Diuretics

Question 1

Thiazide Diuretic Examples and Uses

Answer 1

Hydrochlorothiazide

• most prescribed antihypertensive
• most widely available diuretic in combo with other antihypertensive

Chlorthalidone

• Most evidence for improved CV outcomes
• Twice as potent as HCTZ
• May be more effective in lowering SBP over full 24hr period than HCTZ

Indapamide
- Improves CV outcomes in hypertension patients >80yo

Metalozone
- More effective than other thiazides at CrCL < 30

Question 2

Thiazide Indications and Contraindications

Answer 2

Indications -
Hypertension (potential first lines where CCB would otherwise be used)
Edema from Heart Failure (loop seem better)

Contraindications -
Low GFR < 15-20

Question 3

Thiazide Adverse Effects

Answer 3

• SIGNIFICANTLY INCREASES BLOOD GLUCOSE
• Increases cholesterol and triglycerides
• hyponatremia
• hypokalemia
  » watch for arrhythmias
• hypomagnesemia
• hypercalcemia
  » good for people with osteoporosis or kidney stones
• metabolic alkalosis
• impotence in men
• fatigue
• Increases risk of gout
• DONT GIVE WITH SULFONIMIDE DRUGS

Question 4

Loop Diuretic Example (4) and Uses

Answer 4

Best reserved for edematous conditions + doesn’t reduce HTN as much

Furosemide
- once-daily dosing despite short half-life

Ethacrynic Acid ***

• more ototoxic than other loops
• only loop without sulfa group ***

Bumetanide
- 1mg = 40mg furosemide

Torsemide

Question 5

Loop Diuretic Indications

Answer 5

Chronic Heart Failure
HTN (not first line)
Pulmonary Edema (sx of breathlessness)
Liver/Renal Dysfunction (treats the fluid buildup)

BEST FOR FLUID BUILDUP

Question 6

Loop Diuretic Indications and Contraindications

Answer 6

Hypotension
Dehydration
Hyperglycemia 
Electrolye Loss
Dizziness 
Faintness
Loops are linked to ototoxicity 

Contraindications
Dehydration, Hypovolemia, Caution in Hypokalema, and hyponatremia, can worsen gout, increase risk of arrhythmias due decrease of K

Question 7

Potassium Sparing Diuretics Examples and Uses

Answer 7

Amiloride
- Weak diuretic and BP lowering effect
Triamterene

• Usually used with loops so K sparing helps
• Increase risk of hyperkalemia
• Use cautiously in pts with reduced kidney function and those using ACE or ARB

Question 8

Potassium Sparing Adverse Effects

Answer 8

GI Upset

• nv, loss of appetite
• dizziness
• headache
• skin rash
• hypotension
• hyperkalemia – higher risk with DM2, kidney disorders, and older patients

Question 9

Aldosterone Antagonists (increases K levels) Examples, Indications,

Answer 9

Spironolactone

Indications: Edema, Primary Hyperaldosteronism, HTN, Hypokalemia