Diruetics Flashcards

1
Q

What is the role of the kidney in salt water homeostasis?

A

regulate ECF volume and [ions] in the body

filter, excrete, reabsorbs necessary amount to keep body levels adequate

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2
Q

What are the major clinical indications for diuretic drug therapy?

A

Edema- generalized/local

Hypertension- essential, renal, aldosteronism

other- Hypo/Hypercalcemia, Urolithiasis, Glaucoma, Drug/Mineral toxicosis, metabolic acid/alkalosis, nephrogenic Disorders

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3
Q

What are the major classes of diuretic drugs?

A
Osmotic diuretics
Loop diuretics
Thiazides
K sparing diuretics
CA inhibitors
Xanthines
Urinary Acidifiers
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4
Q

What is the mechanism of Osmotic Diuretics?

A

they are filtered into the nephron at the glomerulus, but cannot be reabsorbed

thus increase osmotic pull, preventing water and ion re-absorption

leading to diuresis

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5
Q

What is mannitol? What is it used for?

A

Osmotic Diuretic

increases PG, increasing medullary blood flow

effective for acute management of cerebral edema

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6
Q

What are the therapeutic uses of Mannitol?

A

cerebral edema- reduces intracranial pressure

acute glaucoma- reduces intraocular pressure

Renal Failure- increases GFR volume, maintains urine flow,

Tx of ischemia/nephrotoxin induced acute tubular necrosis

Poison elimination

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7
Q

What are the adverse effects of Mannitol?

A

contraindicated in animals w/ generalized/acute pulmonary edema

not recommended in animals with cerebral hemorrhage, will enter the brain and cause increased fluid accumulation and increased intracranial pressure

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8
Q

What is the mechanism of action of Loop Diuretics?

A

reduce ion re-absorption via inhibition of Na/K/2Cl- co-transporter in the luminal membrane of the the thick ascending loop of henley

inhibit Ca2+ and Mg2+ re-absorption due to change in electrical gradient (luminal positive potential)

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9
Q

What is the most common loop diuretic?

A

Furosemide (Lasix)

others are: Torsemide, Bumetidine, and Ethacrynic Acid (not used in SA)

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10
Q

What are the therapeutic uses of Furosemide?

A

edema- rapid mobilization, very effective for pulmonary edema

chronic heart failure- best class to use

Acute renal failure- use in combo w/ mannitol

hypercalcemia- increases urinary Ca2+ secretion in dog/cat (tx for Vit D toxicosis)

EIPH in Race horses

HyperK if Mannitol ineffective

Tx of ascites- combo w/ other drugs

Antihypertensive

Tx post-parturient udder edema- approved drug

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11
Q

What are the adverse effects of Furosemide?

A

fluid-electrolyte imbalance, especially hypoK/Cl-

ototoxicity- deafness due to above imbalance in the endolymph of inner ear

Dehydration, metabolic alkalosis, hyperuremia (Gout), hypocalcemia, muscle weakness, CNS depression

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12
Q

Does Furosemide interact w/ other drugs? Which ones?

A

increased ototoxicty/nephrotoxicity w/ aminoglycosides/cisplatin

NSAIDS reduce diuretic response of loop drugs

increased hypoK during cocontaminant tx w/ corticosteroids/amphotericin B

may alter requirements of insulin/other anti-diabetic drugs

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13
Q

When is furosemide/other loop diuretics contraindicated?

A

patients w/ anuria, renal failure, hepatic dysfunction, and diabetes

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14
Q

What is the mechanism of action of Thiazides?

A

inhibition of Na+/Cl- symporter in the distal collecting tubule

increase the re-absorption of Ca2+ due to stimulation of Na+/Ca2+ antiporter

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15
Q

What are the 4 thiazide drugs?

A

Chlorothiazide
Hydrochlorothiazide
Trichlormethiazide
CHlorthalidone

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16
Q

What are the therapeutic usesnof thiazides?

A

long term diuretic therapy- adjunct tx in dogs and cats w/ CHF, animals with resistance to furosemide

Tx of systemic hypertension

tx of post parturient udder edema- approved

Nephrogenic DI in combo w indomethican leads to reduced urine output in dogs w/ DI

Ca-oxalate crystal uroliths- decreases these stones in dogs

17
Q

What are the adverse effects of thiazides?

A

fluid-electrolyte imbalance
hypoK, gout, hyperCa w/ prolonged use
hyperglycemia/glucosuria- inhibition of proinsulin and insulin

Similar drug interaction as loop drugs

18
Q

What is the mechansim of action of K+ sparing drugs?

A

Na+ channel blockers, reduce luminal potential and the driving force for K secretion leads to decrease in K+ secretion

reduction in lumen negative potential decreases H+ secretion in intercalated cells

NET RESULT (of filtrate)
increase Na, Decreased K, Decreased H
19
Q

What are the K sparing drugs?

A

Trimaterene and Amiloride

20
Q

What is the mech of action of Aldosterone Antagonists?

A

competively bind aldosterone receptor, reducing the synthesis of aldosterone-induced proteins, inhibting their fx

Basically- inhibit Na/K channels, Na/K ATPase, Mitochondrial ATP pdx

Leads to a net result is same as K sparing
increase Na, Decreased K, Decreased H

21
Q

What are the aldosterone antagonists?

A

Spironolactone and Potassium canrenoate

22
Q

What are the therapeutic uses of aldosterone antagonists?

A

**used in conjunction w/ loop/thiazides

chronic tx of CHF

primary/secondary aldosteronism

tx of ascites

23
Q

What are the adverse effects of aldosterone antagonists?

A

hyperK

metabolic acidosis

24
Q

What are the CA inhibitors?

A

Carbonic Anhydrase inhibitors
reduce the # of H+ ions available for NA/K exchange

results in increased Bicarb, K+ excretion, and Cl- retention

leads to hyperchloremic acidosis

25
What are CA inhibitors used for?
glaucoma and metabolic alkalosis HYPP in horses
26
What do Xanthines do?
increase renal blood flow and increase GFR decreases Na re-absorption in the PCT used to increase urine output
27
What are Urinary Acidfiers?
Take a fucking wild guess lowers the pH of the ECF and Urine liver converts to NH3, H+ and CL-, H+ buffered by bicard in the plasma; increased Cl- load to kidney pdx loss of NA+ and Cl- and mild diuresis
28
What is Methionine?
Urinary acidifier, S)4 excretion in urine as H2SO4 promotes the excretion of ionizable drugs or poisons by urinary acidifcation will also dissolve/prevent uroliths
29
REVIEW SLIDE ON RENIN ANGIOTENSIN SYSTEM
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