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62 Cards in this Set

  • Front
  • Back
What is the driving force for conservation of Na+ throughout the nephron?
Basal membrane Na/K ATPase exchanger.
Why do loop diuretics reach pharmacologic concentrations in the tubular lumen?
Because they are filtered and not reabsorbed
What is the site of action of thiazide diuretics?
the Na/Cl cotransporter of the distal tubule
T/F: loop diuretics may cause metabolic acidosis.
False
T/F: loop diuretics are referred to as high ceiling diuretics because they are very potent.
False (they are very efficacious)
T/F: Thiazide diuretics may be used to treat hypercalciuria (renal stones)
True
T/F: patients who are allergic to sulfa drugs may be administered bumetanide instead of furosemide
False
Which of the following is a Ca2+ channel blocker:
diazoxide
verapamil
fenoldopam
guanfacine
hydralazine
verapamil
Which of the following is a K+ channel opener:
diazoxide
verapamil
fenoldopam
guanfacine
hydralazine
diazoxide
Which of the following activates NO synthase:
diazoxide
verapamil
fenoldopam
guanfacine
hydralazine
hydralazine
Which of the following is an alpha2 receptor agonist:
diazoxide
verapamil
fenoldopam
guanfacine
hydralazine
guanfacine
Which of the following is a D1 receptor agonist:
diazoxide
verapamil
fenoldopam
guanfacine
hydralazine
fenoldopam
What's the prinicipal site of action of minoxidil?
a. vasomotor center
b. cardiac adrenergic receptors
c. ganglion
d. presynaptic terminal
e. postsynaptic sites
e. postsynaptic sites
What's the prinicipal site of action of metoprolol?
a. vasomotor center
b. cardiac adrenergic receptors
c. ganglion
d. presynaptic terminal
e. postsynaptic sites
b. cardiac adrenergic receptors
What's the prinicipal site of action of diazoxide?
a. vasomotor center
b. cardiac adrenergic receptors
c. ganglion
d. presynaptic terminal
e. postsynaptic sites
e. postsynaptic sites
What's the prinicipal site of action of alpha-methyldopa?
a. vasomotor center
b. cardiac adrenergic receptors
c. ganglion
d. presynaptic terminal
e. postsynaptic sites
a. vasomotor center
What's the prinicipal site of action of nitroprusside?
a. vasomotor center
b. cardiac adrenergic receptors
c. ganglion
d. presynaptic terminal
e. postsynaptic sites
e. postsynaptic sites
What's the prinicipal site of action of clonidine?
a. vasomotor center
b. cardiac adrenergic receptors
c. ganglion
d. presynaptic terminal
e. postsynaptic sites
a. vasomotor center
What's the prinicipal site of action of terazosin?
a. vasomotor center
b. cardiac adrenergic receptors
c. ganglion
d. presynaptic terminal
e. postsynaptic sites
e. postsynaptic sites
What's the prinicipal site of action of nifedipine?
a. vasomotor center
b. cardiac adrenergic receptors
c. ganglion
d. presynaptic terminal
e. postsynaptic sites
e. postsynaptic sites
What's the prinicipal site of action of fenoldopam?
a. vasomotor center
b. cardiac adrenergic receptors
c. ganglion
d. presynaptic terminal
e. postsynaptic sites
e. postsynaptic sites
What's the prinicipal site of action of guanethedine?
a. vasomotor center
b. cardiac adrenergic receptors
c. ganglion
d. presynaptic terminal
e. postsynaptic sites
d. presynaptic terminal
Which of the following has aldosterone-independent Na/K exchange as its target of action:
a. bumetanide
b. acetazolamide
c. hydrochlorothiazide
d. spironolactone
e. triamterene
e. triamterene
Which of the following has aldosterone-dependent Na/K exchange as its target of action:
a. bumetanide
b. acetazolamide
c. hydrochlorothiazide
d. spironolactone
e. triamterene
d. spironolactone
Which of the following has carbonic anhydrase as its target of action:
a. bumetanide
b. acetazolamide
c. hydrochlorothiazide
d. spironolactone
e. triamterene
b. acetazolamide
Which of the following has Na/K/2Cl transporter as its target of action:
a. bumetanide
b. acetazolamide
c. hydrochlorothiazide
d. spironolactone
e. triamterene
a. bumetanide
Which of the following has Na/Cl transporter as its target of action:
a. bumetanide
b. acetazolamide
c. hydrochlorothiazide
d. spironolactone
e. triamterene
c. hydrochlorothiazide
Antagonists of these peptides would be beneficial in the treatment of HTN:
a. bradykinin
b. endothelin-1
c. atrial natriuretic peptide
d. a and b
e. all of the above
b. endothelin-1
Antagonists of these enzymes may be useful in the treatment of HTN:
a. angiotensin-converting enzyme
b. kinase-II
c. endothelin converting enzyme
d. a and b
e. all of the above
e. all of the above
Inhibitors of these enzymes would be helpful in the treatment of hypertension except for:
a. carbonic anhydrase
b. renin
c. NO synthase
d. guanylyl cyclase
e. c and d
e. c and d
What two classes of diuretics are used most commonly?
thiazides and loops
What is one important function of carbonic anhydrase?
conservation of HCO3
What class of diuretics can be used for hypercalcemia?
Loops (used to increase Ca2+ excretion)
Which class of diuretics can be used for epilepsy and glaucoma?
carbonic anhydrase inhibitors (mechanism unknown in epilepsy; decreases intraocular pressure in glaucoma)
Which class of diuretics is primarily used in chemical intoxication to increase urine flow rate to wash out toxin?
Loops
Which class of diuretics is primarily used in the treatment of nephrogenic diabetes insipidus?
Thiazides
Which class of diuretics has elevation of uric acid and plasma lipids as a toxicity?
Thiazides
Toxicity of thiazides (5)
1. Hypokalemia
2. Hypersensitivity rxns (Sulfa)
3. Hyperglycemia (associated with hypokalemia)
4. Retention of Lithium (Na depleted/Li reabsorbed)
5. Elevation of plasma lipids and uric acid
Name some thiazides.
Chlorothiazide
Hydrochlorothiazide
Chlorthalidone
Indapamide
Metolazone (thiazide-like)
Toxicities of loops (5)
Hypokalemia
metabolic alkalosis
temporary deafness
cross-sensitivity with sulfa drugs (except ethacrynic acid)
Retention of Lithium
Displacement of plasma protein-bound drugs
Three sulfamyl derivative loop diuretics
Furosemide
Bumetanide
Torsemide
Two potassium-sparing diuretics
spironolactone
eplerenone
Toxicities of potassium-sparing diuretics
hyperkalemia
hormonal effects (eplerenone possible less so than spironolactone)
Which other class of anti-hypertensives can cause hyperkalemia?
ACE inhibitors (be extra cautious giving K-sparing diuretic to pts on ACEIs)
Example of rational combining two diuretic classes
Loop (e.g., furosemide) + Thiazide
Mechanism of action of osmotic diuretics
1. pulls in fluid from ISF
2. increases filtered load
3. counter-current multiplier mechanism -- osmotics make system isotonic
Examples of osmotic diuretics
mannitol USP
Urea
Sucrose
Glycerol
Effects of CAIs on acid-base balance
depletion of HCO3 (base)
Retention of hydrogen ion (acid)
Effects of CAIs on potassium
intracellular H/K shift during acidosis
increased Na/K exchange
Name two CAIs (carbonic anhydrase inhibitors)
acetazolamide
dichlorphenamide
which class of diuretics can cause hypocalcemia
loops
which class of diuretics can be used for hypercalcemia?
loops
which class of diuretics can cause hypercalcemia?
thiazides
Diuretics like furosemide, ethacrynic acid and hydrochlorothiazide may precipitate an attack of gout because they:
a. decrease the metabolism of uric acid
b. block the secretion of uric acid
c. increase reabsorption of uric acid by the CCMM
d. increase production of uric acid
e. decrease glomerular filtration of uric acid

2005exam3
b. block the secretion of uric acid
Match the following drugs and consequences of their administration.

Drugs; HCTZ, propranolol, losartan, captopril

effects:
a. angioedema
b. metabolic alkalosis
c. hyperkalemia
d. elevated plasma lipids


2005exam3
a. angioedema: captopril
b. metabolic alkalosis: HCTZ
c. hyperkalemia: losartan
d. elevated plasma lipids: propranolol
Select the following rational drug combinations and correct reasons for the combination:
a. spironolactone added to ethacrynic acid and hydrochlorothiazide to treat refractory edema
b. furosemide and hydrochlorothiazide because they have different sites/mechanisms
of action
c. hydrochlorothiazide with acetazolamide to prevent metabolic acidosis
d. a and b
e. all of the above

(2004exam3)
d. a and b
Select the following rational drug combinations and correct reasons for the combination:
a. HCTZ and eplerenone because the combination decreases risk of K+ imbalance
b. furosemide and HCTZ to overcome diuretic tolerance
c. ethacrynic acid and eplerenone to prevent metabolic alkalosis
d. a and b
e. all of the above are rational combinations


(2003exam3)
d. a and b
The following are drug interactions that may lead to hyperkalemia:
a. lisinopril + losartan
b. losartan + spironolactone
c. eplerenone + K+ supplements
d. a and b
e. all of the above


(2003exam3)
e. all of the above
Antihypertensive action of this drug is due in part to prevention of bradykinin degradation:
a. enalapril
b. candesartan
c. bosentan
d. a and b
e. none of the above


(2003exam3)
a. enalapril
This drug's target is a membrane-bound enzyme:
a. captopril
b. ANP
c. hydralazine
d. a and b
e. none of the above


(2003exam3)
d. a and b
When dispensing this drug you should tell the patient to take the first dose upon rising in the morning:
a. doxazosin
b. prazosin
c. terazosin
d. a and b
e. none of the above


(2003exam3)
e. none of the above
The mechanism of action of this diuretic is to block the aldosterone-dependent Na/K exchanger in the distal tubule:
a. amiloride
b. triamterene
c. spironolactone
d. a and b
e. all of the above


(2002 exam 3 q56)
c. spironolactone