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diuretics
extras
| Question | Answer |
|---|---|
| drug interactions with loop diurectics | aminoglycosides, anticoagulants, lithium, propranolol, sulfonylureas, cisplatin, NSAIDS, probenecid, thiazide diurectics, amphotericin B |
| loop diuretics plus a sulfonylureas will cause | hyperglycemia |
| loop diurectics plus NSAIDS will cause | blunted diuretic response and solicylate toxicity when give with high doses of salicylates |
| loop diurectics plus thiazide diurectics | synergism of diurectic activtiy of both leading to profound diuresis |
| loop diurectics plus aminoglycosides will cause what | synergism of ototoxicity caused by both drugs |
| which diuretic class has been shown to reduce morbidity and mortality through controlled clinical trials | the sodium cloride symport (thiazide and thiazide like) but not the sodium potassium 2 choloride symport inhibitors even that they appear to lower blood pressure as effective |
| what is one advantage that Na+-K+-2Cl- symport inhibitors have over the Na+-Cl- symport inhibitors | cause smaller perturbations in the lipid profile |
| what is one disadvantage that loop diurectics have when compared to thiazide type diurectics in the treatment of hypertension | the short half life of loop diuretics |
| ___ were found predominantly to increase NaCl excretion, an effect shown to be independent of carbonic anhydrase inhibition. | benzothiadiazides |
| Inhibitors of Na+-Cl- symport are ___ | sulfonamides |
| The term thiazide diuretics is used here to refer to all members of the class of ___ | inhibitors of Na+-Cl- symport |
| thiazide diuretics inhibit NaCl transport in the ____. This place expresses thiazide binding sites and is accepted as the primary site of action of thiazide diuretics; ___ may represent a secondary site of action. | DCT; the proximal tubule |
| The free energy in the electrochemical gradient for Na+ is harnessed by a ___ in the ____ membrane that moves Cl- into the epithelial cell against its electrochemical gradient. Cl- then exits the ___membrane passively via a Cl-channel. | Na+-Cl- symporter; luminal; basolateral |
| This Na+-Cl- symporter is inhibited by a number of thiazide diuretics (but not by furosemide, acetazolamide, or an amiloride derivative) | statement |
| thiazides are only moderately efficacious because | (i.e., maximum excretion of filtered load of Na+ is only 5%) approximately 90% of the filtered Na+ load is reabsorbed before reaching the DCT. |
| Some thiazide diuretics also are weak inhibitors of carbonic anhydrase, an effect that increases HCO3 - and phosphate excretion and probably accounts for their weak | proximal tubular effects |
| Like inhibitors of Na+-K+-2Cl- symport, inhibitors of Na+-Cl- symport increase the excretion of K+ and titratable acid by | the same mechanisms discussed for loop diuresis |
| Acute administration of thiazides increases the excretion of uric acid. However, uric acid excretion is . | reduced following chronic administration by the same mechanisms discussed for loop diuretics |
| when administered chronically, thiazide diuretics ___ Ca2+ excretion ( | decrease |
| The mechanism involves increased proximal reabsorption owing to volume depletion, as well as direct effects of thiazides to increase Ca2+ reabsorption in the DCT. In this regard, inhibition of the Na+-Cl- symporter in the luminal membrane decreases intrac | mechanism of ca exhange |
| Thiazide diuretics may cause a mild ____ by a poorly understood mechanism, and there is increasing awareness that long-term use of thiazide diuretics may cause magnesium deficiency, particularly in the elderly | magnesuria |
| Since inhibitors of Na+-Cl- symport inhibit transport in the cortical diluting segment, thiazide diuretics attenuate the ability of the kidney to excrete a ___ | dilute urine during water diuresis. |
| However, since the DCT is not involved in the mechanism that generates a hypertonic medullary interstitium, thiazide diuretics do not alter the kidney's ability to ___ | concentrate urine during hydropenia. |
| Since thiazides act at a point past the macula densa, they have _____on TGF. | little or no influence |
| In general, inhibitors of Na+-Cl- symport ______RBF and _____ GFR owing to increases in intratubular pressure. | do not affect ; only variably reduce |
| Sulfonamides are organic acids and therefore are ____ into the proximal tubule by the organic acid secretory pathway | secreted |
| one way drugs can compete with thiazide diuretics would could be by | competing for transport into the proximal tubule. drugs like probenecid |
| The incidence of erectile dysfunction is ____ with Na+-Cl- symport inhibitors than with several other antihypertensive agents (e.g., b adrenergic receptor antagonists, Ca2+ channel blockers, angiotensin converting enzyme inhibitors, and a1-receptor antag | greater |
| As with loop diuretics, most serious adverse effects of thiazides are related to abnormalities __ and ___ | of fluid and electrolyte balance. |
| These adverse effects include ___cellular volume depletion, ____tension, ___kalemia, ____natremia, ___chloremia, metabolic ___, hypomagnesemia, ___calcemia, and ____uricemia. | extra; hypo; hypo; hypo; hypo; alkalosis; hyper; hyper |
| Thiazide diuretics also _____and latent diabetes mellitus may be unmasked during therapy. | decrease glucose tolerance, by a poorly understood mech but may involve reduced insulin secretion and alterations in glucose metabolism |
| Hyperglycemia may be related in some way to K+ depletion, in that hyperglycemia is reduced when ___ is given along with the diuretic | K+ |
| In addition to contributing to hyperglycemia, thiazide-induced hypokalemia __ the antihypertensive effect and cardiovascular protection afforded by thiazides in patients with hypertension. | compromises |
| Thiazide diuretics also may ____ plasma levels of LDL cholesterol, total cholesterol, and total triglycerides. | increase |
| Thiazide diuretics are contraindicated in individuals who are hypersensitive to | sulfonamides. |
| thiazide diuretics may ____ the effects of anticoagulants, uricosuric agents used to treat gout, sulfonylureas, and insulin | diminish |
| thiazide diuretics may___the effects of anesthetics, diazoxide, digitalis glycosides, lithium, loop diuretics, and vitamin D. | increase |
| the effectiveness of thiazide diurectis may be reduced by ____ and ____ | NSAIDS (nonselective and selective COX-2 inh) Bile Acid seqestrants |
| what are two drugs that might increase the risk of hypokalemia induced by thiazide diurectics | amphotericin B and corticosteroids |
| thiazide diurectics and quinidine given together causes what | prolongation of the QT interval and can lead to the development of polymorphic ventricular tachycardia (torsades de pointes) owing to triggered activity originating from early after-depolarization (thiazide diuretics cause hypokalemia which increases the |
| what are the therapeutic uses or thiazide diurectis | treatment of the edema associated with heart (congestive heart failure), liver (hepatic cirrhosis), and renal (nephrotic syndrome, chronic renal failure, and acute glomerulonephritis) disease |
| with some exceptions, thiazide diuretics are ineffective when | the GFR is less than 30 to 40 ml/min. |
| A common dose for hypertension is ___of hydrochlorothiazide or the dose equivalent of another thiazide. | 25 mg/day |
| Thiazide diuretics, which reduce urinary excretion of Ca2+, sometimes are employed to treat ___and may be useful for the treatment of osteoporosis | calcium nephrolithiasis |
| Thiazide diuretics also are the mainstay for treatment of ____, reducing urine volume by up to 50%. | nephrogenic diabetes insipidus |
| ____can provide immediate diuresis and are used for heart failure and in lieu of ___ in patients with compromised renal function. | Loop diuretics ; thiazides |
| The thiazide diuretics are | weakly acidic |
| These compounds are ___ metabolized and are ___ excreted unchanged in the urine | not extensively; primarily |
| Thiazide diuretics are used to treat edemas caused by ___as well as in hepatic or renal disease. | cardiac decompensation |
| the effect of thiazide diuretics may be attributed to a | reduction in blood volume and a direct relaxation of vascular smooth muscle. |
| Thiazide diuretics may induce a number of adverse effects, including hypersensitivity reactions, gastric irritation, nausea, and electrolyte imbalances, such as | hyponatremia, hypokalemia, hypomagnesemia, hypochloremic alkalosis, hypercalcemia, and hyperuricemia. |
| Individuals who exhibit hypersensitivity reactions to one thiazide are likely to have a hypersensitivity reaction to other thiazides and sulfamoyl-containing diuretics | (e.g., thiazide-like and some high-ceiling diuretics). |
| _____ use of thiazide diuretics also may result in decreased glucose tolerance and increased blood lipid (low-density lipoprotein cholesterol, total cholesterol, and total triglyceride) content. | long term use |
| In contrast to thiazide diuretics, metolazone may be effective as a diuretic when | the GFR falls below 40 mL/min. |
| The dose of metolazone ___given as a single oral dose. Side effects are similar to adverse effects induced by the thiazide diuretics. | 2.5 to 20 mg |
| Chlorthalidone (pKa = 9.4) is an example of a diuretic in this class of compounds that bears a structural analogy to the | quinazolinones |
| Chlorthalidone has a long duration of action (48–72 hours)and may be administered | in doses of 25 to 100 mg three times a week |
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