(3.1) Diuretics (Wolff) Flashcards

1
Q

What are the (3) thaizide diuretics?

A

Hydrochlorothiazide

Metolazone

Chlorthalidone

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2
Q

What are the (4) loop diuretics?

A

Furosemide

Torsemide

Bumetanide

Ethacrynic acid

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3
Q

What are the K+ sparing diuretics (specifically the 2 Na+ channel blockers)?

A

Amiloride

Triamterene

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4
Q

What are the K+ sparing diuretics (specifically the 2 aldosterone antagonists)?

A

Spironolactone

Eplerenone

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5
Q

What is the carbonic anhydrase inhibitor?

A

Acetazolamide

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6
Q

What is the osmotic diuretic?

A

Mannitol

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7
Q

What are the (2) aquaretics?

A

”-vaptan”

Conivaptan

Tolvaptan

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8
Q

Define:

Diuretic

A

Substance that promotes the excretion of urine

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9
Q

Define:

Natriuetic

A

Substance that promotes the renal excretion of sodium

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10
Q

Define:

Aquaretic

A

Substance that produces free water clearance

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11
Q

What class of diuretics act at the proximal tubule?

A

Osmotic diuretics

Carbonic anhydrase inhibitors

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12
Q

What class of diuretics act at the thick ascending limb of henle?

A

Loop diuretics

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13
Q

What class of diuretics act at the distal convoluted tubule?

A

Thiazide

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14
Q

What class of diuretics act at the cortical collecting duct?

A

Na+ channel blockers

(spironolactone)

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15
Q

What class of diuretics act at the collecting duct?

A

-Vaptans

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16
Q

What are the common clinical reasons for administering diuretics?

A

Essential hypertension

Edema (associated with liver/kidney/congestive heart failure)

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17
Q

What’s a nice way to remember where the K+ losing vs K+ sparing diuretics act?

A

K+ losing act more proximal to the glomerulus

K+ sparing act more distal to the glomerulus

18
Q

Hyperkalemia causes _________ on EKGs

A

Hyperkalemia causes tall T waves on EKGs

19
Q

What is a paradoxical reaction of the heart to hyperkalemia?

A

BRADYCARDIA

20
Q

Hypokalemia causes _________ on EKGs

A

Hypokalemia causes flattened T waves and tall U waves on EKGs

21
Q

What is the mechanism of action of loop diuretics?

A

Block the Na+-K+-2Cl- cotransporter in the thick ascending limb

22
Q

Loop diuretics are efficacious even when ____ and ____ are low

A

Loop diuretics are efficacious even when RBF and GFR are low

23
Q

What are the adverse effects of loop diuretics?

A

Hypokalemia

Hypomagnesemia

Hypocalcemia

Ototoxicity

24
Q

What drug is among the few diruetics that can be used by people who are allergic to “sulfa drugs”?

A

Ethacrynic acid

25
What is the mechanism of action of **thiazides?**
Block the **Na-Cl cotransporter** in the _distal convoluted tubule_
26
Thiazides do NOT work well with _____ and/or \_\_\_\_\_\_
Thiazides do NOT work well with **low RBF** and/or **low GFR**
27
Thizide diuretics are indicated for?
Primary hypertension Nephrogenic diabetes insipidus
28
What are the **adverse effects** of **Thiazide** diuretics?
Hypovolemia K+ losing Hypochloremic metabolic alkalosis Hypomagnesemia
29
What is the mechanism of action of **K+ sparing diuretics?**
Can be one of two mechanisms... 1) (Amiloride) Blocks the luminal **Na+** channels in the **collecting duct** 2) (Spironolactone) Blocks the **Aldosterone** receptor in the collecting duct
30
Na+ channel blockers (amiloride and triamterene) exert their effects...
QUICKLY!!! Since the channel is blocked directly, effects are seen more rapidly than with **spironolactone**
31
What is the mechanism of action of **spironolactone?**
Blocks the ability of **aldosterone** to bind to its receptor --\> leads to **increased Na+ excretion** and **decreased K+ excretion**
32
What is notable about the pharmacokinetics of **spironolactone?**
Can take 48 hours to work!!! SO SLOW
33
What are the adverse effects of **spironolactone?**
Hyperkalemia Endocrine effects (gynecomastia, impotence, menstrual irregularities, hirsutism and deepening voice)
34
What is the mechanism of action of the **vaptans?**
Block the **antidiuretic hormone receptor** in the _collecting duct_
35
What is the mechanism of action of **acetozolamide?**
Inhibits **carbonic anhydrase**
36
What are the indications for **acetozolamide?**
Urinary alkalinization Glaucoma Acute **mountain sickness**
37
What are the adverse effects of **acetazolamide?**
Hyperchloremic metabolic acidosis Renal stones Potassium wasting
38
What is the mechanism of action of **mannitol?**
Mannitol is a non-metabolized sugar, freely filtered with **minimal reabsorption** The **inability to reabsorb** this solute keeps water in the proximal tubule lumen; this water is delivered to the distal portions of the nephron where much of it is **excreted**
39
The net effect of administering mannitol is to...
Excrete **total body water** in excess of **plasma electrolytes**
40
What is noteworthy about the pharmacokinetics of **mannitol?**
Given in GRAMS!!! A lot more than the other diuretics (eg 50-200grams)
41
What are two examples of **alternative medicine** diuretics?
Herbal diuretics Licorice
42