#5 Komiskey Diuretics 1 Flashcards
You have a patient with altitude sickness and you would like to prescribe a medication that works in the proximal tubule by blocking sodium bicarbonate reabsorption. What would you choose and what could be a possible side effect?
CAAP (Carbonic Anhydrase inhibitors like Acetazolamide work in the Proximal tubule)
Acetazolamide
SE: metabolic acidosis
Can also be used to treat glaucoma
You are in the hospital and the resident asks you what osmotic diuretic would you use to decrease intracranial pressure. You answer?
Mannitol
You just prescribed Furosemide for your patient and you give them a list of possible side effects. This list would include what items?
OH DANG! (Loops loose of K+, Ca2+, Mg) Ototoxicity Hyperkalemia Dehydration Allergy (to sulfa) Nephritis Gout Ethacrynic Acid --> high ototoxicity
You would like to prescribe a loop diuretic because you remember Dr. Komiskey saying they would not develop acidosis but you can’t remember how they work or which ones they are. You ask a friend and she says:
The LOOP of FURy ascends up Mt. Saint Henle Loop diuretics Furosemide, Bumetanide, Torsemide Ascending loop of Henle Blocks Na+/K+/2Cl- cotransporter
A patient comes into your office with gout. He mentioned that he was on a diuretic. Based on the gout which two would you suspect?
Loop or Thiazide
Your patient has had a long history of calcium oxalate stones and you are considering putting them on a medication in this diuretic class to decrease the excretion of calcium.
Thiazide
What is the mechanism of action for Hydrochlorothiazide?
(If you don’t want your THIghs to look like DISTAL TUBULES you should not keep Na+/Cl- around)
MOA: Inhibits Na+/Cl- transport in the distal convoluted tubule
Your patient is diabetic. Why might you avoid thiazides?
SE: Hyperlipidemia
HCTZ: Hyperglycemia
Other HCTZ SE: (Hypercalcemia, hypokalemia, hypomagnesemia, Hyperuricemia, Pancreatitis, metabolic alkalosis, **Stevens-Johnson rash*)
What medication might cause Stevens-Johnson syndrome?
Hydrochlorothiazide
Stevens-Johnson Syndrome – rare, serious disorder of your skin and mucous membranes. It’s usually a reaction to a medication or an infection. Often, Stevens-Johnson syndrome begins with flu-like symptoms, followed by a painful red or purplish rash that spreads and blisters. Then the top layer of the affected skin dies and sheds.
Your patient is on a loop diuretic but is losing too much K+. What diuretic would you combine with the Furosemide that the patient is currently on?
Spironalactone
COLLECT Potato SPears to block ALDO
Spironolactone blocks the effects of Aldosterone in the late distal tubules and COLLECTing ducts.
You need a medication to treat Liddle’s Syndrome. Which Na+ inhibiting K+ sparing diuretic could you use?
Triamterene (shorter half life) or Amiloride (also used to treat HTN, CHF, Li induced diabetes insipidus)
Liddle’s syndrome: gain of function - abnormality of ENa Channel
Results in Na retention and low levels of aldosterone