Unit 8 - 2 Pharm

Front 1

carbonic anhydrase inhibitor

Back 1

acetazolamide; inhibits reabsorption of HC03- in the proximal convoluted tubule

Front 2

loop diuretic

Back 2

furosemide; inhibits NKCC pump resulting in retention of water, Na, and Cl in tubule

these are the MOST EFFICACIOUS

work in the thick ascending loop of henle

Front 3

most effective diuretics

Back 3

loop diuretics

Front 4

most commonly used diuretics

Back 4

thiazides

Front 5

thiazides

Back 5

inhibit reabsorption of Na and Cl in distal convoluted tubule; retention of water in tubule

most commonly used diuretics

Front 6

aldosterone antagonist

Back 6

spirolactone; potassium sparing (bc keeps Na in lumen and thus inhibits K secretion)

works in collecting tubule and duct

Front 7

amiloride, triamterene

Back 7

blocks Na channels in collecting tubule and duct

Front 8

how do most diuretics reach the nephron?

Back 8

secretion in the middle third of the proximal tubule; since they compete w transporters for uric acid, you can see hyperuricemia when using diuretics like hydrochlorothiazide or furosemide

Front 9

hyperuricemia

Back 9

secretion in the middle third of the proximal tubule; since they compete w transporters for uric acid, you can see hyperuricemia when using diuretics like hydrochlorothiazide or furosemide

Front 10

why are loop diuretics the most effiacious class of diuretics?

Back 10

bc they work at the ascending loop of henle which is the major site of salt reabsorption

Front 11

tx hypercalcemia

Back 11

loop diuretics; promote calcium excretion

Front 12

tx hypertension

Back 12

thiazides; dilate arterioles and reduce blood volume

Front 13

secodary hyperaldosterone tx

Back 13

cirrhosis = ascites = decreased blood volume = increased aldosterone levels to increase blood volume

tx w spirolactone

Front 14

tx chf

Back 14

kidneys get less blood -> increase salt and water retention -> loop diuretics (most efficacious in this life threatening condition)

Front 15

which drugs increase calcium in the urine

Back 15

loop diuretics

Front 16

which drugs decrease calcium in the urine

Back 16

thiazide diuretics

Front 17

how to avoid hypokalemia

Back 17

potassium sparing diuretics like spirolactone, amiloride or triamterene

supplement with foods high in K

salt restriction

Front 18

side effects of diuretics

Back 18

hypokalemia

hyperuricemia

hypotension

hyponatremia

hypercalcemia

Front 19

which drugs can cause hypomagnesia

Back 19

loop diuretics; magnesium not reabsorbed in dct

Front 20

best drugs for emergency volume overload situations

Back 20

IV loop diuretics (furosemide)

Front 21

best drugs for hypercalcemia

Back 21

loop diuretics

Front 22

best drugs for hyperkalemia

Back 22

loop diuretics

Front 23

mannitol

Back 23

osmototic diuretic; freely filtered and minimally reabsorbed; pulls water into lumen which is excreted

Front 24

An elderly patient with a history of heart disease and who is having difficulty breathing is
brought into the emergency room. Examination reveals that she has pulmonary edema.

Back 24

IV furosemide

Front 25

A group of college students is planning a mountain climbing trip to the Andes

Back 25

carbonic anhydrase inhibitor = acetazolamide

Front 26

An alcoholic male has developed hepatic cirrhosis. To control the ascites and edema, he is
prescribed which one of the following

Back 26

Spironolactone is very effective in the treatment of hepatic edema. These
patients are frequently resistant to the diuretic action of loop diuretics, although a combination
with spironolactone may be beneficial. The other agents are not indicated.

Front 27

A 55-year-old male with kidney stones has been placed on a diuretic to decrease calcium
excretion. However, after a few weeks, he develops an attack of gout. Which diuretic was he
taking

Back 27

Hydrochlorothiazide is used to decrease calcium excretion; decreases formation of kidney stones caused by calcium phosphate or calcium oxate

However, hydro-chlorothiazide can also inhibit
the excretion of uric acid and cause its accumulation, leading to an attack of gout in some
individuals. Furosemide increases the excretion of calcium, whereas the K
+
-sparing diuretics,
spironolactone and triamterene, do not have an effect.

Front 28

A 75-year-old woman with hypertension is being treated with a thiazide. Her blood pressure
responds and reads at 120/76 mm Hg. After several months on the medication, she complains of
being tired and weak. An analysis of the blood indicates low values for which of the following

Back 28

Potassium; Hypokalemia is a common adverse effect of the thiazides and causes
fatigue and lethargy in the patient. Supplementation with potassium chloride or with foods high
in K
+
corrects the problem. Alternatively, one may add a potassiumsparing diuretic like
spironolactone. Calcium, uric acid, and glucose are usually elevated by thiazide diuretics. The
sodium loss does not weaken the patient

Front 29

Which drug would be contraindicated in a patient with hyperkalemia?

Back 29

spirolactone; it would decrease K excretion (potassium sparing diuretic)

Front 30

Which would be the initial treatment choice to manage the hypertension in an African-American
woman with a past medical history of gout and severe hypokalemia

Back 30

African American patients with hypertension respond poorly to valsartan,
atenolol and enalapril. Hydrochlorothiazide is generally consider the first-line drug. However,
and because of the patient’s medical history of hypokalemia and gout, spironalctone is the drug
of choice. Additionally, the feminizing hormonal effects of spironolactone may be bothersome
in men, but not in women

Front 31

renal blood flow

Back 31

renal blood flow: 900 L/day (1/4 of cardiac output); 180 L/day is filtered; 1 L/day is excreted

Front 32

major side effect of carbonic anhydrase inhibitors

Back 32

CA transports bicarb from lumen into cell


increased bicarb excreted → metabolic acidosis

Front 33

major side effects of loop diuretics (furosemide)

Back 33

hypocalcemia
hypokalemia
hypochloremia
alkalosis secondary to HC03 retention

Front 34

first line therapy for essential hypertension

Back 34

thiazide diuretics (hydrochlorothiazide)

Front 35

major side effects of thiazides

Back 35

bc of increased distal Na deliver = hypokalemia, hypochloremia, alkalosis secondary to HC03- retention

calcium retention
uric acid retention = GOUT

Front 36

gynecomastia, sexual dysfunction side effects

Back 36

aldosterone antagonists (spirolectone)/potassium sparing diuretic

Front 37

which drug can cause acidosis

Back 37

potassium paring diuretics secondary to H+ retention (normally K and H excreted in exchange for sodium)

Front 38

vasopressin (ADH) antagonists

Back 38

conivaptan; used for hyponatremia

Front 39

which drugs main indication is hyponatremia (SIADH)

Back 39

conivaptan; ADH antagonist

Front 40

side effects of mannitol

Back 40

hypernatremia secondary to hemoconcentration

dehydration secondary to drawing water from intracellular compartment

Front 41

why is combining a loop diuretic and thiazide risky

Back 41

profound hyponatremia, hypokalemia, and hypovolemia

all sites of sodium reabsorption blocked (thiazide blocks pct, dct and loop blocks loop)

Front 42

2 methods to combat the natriuretic effect of drugs used as diuretics

Back 42

1. improve cardiac output to improve renal perfusion pressure and glomerular filtration

2. increase the dose of loop diuretic: these are high ceiling drugs (but must be filtered)

3. use a thiazide diuretic and loop diuretic in combination (but risky bc hyponatremia, hypokalemia, hypovolemia)

4. inhibit the compensatory activation of renin-angiotensin-aldosterone system: (ACE inhibitors, AT antagonists)

Front 43

DREM Method

Back 43

1. determine normal dose or dose interval (for pt w normal renal function
2. estimate pts GFR (normal = 100)
3. adjusted dose = normal dose x (eGFR/100)
4. adjusted dose interval = normal dose interval x (100/eGFR)