Clinical Diuretics Flashcards
What are the two diuretics that exert their actions from the “blood side” vs the “urine side” of the nephron?
Spironolactone
Eplerenone
Majority of diuretics enter the nephron via organic ion transporters. What class is the exception that enters via glomerular filtration?
Osmotic diuretics
Furosemide, spironolactone, thiazides, ethacrynic acid, amiloride, triamterene and carbonic anhydrase inhibitors. Which 2 of the above work by indirectly inhibiting their target transporters vs. direct binding to their transporter targets?
Spironolactone and carbonic anhydrase inhibitors
What are the two major proteins by which diuretics enter the nephron? Where are these proteins located?
Organic acid transporter
Organic base transporter
Proximal tubule
What is the transporter target of furosemide? What is the binding site? What is its effect on the medullary interstitial osmotic gradient?
Na, K, Cl symporter inhibitor
Binds the chloride site
Decreases the gradient, because more sodium is excreted
How does furosemide decrease left ventricular filling pressure? What is the mechanism provided?
By increasing venous capacitance
Eicosanoid mechanism
Sodium depletion, hypokalemia, hypomagnesemia, uric acid retention and ototoxicity. These are all potential side effects associated with _
Furosemide
What is the effect of thiazide diuretics on calcium? What is the big picture?
Reduced calcium excretion
Decreased risk for fractures
Volume depletion, hyponatremia, hypokalemia, hyperlipidemia, hypomagnesemia, hyperuricemia and glucose intolerance are all potential side effects of _
Thiazide diuretics
Foamy urin, protein in urine, high serum cholesterol and creatinine, generalized edema. These are all indicators of _
Nephrotic syndrome
What are 3 potential causes of diuretic resistance?
Incorrect diagnosis
Non-compliance
Inappropriate NaCl intake
What is a common hormonal disturbance associated with patients with liver cirrhosis? What is the effect on sodium reabsorption?
Secondary hyperaldosteronism
Increased distal sodium reabsorption
What are 2 drugs that can be used to treat secondary aldosteronism? What is their mechanism of action? What is their effect on potassium?
Spironolactone and Eplerenone
Bind and inhibit cytosolic aldosterone receptor
Potassium sparing drugs
Hyperkalemia, GI distress and hyponatremia are associated with what 2 drugs?
Spironolactone and eplerenone
Gynecomastia and agranulocytosis is associated with what drug? Why?
Spironolactone
Cross reactivity at steroid receptors
