Br Pharmacology: Diuretics

Front 1

What is the MOA of acetazolamide?

Back 1

1) inhibits carbonic anhydrase in brush border and intracellularly in PCT cells
2) inhibits carbonic anhydrase systemically

Front 2

What are the effects of acetazolamide?

Back 2

1) sodium bicarb is excreted
2) metabolic acidosis
3) hypokalemia because more Na+ present at CCT
4) hyperchloremia

Front 3

Are the effects of acetazolamide short term or longterm? What is acetazolamide useful for in the eye? Are its effects in eye limited?

Back 3

1) NaHCO3 excretion slows with continued drug use over 2-3 days
2) reducing intraocular pressure in glaucoma
3) effect does not ware off as in kidney

Front 4

how can acetazolamide effect the CNS and subsequently what can it treat?

Back 4

1) acidosis in CNS causes hyperventilation
2) hyperventilation can protect against high altitude sickness

Front 5

Besides acetazolamide which two similar agents are used topically for glaucoma?

Back 5

1) dorzolamide
2) brinzolamide

Front 6

What are toxic effects of acetazolamide? How are they toxic in people with hepatic impairment?

Back 6

1) drowsiness and parestheias
2) cross allergenicity with sulfadrugs
3) alkalinization of urine can lead to precipitation of calcium salt causing renal stones
4) can cause hepatic encephalopathy because of increased ammonia reabsorption
5) hyperchloremia metabolic acidosis

Front 7

What are examples of loop diuretics? What is not a sulfa derivative?

Back 7

1) furosemide
2) bumetanide
3) torsemide
Note: sulfa derivatives
4) ethacrynic acid is not sulfa drug

Front 8

What is MOA of loop diuretics?

Back 8

1) inhibit cotransporter of Na, K, 2 Cl
2) creates positive lumen potential which reduces reabsorption of Ca, and Mg

Front 9

What are effects of loop diuretics on pH, Ca and K? where do they work in nephron?

Back 9

1) hypocalcemia
2) hypokalemia
3) alkalosis
4) work in the TAL

Front 10

How do NSAIDs interfere with loop diuretics action?

Back 10

1) prostaglandins maintain GFR
2) when decreased the loop diuretics are not as effective

Front 11

What are the major clinical uses of loop diuretics?

Back 11

1) treating edematous states like:
a. heart failure
b. ascites
c. nephrotic syndrome
d. pulmonary edema
2) can be used for malignant hypercalcemia states

Front 12

What are side effects of furosemide?

Back 12

1) otoxicity
2) hypokalmic metabolic alkalosis
3) dehydration
4) allergy (sulfa)
5) interstitial nephritis
6) GOUT

Front 13

What can ethacrynic acid be used to treat?

Back 13

1) everything furosemide can
2) used for hyperuricemia and acute gout
Note: never used for long term in gout

Front 14

Where do thiazides work? what is MOA?

Back 14

inhibit NaCl transporter in early DCT

Front 15

What are effects of thiazides on ions and pH?

Back 15

1) hyopkalemic metabolic alkalosis
2) increased reabsorption of Ca2+ and decreased urine Ca2+ (opposite of loop diuretics)
3) can reduce excretion of water and lead to hyponatremia

Front 16

Clinically what are thiazides used for?

Back 16

1) HTN
2) CHF (loop diuretics preferred)
3) idiopathic hypercalciuria
4) nephrogenic diabetes insipidus

Front 17

What are toxic effects of thiazides?

Back 17

1) hypokalemic metabolic alkalosis
2) hyponatremia from water retention
3) hyperglycemia
4) hyperlipidemia
5) hyperurecemia
6) hypercalcemia
7) sulfa allergy

Front 18

Which drugs antagonize the aldosterone receptor and decrease Na/K ATPase expression in cortical collecting tubule?

Back 18

1) spironolactone
2) eplerenone

Front 19

which drugs block the epithelial Na channels in the cortical collecting tubules? same site where spironolactone works!

Back 19

1) amiloride
2) triamterene

Front 20

what are toxic effects of K+ sparing diuretics?

Back 20

1) hyperkalemia
2) metabolic alkalosis
3) endocrine effects:
a. gynecomastia
b. antiandrogen effects

Front 21

Clinically what are side effects of K+ sparing diuretics?

Back 21

1) hyperaldosteronism
2) hyperkalemia
3) CHF
4) spironolactone = gynecomastia and antiandrogen effects

Front 22

Which drugs should K+ sparing diuretics potentially not be given with?

Back 22

1) ACE inhibitors
2) angiotensin blockers
Note: avoids hyperkalemia

Front 23

What is the MOA of mannitol?

Back 23

1) osmotic diuretic
a. reabsorption of water in descending limb of henle and collecting ducts reduced
2) increased tubular osmolarity
3) increased urine flow

Front 24

Which drugs though rarely used have similar properties of mannitol?

Back 24

1) glycerin
2) isosorbide
3) urea

Front 25

Clinically what is mannitol used for?

Back 25

1) to maintain high urine output in conditions like hemolysis or rhabdomyolysis
2) decrease intraocular pressure for glaucoma
3) decrease ICP

Front 26

What are toxic effects of mannitol?

Back 26

1) pulmonary edema
2) dehydration
3) hyponatremia when intracellular water is pulled out of cells

Front 27

What conditions is mannitol contraindicated in?

Back 27

1) anuria
2) CHF because mannitol causes pulmonary edema somehow

Front 28

Which drug is an ADH agonist?

Back 28

1) desmopressin

Front 29

Which drugs are ADH antagonists?

Back 29

1) demeclocycline
2) conivaptin
3) Li+

Front 30

Which receptor does ADH act on? what is receptor coupled to?

Back 30

1) V2
2) Gs increases cAMP
3) causes AQP2 water channels to insert in luminal membrane

Front 31

Which receptors does conivaptan work on?

Back 31

1) V1a
2) V2
3) antidiuretic hormone (vasopressin receptor) antagonist used for SIADH induced hyponatremia

Front 32

What does demeclocycline cause in children younger than 8?

Back 32

1) bone and teeth abnormalities because it is a tetracycline
Note: treatment of hyponatremia due to the syndrome of inappropriate antidiuretic hormone (SIADH) when fluid restriction alone has been ineffective.
Note: can lead to nephrogenic diabetes insipidus

Front 33

What does lithium cause as a toxic effect in the kidney?

Back 33

nephrogenic diabetes insipidous

Front 34

What are ACE inhibitors used for clinically?

Back 34

1) HTN
2) CHF
3) diabetic renal disease

Front 35

What are side effects of ACE inhibitors?

Back 35

1) cough
2) angioedema
3) proteinuria
4) taste changes
5) Hypotension
6) fetal RENAL DAMAGE
7) rash
8) HYPERkalemia

Front 36

Why should ACE inhibitors be avoided in B/L renal artery stenosis?

Back 36

they significantly decrease the GFR by preventing constriction of efferent arterioles

Front 37

What is losartan?

Back 37

angiotensin II receptor antagonist
Note: does not cause cough

Front 38

Aminoglycosides used with loop diuretics potentiate adverse effect

Back 38

Ototoxicity

Front 39

Loops lose and thiazide diuretics retain

Back 39

Calcium

Front 40

Class of drugs that may cause cross-sensitivity with thiazide diuretics

Back 40

Sulfonamides

Front 41

Diuretic used to treat primary aldosteronism

Back 41

Spironolactone