Questions and Answers
Which of the following is a carbonic anhydrase inhibitor?
What is the mechanism of action for loop diuretics?
Block Na/K/2Cl cotransporter
Thiazides are considered high-ceiling diuretics.
False
The first-line antitubercular drug is _____ .
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Which medication is an aldosterone antagonist?
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What is the primary use of osmotic diuretics?
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What is a common side effect of loop diuretics?
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Match the following antiplatelet drugs with their mechanism of action:
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Digoxin is a positive inotropic agent.
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What vitamin is used to treat warfarin overdose?
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The primary adverse effect of aminoglycosides used with loop diuretics is _____ .
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Study Notes
Diuretics
- Carbonic anhydrase inhibitor: Acetazolamide used in proximal convoluted tubule.
- MOA: Inhibits carbonic anhydrase, reducing H+ formation and Na-H exchange, leading to sodium excretion with bicarbonate and water.
- Therapeutic uses: High altitude sickness, glaucoma, urinary alkalinization.
- Osmotic diuretics: Mannitol and glycerol increase plasma osmolarity for fluid shifts.
- Therapeutic uses: Cerebral edema, acute congestive glaucoma, oliguria, hemodialysis.
- Loop diuretics (Furosemide, Bumetanide) act on the thick ascending limb, inhibiting Na/K/2Cl cotransporter.
- Therapeutic uses: CHF, hypertensive emergencies, pulmonary edema.
- Adverse effects: Hyperuricemia, ototoxicity, hypokalemia, metabolic alkalosis.
- Thiazide diuretics (Hydrochlorothiazide, Chlorthalidone, Indapamide) inhibit Na/Cl symport in early distal tubule.
- Therapeutic uses: Mild hypertension, nephrolithiasis.
- Adverse effects: Impaired carbohydrate tolerance, hyperlipidemia.
- Potassium-sparing diuretics include aldosterone antagonists (Spironolactone, Eplerenone) and direct Na-channel inhibitors (Amiloride, Triamterene).
- Promote potassium retention and are often combined with thiazides/loops to prevent potassium loss.
- Adverse effects: Hyperkalemia, hyperchloremic metabolic acidosis.
Antiasthmatics
- Short-acting beta-agonist (SABA): Salbutamol provides quick relief.
- Long-acting beta-agonist (LABA): Salmeterol for prolonged bronchodilation.
- MOA for beta-agonists: Activates B2 receptors increasing cAMP leading to bronchodilation.
- Adverse effects: Tremors, tachycardia, hyperglycemia, hypokalemia.
- Muscarinic antagonist (Ipratropium) is preferred for COPD.
- Phosphodiesterase III inhibitors: Aminophylline, Theophylline have a narrow therapeutic index.
- Inhalational corticosteroids (Budesonide, Fluticasone, Beclomethasone) may cause oropharyngeal candidiasis.
Antitussives and Antihistamines
- Antitussives for non-productive cough include: Codeine, Dextromethorphan, Benzonatate.
- Mucolytics (Bromhexine, Acetylcysteine) thin mucus for easier expulsion.
- H1 antihistamines:
- 1st generation: Diphenhydramine, Doxylamine, Promethazine (cross BBB, sedating).
- 2nd generation: Fexofenadine, Loratadine (less sedating, longer duration).
Antitubercular Agents
- First-line drugs:
- Isoniazid with Pyridoxine to prevent peripheral neuritis.
- Rifampin causes red-orange urine and flu-like symptoms.
- Pyrazinamide and Ethambutol may lead to hepatotoxicity and optic neuritis.
- Chemoprophylaxis with Streptomycin.
- Treatment phases: Intensive phase with 4 drugs for 2 months, continuation phase with 2 drugs for 4 months.
Anticoagulants
- Parenteral agents:
- Heparins (LMWH: Enoxaparin), fondaparinux, thrombin inhibitors (Lepirudin).
- Oral agents:
- Warfarin, direct oral anticoagulants (Dabigatran, Rivaroxaban).
- Expected adverse effects: Hematuria, heparin-induced thrombocytopenia, osteoporosis.
- Antidotes: Protamine sulfate for heparin, Vitamin K1 for warfarin.
Antiplatelet Drugs
- Inhibit TXA2 synthesis: Aspirin irreversibly inhibits COX1.
- Other agents: Cilostazol and Clopidogrel (ADP receptor antagonist).
- Glycoprotein IIb/IIIa receptor antagonists include Abciximab.
Antianginals
- Acute relief: Sublingual nitroglycerin, isosorbide dinitrate.
- Chronic treatment: Oral isosorbide mononitrate, beta-blockers (Propranolol), calcium channel blockers.
- MOA: Increased cGMP from nitric oxide leads to vasodilation.
- Adverse effects: Tolerance, extensive vasodilation.
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Description
Explore the mechanism of action, therapeutic uses, and different types of diuretics, including carbonic anhydrase inhibitors, osmotic diuretics, and loop diuretics. This quiz will test your understanding of how these medications function and their clinical applications.
