Renal CIS

Question 1

_______ = how much of a drug gets into the system through metabolism

Answer 1

Biodistribution

Question 2

________ = expected and unintended effects of a drug

Answer 2

Adverse effect

Question 3

_______ = physiologic affinity

Answer 3

Selectivity

Question 4

Thiazides, K-sparing diuretics, and carbonic anhydrase inhibitors act on the DT and CCD, which are _______-sensitive areas due to the presence of ______ receptors

Answer 4

Aldosterone; MR

Question 5

What type of diuretic reduces Na reabsorption along the proximal tubule

Answer 5

Carbonic anhydrase inhibitor

Question 6

What type of diuretic inhibits Na and Cl transport along the TAL of the LOH

Answer 6

Loop diuretics

Question 7

Carbonic anhydrase inhibitors increase the excretion of what?

Answer 7

Bicarbonate

Question 8

What class of diuretic has been used in to reduce intraocular pressure in glaucoma as well as to prevent high-altitude sickness?

Answer 8

CAI’s

Question 9

_______ diuretics are substances that are freely filtered but poorly reabsorbed

Answer 9

Osmotic (mannitol)

Question 10

Mannitol is _________, so it can expand ECF volume and increase ECV

Answer 10

Hypertonic

Question 11

Primary adverse effect of mannitol

Answer 11

Osmotic diarrhea

Question 12

Which of the following is not a loop diuretic?

A. Furosemide
B. Indapemide
C. Torsemide
D. Bumetanide

Answer 12

B. Indapamide

[b is a thiazide]

Question 13

Which class of diuretics are considered “potassium-wasting”

Answer 13

Loop diuretics

Question 14

Primary adverse effects associated with loop diuretics

Answer 14

Ototoxicity –> hearing loss and/or tinnitus

Hypomagnesemia

[also note sulfa allergies are a contraindication]

Question 15

Loop diuretics increase excretion of what ions?

Answer 15

Calcium and magnesium

Question 16

Thiazides inhibit the ______cotransporter, thus increasing urine volume, ________ urinary calcium, and _________ urinary Na and Cl

Answer 16

NCC; decreasing; increasing

Question 17

Primary adverse effect of thiazides

Answer 17

Hyponatremia

Question 18

Which of the following are you most likely to use in a patient with CHF?

A. Carbonic anhydrase inhibitor
B. Loop diuretic
C. Thiazide
D. K-sparing diuretic

Answer 18

B. Loop diuretic

[more potent and specific]

Question 19

Which of the following is considered a “mineralocorticoid antagonist”?

A. Carbonic anhydrase inhibitor
B. Loop diuretic
C. Thiazide
D. K-sparing diuretics

Answer 19

D. K-sparing diuretics

Question 20

What is the difference between spironolactone and eplerenone?

Answer 20

Both are k-sparing diuretics.

Eplerenone has 100x greater affinity and selectivity for MR than spironolactone

Question 21

What class of diuretics is not frequently used on its own?

Answer 21

Na+ channel blockers like amiloride and triamterene

Question 22

Which of the following correctly describes caffiene?

A. Natriuretic adenosine receptor agonist
B. Natriuretic adenosine receptor antagonist
C. Aquaretic adenosine receptor agonist
D. Aquaretic adenosine receptor antagonist

Answer 22

B. Natriuretic adenosine receptor antagonist

Question 23

Physiology of edema regarding capillary hydrostatic pressure

Answer 23

Arteriolar dilation

Venous constriction

Increased venous pressure = CHF

ECF increased

Question 24

Physiology of edema regarding capillary oncotic pressure

Answer 24

Decreased plasma protein concentration

Severe liver failure (failure to synthesize protein)

Question 25

Physiology of edema regarding hydraulic conductance

Answer 25

Burn inflammation (release of histamine; cytokines)

Impaired lymphatic drainage

Question 26

Would you prescribe a diuretic for a patient presenting with LE edema consistent with chronic venous insufficiency in the absence of other medical hx?

Answer 26

No; diuretics would only dehydrate the pt and potentially lead to adverse effects

More likely to recommend compression stockings and decrease Na intake

Question 27

What conditions involving edema typically require treatment with a diuretic?

Answer 27

Pulmonary edema

CHF, nephrosis, cirrhosis

Question 28

Which class of diuretic would you use to treat pulmonary edema?

Answer 28

Pulmonary edema can be urgent/emergent –> tx with more potent diuretic = loop diuretic

Question 29

Diuretics _______ effective blood volume, contributing to tissue perfusion and fluid mobilization due to a ________ in venous and intracapillary pressure

Answer 29

Decrease; decrease

[plasma volume is maintained]

Question 30

Which of the following would you keep track of when treating a patient with a diuretic for edema?

A. Weight
B. BUN
C. Creatinine
D. All of the above

Answer 30

D. All of the above

Question 31

Other than loop diuretics, which class of diuretic has significant benefit in patients with heart failure involving reduced EF?

Answer 31

Spironolactone = MR antagonist

Blocks aldosterone cardiac effects, so will inhibit pro-arrythmia risk in CHF and improves EF

Mediated by induction of aldosterone synthase by angiotensin II in the failing ventricle; works to augment ACE inhibition in HF patients

Question 32

Which of the following would you try to avoid prescribing to manage the edema in a patient with diabetes mellitus?

A. Thiazides
B. Loop diuretics
C. Carbonic anhydrase inhibitors
D. K-sparing diuretics

Answer 32

A. Thiazides

These can cause hyperglycemia by inhibiting insulin