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Pharmacology > Anti-HPN: Diuretics > Flashcards

Anti-HPN: Diuretics Flashcards

1
Q

Diuretics MOA

A

Increase urinary excretion of Na+ (natriuresis) and water (aquaresis) = Diuretics
Site of action: Kidney Tubule

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2
Q

Proximal Convoluted Tubule (PCT)

A

Main site of HCO3- reabsorption
Reabsorption of Na ions
Water permeable

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3
Q

Thick Ascending Limb (TAL)

A

Reabsorption of Na+, K+ and Cl-
Secondary reabsorption of Mg, Ca (divalent cations)
Water impermeable

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4
Q

Distal Convoluted Tubule (DCT)

A

Reabsorption of Na+, Cl-
Reabsorption of Ca (mediated by PTH)
Water impermeable

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5
Q

Collecting Duct (DT)

A

Reabsorption of Na+
Secretion of K+

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6
Q

Diuretics Drugs

A

a. PC
* Carbonic Anhydrase Inhibitors (CAIs)
* Osmotic Diuretic (Mannitol)
* Methylxanthine (Caffeine)
* Acidifying salts (NH4Cl)

b. TDL: Osmotic diuretic (Mannitol)

c. TAL: Loop Diuretics

d. DCT: Thiazide diuretics

e. CD: Potassium Sparing Diuretics

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7
Q

Thiazide Diuretics MOA

A

Inhibits Na+ / Cl- Transporter in early distal convoluted tubule

↑ Na, K excretion ↓ Calcium excretion

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8
Q

First line for hypertension and management of Nephrogenic Diabetic Insipidus

A

Thiazide Diuretics

Others:
Management of nephrolithiasis
Adjuncts in the management of CHF

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9
Q

Thiazide Diuretics

A

a. Benzothiazides
* HCTZ, chlorothiazide

b. Thiazide-like
* Metolazone, Indapamide, Chlorthalidone

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10
Q

Side Effects of Thiazide Diuretics

A

HyperGLUC
Gycemia
Lipidemia
Uricemia
Calcemia

Hypokalemia

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11
Q

MOA of Loop Diuretics

A

Inhibit Na+/K+/2Cl– transporter in thick ascending limb of loop of Henle.

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12
Q

Loop Diuretics is also called

A

High Ceiling Diuretics - produces dose-dependent diuresis

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13
Q

Loop Diuretics

A

i. Sulfonamide-like Compounds
* Furosemide
* Bumetanide

ii. Sulfonylurea
* Torsemide

iii. Phenoxyacetate
* Ethacrynic acid

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14
Q

Clinical Uses of Loop Diuretics

A

Adjuncts in the management of pulmonary congestion in CHF
Management of oliguric and anuric Acute renal failure
Management of anion poisoning

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15
Q

Side Effects of Loop Diuretics

A
  • Electrolyte-imbalance (hypo-)
  • Sulfonamide associated AE: Ototoxicity: increased risk (+) aminoglycosides, cisplatin
  • Metabolic Associated AE: HyperGLU: glycemia, lipidemia, uricemia
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16
Q

Furosemide

A

4-chloro-N-furfuryl-5-sulfamoyl anthranilic acid

17
Q

Potassium-Sparing Diuretics

A

a. Aldosterone Antagonist (↑ K+ Secretion, ↓ Na+ reabsorption)
* Spironolactone, Eplerenone

b. Epithelial Na+ Channel Blockers
(ENaC)
* Amirolide, Triamterone

18
Q

Clinical Uses of K-sparing Diuretics

A

Prevention of diuretic-induced hypokalemia
Adjuncts in the management of CHF
Management of hyperaldosteronism-induced HTN

19
Q

DOC in px with hepatic cirrhosis

A

Spironolactone

20
Q

Adverse Effects of K-Sparing Diuretics

A
  • Hyperkalemia
  • Spironolactone:
    > Anti-androgen
    > Gynecomastia
    > Decreased libido
    > Hirsutism
  • Triamterene: increased chance of renal
    stone formation
21
Q

Carbonic Anhydrase Inhibitors (CAIs)

A

-Zolamides
* Acetazolamide
* Dorzolamide
* Brinzolamide
* Diclorphenamide

  • sulfonamide-like compounds
  • active moiety: Sulfonamoyl (SO2-NH2)
22
Q

First line management of Open-angle glaucoma and altitude Sickness

A

Carbonic Anhydrase Inhibitors
(-zolamide)

23
Q

MOA of Carbonic Anhydrase Inhibitors

A

Inhibits carbonic anhydrase in proximal convoluted tubule of the kidneys & ciliary bodies of the eyes

24
Q

Effects of Carbonic Anhydrase Inhibitors (CAIs)

A
  • PCT - short-lived natriuretic effect (NMT 3
    days)
  • Continuous loss of HCO3 - metabolic acidosis
  • Eyes - decreased intraocular pressure
    (IOP)
25
Q

Clinical Uses of Carbonic Anhydrase Inhibitors (CAIs)

A

First line in the management of open angle
glaucoma
Presurgical tx in acute angle closure glaucoma
Management of metabolic alkalosis
Management of acute mountain sickness
Management of catamenial seizure (Seizure during mens)

26
Q

Adverse Effects of Carbonic Anhydrase Inhibitors (CAIs)

A

Increases risk of metabolic acidosis
Sulfonamide associated AE: rashes/ dermatitis (SJS & TEN)
Hematologic: hemolytic anemia, aplastic
anemia, neutropenia
Hypersensitivity reaction

27
Q

Contraindications of Carbonic Anhydrase Inhibitors (CAIs)

A

Patient with COPD
Patient with chronic liver disease = ENCEPHALOPATHY

28
Q

Osmotic Diuretics

A

Mannitol
Glycerol

29
Q

MOA of Osmotic Diuretics

A

Creates osmotic gradient in water permeable
regions of the kidney tubule

30
Q

Clinical Uses of Osmotic Diuretics

A

Management of increased intracranial
pressure

31
Q

Side Effects of Osmotic Diuretics

A

Hyponatremia followed by hypernatremia
Headache
Nausea, vomiting
Dehydration
Massive loss of water (hypovolemia)

Pharmacology (26 decks)

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