Pharm Module 2

Question 1

which diuretic has an osmotic effect

Answer 1

• mannitol

Question 2

which diuretic acts as a carbonic anhydrase inhibitor

Answer 2

• acetazolamide

Question 3

which diuretics are loop diuretics

Answer 3

• furosemide
• torsemide
• bumetanide
• ethacrynic acid

LOOP FUCK THAT BITCH, EH

Question 4

which diuretics are thiazide diuretics

Answer 4

• Hydrochlorothiazide
• Chlorthalidone
• Metolazone

Question 5

which drugs are considered K+ sparing

Answer 5

• aldosterone antagonists

- ENaC inhibitors

Question 6

which drugs are aldosterone antagonists

Answer 6

• spironolactone

- eplerenone

Question 7

which drugs are ENaC inhibitors

Answer 7

• triamterene

- amiloride

Question 8

side effects of carbonic anhydrase inhibitors

Answer 8

• hypokalemia

- metabolic acidosis

Question 9

side effects of loop diuretics

Answer 9

• hypokalemia
• hypercalcuria
• hyperuricemia
• metabolic alkalosis

Question 10

side effects of thiazide diuretics

Answer 10

• hypokalemia
• hypocalcuria and hypercalcemia
• hyperuricemia
• metabolic alkalosis
• hyperglycemia

Question 11

side effects of ENaC inhibitors

Answer 11

• hyperkalemia

- metabolic acidosis

Question 12

side effects of aldosterone antagonists

Answer 12

• hyperkalemia
• Metabolic Acidosis
• gynocomastia

Question 13

side effects of osmotic diuretics

Answer 13

• hypokalemia

- metabolic alkalosis

Question 14

where do carbonic anhydrase inhibitors and osmotic diuretics act

Answer 14

• PCT

Question 15

where do loop diuretics act

Answer 15

• ascending limb of LOH

Question 16

where do thiazide diuretics act

Answer 16

• DCT

Question 17

where do potassium sparing diuretics act

Answer 17

• collecting duct

Question 18

MOA of acetazolamide

Answer 18

• inhibits activity of carbonic anhydrase
• blocks generation of H+ in epithelial cells
• reduces absorption of Na+ by H+/Na+ antiporter
• Na+ and H2O build up in developing urine

Question 19

how does acetazolamide cause metabolic acidosis

Answer 19

• blocks production and reabsorption of HCO3-

reduced buffering –> decreased blood pH (acidic)

Question 20

how does acetazolamide cause hypokalemia

Answer 20

• urine Na+ high when reaching collecting duct
• Na+ reabsorbed through ENaC
• K+ excreted through ROMK

Question 21

how do loop diuretics cause hypokalemia

Answer 21

• same way as acetazolamide

- decreased EBV activates RAAS

Question 22

how do loop diuretics cause metabolic alkalosis

Answer 22

• aldosterone promotes loss of H+ by stimulating H+ ATPase in alpha intercalated cells

Question 23

how do loop diuretics cause hypocalcemia/hypercalcuria

Answer 23

• loss of K+ gradient through ROMK so paracellular Ca2+ transport inhibited

Question 24

what may hypercalcuria cause

Answer 24

• neprholithiasis (development of kidney stones)

Question 25

how do loop diuretics cause hyperuricemia and gout

Answer 25

- reduce renal clearance of urate | - compete with urate for clearance

Question 26

what transport proteins transport loop diuretics into the lumen importance of this

Answer 26

- OAT4 and OAT10 | - anti porters that reabsorb urate and cause it to build up in the blood

Question 27

MOA of thiazide diuretics

Answer 27

- act on Na/CL cotranspoter in DCT

Question 28

which is more potent, thiazide diuretics or loop diuretics?

Answer 28

- loop diuretics

Question 29

how do thiazide diuretics cause hypokalemia

Answer 29

- same way as carbonic anhydrase inhibitors and loop diuretics

Question 30

how do thiazide diuretics cause hypercalcemia/hypocalcuria

Answer 30

- inhibit uptake of Na through Na/CL transporter - reduces epithelial cell concentration of Na - basolateral Na/Ca2+ antiporter pumps in more Na into epithelial cells and pumps out Ca2+ into blood

Question 31

are thiazide diuretics associated with kidney stones?

Answer 31

- no

Question 32

how do thiazide diuretics cause metabolic alkalosis

Answer 32

- same way as loop

Question 33

how do thiazide diuretics cause hyperuricemia and gout

Answer 33

- compete with urate for for secretion by basolateral transporters OAT1 and OAT2

Question 34

how do thiazide diuretics cause hyperglycemia and maybe diabetes

Answer 34

- reduce volume of extracellular water compartment - decrease CO - increase sympathetic stimulation - inhibits hepatic glucose uptake causing serum glucose levels to rise - hypokalemia decreases insulin secretion which will result in increased serum glucose levels

Question 35

how do K+ sparing diuretics cause hyperkalemia

Answer 35

- block ENaC so Na+ stays in lumen | - no K+ secretion

Question 36

how do K+ sparing diuretics cause metabolic acidosis

Answer 36

- Na remains in tubular lumen | - lose negative charge gradient so H+ ATPase doesn't secrete H+ into lumen

Question 37

how spironolactone causes anti-testosterone effects?

Answer 37

- competes with binding of testosterone to SHBG - inhibits synthesis of testosterone - converts testosterone to estradiol

Question 38

can eplerenone cause these antiandrogenic effects? why?

Answer 38

- no | - more selective for aldosterone receptor

Question 39

is mannitol reabsorbed or secreted?

Answer 39

- no | - stays in tubule lumen

Question 40

MOA of mannitol

Answer 40

- draws water into tubule

Question 41

how mannitol causes hypokalemia and metabolic alkalosis

Answer 41

- increases lumen water content - decreases concentration of tubular lumen K+ and H+ by dilution - solutes drawn out of serum and into lumen