Diuretyki
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Questions and Answers

What is the primary function of diuretics?

  • To increase blood pressure
  • To reduce urine production
  • To decrease potassium levels
  • To eliminate excess water from the body (correct)

    • What is the basic unit of the kidney?

  • Glomerulus
  • Nephron (correct)
  • Peritubular capillaries
  • Renal tubule

    • Where does the filtered content go after passing through the glomerulus?

  • Into the peritubular capillaries
  • Through the renal tubule (correct)
  • Into the collecting duct
  • Back into the blood through the efferent arteriole

    • What is the role of the renal tubule?

    <p>To regulate the balance of fluid and ions</p> Signup and view all the answers

    What type of diuretics acts on the loop of Henle?

    <p>Loop diuretics</p> Signup and view all the answers

    What is the final destination of the fluid that goes through the distal convoluted tubule?

    <p>The collecting duct</p> Signup and view all the answers

    Which of the following is the most ototoxic loop diuretic?

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

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

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

    What electrolyte imbalance is associated with the broken magnet in the picture?

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

    Which of the following is NOT an indication for the use of loop diuretics?

    <p>Diabetic nephropathy</p> Signup and view all the answers

    What is the effect of loop diuretics on calcium excretion?

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

    Which of the following is a common side effect of loop diuretics?

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

    What percentage of the filtered sodium is reabsorbed in the loop of Henle, mostly in the thick ascending limb?

    <p>25%</p> Signup and view all the answers

    What is the primary function of the Na/K ATPase on the basolateral side of the tubule cell?

    <p>Pump three sodium ions into the interstitial fluid in exchange for two potassium ions</p> Signup and view all the answers

    How do loop diuretics affect the reabsorption of sodium, potassium, and chloride in the thick ascending limb?

    <p>They bind to the Cl- site on the transporter and block it, preventing reabsorption</p> Signup and view all the answers

    What is the effect of loop diuretics on calcium excretion compared to thiazide diuretics?

    <p>Loop diuretics increase calcium excretion, while thiazide diuretics decrease it</p> Signup and view all the answers

    What is the primary mechanism by which loop diuretics increase the renal plasma flow and glomerular filtration rate?

    <p>They stimulate the release of prostaglandins</p> Signup and view all the answers

    What is the effect of NSAIDs on the efficacy of loop diuretics?

    <p>They decrease the efficacy of loop diuretics</p> Signup and view all the answers

    What is the primary mechanism by which loop diuretics cause hypokalemic metabolic alkalosis?

    <p>Increased excretion of potassium and hydrogen ions in the urine</p> Signup and view all the answers

    What is the major indication for the use of loop diuretics?

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

    What is the primary reason for avoiding loop diuretics in dehydrated patients?

    <p>Risk of exacerbating dehydration</p> Signup and view all the answers

    What is the effect of loop diuretics on the body's water balance?

    <p>They decrease the body's water retention</p> Signup and view all the answers

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

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

    What is the primary mechanism by which loop diuretics lower blood pressure?

    <p>They decrease the plasma volume and cardiac output</p> Signup and view all the answers

    What is the function of the Na+K+2Cl- cotransporter in the thick ascending limb?

    <p>To reabsorb sodium, potassium, and chloride from the lumen</p> Signup and view all the answers

    Which of the following is a contraindication for the use of loop diuretics?

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

    What is the primary mechanism by which loop diuretics cause hyperuricemia?

    <p>Increased reabsorption of uric acid in the proximal tubule due to low circulating fluid volume</p> Signup and view all the answers

    Which of the following is a side effect unique to ethacrynic acid?

    <p>None of the above</p> Signup and view all the answers

    What is the primary mechanism by which loop diuretics cause hypomagnesemia and hypocalcemia?

    <p>Increased excretion of magnesium and calcium in the urine</p> Signup and view all the answers

    Which of the following is a drug that is not a sulfonamide loop diuretic?

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

    What is the primary reason for using ethacrynic acid in patients with a sulfonamide allergy?

    <p>It is a safer alternative to sulfonamide loop diuretics in patients with a sulfonamide allergy</p> Signup and view all the answers

    What is the primary mechanism by which loop diuretics correct hypercalcemia?

    <p>Increased excretion of calcium in the urine</p> Signup and view all the answers

    What is the primary function of the renal tubule in maintaining homeostasis?

    <p>To secrete and reabsorb fluid and ions in order to maintain balance</p> Signup and view all the answers

    What is the unique characteristic of potassium sparing diuretics?

    <p>They retain potassium, rather than wasting it</p> Signup and view all the answers

    What is the structure that filters the blood in the nephron?

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

    What is the purpose of the microvilli on the apical surface of the tubule cells?

    <p>To increase the surface area for reabsorption</p> Signup and view all the answers

    What is the final destination of the fluid that goes through the distal convoluted tubule?

    <p>The collecting duct</p> Signup and view all the answers

    What is the function of the tubule cells in the proximal convoluted tubule?

    <p>To secrete and reabsorb fluid and ions</p> Signup and view all the answers

    What is the primary site of action of topical carbonic anhydrase inhibitors in the treatment of glaucoma?

    <p>Ciliary body in the eyes</p> Signup and view all the answers

    What is the primary indication for using acetazolamide in patients with edematous states?

    <p>The presence of alkalosis</p> Signup and view all the answers

    What is a common side effect of acetazolamide?

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

    What is the primary mechanism by which acetazolamide prevents the formation of uric acid stones?

    <p>By increasing the pH of the urine</p> Signup and view all the answers

    What is a contraindication for the use of acetazolamide?

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

    Where is the enzyme carbonic anhydrase type 4 primarily found?

    <p>Among microvilli</p> Signup and view all the answers

    What is the effect of administering acetazolamide on urine output?

    <p>Mild increase</p> Signup and view all the answers

    What is the purpose of administering acetazolamide to patients with cystinuria?

    <p>To increase urine pH</p> Signup and view all the answers

    What is the role of carbonic anhydrase in the eyes?

    <p>To facilitate bicarbonate movement</p> Signup and view all the answers

    What is the mechanism by which carbonic anhydrase inhibitors treat glaucoma?

    <p>By reducing aqueous humor production</p> Signup and view all the answers

    What is the primary site of action of carbonic anhydrase inhibitors in the treatment of glaucoma?

    <p>Ciliary body</p> Signup and view all the answers

    What is the effect of carbonic anhydrase inhibitors on bicarbonate movement in the kidneys?

    <p>Decrease bicarbonate reabsorption</p> Signup and view all the answers

    What is the primary use of acetazolamide in edematous states?

    <p>To treat alkalosis</p> Signup and view all the answers

    Which of the following is a site where carbonic anhydrase is found?

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

    What is the effect of carbonic anhydrase inhibitors on urine pH?

    <p>Increase urine pH</p> Signup and view all the answers

    What is the primary mechanism by which acetazolamide decreases CSF production?

    <p>Inhibiting the formation of bicarbonate in the CSF</p> Signup and view all the answers

    Why is acetazolamide used in the management of sleep apnea?

    <p>It increases the amount of oxygen available in the blood</p> Signup and view all the answers

    What is a side effect of carbonic anhydrase inhibitors related to potassium?

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

    Why are carbonic anhydrase inhibitors contraindicated in people with cirrhosis?

    <p>They decrease the excretion of ammonia in the urine</p> Signup and view all the answers

    What is a side effect of large doses of acetazolamide?

    <p>Drowsiness and paresthesias</p> Signup and view all the answers

    How do carbonic anhydrase inhibitors affect the kidneys?

    <p>They increase the excretion of phosphate and calcium</p> Signup and view all the answers

    What is a use of acetazolamide in people climbing to high altitudes?

    <p>To treat mountain sickness</p> Signup and view all the answers

    What is a metabolic effect of carbonic anhydrase inhibitors?

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

    Why is it important to monitor urine pH when using carbonic anhydrase inhibitors?

    <p>To prevent the formation of calcium phosphate stones</p> Signup and view all the answers

    What is the mechanism by which acetazolamide decreases CSF pH?

    <p>By decreasing bicarbonate production in the CSF</p> Signup and view all the answers

    What is the primary site of action of potassium sparing diuretics in the renal tubule?

    <p>Cortical collecting tubules</p> Signup and view all the answers

    What is the main function of the renal tubule in maintaining homeostasis?

    <p>Reabsorption and secretion of ions and water</p> Signup and view all the answers

    What is the basic structural unit of the kidney?

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

    What is the role of the glomerulus in the nephron?

    <p>Filtration of blood</p> Signup and view all the answers

    What is the primary difference between potassium sparing diuretics and other types of diuretics?

    <p>Effect on potassium levels</p> Signup and view all the answers

    Which segment of the renal tubule is responsible for the majority of ion reabsorption?

    <p>Proximal convoluted tubule</p> Signup and view all the answers

    What is the primary benefit of using aldosterone receptor antagonists in patients who have had a myocardial infarction?

    <p>Reducing the rate of remodelling in the heart</p> Signup and view all the answers

    What is the main mechanism by which spironolactone treats polycystic ovarian syndrome?

    <p>Blocking androgen receptors</p> Signup and view all the answers

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

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

    What is the mechanism by which ENaC channel blockers work?

    <p>Blocking epithelial sodium channels</p> Signup and view all the answers

    What is a rare genetic disease that can be treated with ENaC channel blockers?

    <p>Liddle's syndrome</p> Signup and view all the answers

    What is a potential side effect of using triamterene?

    <p>Kidney stones</p> Signup and view all the answers

    What is the main difference between aldosterone antagonists and ENaC channel blockers?

    <p>Aldosterone antagonists block aldosterone receptors, while ENaC channel blockers block epithelial sodium channels</p> Signup and view all the answers

    What is the main mechanism by which potassium-sparing diuretics treat edema?

    <p>Eliminating excess sodium and water from the body while retaining potassium</p> Signup and view all the answers

    What is a potential side effect of using aldosterone antagonists?

    <p>Antiandrogenic effects</p> Signup and view all the answers

    What is the main indication for using amiloride?

    <p>Liddle's syndrome</p> Signup and view all the answers

    What is the primary function of the H+/ATPase pump in α-intercalated cells?

    <p>To pump hydrogen ions into the tubule</p> Signup and view all the answers

    What is the effect of aldosterone on principal cells?

    <p>It increases the synthesis of ENaCs and Na-K ATPase transporters</p> Signup and view all the answers

    What is the mechanism by which potassium sparing diuretics decrease potassium excretion?

    <p>By blocking the ENaC channels on the cell membrane</p> Signup and view all the answers

    What is the primary indication for the use of potassium sparing diuretics?

    <p>Hypertension and edematous states</p> Signup and view all the answers

    What is the effect of aldosterone receptor antagonists on sodium reabsorption?

    <p>They decrease sodium reabsorption</p> Signup and view all the answers

    What is the primary mechanism by which potassium sparing diuretics increase sodium excretion?

    <p>By blocking the ENaC channels on the cell membrane</p> Signup and view all the answers

    What is the primary site of action of potassium sparing diuretics?

    <p>The distal convoluted tubule and collecting duct</p> Signup and view all the answers

    What is the effect of potassium sparing diuretics on hydrogen ion secretion?

    <p>They increase hydrogen ion secretion</p> Signup and view all the answers

    What is the primary mechanism by which aldosterone receptor antagonists treat hyperaldosteronism?

    <p>By blocking the action of aldosterone</p> Signup and view all the answers

    What is the primary indication for the use of aldosterone receptor antagonists?

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

    What is the primary function of the renal tubule in maintaining homeostasis?

    <p>Reabsorption of electrolytes and ions</p> Signup and view all the answers

    Which part of the nephron is responsible for filtering the blood?

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

    What is the destination of the fluid that passes through the distal convoluted tubule?

    <p>Collecting duct</p> Signup and view all the answers

    What is the site of action of thiazide and thiazide-like diuretics?

    <p>Distal convoluted tubule</p> Signup and view all the answers

    What is the primary function of the glomerulus?

    <p>Filtering the blood</p> Signup and view all the answers

    What is the purpose of the renal tubule in the nephron?

    <p>To reabsorb electrolytes and ions</p> Signup and view all the answers

    What is the primary mechanism by which thiazides decrease uric acid excretion in the kidneys?

    <p>They compete with uric acid for secretion in the proximal convoluted tubule</p> Signup and view all the answers

    What is the primary site of action of thiazides in the nephron?

    <p>Distal convoluted tubule</p> Signup and view all the answers

    What is the primary indication for the use of thiazides in patients with calciuria?

    <p>To prevent calcium nephrolithiasis</p> Signup and view all the answers

    What is the effect of thiazides on sodium reabsorption in the distal convoluted tubule?

    <p>They decrease sodium reabsorption</p> Signup and view all the answers

    What is the primary mechanism by which thiazides increase calcium reabsorption in the distal convoluted tubule?

    <p>They increase the activity of the sodium-calcium exchanger</p> Signup and view all the answers

    What is the primary difference between thiazides and thiazide-like diuretics?

    <p>Their chemical structure</p> Signup and view all the answers

    What is the primary indication for the use of thiazides in patients with nephrogenic diabetes insipidus?

    <p>To treat nephrogenic diabetes insipidus</p> Signup and view all the answers

    What is the effect of thiazides on uric acid levels in the blood?

    <p>They increase uric acid levels</p> Signup and view all the answers

    What is a common side effect of thiazides related to glucose metabolism?

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

    What is the primary mechanism by which thiazides cause hypovolemia?

    <p>They increase urine output</p> Signup and view all the answers

    What is the primary mechanism of action of thiazide diuretics?

    <p>Inhibit the sodium-chloride symporter in the distal convoluted tubule</p> Signup and view all the answers

    What is the effect of thiazide diuretics on potassium levels in the blood?

    <p>Decrease potassium levels by increasing potassium excretion</p> Signup and view all the answers

    What is the primary indication for the use of thiazide diuretics?

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

    What is the effect of thiazide diuretics on calcium levels in the urine?

    <p>Decrease calcium levels in the urine</p> Signup and view all the answers

    What is the common side effect of thiazide diuretics in people with sulfonamide allergies?

    <p>Allergic reaction</p> Signup and view all the answers

    What is the effect of ADH on sodium concentration in the blood?

    <p>Decrease sodium concentration in the blood</p> Signup and view all the answers

    What is the term for low serum potassium levels and high blood pH?

    <p>Hypokalemic metabolic alkalosis</p> Signup and view all the answers

    What is the name of the thiazide-like diuretic that is represented by a metallic laser gun in the mnemonic?

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

    What is the term for the increased concentration of uric acid in the blood?

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

    What is the primary mechanism by which thiazide diuretics correct nephrogenic diabetes insipidus?

    <p>Increase water reabsorption in the collecting duct</p> Signup and view all the answers

    What is the primary mechanism of action of mannitol as an aquaretic diuretic?

    <p>Decreasing water reabsorption in the proximal convoluted tubule and thin descending limb</p> Signup and view all the answers

    What is the main therapeutic use of osmotic diuretics like mannitol?

    <p>Lowering intraocular pressure in glaucoma and before ophthalmologic procedures</p> Signup and view all the answers

    How does mannitol's osmotic activity affect the kidneys?

    <p>It decreases sodium reabsorption and increases water excretion</p> Signup and view all the answers

    What is the effect of mannitol on electrolyte balance?

    <p>It promotes water excretion without significantly affecting electrolyte balance</p> Signup and view all the answers

    What is the fate of mannitol after IV administration?

    <p>It is secreted by the glomerulus into the renal tubule</p> Signup and view all the answers

    What is the effect of mannitol on the renal tubule?

    <p>It decreases water reabsorption in the proximal convoluted tubule and thin descending limb</p> Signup and view all the answers

    What is a potential side effect of mannitol when it first enters the bloodstream?

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

    Why is mannitol used to treat rhabdomyolysis and hemolysis?

    <p>To increase renal blood flow and flush out harmful substances</p> Signup and view all the answers

    What is a potential complication of mannitol use in patients with congestive heart failure?

    <p>Pulmonary edema</p> Signup and view all the answers

    What is a potential electrolyte imbalance that can occur when mannitol increases urine production?

    <p>Hypernatremia and hyperkalemia</p> Signup and view all the answers

    What is the primary mechanism by which mannitol exerts its effect?

    <p>Increasing osmolality of the urine</p> Signup and view all the answers

    Why is it important to ensure adequate water replacement when mannitol is used?

    <p>To prevent dehydration</p> Signup and view all the answers

    Study Notes

    Diuretics and the Kidneys

    • Diuretics are medications that act on the kidneys to increase production of urine, thereby eliminating water from the body.
    • The basic unit of the kidney is called a nephron, which is made up of a glomerulus and a renal tubule.
    • The renal tubule has several segments: proximal convoluted tubule, loop of Henle (thin descending, thin ascending, and thick ascending limbs), and distal convoluted tubule, which empties into the collecting duct.

    Thiazide and Thiazide-like Diuretics

    • Act on the distal convoluted tubule to increase urine output.
    • Decrease sodium reabsorption, leading to increased calcium reabsorption and decreased uric acid secretion.
    • Used to treat hypertension, edematous states, calciuria, osteoporosis, and nephrogenic diabetes insipidus.
    • Side effects: hyperglycemia, hyperlipidemia, hyperuricemia, hypercalcemia, hyponatremia, hypokalemic metabolic alkalosis, and sulfa allergies.

    Loop Diuretics

    • Act on the thick ascending limb of the loop of Henle to increase urine output.
    • Inhibit Na+K+2Cl- cotransporters, leading to increased excretion of sodium, potassium, chloride, calcium, and magnesium.
    • Used to treat edematous states, hypertension, hypercalcemia, hyperkalemia, and bromide, iodide, or fluoride intoxications.
    • Side effects: ototoxicity, hypokalemia, hypocalcemia, hypomagnesemia, hyperuricemia, and allergic reactions to sulfonamide derivatives.

    Key Differences

    • Thiazide diuretics decrease calcium excretion, while loop diuretics increase calcium excretion.
    • Loop diuretics are more potent in their diuretic effect and are used to treat edematous states and acute intoxifications.

    Mnemonics

    • Thiazide diuretics: a psychic holding a seance for thiazide-like diuretics, with objects representing indications and side effects.
    • Loop diuretics: a rollercoaster with a big loop, a salt shaker, a banana, and 2 swimmers for Na+K+2Cl- cotransporters, and a hot spring with sulfuric smell for sulfonamide loop diuretics.### Osmotic Diuretics
    • Osmotic diuretics, like mannitol, increase urine production by pulling water into the renal tubule, reducing sodium reabsorption.
    • Act in the proximal convoluted tubule and thin descending limb of the nephron, where they are freely permeable to water.
    • As a result, water stays in the tubule, increasing flow rate and reducing sodium reabsorption, leading to a sodium loss and a greater water loss (aquaretic diuretic).
    • Used to treat glaucoma and increased intracranial pressure, and to flush out harmful substances (e.g., myoglobin, hemoglobin) from the kidney.

    Carbonic Anhydrase Inhibitors

    • Inhibit carbonic anhydrase enzyme, reducing bicarbonate reabsorption in proximal tubules.
    • Cause mild diuresis, making them useful for edematous states when alkalosis is present.
    • Used to treat glaucoma, mountain sickness, and cystinuria, and to prevent kidney stone formation.

    Diuretics

    • Increase urine production, eliminating water and electrolytes from the body.
    • There are five main types: carbonic anhydrase inhibitors, osmotic diuretics, thiazide and thiazide-like diuretics, loop diuretics, and potassium-sparing diuretics.

    Potassium-Sparing Diuretics

    • Act on cortical collecting tubules, increasing potassium levels in the cell and reducing sodium reabsorption.
    • Used to treat hypertension and edematous states, and in combination with other diuretics to reduce potassium loss.
    • Aldosterone receptor antagonists (e.g., spironolactone, eplerenone) are used to treat hyperaldosteronism.

    Nephron Structure and Function

    • The basic unit of the kidney, consisting of a glomerulus, renal tubule, and peritubular capillaries.

    • The renal tubule has several segments, including the proximal convoluted tubule, loop of Henle, and distal convoluted tubule.

    • Each segment plays a role in the reabsorption and secretion of fluids and ions to maintain homeostasis.### Potassium Sparing Diuretics

    • Potassium sparing diuretics eliminate excess sodium and water from the body while retaining potassium.

    • They act in two ways: aldosterone receptor antagonists and ENaC channel blockers.

    Aldosterone Receptor Antagonists

    • Include spironolactone and eplerenone.
    • Block aldosterone receptors on the collecting tubule principal cells.
    • Cancel out aldosterone's physiological effects.
    • Reduce mortality after a myocardial infarction by reducing remodelling in the heart.
    • Bind to androgen receptors, preventing testosterone from binding, making them useful for blunting testosterone effects in polycystic ovarian syndrome.
    • Symptoms of polycystic ovarian syndrome include infertility, hair loss, acne, and hirsutism.

    ENaC Channel Blockers

    • Include amiloride and triamterene.
    • Block epithelial sodium channels.
    • Useful in treating Liddle's syndrome, a rare genetic disease where ENaC channels are continuously activated, causing sodium retention and renal potassium wasting.

    Side Effects

    • Hyperkalemia (too much potassium in the blood) can lead to arrhythmias.
    • Use of potassium-sparing diuretics with potassium supplements or other medications that increase potassium (ACE inhibitors or ARBs) should be monitored closely.
    • Metabolic acidosis can occur due to a buildup of hydrogen ions in the blood, lowering blood pH.
    • Rare side effects of spironolactone include antiandrogenic effects like gynecomastia and impotence.
    • Triamterene can form kidney stones due to its low solubility and may induce acute renal failure when associated with indomethacin, an NSAID.

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    Learn about the different types of diuretics, their mechanism of action, and how they affect kidney function. This quiz covers the basics of nephrons, glomerulus, and more.

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