Pharm exam 4 - Diuretics

What is bicarbonate diuretic?

a diuretic that selectively increases sodium bicarbonate excretion.

What is an example of a bicarbonate diuretic?

carbonic anhydrase inhibitor

What type of pH problem occurs as a results of bicarbonate diuresis?

hyperchloremic metabolic acidosis

Describe nephrogenic DI

loss of urine-concentration ability in the kidney caused by a lack of responsiveness to antidiuretic hormone.

Where does a potassium sparing diuretic work on in the nephron?

collecting tubule

What does a potassium sparing diuretic do?

reduces the exchange of potassium for sodium in the collecting tubule

Renal physiology does all of the following except?

break down protein to an energy source for the body; make RBC

3 multiple choice options

NSAIDS do what in the efficacy of loop diuretics?

reduce

What is urodilatin?

natriuretic peptide; similar to ANP but is synthesized and functions in the kidney.

What is urodilatin MOA?

reduces afferent vasomotor tone; increases efferent vasomotor tone; increase GFR; natruresis

what are the indications for urodilatin?

diuretic and natriuretic

How do most diuretics function?

blocking sodium reabsorption in the nephron

What are the indications for acetazolamide?

diuretic, open angle glaucoma, altitude sickness, and epilepsy.

What is acetazolamide?

carbonic anhydrase inhibitor

What are the side effects of acetazolamide?

paresthesia

What class/MOA is dapagliflozin?

SGLT2 inhibitor

What is a con to using a flozin?

increases risk of UTI and genital yeast infection

What are loop diuretics indicated for?

chronic renal failure (CrCl<30), hypertension, and hypercalcemia.

What do loop diuretics increase the excretion of?

potassium, magnesium, and calcium

What type of pH problem might a patient have while on a loop diurectic?

metabolic alkalosis due to hypokalemia

Does loop diurectics increase or decrease uric acid?

increase

What are the side effects loop diurectics?

tinnitus, ear pain.

What is the duration of action of furosemide?

6-8 hours

What drug is more ototoxic than other loop diuretics?

ethacrynic acid

What loop diuretic can be useful in pts with sulfa allergy?

ethacrynic acid

What are the loop diuretics?

bematanide; ethacrynic acid; furosemide; torsemide

What are the thiazide diuretics?

chlorthalidone; hydrochlorothiazide; indapamide; metolazone

What can thiazide diuretics cause?

significantly increase blood glucose

Where do thiazides work in the nephron?

distal convoluted tubule

What is thiazide diuretics MOA?

block reabsorption of Na at the distal convoluted tubule

What class of diuretics increase potassium and magnesium excretion?

thiazide

What do thiazide diuretics do to calcium?

enhance Ca reabsorption into blood, which decreases urine Ca and decreases Ca kidney stones.

What are the side effects of using thiazide diurectics?

hypokalemia, hyperglycemia, hyperuricemia, hyperlipidemia.

What would you need to do if a patient was on lithium and prescribed a thiazide diuretic?

decrease lithium dose

What kind of effect does thiazide diuretics have with loop diuretics?

synergistic effect

What are the potassium sparing diuretics?

spironolactone; eplerenone; triamterene; amiloride

What is the great thing about potassium sparing diuretics?

produce a mild diuresis without affecting blood potassium levels

What are potassium sparing diuretics MOA?

block the exchange between sodium and potassium in the collecting tubule causing sodium to stay in the tubule and leave through the urine

What drug could you prescribe to a patient with polycystic ovary disease?

spironolactone

What are the side effects of spironolactone?

hyperkalemia, gynecomastia, and erectile dysfunction

What might you prescribe to a patient with hirsutism?

spironolactone

What is a pro of using eplerenone?

fewer adverse endocrine effects

What is mannitol?

osmotic diuretic which is very potent and only given IV

What is the MOA of mannitol?

freely filtered at the glomerulus, but only poorly absorbed from the tubule, mannitol remains in the lumen and holds water by virtue of its osmotic effect

What are the indications of mannitol?

cerebral edema, acute glaucoma

What are the side effects of mannitol?

pulmonary edema

When using carbonic anhydrase diuretics what happens with urine bicarb?

increase

When using carbonic anhydrase diuretics what happens with urine K?

increase

When using carbonic anhydrase diuretics what happens with body pH?

decrease

What is conivaptan?

ADH antagonist

What is MOA of conivaptan?

V2-receptor antagonist.

Where does conivaptan work in the nephron?

collect duct

What can tolvaptan be used for?

euvolemic hyponatremia due to CHF.

Where does tolvaptan work in the nephron?

collecting duct

What symptoms do you have with alkalosis?

CNS stimulation-nervousness and convulsions

What do you treat alkalosis with

ammonium chloride

What could you give to a patient with less severe cases of alkalosis?

sodium chloride combine with potassium chloride

What electrolyte is found predominantly in the extracellular fluid?

sodium

what is primarily responsible for the osmolality of the ECF space?

sodium

What is the major intracellular cation?

potassium

What is the most abundant mineral in the body?

calcium

What electrolyte promotes enzyme reactions within the cell during metabolism?

magnesium

What is the major extracellular anion?

chloride