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19. Diuretics (19)
Terms in this set (39)
Potassium sparing diuretics (aldosterone antagonist)
-Spironlactone (big one)
Carbonic anhydrase inhibitors
Diuretics promote the excretion of H2O and _____
Indications for diuretics
-Chronic, cyclic edema
-Na+ retention induced by other drugs
-Congestive HF or CHF
-Chronic renal failure
-Hypercalcemia or hypercalciuria
-Various drug overdoses
Sympathetic neurons synapse on smooth muscle and granular cells, what does this cause?
What are the three pathways of renin management?
1. Macula densa cells in the distal convoluted tubule inhibit renin release if they sense increased sodium chloride. Macula densa cells in the distal convoluted tubule stimulate renin release if they sense decreased sodium chloride
2. Blood pressure - If the blood pressure is elevated, renin is decreased, if the blood pressure falls, renin is increased.
3. Beta-adrenergic receptors - Norepinephrine binds to Beta 1, causing renin release
Where does angiotensin come from, where does it combine with renin?
-From the liver, they meet in the vasculature
Angiotensin 1 is inactive until it combines with angiotensin converting enzyme (ACE), where does ACE reside?
-On the surface of endothelial cells in the vasculature
a) Renin is an Enzyme Secreted from the Granular Cells of the Juxtaglomerular Apparatus
b) Renin Reacts with a Plasma Protein (Angiotensinogen) and the Product is Angiotensin I
c) Angiotensin I reacts with Angiotensin Converting Enzyme (ACE) and the Product is Angiotensin II
d) Effect of Angiotensin II
1] Very Potent Vasoconstrictor (Smooth muscle)
2] Stimulates the release of aldosterone (Na and water reabsorption)
What goes out of the glomerulus and into bowman's capsule?
-What percentages of each substance is reabsorbed?
What is the order in which water and sodium is filtered, from most to least?
1. Proximal tubule
2. Loop of Henle
3. Distal tubule
4. Collecting duct
How do carbonic anhydrase inhibitors work?
-Inhibit formation of H+ and HCO3- from CO2 and H20, resulting in diminished reabsorption of HCO3- and Na+
These drugs are seldom used as diuretics, they are used for alkalization of the urine in drug overdose and mountain sickness
-Carbonic anhydrase inhibitors (Acetazolamide)
Adverse effects of Acetazolamide
-Hyperchloremic metabolic acidosis
How do loop diuretics work?
-They inhibit the cotransport of sodium, potassium, and chloride in the thick ascending limb
Where do loop diuretics work?
The thick ascending limb of the loop of Henle (TAL)
-Which is the most common loop diuretic?
-Which are the more potent loop diuretics?
-Bumetanide and torsemide (potent)
Uses of loop diuretics
-Cardiac (MI, CHF)
-Hypercalcemia (with a saline infusion)
-Hypertension (severe cases)
Side-effects of loop diuretics
-Hypovolemia and hypotension
Loop diuretics can have cross reactivity to _____, which specific diuretic has shown fewer problems with this?
This diuretic has a slow onset and is long lasting, but is less efficacious than loop diuretics
Where do thiazides work?
Distal convoluted tubule (DCT)
Which diuretic would probably be used for hypertension?
How do thiazides work on hypertension?
-Reduce blood volume (returns to normal over 6-8 weeks, but antihypertensive effect remains)
-Reduce vascular resistance by relaxation of arterioles (Na+ increases vessel stiffness)
-Reduce responsiveness of arterioles to NE (because of lower Na+)
Which diuretic is used in nephrogenic diabetes insipitus?
How do thiazides work on diabetes insipitus?
-Work similar to vasopressin
How does vasopressin work on diabetes insipitus?
-Work similar to antidiuretic hormone (ADH)
-_____ diabetes insipitus involves impaired release of ADH
-_____ diabetes insipitus involves impaired renal response to ADH
Side effects of thiazides
How do K+ sparing diuretics work?
-Spironolactone and eplerenone are aldosterone antagonists
-Triameterene and Amiloride inhibit Na+ transport in distal tubules
Where do K+ sparing diuretics work?
-Cortical collecting tubule (CCT)
Uses of K+ sparing diuretics
-Polycystic ovary syndrome
Side effects of spironolactone
-Anti-androgen effect (gynecomastia, impotence)
Side effects of triamterene/Amiloride
-Increases uric acid
How does mannitol work?
Mannitol is freely filtered at the glomerulus but poorly reabsorbed from the tubule, they remain in the lumen and hold water by virtue of their osmotic effect
Where does mannitol work?
Mannitol works primarily on the proximal convoluted tubule
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