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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?
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?
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?
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?
Which of the following conditions is NOT an indication for thiazide diuretic therapy?
What is the effect of thiazide diuretics on urinary calcium excretion?
What is the effect of thiazide diuretics on urinary calcium excretion?
Which type of diuretic acts on the proximal convoluted tubules?
Which type of diuretic acts on the proximal convoluted tubules?
What is the effect of thiazide diuretics on blood volume and GFR in nephrogenic diabetes insipidus?
What is the effect of thiazide diuretics on blood volume and GFR in nephrogenic diabetes insipidus?
Which of the following is a metabolic effect of thiazide diuretics?
Which of the following is a metabolic effect of thiazide diuretics?
Which of the following loop diuretics has a higher potency and consistently high oral bioavailability?
Which of the following loop diuretics has a higher potency and consistently high oral bioavailability?
What is the primary mechanism of action of potassium-sparing diuretics?
What is the primary mechanism of action of potassium-sparing diuretics?
Which loop diuretic is most likely to cause deafness?
Which loop diuretic is most likely to cause deafness?
What is a common side effect of potassium-sparing diuretics?
What is a common side effect of potassium-sparing diuretics?
Which potassium-sparing diuretic does not bind to aldosterone receptors?
Which potassium-sparing diuretic does not bind to aldosterone receptors?
What is the mode of action of amiloride?
What is the mode of action of amiloride?
What is a clinical use of amiloride?
What is a clinical use of amiloride?
What is a gastrointestinal side effect of potassium-sparing diuretics?
What is a gastrointestinal side effect of potassium-sparing diuretics?
What is the primary mechanism of action of triamterene?
What is the primary mechanism of action of triamterene?
What is a common adverse effect of spironolactone?
What is a common adverse effect of spironolactone?
What is the indication for spironolactone in certain cases of heart failure?
What is the indication for spironolactone in certain cases of heart failure?
What is the mechanism of action of ADH in the collecting tubule?
What is the mechanism of action of ADH in the collecting tubule?
What is a common adverse effect of ADH agonists?
What is a common adverse effect of ADH agonists?
What is the difference between spironolactone and its analog?
What is the difference between spironolactone and its analog?
What is the primary mechanism of action of Quinolone antibiotics?
What is the primary mechanism of action of Quinolone antibiotics?
Which of the following is a contraindication for the use of Fluoroquinolones?
Which of the following is a contraindication for the use of Fluoroquinolones?
What is the main adverse effect of Methenamine?
What is the main adverse effect of Methenamine?
What type of bacteria are Quinolones highly effective against?
What type of bacteria are Quinolones highly effective against?
Which of the following is a side effect of Fluoroquinolones?
Which of the following is a side effect of Fluoroquinolones?
Which generation of Fluoroquinolones includes Moxifloxacin?
Which generation of Fluoroquinolones includes Moxifloxacin?
What is the effect of Quinolones on DNA?
What is the effect of Quinolones on DNA?
What is the role of DNA gyrase and topoisomerase in bacterial DNA?
What is the role of DNA gyrase and topoisomerase in bacterial DNA?
What is the mechanism of action of loop diuretics in the thick ascending limb (TAL)?
What is the mechanism of action of loop diuretics in the thick ascending limb (TAL)?
Which of the following thiazide diuretics is most commonly used?
Which of the following thiazide diuretics is most commonly used?
What is the effect of loop diuretics on uric acid secretion?
What is the effect of loop diuretics on uric acid secretion?
Which of the following is a characteristic of indapamide?
Which of the following is a characteristic of indapamide?
What is the effect of loop diuretics on Ca++ reabsorption?
What is the effect of loop diuretics on Ca++ reabsorption?
What is the effect of NSAIDs on loop diuretics?
What is the effect of NSAIDs on loop diuretics?
What is the adverse effect of loop diuretics on potassium levels?
What is the adverse effect of loop diuretics on potassium levels?
What is the route of administration of loop diuretics?
What is the route of administration of loop diuretics?
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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
- Torsemide:
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
- 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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