Trachte- ADH and Diuretics Flashcards
Why do Loop Diuretics impair hearing?
NKCC1 is present in the ear. When inhibited, there is not enough K+ in the cochlea.
What are the 2 Loop Diuretics?
Furosemide
Bumetanide
Which part of the loop do the loop diuretics work?
What pump and where?
Thick ascending limb
NKCC pump, lumenal side of cell
Where does hydrochlorothiazide work?
What channel?
Distal Tubule
Na Cl Symporter on lumenal side of cell
What are the 2 thiazide diuretics?
Hydrochlorothiazide
Chlorthalidone
What receptor do thiazides bind?
SUR on the K+ channel
What is the normal effect of glucose on a cell of the distal tubule?
Glucose -> ATP in cell -> Inhibits K+ exit -> Depolarizes cell -> Ca ++ enters -> Insulin is excreted
What happens when thiazides bind to SUR?
K+ leaves cell –> Cell hyperpolarizes –> No insulin –> Hyperglycemia
Why are thiazides vasodilators?
They hyperpolarize blood vessel cells too! Less Ca++ can get in because cell is hyperpolarized.
What condition to thiazides predispose patients to?
What is increased?
Gout
Uric Acid
What 4 comorbid conditions are thiazides good for?
CHF
CAD
Diabetes
Stroke
What drugs are good post MI to prevent K+ wasting?
Spironolactone
Eplerenone
What is the MOA of Spironolactone and Eplerenone?
Aldosterone Receptor Blockers
What drugs inhibit ENaC?
Triamterine
Amiloride
What is the effect of inhibiting ENaC?
More Sodium is excreted
Where is aldosterone made?
Cortex glomerulosa of adrenal gland
What kind of receptor does ADH bind?
What is the outcome?
GPCR
Increased aquaporin insertion into the membrane
What is demecocycline?
Antibiotic with some activity as an ADH antagonist
MOA of mannitol?
Major osmotic diuretic
Not reabsorbed in nephron and therefore exerts an osmotic effect to retain water in lumen
When would you use mannitol?
To reduced body water or to reduce intracranial or intraocular pressure
MOA Probenicid
Inhibits renal organic acid transporter to facilitate excretion (Treatment for gout because inhibits uric acid reabsorption)
MOA Sulfinpyrazone
Inhibits renal organic acid transporter to facilitate excretion
(Treatment for gout because inhibits uric acid reabsorption)
MOA Allopurinol
Xanthine Oxidase Inhibitor
Colchicine
Microtubule inhibitor with anti-inflammatory properties, used to treat gout
What drug prevents fibrotic changes in kidneys and hearts caused by aldosterone and has been shown to improve survival in heart failure?
Eplerenone
What is the synthetic form of vasopressin?
Desmopressin
