Term
Carbonic anhydrase inhibitors
Prototype:
Acetazo-lamide (Diamox)
List Site of Action, Mechanism, Uses, and Side Effects |
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Definition
Site:
Proximal tubule (primary) & collecting duct (secondary). Also present in eye, CNS, & other extra-renal tissues
Mech:
Carbonic anhydrase is necessary for reabsorption of bicarbonate; in its absence, bicarbonate is excreted so it causes metabolic acidosis.
Uses:
This is a weak diuretic. It is used for treatment of glaucoma, reduction of intra-ocular pressure, correction of metabolic alkalosis, prevention of mountain sickness
Side Effects:
Acidosis
Hypersensitivity rxn
hypokalemia |
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Term
Osmotic diuretics
Prototype:
Mannitol
List Site of Action, Mechanism, Uses, and Side Effects |
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Definition
Site:
Late proximal tubule & descending loop of Henle
Mech:
Pharmacologically inert compounds that increase intraluminal osmolarity, osmotically drawing water into the lumen and decreasing intracellular volume while increasing circulating volume, RBF, & GFR
Uses:
Treatment of acute cerebral edema (by sucking up fluid) & acute renal failure/ tubular necrosis (by increased RBF)
Side Effects:
dehydration
hypokalemia |
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Term
Loop diuretics
Prototype:
Furosemide (Lasix)
List Site of Action, Mechanism, Uses, and Side Effects |
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Definition
Site:
Thick ascending loop of Henle NKCC, some extra-renal tissues (veins & ears)
Mech:
Inhibit the NaKCl2 (NKCC) co-transporter, directly blocking Na+, K+, and Cl- reabsorption (and weakly blocking carbonic anhydrase), and indirectly blocking Ca2+ and Mg2+ reabsorption (which rely up on the activity of the NKCC transporter for reabsorption)
Uses:
RAPID diuresis, treatment of volume-expanded states such as acute pulmonary edema and congestive heart failure with MI, treatment of hypertension (especially in chronic renal insufficiency), treatment of symptomatic hypercalcemia
Side Effects:
hypersensitivity rxn
hypokalemia
hypocalcemia and hypomagnesium
ototoxicity
hypercalciuria (--> stones)
metabolic alkalosis
destroy the conc gradient in the medulla |
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Term
Thiazide diuretics
Prototype:
----thiazides
List Site of Action, Mechanism, Uses, and Side Effects |
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Definition
Site:
Distal convoluted tubule - NaCl co transporter
Mech:
Inhibit the sodium-chlorine co-transporter, which normally functions to transport sodium and chlorine out of the lumen of the nephron. This leads to increased excretion of sodium and chlorine, which osmotically increases excretion of water as well and reduced sodium in cells causes increase in basolateral Na-Ca antiporter to increase Ca absorption
Uses:
Generally the first line treatment for HTN. This is a mild diuretic good for slow correction of BP.
Treatment of chronic hypertension and edema
Adjunct osteoporosis
Side Effects:
hyperglycemia
hypokalemia
hypersinsitivity
hypocalciuria
metabolic alkalosis |
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Term
Potassium-sparing diuretics
Prototype:
Triamteren (Dyrenium), amiloride (Midamor)
List Site of Action, Mechanism, Uses, and Side Effects |
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Definition
Site:
Collecting Duct ENaC
Mech:
Inhibit sodium channels in principal cells of the collecting ducts (ENaCs). Normally, sodium influx down the concentration gradient into the interstitium drives potassium excretion into the lumen; blockade of sodium channels promotes sodium excretion and potassium retention.
Uses:
Treatment of hypokalemia (incombination with other diuretics), augmentation of anti-hypertensive effects of other diuretics, treatment of cystic fibrosis
Side Effects:
hyperkalemia |
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Term
Potassium-sparing diuretics
Prototype:
Spirono-lactone (Aldactone)
List Site of Action, Mechanism, Uses, and Side Effects |
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Definition
Site:
Collecting Duct competative antagonist of aldosterone receptors (therefore less active ENaCs)
Mech:
Block aldosterone receptors (so you can’t open more ENaCs). Sodium absorption and postassium excretion are normally regulated by aldosterone, so these agents have the same net effects as the other types of potassium-sparing diuretics
Uses:
congestive heart failure in African Americans
Side Effects:
hyperkalemia |
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Term
List where each of the following act:
carbonic anhydrase inhibitors
furosemide (loop)
K sparing
thiazides
mannitol (osmotic) |
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Definition
Carbonic anhydrase inhibitors
---PCT
Mannitol (osmotic)
---descending LOH
Furosemide (loop)
---NKCC of TAL
Thiazide
---DCT at NaCl cotransporter
Potassium Sparing
---at CD ENaC |
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Term
| Treatment options for Benign prostatic hyperplasia |
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Definition
alpha-adrenergic blockers (terazosin, tamsulosin)
5-alpha reductase inhibitors (finasteride)
anti-cholinergics (decrease parasympathetic activity of squeezing bladder)
transurethral resection of the prostate (TURP) |
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Term
| Treatment options for Prostatic Carcinoma |
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Definition
Prostatectomy
Anti-androgen therapy
--Orchiectomy
--Estrogen but then hypercoagulable
--Leuprolide - analogs of GnRH
--Flutamide to inhibit the androgen receptor. |
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