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Pharmacology 2 > Exam 2: Diuretics > Flashcards

Exam 2: Diuretics Flashcards

1
Q

What are the conditions that promote the development of edema?

A
  • Altered blood circulation
  • Altered blood composition
  • inadequate lymphatic drainage
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2
Q

Where does potassium reabsorption occur?

Secretion?

A

Reabsorption at the proximal tubule

Secretion at the distal tubule and collecting duct

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3
Q

How do thiazide diuretics affect calcium reabsorption?

A

Increased calcium reabsorption

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4
Q

How do loop diuretics affect calcium and Mg excretion?

A

Increase calcium and magnesium excretion

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5
Q

Acidic drugs compete for ** excretion, leading to a ** attack.

A

Uric acid

Gouty

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6
Q

What 3 drugs are carbonic anhydrase inhibitors?

A

Acetazolamide, Dorzolamide, and Brinzolamide

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7
Q

What is the MOA of Carbonic anhydrase inhibitors?

A

-Inhibits the CA enzyme and blocks Bicarb production. This leads a decreased availability of H+ for exchange with Na+, resulting in increased Na+ loss

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8
Q

What are the indications for CA inhibitors?

A
  • Glaucoma
  • Alkaline urine
  • Alkalosis
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9
Q

What are the adverse effects of CA inhibitors?

A
  • Hyperchloremic metabolic acidosis
  • Hypokalemia
  • Hyperuricemia
  • Renal stones
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10
Q

What are the contraindications with CA inhibitors?

A
  • Hepatic cirrhosis

- sulfa hypersensitivity

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11
Q

What are the two loop diuretics?

A

Furosemide and Ethacrynic acid

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12
Q

What is the MOA of loop diuretics?

A
  • Block the NCKK2 transporters, impairing the concentration and diluting function of the kidney.
  • Induce kidney PGs, to decrease salt transport and to Vasodilate
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13
Q

What are the indications for loop diuretics?

A
  • HF
  • Pulmonary edema
  • Hypercalcemia
  • Works well at low GFR
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14
Q

How do loop diuretics relieve pulmonary edema?

A

Relieve pulmonary congestion by increasing systemic venous capacitance

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15
Q

How do loop diuretics treat hypercalcemia?

A

Loops decrease reabsorption of Mg and Ca by reducing the K+ gradient

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16
Q

What are the adverse effects of loop diuretics?

A
  • Hypokalemia metabolic alkalosis
  • Hypochloremia
  • Hypocalcemia and Hypomagnesemia
  • Hyperuricemia
  • Irreversible ototoxicity
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17
Q

What are the contraindications of loop diuretics?

A
  • Sulfa hypersensitivity
  • Aminoglycosides (enhanced ototoxicity)
  • Digoxin (loss of K increases toxicity)
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18
Q

What is the main difference between furosemide and ethancrynic acid?

A

Ethacrynic acid is not a sulfa derivative and can be used in people allergic to sulfa
-Also has the highest risk of ototoxicity

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19
Q

What drug us a thiazide diuretic and what drugs are compounds related to thiazides?

A
  • Thiazide (HCTZ)

- Related compounds: Metalazone and indapamide

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20
Q

What is the MOA of thiazide diuretics?

A

Inhibition of sodium reabsorption at the early distal tubule by inhibiting the Na/Cl co transporter

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21
Q

What are the indications for thiazide diuretics?

A
  • HTN (causes relaxation of smooth muscle and vasodilation)
  • HF
  • Nephrolithiasis
  • Nephrogenic DI
22
Q

What are the adverse effects of thiazide diuretics?

A

Reduced insulin secretion, Hypokalemia metabolic alkalosis, Hyperuricemia, magnesium loss, hyperglycemia, and elevated serum lipids

23
Q

How do Thiazide diuretics decrease calcium secretion?

A
  • Increase activity of PTH dependent Ca channels
  • Not due to PTH, but due to increased luminal Na which leads to increase in cell membrane potential and increased Ca reabsorption
24
Q

What is different about Indapamide compared to the other thiazides?

A

Indapamide is excreted by biliary system and is useful in patients with renal insuffiency

  • Does not cause increased plasma lipids
  • Vasodilation
25
Q

What are the contraindications for thiazides?

A
  • Sulfa hypersensitivity
  • Hypokalemia can precipitate digitalis toxicity
  • diabetics, hyperglycemia and carbohydrate intolerance may occur
  • Lithium toxicity
26
Q

Which thiazide diuretic works with a reduced GFR?

A

Metalazone

27
Q

What are the two classes of Potassium sparing diuretics?

A
  • Aldosterone antagonists

- Direct inhibitors of Na+ flux

28
Q

What kind of drug is spironolactone?

A

Aldosterone antagonists

29
Q

What is the MOA of aldosterone antagonists?

A

1) competitive inhibitor of aldosterone, which promotes the excretion of N and retention of K at the late distal tubule and collecting duct

30
Q

What are the indications for spironolactone?

A
  • edema associated with HF, cirrhosis, and nephrotic syndrome
  • Most effective drug for treating hyperaldosteronism
31
Q

What are the adverse effects of spironolactone?

A
  • Relatively few, occasional GI upset, nausea, vomiting
  • Gynecomastia (androgen receptor antagonist
  • Occasional hyperkalemia
32
Q

What are the contraindications for spironolactone?

A

Hyperkalemia, chronic renal insuffiency, and liver damage

33
Q

What kind of drug is eplerenone?

A

Aldosterone antagonist

34
Q

What is the MOA of eplerenone?

A

-Same as spironolactone effects at the aldosterone receptor, but less incidence of endocrine related side effects

35
Q

What kind of drugs are amiloride and triamterene?

A

Potassium sparing diuretics that are direct inhibitors of Na flux

36
Q

What is the MOA of Amiloride and triamterene?

A

-Inhibit the Na/K ion exchange independently of aldosterone, leading to decreased K excretion

37
Q

What is the main use of potassium sparing diuretics?

A

Combination with K losing diuretics

38
Q

What is the DOC or Li+ induced DI?

A

amiloride

39
Q

What are the adverse effects of potassium sparing diuretics?

A
  • Hyperkalemia

- nausea, vomiting, leg cramps, dizziness

40
Q

What are the 4 osmotic diuretics?

A

Mannitol, isosorbide, Glycerin, and urea

41
Q

What are the indications for osmotic diuretics?

A
  • prophylaxis of acute renal failure
  • decrease IOP
  • decreased ICP
  • Protect kidney
42
Q

What is the contraindication for osmotic diuretics?

A

HF

43
Q

What is desmopressin and what is it used for?

A

Synthetic ADH used to treat central DI

44
Q

What kind of drug is conivaptan?

A

ADH antagonist

45
Q

What are the indications for conivaptan?

A

-treatment of euvolemic or hypervolemic hyponatremia in hospitalized patients (increases Na concentrations and increases free H20 clearance)

46
Q

Wha are the adverse effects of Conivaptan?

A

Hypokalemia

  • injection site reactions
  • orthostatic hypotension
47
Q

What is the contraindication to conivaptan?

A

Hyponatremia associated with hypovolemia

48
Q

What kind of drug is tolvaptan?

A

ADH antagonist that is similar to conivaptan, but it is a non-peptide V2 vasopressin receptor antagonist

49
Q

Why do CA inhibitors cause Hyperchloremia?

A

Na+ loss is in the form of NaHCO3 instead of NaCl

50
Q

Why are CA inhibitors not used for long term therapy?

A

The effectiveness of the drug decreases in a few days because accumulation of H+ within the tubule from normal metabolic processes allows the Na/H exchange to take place again, preventing the diuretic effect

51
Q

What is the MOA of osmotic diuretics?

A

Filtered, but not reabsorbed by the kidney. Keeps water in the tubules and produces diuresis

52
Q

What is the MOA of Conivaptan?

A

Non-peptide V1a and V2 receptor antagonist

Pharmacology 2 (12 decks)

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