excess glucose to be reabsorbed and thus excreted

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22
Q

Osmotic Diuretic: Prototype

A

Mannitol (Must be given IV, orally it will cause diarrhea)

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23
Q

Osmotic Diuretic: MOA

A

Prevents absorption of water through osmotic force mainly in Thin Descending Limb, also PCT

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24
Q

Osmotic Diuretics: Applications

A

Reduction of intracranial and intraocular pressure

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25
Osmotic Diuretics: Risks
Hyperkalemia, Hypernatremia, and Hyponatremia (if any renal failure)
26
Osmotic Diuretics: Drugs
Mannitol (Prototype) | Glycerin isn't really used much
27
Osmosis
Movement of water (solvent) from low to high solute concentration through semipermeable membrane
28
Osmotic Diuretics: MOA at PCT
Mannitol will reduce water reabsorption
29
Osmotic Diuretics: MOA in Thin Descending Limb in loop of Henle
Decreased sodium reuptake and decreased water reabsorption leading to an indirect effect in DCT and Collecting duct. Will have increased delivery in lumen space, increasing the rate which also lowers Na reabsorption in DCT and Collecting duct, thanks to rate of flow. increase urinary excretion of just about all electrolytes
30
Osmotic Diuretics: Clinical applications
Reduction of Intracranial pressure and Reduction of Intraocular Pressure. sometimes in drug OD, to make you pee more
31
Osmotic Diuretics Notables
Mannitol should be given IV Key risks is dehydration Hyperkalemia, Hyperatremia and Hyponatremia are all risks depending on dose and pathology
32
Osmotic Diuretic: Hypernatremia
Due to ENaC
33
Osmotic Diuretic: Hyponatremia
Can occur in patient with renal damage due to retaining mannitol in the blood
34
Osmotic Diuretic: Hyperkalemia
Can occur in high dose, patient dependent. | due to expansion of ECF volume, pulls K+ into plasma
35
Loop diuretics focus on which channel?
Inhibitors of NKCC2 Also known as "High Ceiling" diuretics
36
Where do loop diuretics work?
Thick ascending limb.
37
Loop Diuretic: Prototype
Furosemide
38
Loop Diuretic: MOA
Inhibition of NKCC2 in the Thick Ascending Limb By inhibiting NKCC2, will reduce ROMK activity which drives Mg,Ca moving back into interstitial space. Can also cause potassium wasting
39
Loop Diuretic: Applications
Mainly used for acute pulmonary edema and hypertension Not first line of therapy for Hypertension,
40
Loop Diuretics: Notables
High Ceiling = most effective at producing diuresis Risk: Hypokalemic metabolic alkalosis, hyperuricemia, hypomagnesemia, ototoxicity Allergic Reaction
41
Potassium wasting
Happens at the level of the collecting duct Increase in ions in lumen. The high conc of sodium taken up by principle cells (via ENaC) will cause potassium to move through the principle cell and back into the urine
42
Loop Diuretics: Drugs
Prototype: Furosemide Torsemide, Bumetanide, Ethacrynic acid
43
Loop Diuretics: Acute Pulmonary edema
Very effective at removing water and treating edema
44
Cardiogenic
Cardiac component, related to cardiac dysfunction
45
Loop Diuretics: Hypertension and Hypercalcemia
Hypercalcemia = High plasma calcium levels Works by reducing ROMK activity, reducing how much Ca it drives into cell
46
Loop Diuretics: Hypertension and Hypercalcemia
Hypercalcemia = High plasma calcium levels Works by reducing ROMK activity, reducing how much Ca it drives into cell
47
Thiazides: Prototype
Hydrochlorothiazide
48
Thiazide: MOA
Inhibition of NCC in the DCT
49
Thiazide: Applications
Hypertension Heart Failure Nephrolithiasis due to idiopathic hypercalciuria (Kidney stone), and nephrogenic diabetes insidious (excessing urination)
50
Thiazide: Notables
Preferred over loops due to longer duration of action Potassium wasting, lesser extent than loop diuretics though Hypokalemic metabolic alkalosis, impaired carbohydrate tolerance, hyperlipidemia, hyponatremia, ***impaired uric acid metabolism and gout** , allergy
51
Thiazides: Drugs
HCTZ (prototype) Metolazone Chlorthiazide Chlorthalidone
52
Thiazide Detailed MOA
Inhibition of NCC in DCT Will cause modest increase in Na excretion Some K+ wasting Will enhance Ca reabsorption, opposite of loop diuretics which will decrease Ca in urine
53
Clinical Indications Thiazides
Hypertension Edema in Heart failure Kidney stones Excessive peeing
54
Where is ADH produced
Produced in the Hypothalamus
55
Where is ADH stored
stored in the pituitary gland
56
What do Vasopression Receptor Antagonists target (Vaptans)
Vasopressin receptors
57
Quick facts about Aquaporins
6 Transmembrane regions Create a pore, H2O moves in single file. Selective binding for H2O
58
How many monomers is an aquaporin made of?
Four
59
Vaptans: Prototype
Canivaptan
60
Vaptans: MOA
Inhibition of V1 and V2 receptors (Nonselective) or Inhibition of V2 receptors (Selective)
61
Vaptans: Applications
Autosomal dominant polycystic kidney disease (try and slow progression) Heartfailure SIADH (Excessive release of ADH)
62
Vaptans: Notables
Nephrogenic diabetes insipidus (excessive water in urine) Renal failure (Lithium and demeclocycline) Dry mouth Thirst Hypotension (Tolvaptan) Lithium = a lot of side effects
63
Vaptan: Drugs
Conivaptan (IV only, usually continuous) Tolvaptan * Lithium * Demeclocylcine
64
Vaptan: MOA Steps
Vaptan prevent binding to V2 receptor and prevents the following from occuring V2 work by.... Activating Adenylyl cyclase 6, which activates cAMP, which activates Protein Kinase A PKA phosphorylates AQUA-2, which gets placed in lumen and causes water to move from Lumen through cell and into capillary
65
3 Main indications for vaptans
Polycystic Kidney Disease:(cAMP mediates cysts development, since cAMP is in cascade of V2 signaling....inhibiting V2 will slow cysts) Heart failure: Low blood volume triggers vasopressin release, so prevent cycle can help manage SIADH: increase ADH leading to decreased plasma osmolality or increased arterial circulating volume
66
What do Potassium Sparing Diuretics target?
ENaC Work via ENaC inhibitors and Aldosterone Antagonists (slower reaction, days to weeks for maximal effect)
67
Two kinds of K+ Sparing Diuretics?
ENac Inhibitors and Aldosterone Antagonists
68
K+ Sparing Diuretics: Prototype
ENaC inhibitor: amiloride Aldosterone Antagonists: spironolactone
69
K+ Sparing Diuretics: MOA
Direct or indirect inhibition of ENaC
70
K+ Sparing Diuretics: Applications
Edema Hypertension *Hyperaldosteronism for AAs
71
K+ Sparing Diuretics: Notables
Weak diuretics but important for patients with hypokalemia
72
K+ Sparing Diuretics: Risks
Hyperkalemia, hyperchloremic metabolic acidosis, Gynecomastia (Man Boobies...AAs), Acute renal failure and Kidney stones
73
Direct ENaC inhibitors:
Amiloride (Prototype) | Triamterene
74
Indirect ENaC inhibitors
Spironolactone (Prototype) | Epierenone
75
K+ Sparing Diuretic MOA detailed
Direct: Blocking ENaC, preventing uptake of sodium so it stays in lumen (urine) Indirect: Prevent signaling of aldosterone receptor, which is responsible for up regulating insertion of ENaC and Na/K+ ATPase
76
K+ Sparing Diuretics: Drivers for side effects
Reduction in Na uptake, will decrease electrogenic exchange of Na for K/H, which can cause hyperkalemia and acidosis.
77
Why are K+ Sparing Diuretics less effective?
Because the collecting duct only filters about 2-5% Na
78
Why are Thiazides preferred over loop diuretics?
Longer half life

Pharmacology & Medical Chemistry II (43 decks)

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