Term
Loops good for ___ = major use
Thiazides are good for ___ = major use
But can use either for each |
|
Definition
|
|
Term
| acetozolamine is what type of drug? |
|
Definition
| Carbonic anhydrase inhibitors |
|
|
Term
| bumetanide is what type of drug? |
|
Definition
|
|
Term
| furosemide is what type of drug? |
|
Definition
|
|
Term
| torsemide is what type of drug? |
|
Definition
|
|
Term
| chlorothalazide is what type of drug? |
|
Definition
|
|
Term
| chlorthalidone is what type of drug? |
|
Definition
|
|
Term
| hydrochlorothiazide is what type of drug? |
|
Definition
|
|
Term
| indapamide is what type of drug? |
|
Definition
|
|
Term
| metolazone is what type of drug? |
|
Definition
|
|
Term
| eplerenone is what type of drug? |
|
Definition
| Potassium Sparing diuretic - Aldosterone antagonist |
|
|
Term
| spiranolactone is what type of drug? |
|
Definition
| Potassium Sparing diuretic - Aldosterone antagonist |
|
|
Term
| amiloride is what type of drug? |
|
Definition
| Potassium sparing diuretic - Na Channel Antagonist |
|
|
Term
| triamterene is what type of drug? |
|
Definition
| Potassium sparing diuretic - Na Channel Antagonist |
|
|
Term
| mannitol is what type of drug? |
|
Definition
|
|
Term
| Loops are ____ secreted into urine |
|
Definition
|
|
Term
| Three basic renal processes that effect ECF: (3) |
|
Definition
filtration
Active tubular secretion
Reabsorption |
|
|
Term
Filtration = ____ step in urine formation
_______ process
Occurs at the _____
All ___ molecules (electrolytes, AA, glucose, drugs, metabolic wastes) undergo filtration
Cells and ____ molecules (lipids and proteins) remain behind in the blood
The ECF undergoes complete cleansing many times each day
____ L per day is filtered
____ & ___ ions are the predominant solutes in the filtrate
____ & ___ ions are present in smaller amounts |
|
Definition
First
Nonselective
glomerulus
small
large
180 L
Sodium (Na+) & chloride (Cl-)
Bicarbonate (HCO3-) and potassium (K+) |
|
|
Term
_____ drugs better filtrated
Ex. Sulfates are added onto drugs = makes them more ___ & better filtrated |
|
Definition
|
|
Term
Review the renin-angiotensin-aldosterone system (RAAS):
When blood volume is low, juxtaglomerular cells in the kidneys secrete ____ which stimulates the production of ______, which is then converted to _______ by ACE which causes blood vessels to ____ , resulting in increased blood pressure. It also stimulates the secretion of the hormone ____ from the adrenal cortex which causes the tubules of the kidneys to increase the reabsorption of ___ and ___ into the blood. This increases the volume of fluid in the body, which also increases blood pressure. |
|
Definition
renin
angiotensin I
angiotensin II
constrict
aldosterone
sodium
water |
|
|
Term
| Afferent arterioles of the kidney have tonic dilation via ____. Constriction occurs with ____ & ____ and Blood flow through tubule _____ = filtration drops, fluid in body ______ b/c not filtering as much = swelling |
|
Definition
prostaglandins
NSAIDS and Cox-2 inhibitors
decreases
increases |
|
|
Term
| Efferent arterioles of the kidney have tonic constriction with _____. ____ & ____ interrupt this constriction leading to dilation of efferent arteriols = resistance decreases so filtration _____ b/c pressure decreases |
|
Definition
angiotensin II
ARBs and ACE-Is
decreases |
|
|
Term
Active tubular secretion:
Pumps transport compounds from the plasma into the lumen of the nephron
Two kinds of “pumps”:
For organic ___ (diuretics, uric acid, p-aminohippuric acid, antibiotics, etc…)
For organic ___ (creatinine, procainamide, choline, etc…)
Pumps are located in the ____ tubule |
|
Definition
|
|
Term
Reabsorption:
Greater than 99% of the water, electrolytes, and nutrients that are filtered at the glomerulus undergo reabsorption
Solutes (AA, glucose, electrolytes) undergo ___ transport
Water follows ____ along the osmotic gradient created by solute reuptake
This process is where ____ produce their effect. |
|
Definition
active
passively
diuretics |
|
|
Term
Glomerular filtration rate (GFR) can be changed by drugs affecting ______. Drugs: (3)
_____ (caffeine, theophylline, aminophylline) produce their weak diuretic effect by causing increased cardiac output and vasodilation resulting in _____ RBF, which ____ GFR.(also inhibit ___ secretion – different site) |
|
Definition
renal blood flow (RBF)
ACE-Is, ARBs and NSAIDS
Xanthine alkaloids
increased
increases
ADH |
|
|
Term
| Organic acid/base secretory systems of the kidney are located in the _______ |
|
Definition
| proximal convoluted tubule |
|
|
Term
Loop of Henle Thin descending limb:
Does not participate in ____ reabsorption
____ reabsorption only
Drugs: ______________ |
|
Definition
salt
Water
osmotic diuretics (i.e. mannitol, glucose) |
|
|
Term
Loop of Henle Thick ascending limb:
About 35% ____ reabsorbed
Impermeable to __________
NaCl transport system – Na+/K+/2Cl- cotransporter (symporter) is selectively blocked by ______ diuretics
Mg++ and Ca++ are reabsorbed
Drugs: ____________________ |
|
Definition
NaCl
water
loop
loop diuretics |
|
|
Term
Distal convoluted tubule Early segment:
Relatively impermeable to _____
NaCl transporter is blocked by _____ diuretics
Ca++ is actively reabsorbed
About 10% ____ reabsorbed
This process is regulated by _____ hormone
Drugs: ___________________ |
|
Definition
water
thiazide
NaCl
parathyroid
thiazide diuretics |
|
|
Term
Distal nephron (late distal convoluted tubule and collecting duct)
___________ exert a significant influence here
Volume depletion enhances ___________secretion |
|
Definition
Mineralcorticoids (i.e. aldosterone)
aldosterone |
|
|
Term
Distal nephron (late distal convoluted tubule and collecting duct
Exchange mechanism
2-5% of ____ reabsorbed
Major site of ____ secretion (excretion)
_____ will increase water permeability in collecting tubule, causing concentrated urine
Drugs: __________________________ |
|
Definition
NaCl
potassium (K+)
ADH (antidiuretic hormone)
aldosterone, vasopressin (DDAVP) |
|
|
Term
| ______ determines final urine concentration |
|
Definition
|
|
Term
| _________ secretion is regulated by serum osmolality and volume status |
|
Definition
|
|
Term
| ADH deficiency is known as __________ |
|
Definition
| diabetes insipidus (water diuresis) |
|
|
Term
|
Definition
| for swelling (edema) & bp |
|
|
Term
ECF shifts between the ____ space (blood vessels) and the _____ space (tissue) to maintain the fluid balance within the ECF compartment. When you retain fluid -> backs up into the ____ first, but as it gets full, then leakage into ____ = _____ edema. When give duretics, we try to reduce ____ fluid volume (could make you hypotensive) to drain ____.
Test ___ for dehydration & _____ for hypotension |
|
Definition
intravascular
interstitial
plasma
IF
pitting
plasma
IF
turgor
orthostatics |
|
|
Term
| Diuretcis are Agents that promote ____ (sodium loss) and subsequent ____ (water loss). They Antagonize the hydroosmotic effect of ___________. |
|
Definition
natriuresis
diuresis
vasopressin (antidiuretic hormone) |
|
|
Term
| Most Na+ (70%) is reabsorbed in the _________ |
|
Definition
|
|
Term
Primary therapeutic uses of Diuretics:
Tx of hypertension
Tx of fluid retention - such as:
_____
Use diuretics to remove _______
___________ disease (CRF)
___________ cirrhosis |
|
Definition
CHF
excess fluid from edema
renal hepatic |
|
|
Term
Carbonic anhydrase inhibitors:
prevent formation of ____ & ____
Less ___ to exchange for Na+
Less ___ reabsorbed
Water follows ___ so less water reabsorbed & it stays in tubule |
|
Definition
|
|
Term
| With Carbonic anhydrase inhibitors, the Inhibition of sodium (bicarbonate) (NaHCO3) reabsorption in the luminal membranes of the proximal tubules. Causes sodium bicarbonate to be excreted in urine – hence metabolic ____ |
|
Definition
| acidosis b/c high amounts of H+ in blood |
|
|
Term
| Carbonic anhydrase inhibitors work in the ________ of the kidney |
|
Definition
|
|
Term
Carbonic anhydrase inhibitors:
-SO2NH2 (sulfonamide) group is essential for activity (why is this important?) |
|
Definition
| b/c need to be cautious in pts. w/ sulfa allergies |
|
|
Term
Carbonic anhydrase inhibitors:
Duration of the diuretic (natriuretic) effects is limited in terms of time due to ________ within the distal parts of the nephron. Thus the diuretic efficacy of the CAIs ___ within few days of the treatment. _______ does not decrease with the decreased diuretic efficacy. |
|
Definition
compensation
decreases
Metabolic acidosis |
|
|
Term
Carbonic anhydrase inhibitors Uses:
_______(chronic simple) – decreases formation of aqueous humor
_______ (Diamox®)
Topical - _____(Trusopt®) |
|
Definition
Open angle glaucoma
Acetazolamide
Dorzolamide |
|
|
Term
Carbonic anhydrase inhibitors Uses:
Create an _____ to facilitate urinary excretion of acidic agents (weak acids). It Makes urine more ___– makes weak acids more _______ = more likely to be excreted |
|
Definition
alkaline
basic
charged (polar) |
|
|
Term
Carbonic anhydrase inhibitors Uses:
Metabolic _____ - in patients suffering from HF and edema when standard treatment employing volume correction is not applicable. |
|
Definition
|
|
Term
Carbonic anhydrase inhibitors Uses:
High altitude (mountain) sickness - weakness, dizziness, insomnia, HA, and nausea at altitude
Above 3,000 meters there is ↑ risk of ____ or ___ edema
Edema can be decreased if _____ is administered ___ hours before going to altitude. |
|
Definition
pulmonary or cerebral
acetazolamide
24 |
|
|
Term
| Osmotic diuretics work in the _________ of the kidney |
|
Definition
|
|
Term
| Osmotic diuretics are filtered at the glomerulus. In the tubule, it creates an osmotic gradient that favors ____________ in the tubular lumen. |
|
Definition
|
|
Term
| Aside from mannitol, what are the other 3 (less impt) osmotic diuretics? |
|
Definition
Glycerin (glycerol)
Urea
Isosorbide |
|
|
Term
| _______ = osmotic diuretic drug of choice: b/c it is non-toxic, freely filtered, non-reabsorbable and non-metabolized |
|
Definition
|
|
Term
Osmotic Diuretics (Mannitol)
Non-electrolyte, highly ___, inert.
Confined to ____ (don’t enter cells), in other words they are not reabsorbed.
Freely filterable at glomerulus
Provide a higher solute load in the nephron – osmotic pressure prohibits normal water reabsorption by _____(osmotic) action
Poorly absorbed, given _________ |
|
Definition
polar
ECF
passive
parenterally |
|
|
Term
Osmotic Diuretics: Uses
______ failure (i.e., maintain urine flow)
Reduce _____ volume and pressure. Often used after ___ injury. Mannitol Will keep fluid inside vessels =increases oncotic pressure
_____ - Decrease the pressure and volume of intraocular fluid and CSF
Hemodialysis Facilitate urinary excretion of ____ substances |
|
Definition
Acute renal
cerebrospinal fluid
head
Glaucoma
toxic |
|
|
Term
Osmotic Diuretics: Side-Effects
Transient expansion of ___ volume,
Can result in or exacerbate ____ and/or ____. |
|
Definition
ECF
cardiac failure
pulmonary edema |
|
|
Term
|
Definition
|
|
Term
| Loop diuretics are very effective diuretics especially for net ______. “volume control" |
|
Definition
|
|
Term
| Prototype Loop diuretics? |
|
Definition
|
|
Term
Loop diuretics
Oral absorption: diuresis begins in ____-____ minutes and persists for __ hours
I.V. administration: diuresis begins within __ minutes and persists for _ hours.
With I.M. administration, diuresis begins in __ minutes |
|
Definition
|
|
Term
Usual dosages:
Furosemide Lasix _____ mg PO daily is a good starting dose *know this specifically for exam |
|
Definition
|
|
Term
| Bumetanide: Used as an ___ dosage for ____ |
|
Definition
|
|
Term
|
Definition
CHF
CRF
HTN
hepatic cirrhosis |
|
|
Term
Diuretics – Loop: Clinical Indications:
1. Edema of ___, ____, or ______ origin especially that has been unresponsive to other diuretics
2. Acute _____ edema associated with ____
3. ____ that can not be controlled with other diuretics
4. _____ - especially useful in patients with severe renal impairment. Loop diuetics can promote diuresis even when renal blood flow and glomerular filtration rate are low.
5._____ - Loops can increase excretion of Ca++ in the urine. |
|
Definition
hepatic, cardiac, or renal
pulmonary
CHF
HTN
Acute renal failure
Hypercalcemia |
|
|
Term
| Loop diuretics work in the _______ of the kidney |
|
Definition
| Loop of Henle - thick ascending limb |
|
|
Term
| Loop diuretics are highly ____ in the plasma but are ____ secreted in the tubular lumen via transporter system |
|
Definition
|
|
Term
Without Loop Diuretics: The Thick Ascending Limb Function:
Symporter is electrically neutral pulls _, _, & _ out of the tubular fluid into the tubular cell.
However, net result is excess __ within the cell
__ follows concentration gradient back into lumen (it leaks back into the the lumen). Therefore, the lumen become positively charged.
Positive lumen charge drives divalent cations __ & __ out of the lumen via paracellular pathway |
|
Definition
N, K and 2Cl
K+
K+
Ca++, Mg ++ |
|
|
Term
Loop Diuretics Mechanism:
______ Na+ reabsorption (_____ Na+ excretion)
______ Ca2+ excretion
Good if you have hypercalcemia
normally 30% of filtered Na arrives at loop, and 0.5% is excreted -> Loop diuretics can increase fractional Na excretion to ____%. Enormous amount of salt and water can be excreted with loop diuretics. |
|
Definition
decrease
increases
increases
25 |
|
|
Term
| With Loop Diuretics, The increase in Na delivery to the ____ causes an increase in the exchange of Na for secretion of ___ & ____ . So need to monitor for ___ loss, ___ not as impt. |
|
Definition
Collecting Duct
K+ and H+
K+
H+ |
|
|
Term
LASIX – Desired effects (remember these!)
Effective ___ & ___ diuresis
- Good for volume overload
Increases urinary _____ excretion
- Used to treat hypercalcemia (Malignancy,
Hyperparathyroidism)
Increases urinary excretion of ______
- Used to treat acute hyperkalemia |
|
Definition
rapid and long term
calcium
potassium |
|
|
Term
| Ace inhibitors & arbs, cause K+ retention, sometimes _____ diuretics are good to use in adjunct to excrete excess K+ |
|
Definition
|
|
Term
Loop diuretics, particularly furosemide, acutely increase systemic venous capacitance (_______)
Requires _____ kidneys
Prostaglandin mediation -> Blocked by prostaglandin synthesis inhibitors (____) or by ____ of the kidneys.
_____ reduce the effect of loops |
|
Definition
vasodilate
intact
NSAIDs
removal
NSAIDs |
|
|
Term
Loop Diuretics Decrease ___ ventricular filling pressure (by reducing fluid volume)
Useful in _________
Happens before significant diuresis begins due to decrease in pulmomary vascular ________ |
|
Definition
left
pulmonary edema
resistance |
|
|
Term
| Elevated plasma Ca++ is often due to ____ or ____, which must be Tx surgically. ___ diuretics can be used as a temporary measure to reduce hypercalcemia. |
|
Definition
hyperparathyroidism
malignancy
Loop |
|
|
Term
| _____ diuretics are used for HTN cases that are not responsive to thiazides (e.g, HTN in the presence of chronic renal failure). However, not a first or even second line use for HTN |
|
Definition
|
|
Term
| Hyperkalemia results in ____ of resting membrane potentials i.e. loss of resting membrane potential (cardiac problems). Use ____ diuretics to reduce hyperkalemia. |
|
Definition
|
|
Term
Diuretics - Loop: Adverse Effects:
Effective rapid and long term diuresis -> Sometimes volume depletion can occur = _____ effect |
|
Definition
|
|
Term
Diuretics - Loop: Adverse Effects:
Increases urinary calcium excretion -> May cause calcium based ____ |
|
Definition
|
|
Term
Diuretics - Loop: Adverse Effects:
Increases urinary excretion of potassium and hydrogen ions -> May cause _____ depletion |
|
Definition
|
|
Term
Diuretics - Loop: Adverse Effects:
Excretion of Mg+ -> may cause ____ |
|
Definition
|
|
Term
Diuretics - Loop: Adverse Effects:
ototoxicity (usually reversible -- watch out for patients also taking ________ antibiotics) |
|
Definition
|
|
Term
Diuretics - Loop: Adverse Effects:
CNS: (3)
GI: (3) |
|
Definition
dizziness
headache
tinnitus
nausea
vomiting
diarrhea |
|
|
Term
Diuretics - Loop: Drug interactions:
Aminoglycosides -> may result in ______ |
|
Definition
|
|
Term
Diuretics - Loop: Drug interactions:
Digitalis (digoxin/digitoxin) -> Enhanced efficacy of digitalis (mechanism related to hypokalemia) – enhanced likelihood of _______ |
|
Definition
|
|
Term
Diuretics - Loop: Drug interactions:
Protein binding –> Competes with agents such as warfarin, sulfonylureas (DMII) -> So need to monitor _____ |
|
Definition
|
|
Term
Diuretics - Loop: Drug interactions:
Li (used in treating bipolar disorder)-> ___ is preferentially excreted |
|
Definition
|
|
Term
Diuretics - Loop: Drug interactions:
NSAIDs (e.g., aspirin, ibuprofen)
______ diuretic response
______ effect on treatment of pulmonary edema |
|
Definition
|
|
Term
Diuretics - Loop: Drug interactions:
Thiazides = Diuretic synergism – this is sometimes useful but be careful – watch for ____ |
|
Definition
|
|
Term
Bioavailabity of furosemide ranges from a maximum of 80% to less than 50% in conditions such as ____ volume retention. Ex. Absorbtion rate goes down when you have _____ -> this contradicts what lasix is used for
Thus when the diuretic actions of furosemide are most needed, these same actions may be limited due to reduced bioavailability. |
|
Definition
|
|
Term
| Bioavailabiltiy of furosemide is more _____ compared to torsemide & bumetanide |
|
Definition
|
|
Term
| Pts w/ heart failure should use ____ or ____ loop diuretics -> something about fluid retention b/c absorption is not as inhibited |
|
Definition
|
|
Term
torsemide (Demedex)
Torsemide is better absorbed from the gut with an __% bioavailability and this absorption is neither significantly impaired during abdominal fluid retention nor influenced by intersubject variation.
Due to the potency of torsemide close evaluation of the ____ & ___ will need to be examined. |
|
Definition
80
potassium and creatinine |
|
|
Term
bumetanide (Bumex)
Use when high doses of furosemide are ineffective in ____.
Bumetanide is better absorbed (__% PO bioavailability) than furosemide, and conconmittant food intake does not significantly impair the absorption. |
|
Definition
|
|
Term
Thiazides – ________ structure
All of them can be given ____(daily treatment, long treatment)
Different t1/2, hydrochlorothiazide (__h) others (>24h) |
|
Definition
|
|
Term
| Thiazides are secreted actively by tubular secretion and act in the ____ convoluted tubule |
|
Definition
|
|
Term
| Thiazides Inhibit the ___-___ Symporter of the distal tubule which results in more ___ in lumen = more water volume excreted |
|
Definition
|
|
Term
___ & ____ = “thiazide-like”
These agents work at the same site as thiazides but have different structures. When loop diuretics fail, these agents may serve as a adjunct with the loop diuretic to produce diuresis. |
|
Definition
|
|
Term
Thiazide Renal effects:
Inhibition of ___ reabsorption in the distal tubule – resulting in decreased ___ retention and intravascular volume
natriuretic and diuretic effects are less pronounced than those of ____ diuretics!!!
increased Ca2+ __________ |
|
Definition
|
|
Term
Thiazide Extrarenal effects:
Decrease ____ = decreasing fluid volume in heart
Decrease ____ = decreased arteriolar vascular resistance
After few weeks (2-3) the ____ gradually decreases |
|
Definition
preload
Afterload
PVR (pulmonary vascular resistance) |
|
|
Term
Thiazides: Uses
1. Hypertension
(___-___ mm Hg maximum fall in arterial blood pressure)
reduces blood volume (volume returns to near normal over 6-8 weeks, but ______ effect remains)
May be due to vascular resistance rather than ___ changes
reduces vascular resistance by relaxation of arterioles (Na+ increases vessel ____, so reducing Na+ relaxes arterioles)
reduces responsiveness of arterioles to ___ (also because of lower Na+) |
|
Definition
10-15
antihypertensive
fluid
stiffness
NE |
|
|
Term
Thiazides: Uses
2. Diabetes Insipidus – nephrogenic
Vasopressin (ADH) disease. Impaired conservation of water -- excrete large volumes of dilute urine (5-10 L/day)
Generally controlled with vasopressin replacement
Thiazides decrease urine output by about ___% in these patients
Mechanism??? Not known |
|
Definition
|
|
Term
Thiazides: Uses
3. ______ edematous states
ex. cyclic edema of menstrual periods |
|
Definition
|
|
Term
Thiazides: Uses
4. To tx Hypercalciuria
Thiazides decrease intracellular Na+
Decreased intracellular Na+ allows greater Na-Ca exchange bringing more Na back into the ___ which exchanges with Ca –taking Ca out of the ___ and into the ___.
Although thiazides rarely cause hypercalcemia they can unmask hypercalcemia due to other causes such as cancer, saroidosis and hyperparathyroidism. |
|
Definition
|
|
Term
Thiazides: Adverse Effects
______ (esp watch with _____)
Na+K+ exchange -> K+ back into lumen |
|
Definition
|
|
Term
Thiazides: Adverse Effects
Hyponatremia with hypovolemia
Hyponatremia = low ___ -> need to check if pt is on a ___ if have low Na+. |
|
Definition
|
|
Term
Thiazides: Adverse Effects
_________ (decreases insulin secretion -- may unmask latent diabetes mellitus)
Usually clinically important only at ____ dose.
Usually reversible with correction of ________ |
|
Definition
Hyperglycemia
high
hypokalemia |
|
|
Term
Thiazides: Adverse Effects
_____ dysfunction
Frequency is even greater than with ___ |
|
Definition
|
|
Term
Thiazides: Adverse Effects
Increased serum _______ – usually clinically important only at high dose |
|
Definition
|
|
Term
Thiazides: Drugs interactions
Lithium – why? |
|
Definition
| Thiazides cause diuresis and sodium loss. Compensatory sodium retention in proximal tubules. Proximal tubules do not distinguish sodium from lithium. Thus, lithium may be retained and accumulates. So be careful with bipolar pts. |
|
|
Term
Thiazides: Drugs interactions
digoxin – check ___ levels |
|
Definition
|
|
Term
Thiazides: Drugs interactions
oral drugs used for _________
(decreases insulin secretion) |
|
Definition
|
|
Term
Loop & Thiazide Comparison:
Concentration/Dilution of Urine |
|
Definition
Loop:
Impairs both; greater free water excretion
> Free water + > fluid loss
Thiazide:
Impairs dilution only; more prone to ↓Na |
|
|
Term
Loop & Thiazide Comparison:
Potassium |
|
Definition
Loops:
Greater kaliuretic effect; better for Tx of ↑Kplasma
Thiazides:
Less kaliuresis |
|
|
Term
| Low dose thiazide first line tx for HTN = __mg PO daily * know this for exam |
|
Definition
|
|
Term
Loop & Thiazide Comparison:
Calcium |
|
Definition
Loops:
Increases Ca excretion; better for Tx of ↑Ca
Thiazide:
don't worry about |
|
|
Term
Loop & Thiazide Comparison:
Special Advantages |
|
Definition
Loops:
Better in renal failure; Relieves resp distress
Thiazides:
Inexpensive; First line agent for HTN |
|
|
Term
Order of the Layers of the Adrenal Cortex from most superficial -> deepest... remember "GFR"
What is secreted from each layer? remember "salt sugar sex" |
|
Definition
zona glomerulosa
zona fasciculata
zona reticularis
mineralocorticoids (e.g., aldosterone)
glucocorticoids (e.g., cortisol)
weak androgens (e.g., dehydroepiandrosterone, adrenosterone) |
|
|
Term
| Potassium Sparing Diuretics - Na Channel blocker work in the ____ of the kidney |
|
Definition
|
|
Term
| Potassium Sparing Diuretics - Aldosterone Antagonists work in the _____ of the kidney |
|
Definition
|
|
Term
| Spiranolactone – Mechanism: competes for the ___ receptor |
|
Definition
|
|
Term
| Spiranolactone Pharmacokinetics: Can take between 10-48 hours to start working. Why such a slow onset? |
|
Definition
| b/c steroids have to block DNA synthesis & have to let all the pumps die off |
|
|
Term
Diuretics – Potassium Sparing Uses
Not very efficacious as diuretics by themselves at least at normally used doses. By this point (collecting duct) in the transit of ___ in the kidney, there isn’t very much left |
|
Definition
|
|
Term
Diuretics – Potassium Sparing Uses
Used to prevent ___ loss
Counteract this side-effect of ___ & _____
_________ syndromes (rare occurrence) |
|
Definition
K+
thiazides & loops
Hyperaldosteronism |
|
|
Term
| When you use aldosterone as pure diuretic? |
|
Definition
| During liver failure (cirrhosis) |
|
|
Term
Diuretics – Potassium Sparing Uses
There are ______ receptors in the heart as well
Local production of ______ in the heart is proportional to degree of heart failure
____ may stimulate cardiac fibrosis and hypertrophy (Bad)
____ & ______ have been shown to be useful in the long term management of heart failure. (we’ll discuss more in the CVS lectures) |
|
Definition
mineralocorticoid
aldosterone
Aldosterone
Spironolactone & eplerenone |
|
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Term
Diuretics – Potassium Sparing Uses
Despite being a relatively weak diuretic effects, aldosterone antagonists have a greater effect in cirrhotic patients than does _____.
Cirrhotic patients have a poor response to furosemide due to reduced ________.
Aldosterone antagonists do not require secretion into the tubular lumen, and thus may remain effective despite marginal renal perfusion in the context of ________. |
|
Definition
furosemide
tubular secretion
cirrhosis |
|
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Term
Diuretics – Potassium Sparing Uses (Na Channel Blockers)
Amiloride, triamterene
Spare potassium by _____ the lumen-negative gradient that drives the expulsion of K/H into the lumen |
|
Definition
|
|
Term
Spiranolactone Adverse Effects:
_______(esp. with ACE inhibitors, NSAIDs)
Most common when co-administered with K+ supplement or patients that eat too much K+ rich food.
_____ effect (steroid structure leads to competitive inhibition of androgen receptors)
gynecomastia; impotence |
|
Definition
Hyperkalemia
Anti-androgen |
|
|
Term
Eplerenone Adverse Effects:
Intended in development to be an aldosterone antagonist with no antiandrogen effects
Side-effect profile shows some ______
Consequently, little different from spironolactone
Approved for post-MI ___ |
|
Definition
|
|
Term
| Amiloride & triampterene Adverse Effects: (4) |
|
Definition
G.I. (nausea, vomiting)
Dizziness
Leg cramps
Nephrolithiasis (triamterene) |
|
|
Term
Vasopressin antagonists (Aquaretics)
Drugs: (3)
Therapeutic Uses:
___________ due to dilution (e.g., as in SIADH) – serum inappropriate ADH release – seen in certain forms of cancer |
|
Definition
Conivaptan
Demeclocycline
Lithium
Hyponatremia |
|
|
Term
Synthetic Vasopressin agonists
Drugs: (1)
Therapeutic Uses: _________
Comes in form of Nasal spray or subQ
Adverse effects – _________(“water intoxication”) |
|
Definition
Desmopressin (DDAVP)
Central diabetes insipidus
hyponatremia |
|
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