Pharmacology of Diuretics
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Questions and Answers

What is the effect of Loop Diuretics on calcium levels?

  • They induce hypocalcemia (correct)
  • They have no effect on calcium levels
  • They can cause both hypocalcemia and hypercalcemia
  • They induce hypercalcemia

    • What is the mechanism of action of Triamterene and Amiloride?

  • They inhibit the synthesis of a protein that stimulates the Na+ pump
  • They inhibit the sodium pump
  • They block Na+ channels directly (correct)
  • They antagonize aldosterone receptors

    • What is the indication for Spironolactone in CHF?

  • It is used to reduce blood pressure
  • It is used to reduce hyperkalemia
  • It is used to reduce mortality by 30% (correct)
  • It is used to reduce edema

    • What is the adverse effect of Loop Diuretics on glucose levels?

    <p>They cause hyperglycemia</p> Signup and view all the answers

    What is the effect of Thiazide Diuretics on calcium levels?

    <p>They induce hypercalcemia</p> Signup and view all the answers

    What is the mechanism of action of Spironolactone?

    <p>It antagonizes aldosterone receptors</p> Signup and view all the answers

    What is the main difference between Triamterene and Amiloride compared to Spironolactone?

    <p>Triamterene and Amiloride act directly on Na+ channels, while Spironolactone antagonizes aldosterone receptors</p> Signup and view all the answers

    What is the consequence of using Loop Diuretics with Nephrotoxic drugs?

    <p>It increases the risk of nephrotoxicity</p> Signup and view all the answers

    What is the advantage of triamterene and amiloride over spironolactone?

    <p>They are more rapid and shorter acting, allowing for daily dosage adjustment.</p> Signup and view all the answers

    What is the mechanism of action of carbonic anhydrase inhibitors?

    <p>Inhibition of carbonic anhydrase enzyme.</p> Signup and view all the answers

    What is the indication for mannitol in cerebral edema?

    <p>Rapid reduction of ICP.</p> Signup and view all the answers

    What is a common adverse effect of spironolactone?

    <p>Gynecomastia.</p> Signup and view all the answers

    What is the contraindication for mannitol in acute renal failure?

    <p>Impaired renal function.</p> Signup and view all the answers

    What is the indication for acetazolamide in emphysema?

    <p>Correction of alkalosis.</p> Signup and view all the answers

    Why is spironolactone preferred in liver cirrhosis?

    <p>It does not cause hypokalemia or alkalosis.</p> Signup and view all the answers

    What is the combination of diuretics that potentiates their diuretic effect and antagonizes hypokalemic effect?

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

    What is the mechanism by which Na+ lost by loop diuretic is reabsorbed in distal tubules?

    <p>In exchange with K+ under the effect of aldosterone</p> Signup and view all the answers

    What is the therapeutic use of Thiazide Diuretics in treating CHF?

    <p>To overcome refractoriness to loop diuretics</p> Signup and view all the answers

    What is the effect of chronic therapy with Thiazide Diuretics on urine output in nephrogenic diabetes insipidus?

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

    Which of the following is a side effect of Thiazide Diuretics?

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

    What is the mechanism of action of Spironolactone?

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

    Which of the following diuretics is preferred in elderly patients to decrease the risk of osteoporosis?

    <p>Thiazide Diuretics</p> Signup and view all the answers

    What is the effect of chronic therapy with Thiazide Diuretics on Ca2+ excretion?

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

    What is the treatment for Na+ lost by loop diuretic?

    <p>Add the aldosterone antagonist (spironolactone)</p> Signup and view all the answers

    Study Notes

    Diuretics

    Loop Diuretics

    • May lead to hypotension, hemoconcentration, thrombosis, ototoxicity, and nephrotoxicity
    • Can cause refractoriness, hyperglycemia, and hyperlipidemia
    • Can induce hypocalcemia and are used in the treatment of hypercalcemia
    • Used with caution with nephrotoxic drugs (e.g., cephalosporins, aminoglycosides) and ototoxic drugs (e.g., aminoglycosides)
    • Can cause liver failure, hypokalemia, and alkalosis, which may precipitate hepatic encephalopathy

    Thiazide Diuretics

    • Inhibit active electroneutral NaCl reabsorption in the early part of the distal tubule (diluting segment)
    • Cause excretion of 5-10% of filtered Na+
    • Have vasodilator action, which is the basis for their antihypertensive effect
    • Available in different preparations, including hydrochlorthiazide, chlorthalidone, indapamide, and metolazone
    • Used to treat hypertension, CHF, nephrogenic diabetes insipidus, and idiopathic hypercalciuria and Ca2+ stones

    Adverse Effects of Thiazide Diuretics

    • Can cause hypokalemia, hypomagnesemia, alkalosis, and hyperuricemia
    • May cause hypersensitivity reactions in patients sensitive to sulfonamides
    • Can cause edema and liver cirrhosis, where spironolactone is the preferred treatment

    Potassium Retaining Diuretics

    • Mineralocorticosteroid antagonists (MRAs) and direct inhibitors of Na+ channels
    • Triamterene and amiloride are direct inhibitors, while spironolactone and eplerenone are MRAs
    • Used to treat CHF, hypertension, and nephrogenic diabetes insipidus
    • Can cause hyperkalemia and metabolic acidosis as adverse effects
    • Gynecomastia can occur as an adverse effect of spironolactone, but not eplerenone

    Osmotic Diuretics

    • Mannitol is an osmotic diuretic used to rapidly reduce ICP in cerebral edema and IOP in acute congestive glaucoma
    • Used in prophylaxis against acute renal failure in patients with oliguria
    • Can cause adverse effects such as heart failure and dilutional hyponatremia, and is contraindicated in acute renal failure and congestive heart failure

    Carbonic Anhydrase Inhibitors (CAIS)

    • Include acetazolamide, brinzolamide, and dorzolamide
    • Mechanism of action involves diuresis with alkaline urine and decreased blood bicarbonate with metabolic acidosis
    • Used to treat emphysema and high altitude sickness, as well as epilepsy as an adjuvant

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    Description

    This quiz covers the adverse effects of loop diuretics and thiazide diuretics, including hypovolemia, hyponatremia, and their impact on calcium levels. It also explores their uses in treating hypercalcemia and hypercalcuria.

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