Diuretics

Question 1

What are the 4 major diuretic categories?

Answer 1

Loop
Thiazide
Osmotic
Potassium-sparing

Question 2

Which diuretic is often the first choice for HTN? What is its other uses?

Answer 2

Thiazide

Uses: HTN, mobilizes edema in pts w/ CHF who have mild to moderate HF.

Question 3

Which electrolyte should be closely monitored when taking thiazides and loop diuretics?

Answer 3

Potassium. They can both cause hypokalemia.

Question 4

When the aminoglycoside antibiotic ________ is combined with ________, the risk for hearing loss is increased.

Answer 4

Gentamicin/furosemide

Question 5

Which diuretic is used for situations that require rapid or massive mobilization of fluid?

Answer 5

Furosemide

Question 6

Which diuretic group should be used to promote fluid loss in pts with severe renal impairment?

Answer 6

Loop diuretics

Question 7

How does Spironolactone cause hyperkalemia?

Answer 7

It blocks the actions of aldosterone which causes retention of potassium and increased excretion of sodium.

Question 8

When prescribing thiazides, caution should be used in what conditions?

Answer 8

Renal impairment, diabetes, gout, digoxin use, lithium use, and if other HTN medications are being used

Question 9

Name three potassium-sparing diuretics.

Answer 9

Spironolactone, Triamterene, Amiloride

Question 10

What are the MOA of nonaldosterone agonists such as Triamterene and Amiloride?

Answer 10

They directly inhibit NA/K exchange in distal nephron

Question 11

What are indications, drug interactions, and SE of Spironolactone?

Answer 11

Indications: HTN & Edema

Interactions: Agents that raise K levels

SE: gynecomastia, menstrual irregularities, impotence, hirsutism, and deepening of voice

Question 12

What is the Black Box Warning associated with Spironolactone?

Answer 12

Tumor formation in rats. Avoid unnecessary use.

Question 13

What are the indications, cautions, and SE of loop diuretics?

Answer 13

Indications: CHF, Pulmonary & cardiac edemas, low renal blood flow, HTN that can’t be controlled w/ thiazides

Caution: renal impairment, diabetes, gout, digoxin, lithium, ototoxic drugs, NSAIDS, other HTN medications

SE: hypokalemia, hyponatremia, dehydration, hypochloremia, hyperglycemia, hyperuricemia, cholesterol changes, ototoxicity

Question 14

What are indications and SE of mannitol?

Answer 14

Indications: prophylaxis of renal failure, reduction of ICP and IOP

SE: CHF and pulmonary edema

Question 15

What are the pharmacokinetics of mannitol?

Answer 15

Acts within 30-60 minutes, 6-8 hours effect, excreted intact in urine