Pharmacology Lecture 2: Diuretics

Question 1

Greatest amount of solute in the kidney

Answer 1

Deep in medulla

Question 2

3 main groups of diuretics

Answer 2

1. Thiazides
2. Loop diuretics
3. Potassium sparing diuretics

Question 3

Strongest type of diuretic

Answer 3

Loop diuretics (need to pee in 15 min)

Question 4

Purpose of potassium sparing diuretics

Answer 4

Adjunct to other diuretics since they cause K+ loss (so prevent hypokalemia)

Question 5

State the parts of the nephron

Answer 5

Question 6

Kidney response to hypovolemia (any risk to blood volume)

Answer 6

Shift blood flow to long loop nephrons to retain salt and H2O

Question 7

Function of proximal tubule

Answer 7

Salt reabsorption (Na+ –> Cl- –> water)

Significant reabsorption of bicarbonate with H+ (maintenance of pH)

Question 8

Function of distal tubule (ascending henle)

Answer 8

Most important site of salt and H2O balance

Question 9

Function of distal convoluted tubule

Answer 9

pH balance

Na+ reabsorption through Na+/K+ exchange mechanism

H2O –> collecting duct –> urine

Question 10

Sodium reabsorption ion flow in proximal tubule

Answer 10

with HCO3

With Cl-

Question 11

Sodium reabsorption ion flow in loop of henle

Answer 11

With NaK / 2Cl

Question 12

Sodium reabsorption ion flow in distal tubule and collecting ducts

Answer 12

Loosely couples to H and K secretion

Question 13

Best drug for hypertension

Answer 13

Thiazides

Question 14

Diuretic capacity of thiazides

Answer 14

Reasonable (need to pee within one hour)

Question 15

How do thiazides improve hypertension?

Answer 15

Lower BP by lowering blood volume

HOWEVER!

WIthin a few months, blood volume returns to normal since kidney is irritates and wants to retain sodium and water, BUT blood pressure stats down by some unknown mechanism

Question 16

Site of action of thiazides

Answer 16

Distal convoluted tubule

Question 17

Main site of action of loop diuretics

Answer 17

Ascending limb of the loop of Henle

Question 18

Most common use of loop diuretics and why this is a problem

Answer 18

Heart failure, however, can make patients feel light headed and may pee pants

Question 19

Advantage of thiazides and loop diuretics in terms of practicality

Answer 19

Inexpensive and easy to make

Question 20

Effect of spironolactone

Answer 20

Block impact of aldosterone

Question 21

Caution with K+ sparing diuretics

Answer 21

Need to be aware of K+ levels to avoid hyperkalemia (especially in older patients with decreased kidney function)

Question 22

Effect of osmotically active substance administered to the kidneys

Answer 22

Drags water with it (diuresis)

Question 23

Define intracerebral edema

Answer 23

Water content in brain too high

Question 24

Adverse effec of thiazides and doctor response in general

Answer 24

Hypokalemia, but most practitioners tolerate mild hypokalemia

Question 25

7 clinical uses for diuretics

Answer 25

1. Heart failure
2. Kidney disease
3. Liver failure
4. Cerebral edema
5. Premenstrual edema
6. High altitude sickness
7. Management of essential hypertension