Diuretics

Question 1

How do thiazide diuretics work?

Answer 1

On distal convoluted tubule
Na/Cl transporter
10% Sodium reabsorption

Possible vasodilation effect

Question 2

What thiazide diuretic is available in an injectable form?

Answer 2

Chlorothiazide

Question 3

If a patient has allergy to sulfonamides they are likely allergic to….

Answer 3

allergic to many things in general

Question 4

What is the initial effect of thiazide diuretics?

Answer 4

plasma volume depletion= decreased BP

Question 5

Can you increase the dose of diuretics to increase effect?

Answer 5

No

Question 6

What electrolyte effects may happen when taking a thiazide diuretic?

Answer 6

Increased loss of Na and Cl
Loss of K (Hyponatremia)
Loss of Mg
Increased Ca (Hypercalcemia)

Question 7

What are some ADRs of thiazide diuretics?

Answer 7

Hyponatremia
Hyperuricemia
Volume depletion
Hypercalcemia
Hypersensitivity
Hyperglycemia
Hyperlipidemia
Hypokalemia

Question 8

Dose a thiazide diuretic

Answer 8

Hydrochlorothiazide 25 mg

1 table daily

Question 9

Dose a thiazide like diuretic

Answer 9

Chlorthalidone 50mg

1 tablet daily

Question 10

When is addition of a thiazide to a loop diuretic helpful?

Answer 10

Refractory edema in heart failure
Cirrhosis
Nephrotic syndrome
Renal failure

Question 11

What is the MOA of loop diuretics?

Answer 11

Work on ascending Loop of Henle on Na/K/Cl transporters

25-30% sodium reabsorption

Question 12

Can you increase the dose of loop diuretics to get an increased effect?

Answer 12

Yes

Question 13

What electrolyte effects can loop diuretics cause

Answer 13

Increased excretion Na and Cl
Loss of K
Loss of Mg
Loss of Ca
-reduced renal vascular resistance

Question 14

What is the onset of loop diuretics?

Answer 14

Relatively rapid

Symptom relief in hours to days

Question 15

What are the main uses in the U.S. of loop diuretics?

Answer 15

Heart Failure
Nephrotic Syndrome
Renal insufficiency
Cirrhosis

Question 16

Dose a loop diuretic

Answer 16

Furosemide 40mg

1 tablet daily

Question 17

How do aldosterone antagonist potassium-sparing diuretics work?

Answer 17

Block stimulation of Na/K exchange in collecting tubule

Spironolactone has hormonal effect

Question 18

How does Amiloride work?

Answer 18

sodium channel blocker in the collecting tubule

Question 19

What are the indications for Spironolactone?

Answer 19

Management of CHF
Cirrhosis of liver w/edema and/or ascites
Nephrotic syndrome

Question 20

What are the indications for Amiloride

Answer 20

Adjunctive treatment with thiazide or other kaliuretic-diuretics in CHF or HTN to restore normal serum K levels
-or to prevent development of K in those at risk

Question 21

What are the ADRs of Spironolactone?

Answer 21

Gastric upset
Gynecomastia
Menstrual irregularities

Question 22

What are the ADRs of Amiloride/Triamtrene?

Answer 22

Leg cramps
Increased BUN
Potassium retention
Increased uric acid

Question 23

What are potential problems when using a potassium-sparing diuretic with a thiazide diuretic?

Answer 23

Excess diuresis

Blunt hypokalemia

Question 24

Dose a potassium-sparing diuretic that is approved for HTN

Answer 24

Amiloride 10mg

1 tablet daily

Question 25

Dose a potassium-sparing diuretic that is approved for cirrhosis of the liver or Nephrotic syndrome

Answer 25

Sprionolactone 25 mg

1 tablet twice a day

Question 26

How does Mannitol work?

Answer 26

Inhibits sodium reabsorption in the proximal convoluted tubule and Loop of Henle

Question 27

When is Mannitol used?

Answer 27

Inpatient setting:

• Reduction of intracranial pressure
• Reduction of ocular pressure

Question 28

What would you give to a patient with low potassium?

Answer 28

Potassium Chloride

K-Dur, Slow-K

Question 29

What diuretics have been shown to be safe in children?

Answer 29

Thiazides and Spironolactone