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RCS > L12- Diuretics > Flashcards

L12- Diuretics Flashcards

1
Q

PCT has (high/low) water permeability and (2) are the main drug targets / transporters

A

1- very high

2- Na+/H+ (NHE3), carbonic anhydrase, acid/base transporters

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2
Q

thin descending loop of Henle has (high/low) water permeability and (2) are the main drug targets / transporters

A

1- high

2- aquaporins

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3
Q

thick ascending loop of Henle has (high/low) water permeability and (2) are the main drug targets / transporters

A

1- very low

2- Na+/K+/2Cl- symporter (NKCC2)

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4
Q

DCT has (high/low) water permeability and (2) are the main drug targets / transporters

A

1- very low

2- Na+/Cl- (NCC)

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5
Q

CT has (high/low) water permeability and (2) are the main drug targets / transporters

A

1- variable

2- ENaC, K+ channels, H+ transporters, aquaporins

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6
Q

In an edematous state there is (inc/dec) NaCl reabsorption, which leads to (2) and (3). Examples that cause this include the following: (4).

A

1- inc NaCl
2- H2O retention
3- inc blood volume
4- HF, hepatic ascites, nephrotic syndrome, premenstrual edema

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7
Q

list some examples of non-edematous states where diuretics may be required

A
  • HTN
  • hypercalcemia
  • diabeted insipidus
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8
Q

define natriuretics and the 2 main clinical uses

A

-inhibits renal ion transported to dec Na+ reabsorption at different sites in the nephron

i) manage abnormal fluid retention (edema)
ii) treat HTN by reducing blood volume

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9
Q

Loop diuretics target (1) part of the nephron, acting on (2) transporter, to have (3) results.

A

(furosemide)
1- thick ascending LoH
2- inhibit NKCC2 (Na+/K+/2Cl- co-transporter)
3- inc Na, K, Cl in tubular lumen –> inc H2O excretion

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10
Q

Loop diuretic uses

A

(furosemide)

  • manages edema in HF, hepatic/renal disease
  • moderate-severe HTN
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11
Q

Loop-diuretic effects on:

(1) [Ca2+]
(2) [Mg2+]
(3) PGs
(4) renal vascular resistance
(5) renal blood flow

A 
(furosemide)
1- inc Ca excretion
2- inc Mg excretion
3- inc PG synthesis
4- dec resistance
5- inc RBF
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12
Q

Loop diuretics are given in (1) fashion and have a (2) half-life

A

(furosemide)
1- orally, paraenterally
2- 2-4 hrs

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13
Q

loop diuretics have the following adverse effects

A

(furosemide)

  • ototoxicity
  • hyperuricemia
  • acute hypovolemia
  • hypokalemia
  • hypomagnesemia
  • allergic reactions
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14
Q

Loop Diuretics:

(1) dec urinary excretion of….
(2) inc urinary excretion of….

A

(furosemide)
1- dec uric acid excretion

2- inc Na, K, Mg, Ca, urine volume excretion

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15
Q

Thiazides target (1) part of the nephron, acting on (2) transporter, to have (3) results.

A

1- DCT
2- inhibits NCCT (Na+/Cl- co-transporter)
3- inc Na, Cl in tubular lumen –> inc H2O excretion

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16
Q

Thiazide uses (hint: 5)

A
  • HTN (alone or in combination)
  • HF (mild-moderate)
  • hypercalciuria (inhibits Ca excretion, used for kidney stones)
  • Diabetes Insipidus (=> hyperosmolar urine)
  • premenstrual edema
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17
Q

Thiazide effects on:

(1) [K+]
(2) [Mg2+]
(3) [Na+ / Cl-]
(4) [Ca+]
(5) PVR

A 
1- inc K excretion
2- inc Mg excretion
3- inc Na/Cl excretion
4- dec Ca excretion
5- dec peripheral vascular resistance (dec blood volume- which will recover although hypotensive effects remain)
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18
Q

Thiazides are given in (1) fashion and have a (2) half-life

A

1- orally

2- 40 hrs (1-3 wks for stable effects)

19
Q

list the thiazides

A
  • HCTZ
  • Chlorthalidone
  • Metolazone
20
Q

thiazides should replace loop-diuretics in the what condition

A

moderate to severe CKD (GFR < 30 mL/min)

21
Q

(1) thiazide has the longest duration of action

(2) is the most potent thiazide

A

1- chlorthalidone (40-60 hr half life, used qd for HTN)

2- metolazone (–> Na excretion in advance of kidney failure)

22
Q

thiazides have the following adverse effects

A
  • hypokalemia, hyponatremia
  • hyperuricemia, hyperglycemia, hyperlipidemia
  • hypersensitivity
  • sexual dysfunction
23
Q

Thiazides:

(1) dec urinary excretion of….
(2) inc urinary excretion of….

A

1- dec uric acid, Ca excretion

2- inc K, Na, Mg, urine volume excretion

24
Q

list the K+-sparing diuretics (include categories)

A

Aldosterone antagonists: Spironolactone, Eplerenone

Na+ channel inhibitors: Triamteren, Amiloride

25
Q

K+-sparing diuretics (Spironolactone, Eplerenone) target (1) part of the nephron, acting as (2), to have (3) results.

A

1- CT
2- aldosterone antagonists
3- prevents ENaC (Na in) and ROMK (K out) transporters on lumenal side –> dec Na reabsorption, dec K excretion

26
Q

K+ sparing diuretic (Spironolactone, Eplerenone) uses

A
  • HF (adjunct, to prevent cardiac remodeling)
  • HTN (adjunct)
  • primary hyperaldoteronism (for Dx and Tx, only time it is used alone)
  • edema (associated with excess aldosterone)
27
Q

K+ sparing diuretics (Spironolactone, Eplerenone) have the following adverse effects

A
  • gastric upset / peptic ulcers
  • endocrine effects (antiandrogen)
  • hyperkalemia
  • nausea, lethargy, mental confusion (rare)
28
Q

____ must be monitored in patients using K+-sparing diuretics (Spironolactone, Eplerenone)

A

potassium levels

29
Q

K+-sparing diuretics (Triamteren, Amiloride) target (1) part of the nephron, acting as (2), to have (3) results.

A

1- CT
2- ENaC (Na+ channel) inhibitors
3- dec Na+/K+ exchange –> inc Na+ in lumen –> inc H2O excretion, dec Na reabsorption, dec K excretion

30
Q

K+ sparing diuretics (Triamteren, Amiloride) have the following adverse effects

A
  • hyperkalemia
  • hyponatremia
  • leg cramps
  • GI upset
  • dizziness, pruritus, HA, minor visual changes
31
Q

K+ sparing diuretics (all):

(1) dec urinary excretion of….
(2) inc urinary excretion of….

A

1- dec K excretion

2- inc Na, urine volume excretion

32
Q

Carbonic Anhydrase inhibitors target (1) part of the nephron, acting as (2), to have (3) results.

A

(acetazolamide)
1- PCT
2- CA inhibitor –> inc HCO3- and Na excretion
3- dec Na+/H+ exchange (basolateral side, Na in, H out) –> dec Na+/K+ ATPase (apical side, Na out, K in) –> more Na+ and HCO3- in the lumen –> more alkaline urine + inc volume

33
Q

CA inhibitor uses

A

(acetazolamide)

  • glaucoma
  • epilepsy (alone or with other antiepileptics)
  • mountain sickness prophalaxis
  • metabolic alkalosis
34
Q

CA inhibitors are given in (1) fashion and have a (2) half-life

A

(acetazolamide)
1- oral (well absorbed) or IV (acute Tx for closed angle glaucoma)
2- 3-6 hrs

35
Q

CA inhibitors adverse effects

A

(acetazolamide)

  • hyponatremia, hypokalemia
  • crystalluria (due to inc HCO3 in urine)
  • metabolic acidosis –> malaise, fatigue, depression, HA, GI upset, drowsiness, paresthesia
36
Q

CA inhibitors:

(1) dec urinary excretion of….
(2) inc urinary excretion of….

A

(acetazolamide)
1- n/a
2- HCO3-, Na, K, urine volume

37
Q

osmotic diuretics target (1) part of the nephron, acting as (2), to have (3) results.

A

(mannitol)
1- everywhere (no specific targets)
2- osmotic agent (inc plasma osmolarity)
3- H2O pulled out of body tissues –> inc urine volume

38
Q

osmotic diuretic uses

A

(mannitol)

  • inc urine flow in patients with acute renal failure
  • reduce intracranial pressure – treats cerebral edema
  • promote excretion of toxic substances
39
Q

osmotic diuretics are given in _____ fashion

A

(mannitol)

IV due to poor GI absorption

40
Q

osmotic diuretics adverse effects and contraindications

A

(mannitol)

  • ECW expansion => hyponatremia
  • tissue dehydration

-not used in CHF, pulmonary embolism

41
Q

ADH antagonists target (1) part of the nephron, acting as (2), to have (3) results.

A

(conivaptan)
1- CT
2- V1/V2 receptor antagonist (normally bind ADH)
3- dec H2O permeability –> dec retention and inc urine volume (dilute urine)

42
Q

ADH antagonist uses

A

(conivaptan)

  • euvolemic and hypervolemic hyponatremia
  • SIADH
  • HF (if benefits&raquo_space;> risks, safety not established)
43
Q

ADH antagonists are given in _____ fashion

A

(conivaptan)
IV only
-metabolized by and potent inhibitor of CYP3A4

44
Q

ADH antagonists adverse effects and contraindications

A

(conivaptan)

  • infusion site rxns
  • thirst
  • AFib
  • GI, electrolyte disturbances
  • nephrogenic diabetes insipidus

-Not used in renal failure, hypovolemic hyponatremia

RCS (29 decks)

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