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Renal System > Diuretic Drugs > Flashcards

Diuretic Drugs Flashcards

1
Q

Acetazolamide:

A

Carbonic Anhydrase Inhibitor

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2
Q

MOA of Acetazolamide?

A

Potent competitive inhibitor of carbonic anhydrase.

  • Inhibit C.A. resulting in bicarbonate loss into urine.
  • Net effect: alkaline urine, enhanced chloride reabsorption
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3
Q

Clinical use of Acetazolamide?

A
  • Glaucoma to reduce intraocular pressure.
  • Cystinuria to alkalinize tubular urine.
  • Management of mountain sickness.
  • Prophylaxis of mountain sickness.
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4
Q

Mannitol

A

Osmotic diuretic

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5
Q

MOA of Mannitol?

A
  • Osmotically inhibit Na+/H2O reabsorption in proximal convoluted tubule.
  • Expand extracellular volume and inc renal medullary blood flow.
  • inc medullary tonicity to impair ability of thin segments of loop of Henle to extract water and absorb NaCl.
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6
Q

Effect of Mannitol?

A

Increased urine flow with small increments of Na, K+ & Cl-.

•Initially increased plasma volume & B.P.

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7
Q

Clinical uses of Mannitol?

A

Reduce intracranial pressure

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8
Q

Name the loop diuretics? (3)

A
  1. Furosemide
  2. Bumetanide
  3. Torsemide
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9
Q

MOA of Loop diuretics?

A

•Inhibit Na+-K+-2Cl symporter in Thick AL of LOH

  • by competing for Cl- binding site
  • also prevents Mg and Ca bc K+ doesn’t come back out into the lumen to restore voltage grad.

• *Increase renal prostaglandins (vasodilate) by inhibiting the MD

  • Increase renal blood flow
  • Stimulate renin release (maintain GFR)
  • GFR also maintained by inc % filtration
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10
Q

Effect of Loop diuretics?

A

Copious diuresis with significant Na loss
• Increase K, Ca2+ and Mg2+ excretion
• Increase excretion of H+ resulting in mild metabolic alkalosis

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11
Q

Uses and administration of Loop diuretics?

A
  • Edema of cardiac, hepatic & renal origin (oral)
  • Acute pulmonary edema.
  • Given I.V. for rapid mobilization of edema fluid
  • By decreasing preload
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12
Q

T or F: Loop diuretics are filtered through the glomerulus?

A

FALSE

  • They are secreted through and organic acid transporter in the proximal tubule
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13
Q

Side effects of Furosemide?

A
  • Fluid and electrolyte imbalance
  • Ototoxicity,
  • Increase BUN, hyperglycemia, hyperuricemia
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14
Q

Drug interactions with Furosemide?

A
  1. Lithium
  2. indomethacin
  3. Procenecid
  4. Warfarin
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15
Q

What drug can be safely used with warfarin?

A

Bumetanide

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16
Q

Uses of Bumetanide?

A

May be substituted for furosemide in select group of patients receiving warfarin, but significantly more $$$.

17
Q

Unique PK of Torsemide?

A
  • Has longer half-life than other loop diuretics
18
Q

Name the Thiazide Diuretics (3)

A
  1. Hydrochlorothiazide (Class I)
  2. Chlorthalidone (Class I)
  3. Metolazone (Class II)
19
Q

MOA of Thiazide Diuretics:

A

•Inhibit Na-CL symporter in early distal tubule (i.e. DCT and CD)

  • Net effect: mild loss of sodium and water
20
Q

Clinical use of Thiazide Diuretics:

A
  • Treatment of mild to moderate edema
  • Essential hypertension (augment others)
  • Diabetes insipidus (nephrogenic)
  • Hypercalciuria
21
Q

Side effects of Thiazide Diuretics:

A
  1. Hypokalemia
  2. Hypomagnesemia
  3. Hyperuricemia,
  4. Hypercalcemia,
    5 Hyperglycemia
  5. Lipid disorders
22
Q

How is metolazone different from the other two thiazide diuretics?

A

More potent

23
Q

When are the class I thiazide diuretics preferred?

A

GFR > 50

24
Q

What occurs when thiazide diuretic doses exceed 25 mg?

A
  • no increase in pharm effects (max out)

- but, more side effects

25
Q

Increasing dosage of Loop diuretics compared to Thiazides

A

The effect of loop diuretics increases with increasing dosage until levels off at 25% NaCl excreted

  • Thiazide maxes out at 5%
  • Loop Diuretics much more efficient
26
Q

Aldosterone Antagonist (2)

A
  1. Spirolactone

2. Eplenerone

27
Q

MOA of Aldosterone Antagonist?

A

Competitive inhibitors to aldosterone receptors in DCT and collecting ducts

  • prevent the translocation of Aldosterone to the nucleus
  • Reduce the aldosterone-induced ENAC channels (involved in Na reabsorption)
28
Q

Pharmalogical effect of Aldosterone Antagonists?

A
  1. Increase Na+ excretion

2. Reduces K+ secretion (“K+ sparing”)

29
Q

Side effects of Spirolactone?

A
  1. Hyperkalemia
  2. Gynecomastia (male)
  3. Hirsutism (female)
  4. Uterine bleeding (female)
30
Q

Advantage Eplenerone?

A

Less side effects

  • due to lower affinity for androgen receptor compared to spirolactone
31
Q

Clinical uses of Aldosterone Antagonists?

A
  1. Diuretic (used in combo w/ HCTZ due to hyperkalemia)
  2. CHF
  3. Cirrhosis**
32
Q

Potassium Sparing diuretics (2)

A
  1. Triametrene

2. Amiloride

33
Q

MOA of K+ sparing diuretics

A

Inhibits Na+ reabsorption and K+ secretion in DCT and CD

- by blocking ENaC channels

34
Q

Pharmalogical effects of K+ sparing diuretics

A
  1. Increase Urinary excretion of Na+ (weak)

2. Inhibit secretion of K+ and H+

35
Q

Clinical use of K+ sparing diuretics?

A

Combined with HCTZ to increase their effectiveness and decrease K+ secretion

36
Q

Side effects of K+ sparing diuretics?

A
  1. Hyperkalemia
  2. Megaloblastic anemia (in PTs w/ Cirrhosis)
  3. Triamtrene can rarely form Kidney stones

Renal System (19 decks)

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