Diuretics And Potassium Supplements

Front 1

Which is the most useful diueretic in the treatment of calcium stones?

Back 1

Thiazide diuretics

Front 2

Do thiazide diuretics cause reduction in blood volume or vascular resistance?

Back 2

yes

Front 3

Do thiazide diuretics have maximal effects on blood pressure below the maximal diuretic dosage?

Back 3

yes

Front 4

Do thiazide diuretic cause an elevation in blood plasma uric acid and triglyceride levels?

Back 4

yes

Front 5

Do thiazide diuretics have ototoxicity?

Back 5

No, loop diuretics do

Front 6

What are the most widely used diuretic drugs?

Back 6

Thiazide diuretics

Front 7

What portion of the nephrons are thiazide diuretics active?

Back 7

distal convoluted tubule

Front 8

Suffix to thiazide diuretics and the 4 exceptions

Back 8

-thiazide
Indapamide, Metolazone, Chlorthalidone, Quinethazone

Front 9

What is the prototype thiazide diuretic (parent of the thiazides)?

Back 9

Chlorothiazide

Front 10

Thiazide-like diuretic

Back 10

Indapamide, Metolazone, Chlorthalidone, hydrochlorothiazide

Front 11

Mechanism of action of Thiazide diuretics

Back 11

Inhibit NaCl trasport in the distal convoluted tubule. NaCl reabsorption is inhibited by preventing the action of the Na/ Cl transporter or symporter from the lumninal side. Increaases the NaCl concentration in the tubular fluid. Because the actions of the diuretics is on the luminal side they need to be excreted into the lumin to indice their action and are, therefore, not effective in pts w/ renal disease

Front 12

effects on urinary excretion by thiazide diuretics

Back 12

increased excretion of Na and Cl (hyper-osmolar urine), loss of K, decreased urinary calcium excretion (promote Ca reabsorption), magnesium deficiency, reduced peripheral vascular resistance (decrease in blood volume and decrease in cardiac output)

Front 13

therapeutic uses of thiazide diuretics

Back 13

hypertension, edema from congestive heart failure, renal edema, hypercalcuria (calcium nephrolithiasis), nephrogenic diabetes insipidus (paradoxically produces a hyperosmolar urine that can lead to reabsorption at the proximal tubule; substitute for ADH)

Front 14

adverse effects of thiazide diuretics

Back 14

hypokalemia (most frequent problem and can cause ventricular arrythmis if the pt is on digitalis), hyperuricemia, volume depletion (orthostatic hypertension), hypercalcemia, hyperglycemia, hyponatremia, hypochloremia, hypomagnesemia

Front 15

SPOKANE, WA

Back 15

GEG (God Envies Griffey)

Front 16

chlorthalidone

Back 16

thiazide-derivative; long duration of action (t1/2 44 hrs). Often used to treat hypertension

Front 17

Metolazone

Back 17

oral quinazoline; used in managment of edema and hypertension. Not a true thiazide. May produce diuresis in pts w/ renal disease. Very potent

Front 18

Indapamide

Back 18

sulfonamide-type simialr to thiazides; antihypertensive and diuretic called the inolines; long half life (10-22 hrs); used as hypertensive with minimal diretic activity; often used in advanced renal failure to stimulate additoin diuresis when used w/ loop diuretics (less likely to accumulate); excreted by GI tract and kidneys

Front 19

A patient complains of paresthesias and occasional nausea with one of her drugs. She has hyerchloremic metabolic acidosis. What drug is she taking?

Back 19

Acetazolamide for glaucoma

Front 20

Do carbonic acid inhibitors cause metabolic acisosis?

Back 20

Yes

Front 21

mechanism of carbonic anhydrase

Back 21

located on the luminal side of the proximal tubule, it catalyzes the dehydration of H2CO3 into H2O and CO2, which is critical for the reabsorption of bicarbonate. The net effect is the transport of NaHCO3 into the interstitial space and an elevation of pH

Front 22

Carbonic anhdydrase inhibitors

Back 22

Acetazolamide, Dichlorphenamide, Methazolamide, Dorzolamide

Front 23

What carbonic anhydrase is a sulfonamide derivative without antibacterial activity?

Back 23

Acetazolamide

Front 24

Therapeutic uses of acetazolamide?

Back 24

edema from heart failure and drug use, reduce IOP in glaucoma (reduces the production of aquesous humor through reducing HCO3 by blocking carbonic anhydrase in the eye, epilepsy, seizures, acute motion sickness

Front 25

Dorzolamide

Back 25

effective topical carbonic anhydrase inhibitor for the treatment of glaucoma and ocular hypertension when acetazolamide has poor corneal penetration

Front 26

A patient was admitted with a history of heart failure and acute LVMI. He also has pulmonary edema. Which drug has a rapid pulmonary effect plus smooth muscle effects that would be useful in this case?

Back 26

Bumetanide

Front 27

Give a case where you would use furosemide plus saline in fusion?

Back 27

managment of severe hypercalcemia

Front 28

which is the loop diuretic with no cross allergenicity to thiazides?

Back 28

Ethacrynic acid (one which is not a sulfonamide derivative) it is a phenoxy acid derivative

Front 29

loop or high ceiling diuretics

Back 29

bumetanide, furosemide, torsemide, ethacrynic acid

Front 30

where do the loop diuretics have there major action?

Back 30

thick ascending loop of henle

Front 31

what drugs have the highest efficacy in mobilizing Na and Cl from the body?

Back 31

loop diuretics

Front 32

most frequently used loop diuretic

Back 32

furosemide

Front 33

torsemide

Back 33

oral and IV loop diuretic. Most active of a new series of anilinopyridine sulfonylurea derivative. twice as potent as furosemide and provides a longer duration at lower urinary concentrations allowing for a 24 hour dosing interval. Avoids paradoxical antodiuresis

Front 34

mechanism of action of loop diuretics

Back 34

inhibit the coupled Na/K/Cl cotransport channel on the luminal side of the ascending loop of henle resulting in a lose of reabsorbtion of Na, K and Cl. Usually very effective in patients w/ renal disease or have responded poorly to thiazides or other loop diuretics

Front 35

Loop diuretics _____ the Ca content of uring and thiazide diuretics _____ the Ca concentration of urine

Back 35

Loop diuretics increase the calcium content and thiazide diuretics decrease the Ca content of urine

Front 36

Loop diuretics cause ______ in renal vascular resistance and _____ in renal blood flow

Back 36

Loop diuretics cause a decrease renal vascular resistance and an increase in renal blood flow

Front 37

Acutely loop diuretics _____ the excretion of uric acid, and chronic administration _____the excretion of uric acid

Back 37

Acutely loop diuretic increase the excretion of uric acid and chronically they will decrease the excretin of uric acid

Front 38

therapeutic uses of loop diuretics

Back 38

acute pulmonary edema of congestive heart failure, treatment of hypercalcemia (when administered along with saline for hydration), hypertension (as a last resort), edema of nephrotic syndrome, edema or cirrhosis

Front 39

which loop diuretic has the longest half life (longest duration of action)?

Back 39

torsemide

Front 40

adverse effects of loop diuretics

Back 40

abnormalities of fliud and electrolyte imbalance, ototoxity, hyperuricemia (blocks excretion of uric acid when given chronically), acute hypovolemia (can lead to cardiac arrhythmias), increase LDL and decrease HDL, hypokalemia

Front 41

potassium sparing diuretics

Back 41

inhibitors of renal epithelial sodium channels---triamterene, amiloride, spirolactone

Front 42

what is the drug that reduces binding of aldosterone to its receptor?

Back 42

spirolactone

Front 43

what are the potassium sparing diuretics that are not aldosterone antagonists?

Back 43

triemterene, amiloride (used for their anti-kaluretic actions along with other diuretics that will increase the potassium excretion

Front 44

where is the mechanism of action of the potassium sparing diuretics?

Back 44

late distal tubule and the collecting duct

Front 45

why are the potassium sparing diuretics triamterene and amiloride given to patients with Addison's disease?

Back 45

because their aldosterone levels are low and the actions of spirolactone will not work ao they are given for their potassium sparing effects and used in conjuction with other diuretics

Front 46

mechanism of action of spirolactone

Back 46

antagonize the effect of aldosterone at the cortical collecting tubule and late distal tubule. Competes with aldosterone for intracellular cytoplasmic receptor sites. The spirolactone-receptor complex cannot translocate into the nucleus and cannot bind to DNA. This prevents the formation of mediator proteins that are responsible to the activation of Na/K exchangers. Without their formation Na is not reabsorbed and K is not excreted

Front 47

What diuretics are used when aldosterone levels are high?

Back 47

potassium sparing diuretics

Front 48

What is the only potassium sparing diuretic routinely used alone to induce negative salt balance?

Back 48

spirolactone

Front 49

adverse effects of spirolactone

Back 49

hyperkalemia, hyperchloremic metabolic acidosis, acute renal failure, kidney stones, gynecomastia and menstral irregularities (chemically resembles sex steroids)

Front 50

which agent is used in a patient with carebral edema?

Back 50

an osmotic agent is needed to remove water from the cells of the edematous brain (i.e. Mannitol)

Front 51

where is the mechanism of action of osmotic diuretics?

Back 51

proximal tubule and descending limb of loop of henle

Front 52

osmotic diuretics

Back 52

mannitol, sorbitol, glycerin, isosorbide, urea

Front 53

What drugs are used in the treatment of patients with increased intracranial pressure, or acute renal failure due to shock, drug toxicities and trauma?

Back 53

osmotic diuretics

Front 54

mechanism of action of osmotic diuretics

Back 54

the drug is filtered through the glomerus and is not brokendown furthur. This leads to an increase in ionic concentration and because the proximal tubule and the descending limb are passively permeable to water, this leads to an increase in the amount of water excreted, but has minimal effect on the secretion of Na. This would mean that these drugs work well in the elimatino of water but not useful in the treatment of the retentino of sodium.

Front 55

which osmotic diuretic is administered intravenously?

Back 55

mannitol

Front 56

which osmotic diuretic is administered parenteral and topically and is approved for the treatment of incracranial pressure and elevated IOP?

Back 56

urea