Pharmacology Quiz 4 - Diuretics Part

Front 1

The definition of a a diuretic is a drug that __a___ urine flow and/or ___b____ excretion/reabsorption (c).

Back 1

a) increases

b) Na+/Cl-

c) excretion

Front 2

Too much Na+/Cl- intake leads to volume overload and _________.

Back 2

pulmonary edema

Front 3

Too little or loss of Na+/Cl- intake leads to __________.

Back 3

CV collapse

Front 4

The kidneys use __a__% of cardiac output and __b__% of O2.

Back 4

a) 22%

b) 7%

Front 5

Renal compensatory mechanisms prevent volume depletion and CV collapse. This mechanism is known as ____________.

Back 5

"Diuretic braking"

Front 6

Diuretic braking involves activation of __a__ & __a__, and increase/decrease (b) in BP, increase/decrease (c) in ANP, increase/decrease (d) in ADH, and renal cell hypotrophy/hypertrophy (e).

Back 6

a) SNS & RAAS

b) decrease BP (decrease pressure natriuresis)

c) decrease ANP

d) increase ADH

e) hypertrophy

Front 7

As far as acid-base relationships go with diuretics, pH is equal to 6.1 + log [_a_] / __b__(0.03).

(a) = metabolic/respiratory (c)
and (b) = metabolic/respiratore (d)

Back 7

a) HCO3

b) pCO2

c) metabolic

d) respiratory

Front 8

The loop of Henle is located in the __a___ and the Bowman's capsule is located in the ____b______ of the nephron.

Back 8

a) medulla
b) cortex

Front 9

__a__% of fluid and solutes are filtered, including what things(b)?

Back 9

a) 16-20%

b) glucose, Na, K, Cl, HCO3, aa's

Front 10

__a___liters of fluid are filtered per day, and __b___liters are excreted per day. Plasma is filtered ___c___ times per day.

Back 10

a) 150-180L

b) 1-2L

c) 50-60 times

Front 11

The proximal tubule allows for excretion/reabsorption (a) of substances such as what (b)?

Back 11

a) reabsorption

b) glucose, aa's, and organic solutes

Front 12

What are some of the %'s of organic solutes that are reabsorbed in the proximal tubule?

Back 12

66% Na
85% NaHCO3
65% K
60% H2O

Front 13

Weak acids and bases are reabsorbed/excreted (a) into the ___b____, and this is the site where diuretics enter/work (c) (the/inside) tubule.

Back 13

a) excreted

b) lumen

c) enter the tubule

Front 14

What % of filtrate is reabsorbed in the proximal tubule?

Back 14

60-70%

Front 15

What makes sodium bicarb and also breaks it?

Back 15

carbonic anhydrase

Front 16

How many acid transporters are there in the proximal tubule and how many base transporters are there?

Back 16

9 acid
5 base

Front 17

Diuretics work at which site of the nephron?

Back 17

loop of Henle

Front 18

The loop of Henle dilutes/concentrates (a) urine and Na reabsorption, and in the descending/ascending (b) loop water leaves the lumen.

Back 18

a) concentrates

b) descending

Front 19

_a__% of Na+ reabsorption occurs in the ____b____ loop, which is impermeable to water.

Back 19

a) 25%

b) ascending

Front 20

5% of Na+ is reabsorbed into the ___a___ tubule. It is here that water movement is controlled by ___b____, and is the site of ___c_____ diuretics.

Back 20

a) distal

b) aldosterone

c) thiazide

Front 21

The macula densa is the area between the ____a_____ amd the _____b______ that regulates Na+---so if Na+ is too high, it'll (c) dilate/constrict (d) afferent/efferent arterioles to decrease filtration through the nephron.

Back 21

a) ascending loop

b) distal tubule

c) constrict

d) afferent

Front 22

The collecting ducts reabsorb about __a___% Na+, and water movement is controlled by ____b_____. This is the site for ____c____ diuretics.

Back 22

a) 2-3%

b) aldosterone and ADH

c) potassium-sparing

Front 23

Loop diuretics inhibit the ____a______ carrier on the ____b_____ of the (c) thin decending/thick ascending loop of Henle.

Back 23

a) Na+/K+/2Cl-

b) luminal membrane

c) thick ascending

Front 24

Examples of loop diuretics include all of the following except:
a) ethacrynic acid
b) metolazone
c) furosemide
d) bumetanide
e) torsemide

Back 24

b) metolazone

Front 25

The least potent loop diuretic, at 3uM, is ________ and the most potent, at 0.2 and 0.3uM are _______ & _______.
a) ethacrynic acid, bumetanide & torsemide
b) bumetanide, furosemide & torsemide
c) torsemide, bumetanide & ethacrynic acid
d) furosemide, bumetanide & torsemide
e) none of the above

Back 25

d) furosemide, bumetanide & torsemide

Front 26

Loop diuretics block the Na+/K+/2Cl- pump, but the Na+/K+ ATPase pump will still work (but not as well b/c there isn't as much Na+ to drive it), but this will all (a) decrease/increase the potential gradiant, and (b) decrease/increase the electrochemical gradiant for __c__ & __c__.

Back 26

a) decrease

b) decrease

c) Mg++ & Ca++

Front 27

_a__ will go back into the lumen to help maintain a potential across the luminal membrane so that there is more (+) charges inside the lumen than inside the cell.
An ____b_____ gradiant is formed to move ___c___ out of the lumen back into extracellular space (reabsorption).

Back 27

a) K+

b) electrochemical

c) Mg++ and Ca++

Front 28

The major actions of loop diuretics involve (a)inhibition/stimulation of NaCl (b) reabsorption/secretion by _c__%.

Back 28

a) inhibition

b) reabsorption

c) 20-25%

Front 29

Loop diuretics increase urine output up to __a__L/day and (b) decrease/increase medullary hypertonicity which (c) increases/decreases counter-current concentration.

Back 29

a) 4L/day

b) decreases

c) decreases (reduces)

Front 30

Loop diuretics will (a) decrease/increase K+ excretion, causing a (b) decrease/increase in K+ adsorption in TAL and (c) decrease/increase of K+ in the LDT and collecting ducts.

Back 30

a) increase

b) decrease

c) increase

Front 31

T/F
A major action of loop diuretics is to decrease calcium and magnesium excretion, which decreases the potential across the tubular cell.

Back 31

false

(increase them)

Front 32

Loop diuretics can cause
a) hyperglycemia and hyperkalemia
b) hyperglycemia and hypokalemia
c) hypoglycemia and hyperkalemia
d) hypoglycemia and hypokalemia

Back 32

b) hyperglycemia and hypokalemia

Front 33

__a__ is a stimulus for insulin release, therefore is you have a decrease in this, you will get ___b____ and impaired insulin release.

Back 33

a) K+

b) hypokalemia

Front 34

Loop diuretics cause a reflex mediated ____a_____ release that makes __b__ receptors trigger a decrease in ___c____ and __d___ receptors trigger an increase in ____e_____.

Back 34

a) catecholamine

b) alpha-2
c) insulin release

d) beta-2
e) glycogenolysis

Front 35

Loop diuretics may cause an impaired _________ glucose uptake (insulin resistance).

Back 35

peripheral

Front 36

Loop diuretics have systemic vasodilator actions such as stimulating ____a____ (which can be blocked by ___b___) or acting as a direct ___c____ on muscle

Back 36

a) prostaglandins (PGE2)

b) NSAIDs

c) relaxant effect

Front 37

The reflex activity of loop diuretics is due to ____a_____, and causes a (b)decrease/increase in renin, a (c)decrease/increase in aldosterone, and a (d)decrease/increase in ADH.

Back 37

a) volume depletion

b) increase
c) increase
d) increase

Front 38

Loop diuretics can cause a (a) decrease/increase in uric acid excretion and (b)decrease/increase uric acid plasma levels, leading to ___d____.

Back 38

a) decrease

b) increase

c) gout

Front 39

In acute conditions, loop diuretics may cause an increase in ____a______ of uric acid. Whereas in chronic conditions there is a decrease in ______b_____.

Back 39

a) PCT reabsorption

b) tubular excretion

Front 40

There is a increase in uric acid concentration when taking loop diuretics due to _______________.

Back 40

plasma volume contraction

Front 41

Loop diuretics may cause mild metabolic ____a____, where there is volume depletion which increases __b___ reabsorption. But most importantly there is an enhancement in __c___ secretion.

Back 41

a) alkalosis

b) HCO3

c) H+ ion

Front 42

Loop diuretics can cause mild ___a____, where there is an increase in sympathetic activity and an increase in _____b_____.

Back 42

a) hyperlipidemia

b) triglycerides

Front 43

Loop diuretics block the transporter in ____a_____ to effect the feedback signal to regulate __b__ and __b__.

Back 43

a) macula densa

b) GFR and Ang II

Front 44

T/F
Loop diuretics are not effective in patients with creatinine clearance rates below 30ml/min.

Back 44

false

(they are effective in loops, but not in thiazides)

Front 45

All of the following are therapeutic indications of loop diuretics except
a) liver cirrhosis
b) renal failure
c) hypercalcemia
d) pulmonary edema
e) nephrotic syndrome

Back 45

c) hypercalcemia

(thiazides used for this)

Front 46

All of the following are adverse effects of loop diuretics except
a) hypokalemia
b) contraction acidosis
c) ototoxicity
d) hyperglycemia
e) hyponatremia

Back 46

b) contraction acidosis

(contraction alkalosis)

Front 47

T/F
Loop diuretics may cause azotemic (decrease BUN) effects and photosensitivity, among other allergic reactions.

Back 47

false

(azotemic increase BUN)

Front 48

All of the following interact with loop diuretics except
a) NSAIDs
b) Warfarin
c) aminoglycosides
d) Lithium
e) weak organic bases
f) digitalis

Back 48

e) weak organic bases

(weak organic acids)

Front 49

______ blunt the natriuretic and BP response of loop diuretics.

Back 49

NSAIDS

Front 50

_________ potentiate ototoxicity when taking a loop diuretic.

Back 50

Aminoglycosides

Front 51

_________ compete for anion transporter and are decreased in lumen concentration which causes a decrease in response to a loop diuretic.

Back 51

weak organic acids

Front 52

_______ competes for plasma protein binding when mixed with a loop diuretic.

Back 52

Warfarin

Front 53

Mixing digitalis with a loop diuretic will cause what to happen?

Back 53

hypokalemia and hypomagnesium...leading to arrhythmias

Front 54

As far as bioavailability goes for the loop diuretic furosemide, which of the following is correct?
a) 80%, IV-PO 2:1 (urinary excretion)
b) 50%, IV-PO 1:1 (urinary excretion)
c) 50%, IV-PO 2:1 (metabolism in the liver)
d) 50%, IV-PO 2:1 (urinary excretion)
e) 80%, IV-PO 2:1 (metabolism in liver)

Back 54

d) 50%, IV-PO 2:1 (urinary excretion)

Front 55

As far as bioavailability goes for the loop diuretic bumetanide, which of the following is correct?
a) 80%, IV-PO 2:1 (urinary excretion)
b) 50%, IV-PO 1:1 (urinary excretion)
c) 50%, IV-PO 2:1 (metabolism in the liver)
d) 50%, IV-PO 2:1 (urinary excretion)
e) 80%, IV-PO 1:1 (metabolism in the liver)

Back 55

e) 80%, IV-PO 1:1 (metabolism in the liver)


(the same goes for torsemide!)