Diuretics and Salt Excretion
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Questions and Answers

Which type of diuretic acts mainly on the cortical region of the ascending loop of Henle and the distal convoluted tubule?

  • Carbonic anhydrase inhibitors
  • Loop diuretics
  • Thiazides (correct)
  • K-Sparing diuretics

    • What is the effect of thiazide diuretics on urinary sodium chloride excretion?

  • No effect
  • Decreased
  • Variable
  • Increased (correct)

    • What is a common side effect of thiazide diuretics?

  • Hypernatremia
  • Hyperchloremia
  • Hypokalemia (correct)
  • Hypocalcemia

    • Which of the following conditions is NOT an indication for thiazide diuretic therapy?

    <p>Chronic kidney disease</p> Signup and view all the answers

    What is the effect of thiazide diuretics on urinary calcium excretion?

    <p>Decreased</p> Signup and view all the answers

    Which type of diuretic acts on the proximal convoluted tubules?

    <p>Carbonic anhydrase inhibitors</p> Signup and view all the answers

    What is the effect of thiazide diuretics on blood volume and GFR in nephrogenic diabetes insipidus?

    <p>Decrease blood volume and GFR</p> Signup and view all the answers

    Which of the following is a metabolic effect of thiazide diuretics?

    <p>Metabolic alkalosis</p> Signup and view all the answers

    Which of the following loop diuretics has a higher potency and consistently high oral bioavailability?

    <p>Bumetanide</p> Signup and view all the answers

    What is the primary mechanism of action of potassium-sparing diuretics?

    <p>Interfere with sodium-potassium exchange in the distal convoluted tubule</p> Signup and view all the answers

    Which loop diuretic is most likely to cause deafness?

    <p>Ethacrynic Acid</p> Signup and view all the answers

    What is a common side effect of potassium-sparing diuretics?

    <p>Hyperkalemia</p> Signup and view all the answers

    Which potassium-sparing diuretic does not bind to aldosterone receptors?

    <p>Triamterene</p> Signup and view all the answers

    What is the mode of action of amiloride?

    <p>Directly inhibits sodium influx in the cortical collecting tubule</p> Signup and view all the answers

    What is a clinical use of amiloride?

    <p>Treatment of heart failure</p> Signup and view all the answers

    What is a gastrointestinal side effect of potassium-sparing diuretics?

    <p>Cramps</p> Signup and view all the answers

    What is the primary mechanism of action of triamterene?

    <p>Direct inhibition of sodium influx in the cortical collecting tubule (CCT)</p> Signup and view all the answers

    What is a common adverse effect of spironolactone?

    <p>Hyperkalemia</p> Signup and view all the answers

    What is the indication for spironolactone in certain cases of heart failure?

    <p>Hyperaldosteronism</p> Signup and view all the answers

    What is the mechanism of action of ADH in the collecting tubule?

    <p>Facilitation of water reabsorption by increasing cAMP</p> Signup and view all the answers

    What is a common adverse effect of ADH agonists?

    <p>Water overload</p> Signup and view all the answers

    What is the difference between spironolactone and its analog?

    <p>The analog has greater selectivity for the mineralocorticoid receptor</p> Signup and view all the answers

    What is the primary mechanism of action of Quinolone antibiotics?

    <p>Inhibiting bacterial DNA replication and transcription</p> Signup and view all the answers

    Which of the following is a contraindication for the use of Fluoroquinolones?

    <p>Pregnancy</p> Signup and view all the answers

    What is the main adverse effect of Methenamine?

    <p>Gastrointestinal tract</p> Signup and view all the answers

    What type of bacteria are Quinolones highly effective against?

    <p>Gram-negative bacteria</p> Signup and view all the answers

    Which of the following is a side effect of Fluoroquinolones?

    <p>Nausea and vomiting</p> Signup and view all the answers

    Which generation of Fluoroquinolones includes Moxifloxacin?

    <p>4th generation</p> Signup and view all the answers

    What is the effect of Quinolones on DNA?

    <p>All of the above</p> Signup and view all the answers

    What is the role of DNA gyrase and topoisomerase in bacterial DNA?

    <p>They help in DNA replication and transcription</p> Signup and view all the answers

    What is the mechanism of action of loop diuretics in the thick ascending limb (TAL)?

    <p>Inhibit Na+/K+/2Cl- pump</p> Signup and view all the answers

    Which of the following thiazide diuretics is most commonly used?

    <p>Hydrochlorothiazide</p> Signup and view all the answers

    What is the effect of loop diuretics on uric acid secretion?

    <p>Interfere with uric acid secretion</p> Signup and view all the answers

    Which of the following is a characteristic of indapamide?

    <p>Lipid soluble</p> Signup and view all the answers

    What is the effect of loop diuretics on Ca++ reabsorption?

    <p>Decrease passive Ca++ reabsorption</p> Signup and view all the answers

    What is the effect of NSAIDs on loop diuretics?

    <p>Decrease diuretic response</p> Signup and view all the answers

    What is the adverse effect of loop diuretics on potassium levels?

    <p>Hypokalemia</p> Signup and view all the answers

    What is the route of administration of loop diuretics?

    <p>Either oral or intravenous</p> Signup and view all the answers

    Study Notes

    Drugs Modifying Salt Excretion

    • Proximal convoluted tubules: Carbonic anhydrase inhibitors
    • Thick ascending loop: Loop diuretics
    • Distal convoluted tubules: Thiazides
    • Cortical collecting duct: K-sparing diuretics

    Thiazide Diuretics

    • Act mainly in cortical region of ascending loop of Henle and distal convoluted tubule
    • Decrease reabsorption of sodium by inhibiting Na+/Cl- cotransporter (NCC) on luminal membrane of tubules
    • Indications:
      • Hypertension (initial therapy of choice if uncomplicated)
      • Mild heart failure (to reduce extracellular volume)
      • Nephrolithiasis (increase urinary calcium excretion)
      • Nephrogenic diabetes insipidus (decrease blood volume and GFR)
    • Adverse effects:
      • Volume depletion
      • Hypokalemia
      • Hypercalcemia
      • Metabolic alkalosis
      • Hyperuricemia
      • Glucose/lipid effects

    Types of Thiazide Diuretics

    • Chlorothiazide
    • Hydrochlorothiazide (most commonly used)
    • Thiazide-like diuretics:
      • More potent and longer half-life than HCTZ
      • Used once daily to treat hypertension
      • Used in major clinical trials
    • Chlorthalidone
    • Metolazone:
      • Very potent
      • Intermediate half-life
      • Typically used in combination with loops
      • Causes Na+ excretion even in advanced heart failure
    • Indapamide:
      • Lipid-soluble
      • Long duration of action
      • Significant anti-hypertensive effect with minimal diuretic effect

    Loop Diuretics

    • High ceiling diuretics
    • Act in thick ascending limb of loop of Henle
    • Increase urinary Na+, K+, and Ca++ excretion
    • Adverse effects:
      • Hypovolemia
      • Hyponatremia
      • Hypokalemia
      • Hyperuricemia
      • Metabolic alkalosis
    • Drug interactions:
      • NSAIDs decrease diuretic response
      • Digitalis increases risk of arrhythmias
    • Examples:
      • Torsemide:
        • Higher potency
        • Oral bioavailability consistently ~80-100%
      • Bumetanide:
        • Higher potency
        • Oral bioavailability consistently ~80-100%
      • Ethacrynic acid:
        • Only non-sulfa loop diuretic
        • Most likely to cause deafness

    K-Sparing Diuretics

    • Act in collecting duct and cortical collecting tubule
    • Prevent potassium from being pumped into the tubule, thus preventing its secretion
    • Adverse effects:
      • Hyperkalemia
      • GI symptoms (cramps, nausea, vomiting, diarrhea)
      • CNS symptoms (dizziness, headache)
      • Other symptoms (urinary frequency, weakness)
    • Examples:
      • Amiloride:
        • Direct inhibitor of sodium influx in cortical collecting tubule
        • Clinical use: treatment of HF
      • Spironolactone:
        • Competitively blocks aldosterone receptors and inhibits its action
        • Clinical use: hyperaldosteronism, hypertension, heart failure, liver failure
      • Triamterene:
        • Direct inhibitor of sodium influx in cortical collecting tubule
        • Metabolized in liver, shorter half-life, given more frequently than amiloride

    ADH Agonist and Antagonist

    • ADH agonist:
      • Act on ascending loop and collecting duct
      • Increase water reabsorption from collecting tubule
      • Adverse effects:
        • Water overload
        • Hyponatremia
    • ADH antagonist:
      • V2 receptor antagonists
      • Block ADH action on collecting duct
      • Adverse effects:
        • Nausea
        • Vomiting
        • Diarrhea
        • Headache
        • Light-headedness
        • Dizziness

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    Description

    Learn about the different types of diuretics, their mechanisms of action, and indications for use. From carbonic anhydrase inhibitors to k-sparing diuretics, this quiz covers it all.

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