MIDTERM 04 - Diuretics Flashcards by Juan Carlos Cornelio

Basic unit of the kidneys

Nephron

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3 steps of urine formation (GTT)

Glomerular filtration, Tubular reabsorption, Tubular secretion

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Forerunners of diuretics; blocks carbonic anhydrase; its segment is the PCT (Types of diuretics)

Carbonic anhydrase inhibitors

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2 most common carbonic anhydrase inhibitors; used for the reduction of aqueous humor production in glaucoma (DB)

Dorzolamide, Brinzolamide

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Contraindication for carbonic anhydrase inhibitors

Liver cirrhosis

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Used for reduction of intraocular pressure (IOP) and intracranial pressure (ICP); its segment is the PCT and descending LoH (Types of diuretics)

Osmotic diuretics

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Prototype drug of osmotic diuretics

Mannitol (IV)

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Mannitol (IV) and urea are examples of __________

Osmotic diuretics

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High-ceiling, most efficacious diuretics; blocks the luminal NKCC2; its segment is the thick ascending limb of LoH (Types of diuretics)

Loop diuretics

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Its most important use is for acute pulmonary edema and peripheral edema (Types of diuretics)

Loop diuretics

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Blocks NCC; its segment is the DCT (Types of diuretics)

Thiazide diuretics

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Prototype drug of thiazide diuretics

Hydrochlorothiazide

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Parent compound of thiazide diuretics

Chlorothiazide

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Hydrochlorothiazide and chlorothiazide are examples of __________

Thiazide diuretics

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Chlorthalidone, indapamide, and metolazone are examples of __________

Thiazide-like diuretics

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Thiazide diuretics are ineffective at GFT <30 to 40 mL/mine, except ___________ and __________ (MI)

Metolazone, Indapamide

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A thiazide-like diuretic that is more potent; acts both on PCT and DCT (Types of diuretics)

Metolazone

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Its segment is the collecting tubules and ducts; used for primary and secondary hyperaldosteronism and Liddle syndrome (Types of diuretics)

K+ sparing diuretics

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2 K+ sparing diuretics that are steroidal MRAs (SE)

Spironolactone, Eplerenone

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3 K+ sparing diuretics that are __________ are finerenone, esazerenone, and aperarenone

Nonsteroidal MRAs

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2 K+ sparing diuretics that block Na+ entry in the epithelial Na+ channels (ENAC) (AT)

Amiloride, Triamterene

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Spironolactone, eplerenone, triamterene, and amiloride are examples of __________

K+ sparing diuretics

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Inhibits SGLT-2; its segment is the PCT (Types of diuretics)

SGLT-2 inhibitors

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Dapagliflozin, canagliflozin, empagliflozin, ertugliflozin, and ipragliflozin are examples of __________

SGLT-2 inhibitors

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SGLT-2 inhibitors are used for __________; they reduce CV death and hospitalization regardless of presence or absence of DM

HFrEF

Considered as a 3rd-line therapy for DM (Types of diuretics)

SGLT-2 inhibitors

SGLT-2 inhibitors are __________; they reduce CV mortality, nonfatal stroke, and nonfatal MI

Cardioprotective

SGLT-2 inhibitors are __________; they protect against declining renal function, ESRD, death due to kidney disease, and AKI

Renoprotective

Cardiac atria (Natriuretic peptide)

Atrial NP

Cardiac ventricles (Natriuretic peptide)

Brain NP

CNS, Kidneys (Natriuretic peptide)

C-type NP

Kidneys (Natriuretic peptide)

Urodilatin

Cardiac atria (Recombinant analog)

Carperitide

Cardiac ventricles (Recombinant analog)

Nesiritide

Kidneys (Recombinant analog)

Ularitide

Binds to NP receptors (NPRs); its segment is the intramedullary collecting duct (Types of diuretics)

Natriuretic peptides

NPR A and B are __________ receptors

Guanylyl cyclase

Used for acute decompensated HF w/ dyspnea at rest or minimal activity (Examples of natriuretic peptides)

Nesiritide

Is studied in acute HF (Examples of natriuretic peptides)

Ularitide

A 1:1 mixture of 8-bromotheophylline and 2-amino-2-methyl-1-propanol (Examples of adenosine antagonists)

Pamabrom

Are nonselective adenosine receptor antagonists; examples include caffeine, theophylline, and theobromine (Examples of adenosine antagonists)

Methylxanthines

4 adenosine receptors

A1, A2a, A2b, A3

Adenosine receptor found in pre-glomerular afferent arteriole (decreases RBF and GFR) and PCT (stimulates NHE3 and Na+ reabsorpstion)

Blocks A1 receptors causing diuresis w/o K+ wasting; its segment is PCT; used as OTC for premenstrual syndrome (Types of diuretics)

Adenosine antagonists

Used in refractory patients to loop diuretics alone (Diuretic combinations)

Loop + Thiazides

Used in preventing hypokalemia; avoided in renal insufficiency and in ACEI recipients (Diuretic combinations)

K+ sparing + CA inhibitors/Loop/Thiazides

Used in renal failure w/ very low GFR (Diuretic combinations)

Furosemide + Metolazone

Heart failure (Edematous or non-edematous state)

Edematous

Renal failure (Edematous or non-edematous state)

Edematous

Liver cirrhosis (Edematous or non-edematous state)

Edematous

Idiopathic edema (Edematous or non-edematous state)

Edematous

Hypertension (Edematous or non-edematous state)

Non-edematous

Nephrolithiasis (Edematous or non-edematous state)

Non-edematous

Hypercalcemia (Edematous or non-edematous state)

Non-edematous

Diabetes insipidus (Edematous or non-edematous state)

Non-edematous

Renoprotection and cardioprotection (Edematous or non-edematous state)

Non-edematous

Used for severe edema (Heart failure - diuretics used)

Loop + Thiazide

Used to correct alkalosis (Heart failure - diuretics used)

Loop + CA inhibitor

Used to correct alkalosis and hypokalemia (Heart failure - diuretics used)

Loop + K+ sparing

Enhances K+ excretion and used for hyperkalemia (Renal failure - diuretics used)

Thiazide/Loop diuretic

Used to control the volume-dependent component of hypertension of nephrotic syndrome (Renal failure - diuretics used)

Loop diuretic

Used for treatment of volume overload in dialysis or predialysis patients (Renal failure - diuretics used)

High-dose furosemide/Furosemide + Metolazone

Exacerbates acidosis (Renal failure - diuretics used)

Acetazolamide

Causes hyperkalemia (Renal failure - diuretics used)

K+ sparing diuretics

Ineffective at GFR <30 mL/min; can be used to reduce the dose of loop diuretics (Renal failure - diuretics used)

Thiazide diuretics

Ineffective because of decreased secretion of the drug into the tubular fluid (Hepatic cirrhosis - diuretics used)

Loop diuretics

Is effective; has potential for causing serious hyperkalemia (Hepatic cirrhosis - diuretics used)

MRAs

Relative contraindication for hepatic cirrhosis; is effective but increases liver function tests

Vaptans

2 ADRs from excessive diuretic use for hepatic cirrhosis (HH)

Hepatorenal syndrome, Hepatic encephalopathy

Edema characterized by fluctuating salt retention and edema

Idiopathic edema

Idiopathic edema is sometimes treated with ____________

Spironolactone

Used as the 1st-line diuretic for essential hypertension; enhances the efficacy of ACE inhibitors (Hypertension - diuretics used)

Thiazide diuretics

More effective than HCTZ due to long half life but has more adverse effects (Hypertension - diuretics used)

Chlorthalidone

Reserved for patients with mild renal insufficiency or heart failure (Hypertension - diuretics used)

Loop diuretics

Used to reduce K+ wasting (Hypertension - diuretics used)

K+ sparing diuretics

May be the most effective single agent in the therapy of drug-resistant hypertension (Hypertension - diuretics used)

Spironolactone

Enhances Ca2+ reabsorption in the DCT and reduces the urinary Ca2+ concentration (Nephrolithiasis - diuretics used)

Thiazide diuretics

Reduces Ca2+ reabsorption significantly and effectively promoting Ca2+ diuresis (Hypercalcemia - diuretics used)

Loop diuretics

__________ is treated with ADH analogs (Types of diabetes insipidus)

Neurogenic/Central DI

Can reduce polyuria and polydipsia; blocks Li-induced NDI (Diabetes insipidus - diuretics used)

Thiazide diuretics

Blocks Li induced polyuria (Diabetes insipidus - diuretics used) (AT)

Amiloride, Triamterene

Are efficacious in reducing polyuria w/ fever adverse effects (Diabetes insipidus - diuretics used)

Acetazolamide

Cardioprotective in patients w/ heart disease (Renoprotection and cardioprotection - diuretics used)

MRAs

Carbonic anhydrase inhibitors (MOA)

Blocks carbonic anhydrase

Carbonic anhydrase inhibitors (Segment)

PCT

Osmotic diuretics (Segment)

PCT and descending LoH

Loop diuretics (MOA)

Blocks NKCC2

Loop diuretics (Segment)

Thick ascending limb of LoH

Thiazide diuretics (MOA)

Blocks NCC

Thiazide diuretics (Segment)

DCT

K+ sparing diuretics (MOA)

Blocks ENaC

K+ sparing diuretics (Segment)

Collecting tubules and ducts

SGLT-2 inhibitors (MOA)

Inhibits SGLT-2

SGLT-2 inhibitors (Segment)

PCT

Natriuretic peptides (MOA)

Binds to NP receptors (NPRs)

Natriuretic peptides (Segment)

Intramedullary collecting duct

Adenosine antagonists (MOA)

Blocks A1 receptors

Adenosine antagonists (Segment)

PCT