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50 Cards in this Set
- Front
- Back
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Where does acetazolamide work?
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convoluted proximal tubule
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Where does mannitol work?
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convoluted proximal tubule
thin descending loop collecting duct |
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Where does furosemide work?
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thick ascending limb
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Where do thiazides work?
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early distal tubule
(maybe straight proximal) |
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where do aldosterone blockers work?
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collecting tubule
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Where do ADH agonists work?
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collecting duct
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Diuretics that work where in the nephron have greatest effect?,
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earlier
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Why is it that Diuretics that work on the earlier nephron have greatest effect?
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they are able to block more sodium and chloride reabsorption
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Predominant location of Carbonic Anhydrase enzyme is the ______
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luminal membrane of the proximal tubule cells
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What major metabolic disturbance might carbonic anhydrase inhibitors cause?
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metabolic acidosis
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Azetazolamide is Not in use as diuretic anymore.
Primary indications are |
glaucoma
(prevents production of aequous humor) Also: To enhance renal excretion of acidic drugs Metabolic Alkalosis Altitude sickness (decreases cerebral and pulmonary edema) Seizures |
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Other CA inhibitor:
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Dorzolamide
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If you're using acetazolamide to treat edema assoc with liver failure, pt may have trouble excreting what?
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bases, like NH4+
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Pt is allergic to antibiotics. Why not use CA inhibitors?
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CA-inhibitors are sulfonamides =>cross-allergenic with antibiotics etc.
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Prototype Osmotic Diuretic
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Mannitol
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Uses of Mannitol
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Decrease intraocular and intracranial pressure
Prevent anuria in hemolysis and rhabdomyolysis |
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the sulfonamide-derived loop diuretic
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Furosemide
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the non-sulfonamide-derived loop diuretic
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Ethacrynic acid
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the most efficacious diuretic agents available.
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loops
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Is furosemide diuresis limited be development of acidosis?
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no
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Normally,
in thick ascending limb, excess cellular K+ leaks into the urine and causes what 2 ions to escape to the interstium thru paracellular pathways. |
Mg2+ and Ca2+
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So, what pharmaceuticals for diuresis can cause hypomagnesemia?
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loops
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3 of the sulfonamide-derived loop diuretics
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Furosemide
Bumetanide Torsemide |
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loop diuretic effects on RAAS.
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turn RAAS on
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major ion loss side effects of loop diuretics
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K+
Ca++ Mg++ |
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Which loop diuretic causes more ototoxicity?
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ethacrynic acid
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why would ethacrynic acid be given over furosemide?
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if pt has sulfonamide sensitivity
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loop diuretics = high _____ diuretics
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ceiling
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Site of action of thiazides
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Inhibit NaCl transport predominantly in the distal convoluted tubule
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Drug that's not a thiazide but a sulfonamide qualitatively similar to the thiazides
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Chlorthaladone
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symport blocked by thiazides
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Na-Cl symport
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Where do thiazides work in relation to the macula densa?
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after
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Major side effects of thiazides
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Immediate/Acute Effects; loss of K+ , Na+, Cl- (and Mg++, but not Ca++)
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2 thiazides to know for the test
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Chlorthalidone*
Hydrochlorothiazide |
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Chronic effects of Thiazide Diuretics
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Hyperuricemia
Hyperlipidemia |
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If you have kidney stones, should you take a thiazide.
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Sure. It will probably help get rid of your stones.
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Thiazide Diuretic Therapy will have the what effect on Ca, Mg, K, Na electrolytes
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Calcium Increased
Magnesium Decreased Potassium Decreased Sodium Decreased |
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Adverse effects of HCTZ
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Hypercalcemia
Hypokalemia Hypomagnesemia Hyperglycemia Hyperuricemia Pancreatitis Metabolic alkalosis Stevens-Johnson syndrome hyperlipidemia |
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3 Potassium-sparing agonists
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Spironolactone
Triamterene Amiloride |
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Which K-sparers are these?
Inhibition occurs by direct pharmacologic antagonism of mineralcorticoid receptors |
spironolactone, eplerenone
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Which K-sparers are these?
inhibition of Na+ influx thru ion channels in the luminal membrane |
amiloride, triamterene
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Aldosterone receptor is found in the _____
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basolateral membrane of the principal cell in the collecting duct.
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Adverse Effects of Spironolactone
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Hyperkalemia
Metabolic acidosis Gynecomastia |
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2 drugs of choice for treatment of Liddle’s syndrome
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Triamterene and Amiloride (potassium sparing diuretics)
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What syndrome is this?
Gain of function abnormality of Epithelial Na Channel Results in sodium retention Low levels of aldosterone Formerly known as pseudohyperaldosteronism |
Liddle’s Syndrome
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Amiloride is used to treat
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HTN
CHF Lithium-induced diabetes insipidus |
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Diuretic Combinations
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Loop Diuretics and Thiazides
Potassium-Sparing Diuretics and Loop agents or Thiazides |
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Treatment of Syndrome of inappropriate ADH secretion (SIADH)
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Conivaptan
IV injection |
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Treatment of Nephrogenic Diabetes Insipidus
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thiazide
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Name of the ADH receptor in the collecting tubule
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V2
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