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What is the Diuretic that causes the most ototoxicity?
What are Some Uses of the High Ceiling (Na/K/2Cl) inhibitors?
- Acute pulmonary edema
- Forced diuresis
Inhibitors of NaCl symport
where is this Primary site of action?
what can these cause secondarily?
- - DCT
- -Na exchanged with K and H in the CT--> hypokalcemia and alkalosis
What do the Na/Cl symport inhibitors cause?
- increase Ca retension (blood levels)
- increase blood sugar and uric acid levels
What diuretics that are active in Renal faliure?
- Furosimides---Increases GFR
What are Thizides used for?
- Hypertension---Long acting
- Renal Stones------ increase Ca reabsorption
- Nephrogenic Diabetis insipidus (non-lithium induced)
What is Thiazides effect on GFR?
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.
What are the adverse effects of Loop/ Thiazide diuretics?
- Hearing loss
- Hypercalcemia- Thiazides
- Hypocalcemia- Furosimide
What will occur if Carbonic Anhydrase is inhibited?
- HCO3 is excreted--> Metabolic acidosis
- Inhibit H+ secretion--> decreased Na absorption.
Name the Carbonic Anhydrase inhibtor
What are its net effects?
- inhibition of HCO3 absorption in the PT
- this inhibits H+ secretion
Urine is rich in Bicarb (alkalytic)--> leading to metabolic acidosis
What are some uses of Carbonic Inhibitors?
What are their toxicities
- To alkalize urine (Stones calcify in acidic urine)
- Acute Mountain sickness
- __________________________Acidosis, hypokalcemia
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.
What is spironolactone?
What is this drug indicated in?
It is an Aldosterone antagonist (Potassium sparing)
Has Anti-androgen effects
- Indicated in instanses of hyperaldosterone (cirrhosis, Heart failure)
- * it decreases mortality in HF
(impotence and gynacomastia)
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
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.
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.
What are the Uses of Mannatol?
To maintain GFR and urine flow in RF
To reduce elevated intracranial tension and intraocular tension
What are the DRUGS ENHANCING ACTION OF VASOPRESSIN?
- • NSAIDS
- • Carbamazepine
- • Chlorpropamide
What are the DRUGS INHIBITING ACTION OF VASOPRESSIN?
- • Demeclocycline
- • Lithium
- • Conivaptin is a v2 antagonist
What are some drugs for CENTRAL diabetes insipidis?
Drugs for NEPHROGENIC DIABETES INSPIDUS?
- -Adequate intake of H2O
- •Amiloride (for Li+ induced)
- •Thiazides (for non-Li+ induced)