Diuretic Drugs Flashcards
1
Q
Diuretic Drugs
A
- accelerate the rate of urine formation
- result in the removal of water and sodium from the body
- used to treat hypertension, heart and renal failure
- removal of fluid causes decreased cardiac output and decreased BP
- some diuretics cause arteriolar dilation
- classified according to their sites of action within the nephron, their chemical structure and their diuretic potency
2
Q
Carbonic Anhydrase Inhibitors
A
- chemical derivative of sulfonamide antibiotics
- inhibit the activty of enzyme carbonic anhydrase anhydrase (found in the kidneys, eyes, and other parts of the body). This enzyme makes hydrogen ions available for exchange in the nephron for sodium. If the enzyme is inhibited sodium and water are excreted.
- bicarbonate, sodium, water and potassium are all excreted.
3
Q
Carbonic Anhydrase Inhibitor (use)
A
- long term management of open-angle glaucoma
- to lower the IOP before eye surgery
- reduce edema
- treatment of high altitude sickness
4
Q
Carbonic Anhydrase Inhibitor (contraindications)
A
- drug allergy
- hyponatremia or hypokalemia
- severe renal or hepatic function
- adrenal gland insufficiency
- acidosis
5
Q
Carbonic anhydrase inhibitors (Adverse effects)
A
- acidosis
- hypokalemia
- drowsiness
- anorexia
- paresthesias
- hematuria
- urticaria
- photosensitivity
- melena
- hyperglycemia
6
Q
Carbonic Anhydrase Inhibitors (interactions)
A
- can cause hypokalemia, an increase in digoxin toxicity can occur when they are combined with digoxin
- use with corticosteroids may cause increased hypokalemia and hyperglycemia
- CAIs increase the effects of amphetamines, carbamazepine, cyclosporine, phenytoin, quinidine
7
Q
Loop Diuretics
A
- very potent diuretic
- structurally related to sulfonamide antibiotics
- active renal prostaglandins = blood vessel dilation = decreased blood pressure, decreased blood volume (increased urine volume excretion)
- rapid onset; long duration of action (once/day dosing common) - usually morning
- continue to work even when the kidney function decreases
8
Q
Loop diuretics (names)
A
- Bumetanide (Bumex)
- Ethacrynic Acid (Edecrin)
- Furosemide (Lasix)
- Torsemide (Demadex)
9
Q
Loop diuretics (uses)
A
- heart failure (removes fluid from body and lungs)
- hypertension (decreases fluid volume, dilates blood vessels = decreases peripheral vascular resistance)
- edema (removal of fluid)
- removal of elevated electrolytes such as K, Na, Ca
10
Q
Loop Diuretics (adverse effects)
A
- ototoxicity, tinnitus
- dizziness, headache, blurred vision
- allergic reactions, stevens-johnson
- agranulocytosis, neutropenia, thrombocytopenia
- hypokalemia, hyperglycemia, hyperuricemia
11
Q
Furosemide (Lasix)
A
- most commonly used loop diuretic
- commonly used in pulmonary edema associated with heart failure, liver disease/ascites, nephrotic syndrome, hypertension
- black box warning for fluid and electrolyte loss
- use with caution in patients with suldonamide allergy
12
Q
Osmostic Diuretics
A
- work along the entire nephron, but most effective in the proximal tubule
- pulls water into the renal tubules from the surrounding tissue
- inhibits tubular resportion of water and solutes
13
Q
Osmotic Diuretics (uses)
A
- increases the GRF which helps to prevent kidney damage during acute renal failure
- reduces intracranial pressure and cerebral edema
- reduces excessive intraocular pressure
14
Q
Osmotic Diuretics (adverse effects)
A
- convulsions
- thrombophlebitis
- pulmonary congestion
15
Q
Mannitol
A
- osmitrol
- given IV only
- may crystallize when exposed to low temps, warm vial and shake vigorously to dissolve crystals
- use a filter during administration
16
Q
Osmotic Diuretics (names)
A
- mannitol (Osmitrol)
- urea
- organic acids
- glucose
17
Q
Potassium-sparing diuretics
A
- work in collecting ducts and distal tubule
- interfere with the sodium-potassium exchange in the tubules
- competitvely bind to aldosterone receptors
- block the resportion of sodium and water that is induced by aldosteron
- prevents K from being pumped into the tubule, this preventing its secretion
18
Q
Potassium-sparing diuretics
A
- Amiloride (Midamor)
- Spironolactone (Aldactone)
- Tiramterene (Dyrenium)
19
Q
Spironolactone and Triamterene (indications)
A
- hyperaldosteronism
- hypertension
- reverising potassium loss caused by potassium losing drugs
- certain causes of HF: preventing of remodeling
20
Q
Amiloride (indications)
A
- similar as spironolactone and triamterene, but less effective in the long term
21
Q
Potassium-sparing diuretics (adverse effects)
A
- dizziness, headache
- nausea, vomiting, diarrhea, cramps
- weakness
- hyperkalemia
22
Q
Potassium-sparing diuretics (interactions)
A
- lithium
- angiotensin-converting enzyme inhibitors
- potassium supplements
- NSAIDS
23
Q
Spironolactone (Aldactone) (side effects)
A
- gynecomastia
- amenorrhea
- irregular menses
- postmenopausal bleeding
24
Q
Thiazide and Thiazide-like diuretics
A
- act in the distal tubule
- inhibit tubular reportion of sodium, chloride, and potassium
- dilates the arterioles by direct relaxation
- results in: water, sodium, and chloride excretion
- potassium is excreted but not as significantly as other diuretics
- decrease BP
25
Q
Thiazide and Thiazide-like diuretics (indications)
A
- hypertension (common use)
- edema
- hypercalciuria
- diabetes insipidus
- heart failure
- adjunct for liver failure, corticsteroid therapy
26
Q
Thiazide and Thiazide-like diuretics (adverse effects)
A
- dizziness, headache, blurred vision
- anorexia, nause, vomiting, diarrhea
- impotence
- jaundice, leukopenia
- urticaria, leukopenia
- hypokalemia, hyperglycemia, hyperuricemia, hypochloremic alkalosis
27
Q
Thiazide diuretics (names)
A
- hydrochlorothiazide (esidrix, hydroDIURIL)
- chlorothiazide (diuril)
28
Q
Thiazide-like diuretics (names)
A
- metolazone (mykrox, zaroxolyn)
- chlorthalidone (hydone, thalitone)
- indapamide (lozol)
