Pharm Module 2 Flashcards
which diuretic has an osmotic effect
- mannitol
which diuretic acts as a carbonic anhydrase inhibitor
- acetazolamide
which diuretics are loop diuretics
- furosemide
- torsemide
- bumetanide
- ethacrynic acid
LOOP FUCK THAT BITCH, EH
which diuretics are thiazide diuretics
- Hydrochlorothiazide
- Chlorthalidone
- Metolazone
which drugs are considered K+ sparing
- aldosterone antagonists
- ENaC inhibitors
which drugs are aldosterone antagonists
- spironolactone
- eplerenone
which drugs are ENaC inhibitors
- triamterene
- amiloride
side effects of carbonic anhydrase inhibitors
- hypokalemia
- metabolic acidosis
side effects of loop diuretics
- hypokalemia
- hypercalcuria
- hyperuricemia
- metabolic alkalosis
side effects of thiazide diuretics
- hypokalemia
- hypocalcuria and hypercalcemia
- hyperuricemia
- metabolic alkalosis
- hyperglycemia
side effects of ENaC inhibitors
- hyperkalemia
- metabolic acidosis
side effects of aldosterone antagonists
- hyperkalemia
- Metabolic Acidosis
- gynocomastia
side effects of osmotic diuretics
- hypokalemia
- metabolic alkalosis
where do carbonic anhydrase inhibitors and osmotic diuretics act
- PCT
where do loop diuretics act
- ascending limb of LOH
where do thiazide diuretics act
- DCT
where do potassium sparing diuretics act
- collecting duct
MOA of acetazolamide
- 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
how does acetazolamide cause metabolic acidosis
- blocks production and reabsorption of HCO3-
reduced buffering –> decreased blood pH (acidic)
how does acetazolamide cause hypokalemia
- urine Na+ high when reaching collecting duct
- Na+ reabsorbed through ENaC
- K+ excreted through ROMK
how do loop diuretics cause hypokalemia
- same way as acetazolamide
- decreased EBV activates RAAS
how do loop diuretics cause metabolic alkalosis
- aldosterone promotes loss of H+ by stimulating H+ ATPase in alpha intercalated cells
how do loop diuretics cause hypocalcemia/hypercalcuria
- loss of K+ gradient through ROMK so paracellular Ca2+ transport inhibited
what may hypercalcuria cause
- neprholithiasis (development of kidney stones)
how do loop diuretics cause hyperuricemia and gout
- reduce renal clearance of urate
- compete with urate for clearance
what transport proteins transport loop diuretics into the lumen
importance of this
- OAT4 and OAT10
- anti porters that reabsorb urate and cause it to build up in the blood
MOA of thiazide diuretics
- act on Na/CL cotranspoter in DCT
which is more potent, thiazide diuretics or loop diuretics?
- loop diuretics
how do thiazide diuretics cause hypokalemia
- same way as carbonic anhydrase inhibitors and loop diuretics
how do thiazide diuretics cause hypercalcemia/hypocalcuria
- 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
are thiazide diuretics associated with kidney stones?
- no
how do thiazide diuretics cause metabolic alkalosis
- same way as loop
how do thiazide diuretics cause hyperuricemia and gout
- compete with urate for for secretion by basolateral transporters OAT1 and OAT2
how do thiazide diuretics cause hyperglycemia and maybe diabetes
- 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
how do K+ sparing diuretics cause hyperkalemia
- block ENaC so Na+ stays in lumen
- no K+ secretion
how do K+ sparing diuretics cause metabolic acidosis
- Na remains in tubular lumen
- lose negative charge gradient so H+ ATPase doesn’t secrete H+ into lumen
how spironolactone causes anti-testosterone effects?
- competes with binding of testosterone to SHBG
- inhibits synthesis of testosterone
- converts testosterone to estradiol
can eplerenone cause these antiandrogenic effects?
why?
- no
- more selective for aldosterone receptor
is mannitol reabsorbed or secreted?
- no
- stays in tubule lumen
MOA of mannitol
- draws water into tubule
how mannitol causes hypokalemia and metabolic alkalosis
- increases lumen water content
- decreases concentration of tubular lumen K+ and H+ by dilution
- solutes drawn out of serum and into lumen
