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Pharmacology - Winter > 3 - Diuretics > Flashcards

3 - Diuretics Flashcards

1
Q

Which drugs are thiazide diuretics?

A
  • Hydrochlorothiazide
  • Chlorthalidone
  • Metolazone
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2
Q

Which drug are loop diuretics?

A
  • Furosemide

- Ethacynic acid

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3
Q

Which drug is a potassium sparing diuretic?

A

Spironolactone

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4
Q

What is the aim of therapy w/ diuretics?

A

Decrease sodium reabsorption by a few %

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5
Q

What would happen if Na reabsorption drops to 95%?

A

1250 mmol/day of Na is excreted, so 9 litres of extracellular fluid is lost

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6
Q

What are the functions of the proximal tubule and which drug works against each function?

A
  • Reabsorbs filtrate water and electrolytes (mannitol, unreabsorbed glucose)
  • 100% of glucose reabsorbed (dapaglifozin)
  • 85% of bicarbonate reabsorbed (acetazolamide)
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7
Q

What is the function of the ascending loop of Henle and which drug works against this function?

A
  • Na, K, Cl co-transported and Ca and Mg follow (reabsorbed)

- Furosemide

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8
Q

What is the function of the distal tubule and which drug works against this function?

A
  • Na/Cl reabsorbed, calcium excreted

- Metolazone

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9
Q

Is water reabsorbed in the ascending loop of Henle?

A

No

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10
Q

Is water reabsorbed in the distal tubule?

A

No

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11
Q

What are the function of the collecting ducts and which drugs work against these functions?

A
  • Aldosterone increase Na reabsorption and increases K and H excretion (spironolactone)
  • ADH (vasopressin) increases water permeability and reabsorption (conivaptan)
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12
Q

Where do thiazide diuretics work?

A
  • Distal tubule to increase NaCl excretion and decrease Ca excretion
  • Some proximal tubule affect (only important when combined w/ loop diuretics)
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13
Q

What are the uses of thiazide diuretics?

A
  • Edema (heart failure, liver cirrhosis)

- Hypertension

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14
Q

What are some disadvantages to thiazide diuretics?

A
  • Increases incidence of other risk factors for CV disease (hyperglycemia, increase LDL levels)
  • Increases incidence of erectile dysfunction
  • Plasma volume contraction due to increased volume loss
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15
Q

What are advantages to thiazide diuretics?

A
  • Orally active
  • Low toxicity
  • No postural hypotension
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16
Q

How are loop diuretics administered?

A

Orally and IV

17
Q

What are the functions of loop diuretics?

A
  • Increase prostaglandin production in nephron
  • Increases Na, Cl, and K excretion and Mg, Ca follow (excreted)
  • Inhibits renal diluting ability and abolishes renal concentrating ability (urine becomes isotonic and slightly dilute)
18
Q

____ may decrease function of loop and thiazide diuretics

A

NSAIDs

19
Q

What are some problems w/ loop diuretics?

A
  • Deafness

- Chronic dilutional hyponatremia

20
Q

What should loop diuretics never be combined w/?

A

Aminoglycoside antibiotics

21
Q

What are loop diuretics used for?

A
  • Renal insufficiency
  • Edema (pulmonary)
  • Hypertension (not as sole medication)
  • Hypercalcemia
  • Heart failure
22
Q

What should be done if px not responding to a loop diuretic?

A
  • Caution regarding circulating chloride concentration

- Add thiazide diuretic

23
Q

Thiazide and/or loop diuretics can cause _____ depletion

A

Potassium

24
Q

When is potassium depletion a concern w/ thiazide and loop diuretics?

A

If low potassium is already a problem (ex: heart failure, cirrhosis)

25
Q

What are the 2 main causes of potassium depletion from thiazide and loop diuretics?

A

1) Secondary hyperaldosteronism (increased renin = increased A2 = increased aldosterone => Na reabsorption and K loss)
2) Increased distal delivery (Na reabsorption inhibited in loop and distal tubule, so collecting tubules increase Na reabsorption)

26
Q

What is the tx for potassium depletion?

A

1) Dietary intake (apricots, bananas)
2) Potassium chloride tablets
3) Emergencies = IV KCl
4) Potassium sparing diuretics (given w/ other diuretics to decrease K loss)

27
Q

Rank the 3 types of diuretics from strongest to weakest at removing sodium

A

Loop > thiazide > potassium sparing

28
Q

What are the functions of spironolactone?

A
  • Blocks aldosterone receptor

- Prevents cardiac remodelling, so may delay progression of heart failure

29
Q

What is the function of triamterene?

A

Decreases sodium permeability

30
Q

What effect do beta antagonists, ACE inhibitors, and ARBs have on plasma potassium concentrations?

A

May increase concentrations

31
Q

What can cause extracellular volume depletion? What are ways to overcome these?

A
  • Inability to concentrate urine/save water - drink more water to excrete solutes
  • Inability to dilute urine/excrete excess urine - ingest hypotonic solution to excrete isotonic urine
32
Q

What effect does furosemide have on extracellular volume depletion?

A

Makes the kidney unable to concentrate or dilute urine

33
Q

What effect do diuretics have on calcium?

A
  • Thiazides decrease calcium excretion (good for hypocalciuria)
  • Furosemide increases calcium excretion
34
Q

What effect do diuretics have on uric acid excretion?

A

Initially increased, but decreased w/ chronic administration

35
Q

What do diuretics have on lithium?

A

Increased proximal tubular reabsorption

36
Q

Which type of diuretic is preferred for tissue edema?

A

Loop diuretic

37
Q

What is the first line single therapy for hypertension?

A

Thiazide diuretic

38
Q

Why are diuretics used for heart failure?

A

Fluid retention increases vascular volume, and diuretics decrease vascular volume

Pharmacology - Winter (18 decks)

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