3. Diuretics Flashcards
The following drug is what kind of diuretic? (maintains urine flow, pull water from cells for excretion)
Mannitol
Osmotic diuretic
The following drug is what kind of diuretic? (urinary alkalinization, mountain sickness, glaucoma)
acetazolamide
Carbonic anhydrase inhibitor
The following drug are what kind of diuretic? (edema, HTN) amiloride triamterene spironolactone eplerenone
K+ sparing diuretics
The following drug are what kind of diuretic? (hyponatremia)
conivaptan
tolvaptan
Aquaretics
The following drug are what kind of diuretic? (HTN, edema)
hydrocholorthiazide
metolazone
chlorthalidone
Thiazide diuretics
The following drug are what kind of diuretic? (edema,HTN) furosemide torsemide bumetanide ethacrynic acid
Loop diuretics
Where do osmotic diuretics and carbonic anhydrase inhibitors work?
CA inhibitors: PCT
Osmotic: mainly PCT and some thin descending loop henle
Where do vaptans work in the kidney?
Collecting duct (block ADH regulated water absorption)
What are the K losing diuretics?
everything but K sparing diuretics (anything that acts before collecting duct)
Hyperkalemia causes tall T waves and bradycardia while hypokalemia causes flattened T waves and?
U waves
Drug:
Characteristics: blocks NaKCCl cotransporter, used for edema, decreases preload, decreases EC volume, rapid dyspnea, tx HTN, WORKS in pts with low GFR (which diuretic doesnt?), lots of toxicities, otoxicity, hypochloremic metabolic alkalosis, hypokalemia/natremia/calcemia/mg, hyperglycemia/uricemia, sulfur drug
Furosemide
Drug:
Characteristics: same as furosemide, longer 1/2 life, better oral absorption, better for HF
Torsemide
Drug:
Characteristics: same as furosemide but more predictable oral absorption
bumetanide
Drug:
Characteristics: same as furosemide but NON SULFUR
ethacrynic acid
What drugs dont work when there is low GFR?
Thiazides (note: loop diuretics work)
Loop diuretics are for rapid and massive fluid removal such as acute pulmonary edema or ?
hypertension
Drug:
Characteristics: blocks NaCl cotransport in distal tubules, K losing, used in mod HTN, not effective in patients with low GFR, used in calcium nephrolithiasis/nephrogenic diabetes insiputus, causes hypokalemia/mg/natremia, hypochloremic metabolic alkalosis, hypercalcemia /glycemia/uricemia and is a sulfur drug
Hydrochlorothiazide (HCTZ)
Drug:
Characteristics: same as HCTZ but poor oral absorption
chlorothiazide
Drug:
Characteristics: same as HCTZ but 1/2 life of 40-60 hrs, preferred by HTN specialists
chlorthalidone
Drug:
Characteristics: sames as HCTZ, long acting, fav for cardiologist used as adjunct diuretic in tx of CHF
metolazone
Drug:
Characteristics: blocks epithelial sodium channels ENaC in collecting ducts, counteracts K+ loss, causes hyperkalemia
amiloride
Drug:
Characteristics: same as amiloride, used for edema and off label HTN, quickly absorbed, 6-9hr duration
tramterene
Drug:
Characteristics: competitive antagonist of aldosterone receptors with side effects due to partial agonist at androgen receptors, K sparing diuretic, reduces fibrosis post MI heart failure (reverses cardiac remodeling), slow on and slow off (2-3day effect), causes hyperkalemia, amenorrhea, hirsutism, gynecomastia, impotence
Spironolactone
Drug:
Characteristics: same as spironolactone but more selective (lacks sulfur), approved for post mi HF, less gynecomastia, 10x more expensive
Eplerenone
Drug:
Characteristics: nonpeptide arginine vasopressin receptor antagonist (anti ADH), affinity for V1A and V2, promotes excretion of free water, tx of euvolemic and hypervolemic, hyponatremia in pts who are hospitalized, symptomatic, not responsive to fluid restriction, monitor closely cause too rapid serum sodium correction can lead to seizures, osmotic demyelination, coma or death
conivaptan
Drug:
Characteristics: same as conivaptan but selective V2 receptor antagonist *oral(Not IV), only in hospital where plasma sodium is monitored, use less than 30 days for hyponatremia, longer use = hepatotoxicity, used to slow progression of adult polycystic kidney dz
Tolvaptan
Drug:
Characteristics: carbonic anhydrase inhibitor, inhibit Na/H exchange, sodium bicarb diuresis = hyperchloremic acidosis, only used in urinary alkalinization, metabolic alkalosis, glaucoma, mountain sickness, can cause K wasting, renal stones
Acetazolamide (not used anymore)
Drug:
Characteristics: eliminate excess intracellular volume, inability to reabsorb keeps water in the PCT, which is excreted, pulls water out of cells, IV, used in prophylaxis of renal failure, reduction ICP, reduction intraocular pressure
Mannitol
