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Kidney tubules
Proximal convoluted tubule, loop of Henle, distal convoluted tubule, collecting duct
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Name 5 factors that increase sodium excretion following lunch at Keifer's.
- 1) Decreased renal nerve activity- alpha 1 receptor stimulates proximal tubular reabsorption.
- 2) Decreased B1 stimulation of renin secretion- decreased renin, AII- inhibition of proximal reabsorption
- 3) Decreased AII-decreased Aldo, inhibition of distal tubular Na transport via ENac
- 4) Dilution of plasma protein concentration- increased GFR, icnreased renal interstitial pressure, inhibition of proximal reabsorption
- 5) Volume expansion, low pressure baroreflex inhibition of ADH
- 6) Alcohol- supresses ADH secretion- Inhibition of CD water reabsorption
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Elevated venous pressure and lowered protein production.
Cirrhosis of the liver
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A carbonic anhydrase inhibitor that inhibits the reabsorption of bicarb in the proximal convoluted tubule. Weak diuretic properties.
Acetazolamide
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Loop diuretics inhibit the Na/K/2Cl cotransport in the ascending loop of Henle, resulting in retention of Na, Cl, and water in the tubule.
Bumetanide, Furosemide, Torsemide, Ethacrynic Acid
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These drugs are the most efficacious of the diuretics.
Bumetanide, Furosemide, Torsemide, Ethacrynic Acid
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Inhibit reabsorption of Na and Cl in the distal convoluted tubule, resulting in retention of water in the tubule.
Thiazides
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Most commonly used diuretic for the tx of hypertension?
Thiazides
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An aldosterone antagonist that inhibits the aldosterone-mediated reabsorption of Na and secretion of K.
Spironolactone
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Two drugs that work on teh collecting tubule and duct to block Na channels.
Amiloride, triamterene
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Agents can prevent loss of K that occurs with thiazide or loop diuretics.
Spironolactone, amiloride, triamterene
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Act on the proximal convoluted tubule
Acetazolamide
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Act on the ascending loop of henle
Bumetanide, furosemide, torsemide, ethacrynic acid
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Act on the distal convoluted tubule
Thiazides
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Act on the collecting tubule and duct
Spironolactone, amiloride, triamterene
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Potassium-Sparing Diuretics
- (Please take a SEAT)
- Spironolactone
- Eplerenone
- Amiloride
- Triamterene
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Potassium-Sparing Diuretics
A steroid similar to aldostrone; antagonist effect
Spironolactone
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Potassium-Sparing Diuretics
Blocks the aldo receptor, more specific
Eplerenon
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Potassium-Sparing Diuretics
Similar in structure to folic acid, block ENaC
Triamterene
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Potassium-Sparing Diuretics
Directly blocks apical membrane ENAC channel in the principal cells of the collecting duct.
Amiloride
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Potassium-sparing diuretics work by
Blocking Na+ reabsorption in the CCD
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Hypokalemic effects of K-sparing diuretcs are due to a decrease in K+ secretion as Na/K exchange occurs in teh collecting duct. Blocking Na entry lowers transepithelial potential reducing driving force for K+ potential.
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When combined with other natriuresis from other diuretics, the K+ sparing effect is greatly ______
Increased
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Which K+-sparing diuretic has less sex steroid actions?
Eplerenone
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Which K+-sparing diuretic has an onset of action of 2-4 days with full effects not seen for weeks? it is metabolized in the liver.
Spironolactone
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Which K+-sparing diuretic has diuresis that begins within 2 hours and duration is 24 hours. It is not metabolized and is excreted intact.
Amiloride
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Prevent hyperkalemia when giving K+-sparing diuretcs by giving ____
Other diuretics (loop diuretics and thiazide)
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Which K+-sparing diuretic can cause gynecomastia, menstrual irregularities, antiandrogen effects?
Spironolactone
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Adverse effects of K+-sparing diuretics?
Hyperkalemia, metabolic acidosis (infrequent when used with loop and thiazide diuretics)
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Which thiazide is better for patients with chronic kidney disease?
Metolazone, Indapamide
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Name the Thiazide and Thiazide-like Diuretics
Hydrochlorothiazide, Chlorothiazide, Chloralidone, Indapamide, Metolazone
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Developed to preferentially increase Cl- excretion over HCO30 excretion.
Thiazide diuretics
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Why is the magnitude of effect of thiazide diuretics lower?
They work on the Distal Convoluted Tubule
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Decreases Ca excretion --> hypercalcemia --> reduce osteoporosis
Thiazide diuretics
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Synthesized to achieve inhibition of carbonic anhydrase
Sulfanamide derivatives
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Thiazide Diuretics are used to treat
- COCHRaN is on thiazides
- Congestive Heart Failure
- Osteoporosis
- Chronic renal failure
- Hypertension
- Renal calculi
- Nephrogenic diabetes insipidus
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