diuretic

Question 1

diurectic when to take

Answer 1

use in oedema, take am avoid night time urination

Question 2

what to give elderly in oedema

Answer 2

low dose diuretic for gravitational oedema - swollen ankle /legs

Question 3

types of diuretics

Answer 3

loop :bumetanide (most potent), furosemide (most gout), torasemide( muscle pain)

thiazide and thiazide related
- bendroflumethiazide, hydrochlorothiazide (skin cancer, chortalidone (long half life- give alt days), indapamide (less aggravation diabetes), metalazone (use severe ri- caution switch brands)

SEAT
3)AA : spiranoloactone (use liver ascites) , eplerenone (post acute mi) , Ki+ sparing - amiloride triamterene blue urine
4) osmotic - mannitol (use in cerebral oedema, raise top)
5) carbonic anhydrase inhibitor i.e acetazolamide (oral glaucoma

Question 4

diuretic moa

Answer 4

increase urine output by kidneys, block sodium reabsorption at diff segments of neuphron

Question 5

caution diuretics

Answer 5

excessive diuresis = hypotension and hypovolemia
temp stop on sick days i.e vomitign sickness and reduce egfr = aki also dehydration risk for aki

Question 6

loop diuretic moa , duration action and onset use, caution, s/e , interaction

Answer 6

block na+/cl-/k+ co transporter
onset 1hr/ duration 6hrs
use resistant htn ,hf , caution exacerbate diabetes and gout. s/e ototoxic acute urine retention, reduce all electrolyte k+, na, cl-, mg2+ ,
interaction other otoxtic drug aminoglycoside glycopeptide
platin/ vinca alkaloid chemo (separate dose long period and nephrotoxicity)

Question 7

tzd dirureic and related

Answer 7

block na/cl- transport on proximal distal convoluted tube
onset = 1-2hrs/ duration 12-24 hrs
use hf hypertension , in ri use metal ozone caution diabetes and gout
decrease na/k+, cl- mg2 but inc mg 2+
s/e gi disturb impotence skin reaction with hydrochlorothiazide non melanoma skin caner long term use limit uv exposure add spf
- high ldl and tg
interaction: inc hypo (see other slide) , inc hypokalamia (DIBTC), INC HYPONATRAiemia lithium toxicity carbamazepine, desmopression , concomitant diuretic antidepressant (also aki with nsaid and tzd)

Question 8

risk nsaid and tzd

Answer 8

AKI

Question 9

k+ sparing diuretic

Answer 9

conserve k+, block na+ in late distal convoluted tube
k+ conservation to weak act alone - use
s/e hyperkalaemia, hyponatramia
triamterene- blue urine
interaction inc hyperkalemaia hadbeans +trimethoprim

Question 10

aldosterone antag

Answer 10

k+ sparing block aldosterone by blocking na+
use hf , adjunct , resistant htn , liver ascites
same s/e hypok+ and hyponatraemia
other s/e gynecomastia , libido change, menstrual disturb , benign breast tumour, hyperthricossi
interactions inc hyperkalemaia i.e had beans + trimethoprim

Question 11

Peripheral vascular disease tx is occlusive or vasospastic

Answer 11

occlusive (PAD) = secondary prevention
high intensity statin or low dose aspirin

VASOspatic i.e reynauds tx nifedipine stop smoke avoid cold and stress