Diuretics

Question 1

What is the general aim of any diuretic

Answer 1

To diminish sodium reabsorption at different point in the nephron
Increase urinary sodium and water loss

Question 2

At which point in the loop of Henle is there the highest concentration

Answer 2

The bottom of the loop

Question 3

What is the overall aim of the counter-current mechanism in the loop of Henle

Answer 3

To create an electrical gradient

Question 4

What is reabsorbed in the proximal tubule

Answer 4

glucose, aa, phosphate

Question 5

What moves out of the descending limb of the loop of henle

Answer 5

water

Question 6

What moves into the ascending limb of the loop of henle

Answer 6

potassium

hydrogen Nh3

Question 7

Name the 5 classes of diuretic

Answer 7

• Carbonic anhydrase inhibitors
• Loop
• Thiazide
• Potassium sparing diuretics
• Osmotic diuretics

Question 8

Name a type of carbonic anhydrase diuretic

Answer 8

Acetazolamide

Question 9

Where do CA diuretics work

Answer 9

Proximal convuluted tubule

Question 10

Usual role of carbonic anhydrase enzyme

Answer 10

• Converts H2C03 to H20 and CO2 in the lumen

- Converts CO2 and H20 into H2CO3 in the pct

Question 11

How do carbonic anhydrase inhibitors work as diuretics

Answer 11

Inhibits transport of bicarbonate out of the proximal convuluted tubule into the interstitium
Leads to less sodium reabsorption and therefore greater sodium bicarbonate and water loss in the urine

Question 12

What are the real life main uses of acetazolamide

Answer 12

• Glaucoma
• Epilepsy
• Mountain Sickness

Question 13

What are the side effects of carbonic anhydrase inhibitors

Answer 13

• Metabolic acidosis
• Sedation
• Bone marrow suppresion

Question 14

Name 2 loop diuretics

Answer 14

Fresemide

Bumetanide

Question 15

Where do loop diuretics work

Answer 15

Ascending limb of loop of henle

Question 16

Which transporter does the loop diuretic block

Answer 16

Na+/ K+/ 2cl- sympoter

Question 17

How do loop diuretics work

Answer 17

• Block Na+/ K+/ 2Cl- sympoter
• Inhibits uptake of these
• Loop diuretics also inhibit potassium and calcium uptake because their uptake is reliant on charge
• Prevents loop from becoming hypertonic so reduces osmotic charge
• Increased urine production

Question 18

What is excreted in loop diuretics

Answer 18

Potassium, sodium, water, magenesium

Question 19

What are some indications for loop diuretics

Answer 19

Hypertension
Heart failure
Volume overload from CKD

Question 20

Side effects of loop diuretics

Answer 20

Hypokalaemia
Dehydration
Kidney stones
Deafness

Question 21

Name 2 thiazide diuretics

Answer 21

Bendroflumethiazide

Hydrochlorothiazide

Question 22

Where do thiazide diuretics work

Answer 22

Blocks Na+/Cl- transporter in distal convuluted tubule

Question 23

Main uses for thiazide

Answer 23

Antihypertensive

Reduces plasma volume and peripheral resistance

Question 24

Side effects of thiazide diuretics

Answer 24

Hypokalaemia
Hypocalcaemia
Hyponatraemia
Hyperglycaemia
Hypercholsteroaemia

Question 25

2 types of potassium sparing diuretics

Answer 25

Epithelial Na channel antagonists | Aldosterone antagonists

Question 26

Name 2 epithelial sodium channel antagonists

Answer 26

Amiloride | Triamterene

Question 27

Name 2 aldosterone antagonists

Answer 27

Spironolactone | Eplerenone

Question 28

What does amiloride target

Answer 28

Na+ channel in the collecting tubule | By blocking transport, more sodium is excreted by spares potassium loss

Question 29

Indications to use amiloride

Answer 29

Heart failure Hypokalaemia from other diuretics Cirrhosis

Question 30

Side effects of amiloride

Answer 30

Hyperkalaemia | Hyponatraemia

Question 31

Indications to use aldosterone blockers

Answer 31

Hyperaldosteronism Heart failure Hypokalaemia Cirrhosis

Question 32

Side effects of aldosterone blockers

Answer 32

Hyperkalaemia Glynecomastia Hyponatraemia

Question 33

Define osmotic diuretic

Answer 33

Any osmotically active molecule that is freely filtered from the glomerulus and not reabsorbed by the tubules

Question 34

Name an osmotic diuretic

Answer 34

Mannitol

Question 35

Clinical indications for using osmotic diuretic

Answer 35

Cerebral oedema | Oliguric acute renal failure

Question 36

Side effects of osmotic diuretics

Answer 36

Transient fluid overload | Pulmonary oedema

Question 37

When should you not use any diuretic

Answer 37

Hypotension Dehydration POST SURGERY

Question 38

When should you not use loop/ thiazide diuretics

Answer 38

When hypokalaemic

Question 39

When should you not use amiloride/ aldosterone antagonists

Answer 39

When hyperkalaemic