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Which diuretic blocks carbonic anhydrase thereby increases Na and HCO3 excretion?
acetazolamide
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Which diuretic is an osmotic diuretic meaning it increases water excretion?
Mannitol
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Which diuretic blocks sodium potassium chloride cotransporter thereby increase Na, K and Cl excretion?
loop diuretics
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Which diuretic blocks sodium chloride transporter thereby increase NaCl excretion?
thiazide
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Which diuretic antagonizes aldosterone receptor thereby increasing Na excretion and K retention?
Aldosterone antagonists (MRA)
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Acetazolamide has action on which part of the nephron?
Proximal tubule
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What is the MOA of acetazolamide?
Inhibit carbonic anhydrase on the apical membrane and inside the cell
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True/false: acetazolamide is often used for glaucoma because it increases aqueous humor
True
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What are adverse effects of acetazolamide?
- Hyperchloremic metabolic acidosis
- Renal stones
- Renal potassium wasting
- Hypersensitivity
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What are contraindications for acetazolamide?
- cirrhosis
- Hypersensitivity to sulfa drugs
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Where does sodium glucose transporters 2 inhibitors act on?
- Proximal tubule
- On the Na+/glucose transporters on the apical membrane
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What is an agent of sodium glucose transporters 2 inhibitor?
Dapagliflozin
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What is the MOA of mannitol?
Increase osmolality
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Where does mannitol act?
Areas of nephron permissible to water
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What is the route of administration for mannitol?
Parenteral (injections) usually used in emergent settings
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What are the therapeutic use of mannitol?
Increase urine volume, reduction of intracranial and intra ocular pressure
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What are adverse effects of mannitol?
Fluid electrolyte disturbances
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What is an agent of loop diuretic?
Furosemide
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What is the MOA of furosemide?
Selectively block Na/K/2Cl transporter in the apical membrane of ascending loop
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Which is the most effective diuretic?
Loop diuretics
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What are adverse effect of furosemide?
- ototoxicity
- Hypokalemia, metabolic alkalosis
- Hyperuricemia
- Hypomagnesemia
- Hypersensitivity to sulfa drugs
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True/false: loop diuretics decreases prostaglandin
False; increase in prostaglandin with loop diuretics
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What is the phenomenon called when there is a decreased in salt excretion with prolonged diuretics use?
The braking phenomenon
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Where do thiazides act?
Distal convoluted tubules, apical membrane
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What is the MOA of thiazide?
Blocks Na/Cl transporter on the apical membrane
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What does thiazide do to the calcium level in the blood?
Increases the reabsorption of calcium
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True/false: thiazide often lead to kidney stones because of excretion of calcium
False; thiazide increase the reabsorption of calcium, so it PREVENTS kidney stones
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What are adverse effects with thiazides?
- hyperglycemia
- Hypokalemia, metabolic alkalosis
- Hyponatremia
- Hyperlipidemia
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Where does potassium sparing diuretic act on?
Collecting tubule
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What is an agent of potassium sparking diuretic?
- Spironolactone
- triamterene
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What is the MOA of spironolactone?
Competitive antagonist of aldosterone from binding to mineralcorticoid receptor on the basolateral membrane, so aldosterone could not reabsorb Na+
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What are adverse effects of spironolactone?
- Gynecomastia
- Hyperkalemia
- Hyperchloremic metabolic acidosis
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What is the MOA of triamterene?
Blocks Na+ channels on the apical membrane so Na+ could not be reabsorbed
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What are adverse effects of triamterene?
- Hyperkalemia
- Kidney stones
- Hyperchloremic metabolic acidosis
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Which drugs have direct effect in blocking Na+ channels?
- Aldosterone antagonists
- Triamterene
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Which drug bloacks sodium and bicarbonate reabsorption?
Acetazolamide
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Which drug blocks the NKCC2 symport?
Furosemide
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Which drug blocks NaCl symport?
thiazide
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