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42 Cards in this Set

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What are 2 ways to decrease venous pressure?
1) Decreasing volume
-Diuretics
2) Increasing lumen (venodilation)
-Venodilators
How do diuretics increase the rate of urine flow?
Mostly be decreasing reabsorption of sodium
-Decreases extracellular fluid volume
-Decreases total body NaCl content
-Water follows Na+
Diuretics have no effect on GFR, except for which diuretic?
Osmotic diuretics
What are the 2 major indications of diuretics?
Treatment of edema and effusion
Where is the majority of sodium reabsorbed in the nephron?
~85% is reabsorbed in proximal tubule
What are the 3 transporters responsible for water reabsorption in the nephron?
1) Na+/K+/ 2 Cl- symport
2) Na+/Cl- symport
3) Mineralocorticoid receptor
What are the 4 traditional classifications of diuretics?
1) Osmotic (mechanism of action)
2) Loop diuretics (site of action)
3) Thiazides (chemistry)
4) Potassium-sparing diuretics (effects on K+ excretion)
What are the 4 classifications of diuretics based on mechanism?
1) Osmotic
-Loop of Henle
-Increase in GFR
2) Inhibitors of Na+/K+/ 2 Cl- symport
-Loop of henle
3) Inhibitors of Na/Cl- symport
-Distal convoluted tubule
4) Mineralocorticoid receptor antagonists
-Late distal tubule and collecting duct
According to classification of diuretics based on mechanism, what classification do thiazides fall under?
Inhibitors of Na/Cl symport
What are 3 characteristics of osmotic diuretics?
1) Freely filtered in glomerulus
2) Limited reabsorption
3) Relatively inert pharmacologically
What is the osmotic diuretic that is still used?
Mannitol
What are the 3 mechanisms of action of osmotic diuretics?
1) Increase GFR
2) Decrease proximal tubule reabsorption
3) Decrease reabsorption in Loop of Henle
What are 4 therapeutic uses of osmotic diuretics?
1) Anuric/oliguric renal failure
2) Nephroprotection
-With kidney transplants
3) Control intraocular pressure
-Acute glaucoma
4) Decrease cerebral edema
True or false. Osmotic diuretics are typically a long term usage.
False, used short term not long term things like pulmonary edema and ascites
What are 2 toxicities/ adverse effects of osmotic diuretics?
1) Patients that cannot tolerate increase in ECF
e.g. patient in pulmonary edema from heart failure
2) Hyponatremia
True or false. Osmotic diuretics change the osmolarity.
False, causes hyponatremia but adding other solutes
Inhibitors of Na+/K+/2 Cl- are commonly known as _____.
Loop diuretics
How much sodium reabsorption can inhibitors of Na/K/2 Cl (loop diuretcis) result in?
25%, because that's how much Na+ is reabsorbed in the loop of Henle
What are 3 examples of diuretics that inhibit Na+/K+/2 Cl-?
1) Furosemide*
2) Bumetamide
3) Torsemide
*Pretty much just use furosemide
What is the mechanism of action of loop diuretics?
Block Na+/K+/2 Cl- symport
-Thick ascending loop
-Salt transport virtually stops at this site
True or false. Osmotic diuretics eliminate ~ equal amounts of electrolytes and water.
False, more water than electrolytes
True or false. Loop diuretics eliminate ~ equal amounts of electrolytes and water.
True
What are 5 therapeutic uses of diuretics that inhibit the Na+/K+/2Cl- symport?
1) Anuric/oliguric renal failure
2) Acute pulmonary edema
3) Congestive heart failure
4) Edematous states
5) Ascites
What are the 2 diuretic related adverse effects of loop diuretics?
1) Dehydration and hypotension
2) Hyponatremia, hypochloremia, hypokalemia
What are 4 drugs interactions that can occur with inhibitors of Na+/K+/2Cl-?
1) Aminoglycosides (increases toxicity)
2) Digitalis (increases toxicity)
3) Propranolol
-Increase plasma levels
4) Thiazides (synergistic effect on diuresis-get blockage at more than one site)
What are inhibitors of Na+/Cl- symport commonly called?
Thiazides
What is a more potent diuretic, inhibitors of Na/Cl- symport or Na+/K+/2Cl-?
Na/K/2Cl is more potent,
-> 90% of Na+ is reabsorbed before reaching the distal tubule which is where thiazides act, max excretion of filtered load of Na+ is 5% compared to 25% for loop diuretics
Thiazides cause less dehydration and ______ than loop diuretics.
Hypokalemia
What are 3 thiazides?
1) Chlorothiazide
2) Hydroclorothiazide
3) Metolazone
What is the mechanism of action of thiazides?
Block Na/Cl- symport in distal convoluted tubule
True or false. Thiazides do not alter the renal response to hydropenia.
True
True or false. Thiazides have ~equal excretion of water and metabolites.
True
What are 5 therapeutic uses of thiazides?
1) Edematous states
2) Congestive heart failure (second diuretic, furosemide 1st)
3) Ascites
4) Calcium oxalate stones
-Reduces calcium reabsorption
5) Nephrogenic diabetes insipidus
What diuretics would you want to use for congestive heart failure in an animal with liver disease?
Use furosemide short term then switch to thiazides because furosemide causes hypokalemia
What are 2 diuretic related adverse effects of Na/Cl- symport inhibitors?
- Less pronounced than with loop diuretics
1) Dehydration and hypotension
2) Hyponatremia, hypochloremia, hypokalemia
What are mineralocorticoid receptor antagonists commonly known as?
Aldosterone antagonists OR
K+ sparing diuretics
When are mineralocorticoid receptor antagonists most effective?
Competitive inhibitors, so more effective if aldosterone is increased
What are 2 mineralocorticoid receptor antagonists?
1) Spironolactone
2) Eplerenone
-Costs a fortune! don't use in vet med
What is the mechanism of action of mineralocorticoid receptor antagonists?
Block mineralocrticoid receptor
-Late distal convoluted tubule & collecting ductule
-Competitive inhibition
-Do not alter renal response to hydropenia (dehydration)
What is different about mineralocorticoid receptor antagonist electrolyte excretion compared to other diuretics?
No effect on potassium or Mg2+
What are 3 therapeutic uses of mineralocorticoid receptor antagonists?
1) Second diuretic
-Edematous states
-Congestive heart failure (May prolong survival!!!!)
-Ascites
2) Primary hyperaldosteronism
3) Proteinuria and hypertension
What is the adverse side effect of inhibitors of mineralocorticoid receptor antagonists?
Hyperkalemia (rare in dogs and cats)