Diuretics Flashcards
How do diuretics work
They increase the production of urine
- all of them act from the luminal side of tubular cell membrane except spirinolactone
What are the groups of diuretics
Osmotic diuretics Carbonic anhydrase inhibitors Loop diuretics Thiazides Potassium sparing diuretics
Mannitol is the only osmotic diuretic what’s the mode of administration
IV
Mannitol mechanism of action
Increase osmolalility of plasma and urine so there will be greater plasma volume and elimination from the kidney
Mannitol indications
Glaucoma - not first line
Cerebral swelling
Flushed out toxins
How is mannitol given to flush out toxins
Orally
What is mannitol contraindicated in
Acute heart failure and pulmonary edema
What happens when carbonic anhydrase are given and where do they act
Decreased Movement of bicarbonate and sodium from tubule to blood
THEY ACT ON THE PROXIMAL TUBULE
List carbonic anhydrase inhibitors
Suffix - zolamide
Acetazolamide
Methazolamide
Dichlorphenamide
carbonic anhydrase inhibitors mode of administration
Oral
when are carbonic anhydrase inhibitors generally used
Used to help in edematous states like ascites and PE
When are carbonic anhydrase inhibitors only used
When there is alkalosis
carbonic anhydrase inhibitors urinary electrolytes
↑k+, ↑Na+ and ↑↑HCO3-
Which diuretics are used for glaucoma
Topically brinzolamide and dorzolamide
All indications of carbonic anhydrase inhibitors
Glaucoma
High altitude sickness
Urinary alkalosis and epilepsy
carbonic anhydrase inhibitors adverse effects
Metabolic acidosis and k+ wasting
Where do loop diuretics act
They act on the loop if henle
Thick ascending limb
List the loop diuretics
Sulfonamide derivatives - furosemide, torsemide, bumtanide
Phenoxyacetic Acid derivatives - ethacrynic Acid
Loop diuretic mechanizm of action
Inhibit the co transporter NA+/K+/2CL- in the ascending part of the loop of henle
Leads to increase in Na+ out and decrease in Na+ in
Loop diuretics urinary analysis
↑↑↑Na+, ↑K+, ↑Ca2+, ↑Cl-
Loop diuretics indications
- 1st line in acute heart failure (acute pulmonary edema)
- 2nd line in hypertension(decrease plasma volume decrease CO)
- hypercalcemia and intoxication
- acute renal insufficiency
Adverse effects of loop diuretics
Hypokalemia Metabolic alkalosis Hyponatremia Allergic rxn Ototoxicity Hyperuricemia
Adverse effects of ethacrynic acid
Neutropenia, agranulocytosis and irreversible deafness
Thiazides mode of administration
Oral
List thiazides diuretics
Hydrochlorothiazide (HCTZ)
Chlorothiazide
List thiazides like diuretics
Chlorthalidone
Indapamide
Metolazone
Thiazides mechanism of action
Act on distal convoluted tubule, blocking Na/Cl symporter
Thiazides indications
1st like antihypertensive agents
2nd line in heart failure (edema states)
Idiopathic calciuria (prevents Ca2+ loss)
Nephrogenic diabetes inspidus
Thiazides adverse effects
Hyper uricemia(gout) Hypercalcemia Hyperlipidemia Allergic reaction Hyperglycaemia
Thiazides urianalysis
↑↑Na+, ↑K+, ↓Ca2+, ↑Cl-
List potassium soaring diuretics
Aldosterone antagonists-spirinolactone and -none (eplerenon) -> better less AE
Antagonists of Na+ channels - Amilioride and triamterene
Aldosterone antagonist mechanism of action
Block aldosterone receptors decreasing the number of Na+ channels
Potassium sparing diuretics indications
CHF hyperaldosteronism Hepatic edema Resistant HTN -can also be used for poly cystic ovarian syndrome
Potassium sparing diuretics adverse effects
Hyperkalemia
Gynacomastia(only spirinolactone)
