study_ing
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here's some common confusing qs
1 in the renal-pathology part, mannitol ,clinical use: shock, drug overdose etc. my q is since mannitol is diuretic drug, why it is used in shock??wouldnt it make the patients blood pressure lower??
2 hydrochlorothiazide clinical use : nephrogenic diabetes insipidus . from what i read in katzung, by using thiazidesor or loop diuretics
to reduce blood volume, then they will stimulus to proximal tubular
reabsorption. The proximal tubule thus substitutes--in part--for the deficient concentrating
function of the collecting .......so they actually work by , make the body more dehydration to force the proximal tubular works harder??????
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| study_ing
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mannitol is used if myoglobininuria is suspected. it wud reduce the renal damage ...but if the pt is hypotensive, i dont think its a good choice. ud resuscitate according to the clinical scenario.
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| study_ing
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2. is a commonly confusing problem. the exact mechanism is not known. i remember discussing it on the forum too..but the usual explanation was the one u gave.
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| study_ing
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3.ethacrynic acid : toxicity : similar to furosemide, can be used in hyperuricemia,acute gout (never used to treat gout) .( FA)
my q is since it is
Uricosuric diuretic , why not use to treat gout????
here is what is wrote in katzung : Uricosuric diuretic A diuretic that increases uric acid excretion, usually by inhibiting uric acid reabsorp-
tion in the proximal tubule. Example: ethacrynic acid
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| study_ing
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remember the choice of a drug in a given clinical situation depends on
1. efficacy
2. side effects
for acute gout--use NSAIDS ( but not aspirin )
and colcichine.
3. long term use allopurinol..but never acutely
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| study_ing
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diuretics esp loop anfd thiazide aozed hyperuricemia i think...hence if u had a pt with gout who needed a loop diuretic, u'd choose ethacrynic.
however its not the first line therapy..remember peeing every 15 minutes is hardly comfortable, so if uve got better options its better to use those.
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| study_ing
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probenecid i think wasa uricosuric agent too, but its now replaced by better drugs.
one problem with drugs that promote uric acid loss by inhibiting its reabsorption is that at low doses they may compete for its secretion. henc ethey r best avoided in acute phases.
im glad u r thinking stuff out and looking up answers!! i hope u get an amazing score 
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