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Pharm Ch 26
Diuretic Drugs
| Question | Answer |
|---|---|
| Define: Afferent arterioles | The small blood vessels approaching the glomerulus. |
| Define: Aldosterone | A mineralcorticoid steriod hormone produced by the adrenal cortex that mediates the actions of the renal tubule in the regulation of sodium and potassium balance in the blood. |
| Define: Ascites | An abnormal intraperitoneal accumulation of fluid (500mL or more) containing large amounts of protein and electrolytes. |
| Define: Collecting duct | The most distal part of the nephron between The distal convoluted tubule and the ureters, which lead to the urinary bladder. |
| Define: Distal convoluted tubule | The part of the nephron immediately distal to the ascending loop of Henle and proximal to the collecting duct |
| Define: Diuretics | Drugs or other substances that tend to promote the formation and excretion of urine. |
| Define: Efferent arterioles | The small blood vessels exiting the glomerulus. At this point blood has completed its filtration in the glomerul.us |
| Define: Filtrate | The material that passes through a filter. In the case of the kidney, the filter is the glomerulus and the filtrate is the material extracted from the blood (normally liquid) that becomes urine. |
| Define: Glomerular capsule | The open, rounded, and most proximal part of the proximal convoluted tubule that surrounds the glomerulus and receives the filtrate from the blood. |
| Define: Glomerular filtration rate | The volume of ultrafiltrate extracted per unit of time from the plasma flowing through the glomeruli of the kidney |
| Define: Loop of Henle | The part or the nephron between the proximal and the distal convoluted tubules. |
| Define: Glomerulus | the cluster of kidney capillaries that marks the beginning of the nephron and is immediately proximal to the proximal convoluted tubule. |
| Define: Nephron | The microscopic functional filtration unit of the kidney |
| Name the parts of the Nephron in anatomical order from proximal to distal. | The glomerulus, proximal convoluted tubule, loop of Henle, distal convoluted tubule, and the collecting duct. |
| List the hypotensive mechanisms of diuretics | Diuretics cause direct arteriole dilation, reduce: extracellular fluid volume, plasma volume, and cardiac output |
| True or false? The afferent arterioles send blood in to the Golmerulus and the efferent take blood away. | True, Afferent = approach and Efferent = exit |
| True or False? 60%- 70% of sodium and water get resorbed into the blood stream at the proximal tubule. | True! |
| True or False? Aldosterone regulates the active transport of sodium back into the bloodstream while excreting chloride and hydrogen ions. | False, Potassium is excreted along with the hydrogen ions not chloride. |
| Name the five types of Diuretic drugs. | Carbonic anhydrase inhibitors, Loop, Osmotic, Potassium-sparing, and Thiazide and Thiazide-like Diuretics |
| Name Indications for CAI diuretics. | Treatment of High blood pressure, glaucoma, edema, High altitude sickness, and anti-epleptic |
| Which part of the Nephron reabsorbs 20-25% of the sodium and water? | The ascending Loop of Henle |
| 3% of the body's sodium and water is reabsorbed where? | The collecting ducts |
| CAI's lose their effectiveness after how many days? | 2-4 days |
| Allergy to what type of drug ingredient limits the use of diuretics? | Sulfonamides (but commonly given to such patients) |
| What is the name of the most commonly used CAI diuretic? | Acteazolamide (Diamox) |
| Name contraindications of CAI. | Drug allergy, Hypoatremia (low sodium), Hypokalemia (low potassium), severe renal or Hepatic dsyfunction, adrenal gland insufficiency, and cirrhosis |
| True or False? Acteazolamide is used to treat edema caused by heart failure when other diuretic do not work? | True. |
| Name commonly used Loop diuretics. | Furosemide/Lasix (most common), Bumetanide/Bumex, Torsemide/Demedex |
| Are diuretics safe for lactating mothers and their infants? | No, Use of diuretics in lactating women is not recommended. |
| List Adverse effects of CAI's | Metabolic acidosis, hypokalemia(2 most common), anorexia, hematuria, Drowsiness, photosensitivity, urticaria, melena (blood in stool), and Paresthesias (numbness/tingling of skin) |
| Desribe Mechanism of action for CAIs' | CAI block carbonic anhydrase enzyme leading to a decrease in the levels of H+ ions in renal tubules which leads to increases excretion of bicarbonate, sodium, water, and potassium. |
| Loop diuretics cause potent diuresis. What are the cardiovascular effects caused by large fluid loss? | Reduced blood pressure, reduced pulmonary and systemic vascular resistance, reduced central venous pressure, reduced left ventricle end diastolic pressure |
| What are the metabolic effects of Loop diuretics? | Sodium, Potassium, and Calcium loss. |
| Name indications of Loop diuretics. | Edema (assoc. w/ HF, hepatic or renal disease)e.g. Ascites & pulmonary, hypertension, increase calcium excretion, HF resulting from diastolic dysfunction. |
| Name contraindications of Loop diuretics. | Drug allergy, hepatic coma, severe electrolyte loss. |
| Common adverse effects of Loop diuretics. | dizziness, headache, tinnitus, blurred vision, nausea, vomiting, diarrhea, agranulocytosis (not enough WBCs), thrombocytopenia(not enough platelets), neutropenia-not enough neutrophils), hypokalemia, hyperglycemia, hyperuricemia (too much uric acid) |
| Name most common Osmotic Diuretic? | Mannitol (Osmitrol) |
| Loop diuretics affects decreased by what group of drugs? | NSAIDs |
| Describe Mechanism of action of osmotic diuretics? | Nonabsorbable, producing osmotic effect pulls water into proximal tubule, inhibits tubular resorption of water and solutes, producing rapid diuresis. |
| Name indications for Osmotic diuretics. | Used for patients in first phase of acute renal failure, to promote excretion of toxic substances, reduce intracranial pressure, treatment of cerebral edema |
| Name adverse effects of osmotic diuretics. | Convulsions, Thrombophlebitis (swelling of vein caused by a blood clot), Pulmonary congestion, headaches, chills, chest pains, tachycardia, blurred vision, and fever |
| Explain mechanism of action for Loop diuretics. | They inhibit sodium and chloride resorption in the Loop of Henle. they also increase Renal prostaglandins which dilates the blood vessels and causes a reduction of peripheral vascular resistance |
| True or False? Mannitol made only be given by IV. | True. |
| True or False? Furosemide made be given orally or by IV. | True. |
| True or False? CAI's and Loop Diuretics interact with Digoxin and/or Corticosteroids to cause digitalis toxicity? | True, the mechanism is Hyperkalemia. |
| True or False? Mannitol has multiple drug interactions. | False, Mannitol has no known significant drug interactions. |
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