Cardiovascular System Diuretics
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Questions and Answers

What is the primary function of the Na+/K+ adenosine triphosphatase (ATPase) pump in the proximal convoluted tubule?

  • Reabsorption of sodium ions (correct)
  • Reabsorption of potassium ions
  • Secretion of potassium ions
  • Secretion of sodium ions

    • What is the role of carbonic anhydrase in the proximal tubular cells?

  • Secretion of bicarbonate
  • Reabsorption of bicarbonate (correct)
  • Modulation of sodium reabsorption
  • Modulation of water reabsorption

    • Where is the organic acid secretory system located and what is its primary function?

  • Distal convoluted tubule - reabsorption of uric acid
  • Collecting duct - secretion of uric acid
  • Loop of Henle - reabsorption of diuretic drugs
  • Proximal tubule -transfer the diuretic drugs and uric acid (correct)

    • How are most diuretic drugs delivered to the tubular fluid?

    <p>By secreting a variety of organic acids from the bloodstream into the proximal tubular lumen</p> Signup and view all the answers

    What characterizes the organic acid secretory system?

    <p>It is saturable</p> Signup and view all the answers

    How do diuretic drugs in the bloodstream interact with endogenous organic acids such as uric acid?

    <p>They compete for transfer with endogenous organic acids</p> Signup and view all the answers

    What is the primary function of the ascending loop of Henle?

    <p>Active reabsorption of Na+, K+, and Cl−</p> Signup and view all the answers

    Why does the osmolarity increase along the descending portion of the loop of Henle?

    <p>Due to reabsorption of water</p> Signup and view all the answers

    What effect do drugs affecting the ascending loop of Henle, such as loop diuretics, have?

    <p>Greatest diuretic effect</p> Signup and view all the answers

    How much of the filtered sodium chloride is reabsorbed via a Na+/Cl− transporter in the distal convoluted tubule?

    <p>10%</p> Signup and view all the answers

    What is the primary transporter used for Na+ reabsorption in the collecting tubule and duct?

    <p>Na+/K+-ATPase pump</p> Signup and view all the answers

    Which receptors influence Na+ reabsorption and K+ secretion in the principal cells of the collecting tubule and duct?

    <p>Aldosterone receptors</p> Signup and view all the answers

    What is a characteristic of thiazides as diuretic drugs?

    <p>They have equal maximum diuretic effects except Metolazone</p> Signup and view all the answers

    Why are thiazides sometimes called 'low ceiling diuretics'?

    <p>Because increasing the dose above normal therapeutic doses does not promote further diuretic response</p> Signup and view all the answers

    What is a distinguishing feature of Metolazone among thiazide-like drugs?

    <p>It has higher efficacy than other thiazides</p> Signup and view all the answers

    Which of the following is correct for using thiazides except?

    <p>Heart failure</p> Signup and view all the answers

    Why is hydrochlorothiazide used more commonly than chlorothiazide?

    <p>Because it is more potent</p> Signup and view all the answers

    What distinguishes the efficacy of hydrochlorothiazide from chlorothiazide?

    <p>The efficacy of both drugs is comparable</p> Signup and view all the answers

    Why are thiazide-like diuretics referred to as thiazide-like?

    <p>They have a similar mechanism of action to true thiazides</p> Signup and view all the answers

    What is a distinguishing feature of thiazide-like diuretics?

    <p>They contain the sulfonamide residue in their chemical structures</p> Signup and view all the answers

    Thiazide-like diuretics are called thiazide-like because they contain the sulfonamide residue in their chemical structures.

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

    Thiazide-like diuretics have a different mechanism of action compared to true thiazides.

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

    Chlorthalidone, indapamide, and metolazone are examples of thiazide-like diuretics.

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

    True thiazides are also known as low ceiling diuretics.

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

    Thiazides act mainly in the cortical region of the ascending loop of Henle and the distal convoluted tubule.

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

    Thiazides decrease the reabsorption of Na+ by inhibition of a Na+/Cl− cotransporter on the luminal membrane of the tubules.

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

    Thiazides are also known as high ceiling diuretics.

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

    Thiazide-like diuretics act in the same way as true thiazides in the renal tubules.

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

    What is a potential consequence of increased excretion of Na+ and Cl− in the urine due to treatment with thiazides?

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

    What is a known effect of prolonged use of thiazides in terms of potassium (K+)?

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

    What is a potential consequence of treatment with thiazides in terms of urinary calcium excretion?

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

    What is an initial effect of treatment with thiazides on peripheral vascular resistance?

    <p>Reduced peripheral vascular resistance</p> Signup and view all the answers

    What is a potential consequence of treatment with thiazides in terms of Mg2+?

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

    How do thiazides affect the excretion of sodium chloride in the urine?

    <p>Increased excretion</p> Signup and view all the answers

    Treatment with thiazides can result in the excretion of very hyperosmolar urine.

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

    Thiazides cause loss of K+ from the body with prolonged use.

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

    Thiazides result in a reduction in peripheral vascular resistance.

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

    Thiazides act by increasing the reabsorption of Na+ in the distal convoluted tubule.

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

    In which condition are thiazides not the first choice of treatment?

    <p>Heart failure</p> Signup and view all the answers

    What is the unique ability of thiazides in the treatment of nephrogenic diabetes insipidus?

    <p>Substituting for ADH</p> Signup and view all the answers

    What is a potential benefit of thiazides for patients with calcium oxalate stones in the urinary tract?

    <p>Reducing urinary calcium excretion</p> Signup and view all the answers

    What is the most frequent problem associated with thiazide diuretics?

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

    Which adverse effect of thiazide diuretics can be prevented by limiting water intake and lowering the diuretic dose?

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

    What adverse effect of thiazide diuretics can lead to glucose intolerance and the need for monitoring glucose levels?

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

    What adverse effect of thiazide diuretics can cause orthostatic hypotension or light-headedness?

    <p>Volume depletion</p> Signup and view all the answers

    Potassium depletion is the most frequent problem with thiazide diuretics.

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

    Limiting water intake and lowering the diuretic dose can prevent hyponatremia.

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

    Therapy with thiazides can lead to glucose intolerance.

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

    What is the primary site of action for loop diuretics in the nephron?

    <p>Descending limb of the loop of Henle</p> Signup and view all the answers

    What is the reason for loop diuretics having the greatest diuretic effect among all diuretic drugs?

    <p>They block reabsorption of 25-30% of filtered NaCl at the ascending limb of the loop of Henle</p> Signup and view all the answers

    Which part of the nephron accounts for reabsorption of 25-30% of filtered NaCl?

    <p>Ascending limb of the loop of Henle</p> Signup and view all the answers

    How does loop diuretics' mechanism of action lead to an increase in water excretion?

    <p>By inhibiting the cotransport of Na+/K+/2Cl− at the ascending limb of the loop of Henle</p> Signup and view all the answers

    Which of the following is a therapeutic use of loop diuretics?

    <p>Reducing acute pulmonary edema and acute/chronic peripheral edema</p> Signup and view all the answers

    What is a significant characteristic of loop diuretics in emergency situations?

    <p>High efficacy and rapid onset of action</p> Signup and view all the answers

    How do loop diuretics differ from thiazides in terms of Ca2+ content of urine?

    <p>Thiazides increase the Ca2+ content of urine</p> Signup and view all the answers

    What is a therapeutic use of loop diuretics in treating hypercalcemia?

    <p>Stimulating tubular Ca2+ excretion</p> Signup and view all the answers

    Which loop diuretic is known for being much more potent than furosemide?

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

    What is the primary reason for the infrequent use of ethacrynic acid?

    <p>Adverse effect profile</p> Signup and view all the answers

    In which condition are thiazides not the first choice of treatment?

    <p>Nephrogenic diabetes insipidus</p> Signup and view all the answers

    What distinguishes the efficacy of metolazone among thiazide-like drugs?

    <p>Duration of action</p> Signup and view all the answers

    Furosemide is the most potent loop diuretic.

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

    Ethacrynic acid is commonly used due to its low toxicity.

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

    Bumetanide is an example of a loop diuretic.

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

    Thiazides cause loss of K+ from the body with prolonged use.

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

    Which adverse effect is most likely to be caused by loop Diuretics ?

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

    What is a potential consequence of prolonged use of thiazides in terms of potassium (K+)?

    <p>Potassium depletion (hypokalemic alkalosis)</p> Signup and view all the answers

    Which adverse effect of diuretics can be prevented by using potassium-sparing diuretics or supplementation with K+?

    <p>Potassium depletion (hypokalemic alkalosis)</p> Signup and view all the answers

    What adverse effect of diuretics can cause a severe and rapid reduction in blood volume, with the possibility of hypotension?

    <p>Acute hypovolemia</p> Signup and view all the answers

    Which diuretic adverse effect can lead to increased uric acid in the blood, causing or exacerbating gouty attacks?

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

    Which diuretic adverse effect is most likely to cause deafness and is associated with the use of Ethacrynic acid?

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

    Which diuretic adverse effect can lead to increased uric acid in the blood, causing or exacerbating gouty attacks?

    <p>Hyperuricemia (Increased uric acid in the blood)</p> Signup and view all the answers

    What is the primary transporter used for Na+ reabsorption in the collecting tubule and duct?

    <p>Potassium-sparing diuretics</p> Signup and view all the answers

    What is the primary function of potassium-sparing diuretics?

    <p>Prevent K+ excretion caused by thiazide or loop diuretics</p> Signup and view all the answers

    Why should potassium-sparing diuretics be avoided in patients with renal dysfunction?

    <p>To reduce the risk of hyperkalemia</p> Signup and view all the answers

    What are the two distinct mechanisms of action for potassium-sparing diuretics?

    <p>Aldosterone antagonism and sodium channel blockers</p> Signup and view all the answers

    Which medication should be used cautiously with potassium-sparing diuretics due to its potential to induce hyperkalemia?

    <p>Angiotensin-converting enzyme inhibitors</p> Signup and view all the answers

    In which conditions are potassium-sparing diuretics commonly used?

    <p>Heart failure and liver cirrhosis</p> Signup and view all the answers

    What is the major difference in efficacy between potassium-sparing diuretics and other diuretics?

    <p>Lower efficacy in mobilizing Na+ from the body</p> Signup and view all the answers

    What is the mechanism of action of spironolactone and eplerenone?

    <p>Antagonizing aldosterone at intracellular cytoplasmic receptor sites</p> Signup and view all the answers

    Which class do spironolactone and eplerenone belong to?

    <p>Potassium-sparing diuretics</p> Signup and view all the answers

    What distinguishes the mechanism of action of eplerenone from spironolactone?

    <p>Eplerenone has less endocrine effects than spironolactone</p> Signup and view all the answers

    What is the primary effect of spironolactone and eplerenone on electrolyte balance?

    <p>Prevents reabsorption of Na+ and secretion of K+ and H+</p> Signup and view all the answers

    What is a therapeutic use of spironolactone?

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

    In which condition is spironolactone the diuretic of choice?

    <p>Congestive hepatic cirrhosis</p> Signup and view all the answers

    What is a therapeutic use of eplerenone?

    <p>Treatment of resistant hypertension</p> Signup and view all the answers

    Why are aldosterone receptor antagonists considered for the treatment of resistant hypertension?

    <p>Due to their role in reducing peripheral vascular resistance</p> Signup and view all the answers

    What adverse effects can occur due to the chemical resemblance of spironolactone to some sex steroids?

    <p>Gynecomastia in male patients</p> Signup and view all the answers

    Which adverse effect is associated with the use of aldosterone antagonists?

    <p>Hyperkalemia with nausea, lethargy, and mental confusion</p> Signup and view all the answers

    What is a known consequence of prolonged use of thiazides in terms of potassium (K+)?

    <p>Loss of K+ from the body</p> Signup and view all the answers

    What is the primary effect of triamterene and amiloride on Na+/K+ exchange in the collecting tubule?

    <p>Blocking of Na+/K+ exchange</p> Signup and view all the answers

    Which property makes triamterene and amiloride commonly used in combination with other diuretics?

    <p>Potassium-sparing properties</p> Signup and view all the answers

    What distinguishes the mechanism of action of triamterene and amiloride from aldosterone antagonists?

    <p>Blockage of sodium channels</p> Signup and view all the answers

    What is the primary reason for the use of triamterene and amiloride in combination with other diuretics?

    <p>Potassium-sparing properties</p> Signup and view all the answers

    What is the primary mechanism of action of acetazolamide?

    <p>Inhibition of carbonic anhydrase in the proximal tubular epithelium</p> Signup and view all the answers

    What is the consequence of prolonged therapy with acetazolamide?

    <p>Hyperchloremic metabolic acidosis</p> Signup and view all the answers

    Which electrolyte disturbance is associated with the use of acetazolamide?

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

    What effect does acetazolamide have on phosphate excretion?

    <p>Increases phosphate excretion</p> Signup and view all the answers

    What is the therapeutic use of acetazolamide?

    <p>Treating glaucoma</p> Signup and view all the answers

    What is the primary function of carbonic anhydrase inhibitors like dorzolamide and brinzolamide?

    <p>Decreasing intraocular pressure</p> Signup and view all the answers

    Which condition can be treated by using carbonic anhydrase inhibitors to decrease pH?

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

    What is the therapeutic use of eplerenone?

    <p>Resistant hypertension</p> Signup and view all the answers

    What is a potential adverse effect of using acetazolamide?

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

    Why should acetazolamide be avoided in patients with hepatic cirrhosis?

    <p>It might cause decreased excretion of NH4+</p> Signup and view all the answers

    Which adverse effect is associated with the use of thiazides?

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

    What is a potential adverse effect of diuretics that can cause orthostatic hypotension or light-headedness?

    <p>Potassium depletion</p> Signup and view all the answers

    What is the primary mechanism of action of osmotic diuretics?

    <p>Increased water excretion by preventing further water reabsorption in the tubules</p> Signup and view all the answers

    What is the effect of osmotic diuretics on tubular fluid osmolarity?

    <p>It increases tubular fluid osmolarity</p> Signup and view all the answers

    What is the role of simple, hydrophilic chemical substances such as mannitol and urea in osmotic diuretics?

    <p>They are filtered through the glomerulus and undergo reabsorption</p> Signup and view all the answers

    How do osmotic diuretics differ from other diuretics in terms of their primary effect on electrolyte balance?

    <p>They primarily increase water excretion rather than Na+ excretion</p> Signup and view all the answers

    Osmotic diuretics prevent further water reabsorption, resulting in some degree of diuresis.

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

    Osmotic diuretics directly increase the excretion of electrolytes.

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

    Osmotic diuretics undergo significant reabsorption in the nephron.

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

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