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26 Cards in this Set

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Where do loop diuretics primarily work?
The TAL
What diuretics act on the collecting tubule?
K+ sparing diuretics, osmotic diuretics, and ADH antagonists
What is a drug example of a proximal tubule diuretic?
The CA inhibitor Acetazolamide
What are the three K+ sparring diuretics?
Amiloride, spironolactone, and triamterene
What is one osmotic diuretic? What are some ADH antagonists?
Mannitol
Vaptans and demeclocycline
What is the net effect of CA inhibitors? Why are they used?
They inhibit NaCl reabsorption and bicarbonate reabsorption in the proximal tubule--ACUTE INCREASE IN URINE pH
USED TO TREAT GLAUCOME and ALKALINIZE THE URINE and ACUTE MT. SICKNESS
What are some toxicities of carbonic anhydrase?
hyperchloremic metabolic acidosis, CaPO4 stones, NH3 intoxication, and renal K+ wasting
What do the loop diuretics accomplish by blocking the Na/K/Cl transporter?
They reduce the positive potential in the TAL to ZERO--this increases the urinary NaCl and K+, Mg++, and Ca++ excretion
What are some toxicities of loop diuretics?
Hypercalciuria, K+ and Mg++ wasting, metabolic alkalosis(increases distal sodium delivery to the collecting duct), ototoxicity
If someone has hypercalcemia how should you treat it?
Loop diuretics and normal saline
True/False: Thiazides increase K+ and Ca++ excretion.
FALSE--they increase urinary NaCL and K+ excretion BUT NOT CALCIUM EXCRETION
What is a side effect of thiazide diuretics?
Hypercalcemia
What are thiazides mainly used for?
First line antihypertensive agent
Used in CHF and hypercalciuria(like with loop diuretics)
What are some toxicities of thiazides?
Hyperlipidemia, elevated uric acid, calcium, and glucose, renal K+ wasting, and metabolic alkalosis
When would someone need both a loop AND a thiazide diuretic?
Refractory edema with a low GFR and severe hyperkalemia
What can exacerbate diuretic induced renal K+ (or H+) wasting?
High levels of aldosterone and renin
How do potassium sparing agents mainly work?
INHIBIT luminal ENaC activity(amiloride or triamterene) to reduce the negative transport potential to reduce potassium secretion and hydrogen secretion
SPIRONOLACTONE IS A COMPETITIVE INHIBITOR AT THE GLUCOCORTICOID RECEPTOR FOR ALDOSTERONE
Why are K+ sparing agents used?
Hypokalemic patients who are currently on other diuretics
OR
Primary and secondary aldosteronism
What is the effect of aldosterone in the collecting tubule?
They interact with a glucocorticoid receptor to UPREGULATE ENaC channels

SPIRONOLACTONE IS A COMPETITIVE INHIBITOR AT THE GLUCOCORTICOID RECEPTOR FOR
What are the toxicities of K+ sparing diuretics?
HYPERKALEMIA(especially with renal disease), metabolic acidosis, BPH/gynecomastia(spironolactone)
How do osmotic diuretics work?
Osmotic water flow is driven by medullary hypertonicities and osmotic diuretics obligate free water excretion
They have a major effect in water permeable segment
What are some indication for osmotic diuretics?
Mannitol is indicated in cases of need for reduction of intracellular volume(like cerebral edema)
Intratubular obstruction(cast nephropathy, rhabdomyolysis)
What are some toxicities of mannitol?
Hypernatremia(from hyperglycemia), volume depletion, and acute kidney injury
What are some ADH antagonists? What is a toxicity?
Tolvaptan--hypernatremia
Can be used against acute and chronic hypernatremia, SIADH, Heart failure, and ADPolycystic Kidney Disease
How do loop diuretics cause hypocalcemia?
They inhibit the triple transporter and this eliminates the strong positive transepithelial voltage used to move calcium and other divalents across the paracellular pathway
What drug is given for hypercalciuria?
THIAZIDES--reduces the calcium in the urine