Diuretic Drugs

Question 1

Effects of Hyperkalemia (4) and Hypokalemia (4)

Answer 1

Hyper:
Tall T waves
Wide QRS
Flat P waves
Bradycardia

Hypo:
Flat T waves
ST depression
Tall U waves
Atrial arrhythmia

Question 2

Loop Diuretics

MOA and Adverse Effects (5)

Answer 2

Block NaK2Cl cotransporter in thick ascending limb

Largest Na+ loss (also K+/Ca2+/Mg2+/Cl- lost)
Metabolic Alkalosis
Ototoxic
Sulfa Allergies
Hyperglycemia/Hyperuricemia

Question 3

Loop Diuretics

Examples with Uses (4)

Answer 3

Furosemide: Pulmonary edema and low GFR pts.

Torsemide: Heart failure

Bumetanide: predictable absorption

Ethacrynic acid: non-sulfa (use in case of allergy)

Question 4

Thiazide Diuretics

MOA (2) and Adverse Effects (4)

Answer 4

Blocks NaCl cotransporter in DCT
Spares Ca2+

Largest Mg2+ loss
Metabolic alkalosis
Sulfa allergies
Hypercalcemia/Hyperglycemia/Hyperuricemia

Question 5

Hydrochlorothiazide

Uses (2), Not Useful For

Answer 5

Calcium nephrolithiasis
Nephrogenic Diabetes Insipidus

Not effective in pts with low GFR

Question 6

Other Thiazides (3)
Which is best for HTN?

Answer 6

Chlorthalidone (best for HTN)

Chlorothiazide
Metolazone

Question 7

Potassium Sparing Diuretics

MOA (2) Examples for Each MOA (2)

Answer 7

ENaC blocking in collecting duct
(Amiloride and Triamterene)

Competitive Aldosterone antagonist in collecting duct
(Spironolactone and Eplerone)

Question 8

Amiloride/Triamterene

Use and Adverse Effects (6)

Answer 8

Blocking ENaC can counteract K+ loss from other diuretics

Hyperkalemia/Hyperchloremia
Metabolic Acidosis
Hyponatremia/volemia
Dizziness
Fatigue
N/V/D

Question 9

Spironolactone/Eplerone

Uses (3) and Adverse (6)

Answer 9

Potassium loss
Primary Hyperaldosteronism
Post-MI Fibrosis

Hyperkalemia
Hyponatremia
Amenorrhea
Hirsutism
Impotence
Gynecomastia
(last 4 from partial androgen agonism)

Question 10

Conivaptan

Drug Description, Use, Adverse (4)

Answer 10

Nonpeptide arginine antagonist

Treats euvolemic/hypovolemic hyponatremia

Seizure
Osmotic demyelination
Coma
Death

Question 11

Tolvaptan

Drug Description, Uses (2) and Adverse Effect

Answer 11

selective oral V2 antagonist

Hyponatremia
Adult Polycystic Kidney Disease

Hepatotoxicity (use <30 days)

Question 12

Aquaretics

Examples (2) and General MOA (2)

Answer 12

Conivaptan
Tolvaptan

ADH recetor antagonist in CD
Increase free water loss

Question 13

Carbonic Anhydrase Inhibitor

Example, Uses (3) and Adverse Effects (3)

Answer 13

Acetazolamide

Treats:
Metabolic alkalosis
Glaucoma
Acute Mountain Sickness

Causes:
Hypokalemia
Hyperchloremic acidosis
Nephrolithiasis

Question 14

Osmotic Diuretic

Example, MOA, Uses (3)

Answer 14

Mannitol

Unable to be reabsorbed so it traps water to cause diuresis

Kidney Failure Prophylaxis
Decreases Intracranial and Intraocular pressure

Question 15

Which two diuretic classes are contraindicated in pregnancy?

Answer 15

Loop Diuretics

Thiazide Diuretics