Diuretics

Front 1

inhibits Na/H exchange in the PCT because HCO3 and H cannot form CO2 and H20 rapidly leading to increased HCO3 and H in the lumen

Back 1

Carbonic anhydrase inhibitors

Front 2

why is acetazolamide only a weak diuretic

Back 2

because the excess Na load can be reabsorbed by the ascending loop of Henle

Front 3

Adverse effects of carbonic anhydrase inhibitors

Back 3

Hypokalemia - increased bicarb excretion creates negative lumen potentional and pull out K
Metabolic acidosis
Kidney stones - increased urinary pH

Front 4

therapeutic uses for Acetazolamide

Back 4

glaucoma
acute altitude sickess (respiratory alkalosis)
metabolic alkalosis

Front 5

Who is contraindicated in using acetazolamide

Back 5

patients with liver cirrhosis with high NH3 levels - alkalized urine cannot form NH4 and therefore increased urinary NH3 leads to increased reabsorption and can result in hepatic encephalopathy

Front 6

inhibits to Na/K/2Cl in the TAL

Back 6

loop diruretics

Front 7

adverse effects of loop diuretics

Back 7

hypokalemic metabolic alkalosis - Increased filtered Na load to collecting tubules leads to increased K and H secretion
Hyperuricemia - increased uric acid uptake in PCT
hypercalciuria
Hypomagnesmia - Mg is reabsorbed in the TAL when K is secreted into the lumen and creates (+) potential, Calcium is able to be reabsorbed in DCT
Hypovolemia
Ototoxicity

Front 8

therapeutic uses for loop diuretics

Back 8

acute pulmonary edema
chronic congestive heart failure
edema of nephrotic syndrome
hypercalcemia

Front 9

Inhibits Na/Cl cotransporter in the DCT

Back 9

Thiazide diuretics

Front 10

adverse effects of thiazide diuretics

Back 10

hypokalemic metabolic alkalosis - increased Na load to collecting tubules leads to increased K and H secretion
Hyperuricemia - increase uric acid uptake in PCT
Hyperglycemia - decreased insulin release
Hyperlipidemia
Hypercalcemia

Front 11

therapeutic uses of thiazide diuretics

Back 11

HTN
CHF - drug of choice
Nephrotic syndrome with edema
Hypercalciuria - for patients with calcium oxalate stones
Nephrogenic diabetes insipidus - decreased urine volume by 50%

Front 12

what happens to Calcium when Na/Cl cotransporter is block in DCT

Back 12

increased reuptake due to more axn on the Na/Ca transporter on the basal membrane - leads to decreased urinary excretion of Ca

Front 13

two different types of K-sparing diuretrics

Back 13

aldosterone receptor antagonist - inhibits ENaC channel synthesis in the collecting tubules
Na channel inhibitor - inhibits ENaC channels in the collecting tubules leading to decreased reabsorption of Na and K secretion

Front 14

ENaC antagonists

Back 14

Triamterene
Amiloride

Front 15

Adverse effects of K-sparing diuretics

Back 15

Hyperkalemia and Metabolic acidosis - decreased reabsorption of Na through ENaC leads to decreased secretion of K and H
Gynecomastia - spironolactone
Kidney stones - triamterene

Front 16

patients that K-sparing diuretics are contraindicated in

Back 16

renal failure
ACE inhibitors

Front 17

Therapeutics uses for Spironolactone

Back 17

Liddle's syndrome (HTN) - increased amount of ENaC channels - used in combination with thiazides
Secondary hyperaldosteronism from CHF or liver failure (due to decreased effective volume)
Used in combination with thiazides and loop diuretics to prevent K excretion

Front 18

only diuretic that doesn't need to reach the lumen of the renal tubule to cause an effect

Back 18

Spironolactone

Front 19

Acts on PCT and DLH to decrease Na and H20 reabsorption

Back 19

Osmotic diuretics

Front 20

therapeutic uses for osmotic diuretics

Back 20

cerebral edema
acute renal failure

Front 21

adverse effects of osmotic diuretics

Back 21

immediate ECF volume expansion with hyponatremia
later there is dehydration and hypernatremia if water intake is inadequate

Front 22

contraindicated uses for osmotic diuretics

Back 22

patients with HF and pulmonary congestion because of ECF expansion

Front 23

therapeutic uses for triamterene and amiloride

Back 23

Used in combination with loop diuretics or thiazides to reduce potassium wasting

Front 24

Freely filtered by the glomerulus but poorly reabsorbed from the tubule

Back 24

Mannitol - leading to osmotic diuresis

Front 25

which drugs that decrease the efficacy of loop and thiazide diuretics

Back 25

NSAIDs

Front 26

treatment for hypercalcemia

Back 26

furosemide together with parenteral volume and electrolyte replacement

Front 27

which diuretic can reduce renal calcium stone formation

Back 27

thiazide diruetics - decrease calcium tubular excretion

Front 28

Does loop diuretic usually lead to hypo or hypernatremia

Back 28

hypernatremia, unless the patients drink a ton a water, then they can become hyponatremic

Front 29

why does loop diuretic lead to hypernatremia

Back 29

because the medullary interstitium cannot become hypertonic and reabsorb water via the collecting duct

Front 30

DOC for nephrolithiasis caused by calcium stones

Back 30

Thiazide due to increased Ca reabsorption

Front 31

First line drugs used in patient with HTN and DM

Back 31

ACE inhibitors with thiazide

Front 32

why does hydralazine not cause orthostatic hypotension

Back 32

because it only dilates the arteries and not the veins

Front 33

DOC for nephrogenic diabetes insipidus

Back 33

hydrochlorothiazide

Front 34

How is Ethacrynic acid different from other loop diuretics

Back 34

it is like a sulfonamide and it has some uricosuric effect

Front 35

Like the 3 classic loop diuretics (sulfonamides)

Back 35

furosemide
bumetanide
torsemide

Front 36

diuretic that can be used to treat hypercalcemia

Back 36

loop diuretic

Front 37

why is hydrochlorothiazide the DOC for nephrogenic diabetes insipidus

Back 37

It seems paradoxical to treat an extreme diuresis with a diuretic but the thiazide diuretics will decrease distal convoluted tubule reabsorption of sodium and water, thereby causing diuresis. This decreases plasma volume, thus lowering GFR and enhancing the absorption of sodium and water in the proximal nephron. Less fluid reaches the distal nephron so overall fluid conservation is obtained

Front 38

Thiazide/thiazide-like diuretics

Back 38

chlorothiazide
hydrochlorothiazide
chlorothalidone
indapamide
metolazone

Front 39

mechanism of axn of V2 antagonists

Back 39

inhibit ADH facilitation of cAMP production which causes insertion of additional aquadporin AQP2 water channels in the collect tubule

Front 40

V1 and V2 blocker

Back 40

Conivaptan

Front 41

selective V2 blocker

Back 41

Tolvaptan

Front 42

Which drug causes more potassium loss, loop diuretics or thiazide

Back 42

Thiazide

Front 43

Does thiazide lead to to hypo or hypernatremia

Back 43

hyponatremia - causes cell swelling and can precipitate CNS toxicity