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What is the Diuretic that causes the most ototoxicity?
Ethracrynic acid
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What are Some Uses of the High Ceiling (Na/K/2Cl) inhibitors?
- Edema
- Acute pulmonary edema
- Forced diuresis
- Hypertesion
- Hypercalcemia
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Inhibitors of NaCl symport
where is this Primary site of action?
what can these cause secondarily?
- Chorothiazide
- Chlorthalidone
- Metazolone
- Indapamide
- - DCT
- -Na exchanged with K and H in the CT--> hypokalcemia and alkalosis
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What do the Na/Cl symport inhibitors cause?
- increase Ca retension (blood levels)
- increase blood sugar and uric acid levels
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What diuretics that are active in Renal faliure?
- Furosimides---Increases GFR
- Metalozone
- Indapamide
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What are Thizides used for?
- Edema
- Hypertension---Long acting
- Renal Stones------ increase Ca reabsorption
- Nephrogenic Diabetis insipidus (non-lithium induced)
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What is Thiazides effect on GFR?
Na absorption?
At first, decreases NaCl absorption--> increase in Urine production.
- As a result there is a reflex: it decreases GFR-->Increases Na/Cl aborption in the PT-->
- H2O absorption--> less urine produced.
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What are the adverse effects of Loop/ Thiazide diuretics?
- Hypokalcemia
- Hyperuricemia
- Hearing loss
- Hyperglycemia
- Hypercalcemia- Thiazides
- Hypocalcemia- Furosimide
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What will occur if Carbonic Anhydrase is inhibited?
- HCO3 is excreted--> Metabolic acidosis
- Inhibit H+ secretion--> decreased Na absorption.
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Name the Carbonic Anhydrase inhibtor
What are its net effects?
Acetazolamid
- inhibition of HCO3 absorption in the PT
- this inhibits H+ secretion
Urine is rich in Bicarb (alkalytic)--> leading to metabolic acidosis
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What are some uses of Carbonic Inhibitors?
What are their toxicities
- Glaucoma
- To alkalize urine (Stones calcify in acidic urine)
- Epipepsy
- Acute Mountain sickness
- __________________________
Acidosis, hypokalcemia
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What are some of the EXTRA-RENAL actions of Acetazolimide?
-Decrease in intra-ocular pressure by decreasing aquious humor production
- -Decreased gastric acid secretion
- raised levels of CO2 (acidosis) and lowering of pH.
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What is spironolactone?
What is this drug indicated in?
It is an Aldosterone antagonist (Potassium sparing)
- Indicated in instanses of hyperaldosterone (cirrhosis, Heart failure)
- * it decreases mortality in HF
Has Anti-androgen effects (impotence and gynacomastia)
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Amiloride and Trimterene
- -Na channel inhibitor DT and CD
- -Similar to Spironolactone
- -Used in conjuction with thiazides and Loop diuretics
-Causes Hyperkalcemia when used with ace inhibitors
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Amilioride verse Triamterene
As an arosol, what will happen?
- Amiloride is 10X more potent
- It decreased calcium and magnesium excretion
- Blocks entry of Lithium into renal cells (prevents its toxicity)
Sympathetic improvement in Cystic fibrosis by increasing fluidity and respiratory secretions.
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What is Mannatol?
What is its Primary action?
How is it absorbed?
- -It is an osmotic diuretic
- -No metabolized, filtered in the glomerulus
- -Expands extracellular fluid and increases GFR
- -Primary action is to increase urinary volume
- -It is Not absorbed orally, given IV.
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What are the Uses of Mannatol?
To maintain GFR and urine flow in RF
To reduce elevated intracranial tension and intraocular tension
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What are the DRUGS ENHANCING ACTION OF VASOPRESSIN?
- • NSAIDS
- • Carbamazepine
- • Chlorpropamide
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What are the DRUGS INHIBITING ACTION OF VASOPRESSIN?
- • Demeclocycline
- • Lithium
- • Conivaptin is a v2 antagonist
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What are some drugs for CENTRAL diabetes insipidis?
Drugs for NEPHROGENIC DIABETES INSPIDUS?
- -Desmopressin
- •Chlorpropamide
- •Carbamazepine
- _____________________________
- -Adequate intake of H2O
- •Amiloride (for Li+ induced)
- •Thiazides (for non-Li+ induced)
- •Indomethacin
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