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Urinary system > Diuretics > Flashcards

Diuretics Flashcards

1
Q

What do diuretics do?

A
  • Act on kidneys to increase urine production and eliminate water from the body
  • Reduce plasma volume and cardiac output
  • Reduce BP
  • Reduce oedema/ascites
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2
Q

What are diuretics?

A
  • Drugs that increase renal excretion of Na+ and water
  • Result in an increase in urine volume
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3
Q

What is diuresis?

A
  • The process of excretion of water in the urine
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4
Q

What is natriuresis?

A
  • The process of excretion of sodium in the urine
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5
Q

What are the 5 main classes of diuretics?

A
  • Carbonic anhydrase inhibitors
  • Osmotic diuretics
  • Loop diuretics
  • Potassium sparing diuretics
  • Thiazide and thiazide-like diuretics
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6
Q

Which structures do diuretics affect?

A
  • Carriers or transporters in the luminal membrane or renal tubular cells
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7
Q

Which classes of diuretic act on the PCT?

A
  • Carbonic anhydrase inhibitors
  • Osmotic diuretics
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8
Q

Which class of diuretic acts on the loop of Henle?

A
  • Loop diuretics
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9
Q

Which classes of diuretic act on the DCT?

A
  • Thiazide and thiazide-like diuretics
  • Potassium sparing diuretics (late DCT and early CD)
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10
Q

How do loop diuretics cause hypokalaemia?

A
  • ENac channels work harder to move Na+ out of collecting duct and into cells
  • K+ then leaves these cells via ROMK channels because the extra Na+ makes the positive charge in the cells too high
  • K+ is then excreted
  • This can cause hypokalaemia
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11
Q

Give an example of an osmotic diuretic?

A
  • Mannitol - administered via IV
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12
Q

What is the action of osmotic diuretics?

A
  • Allow water diuresis without affecting Na+ excretion
  • Expands extracellular fluid volume initially
  • Decreases blood viscosity
  • Inhibits renin release
  • Increases renal blood flow
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13
Q

What are the uses of osmotic diuretics?

A
  • Treat acute renal failure due to shock or trauma (maintains urine flow and preserves kidney function)
  • Treat acute drug poisoning by eliminating drugs before they are absorbed from renal tubules
  • Decreases intracranial and intraocular pressure before ophthalmic or brain procedures
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14
Q

Why don’t we use osmotic diuretics often?

A
  • Can expand extra-cellular volume
  • Water stays in plasma as it travels to kidney
  • Could cause problems in certain patients e.g. with heart failure
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15
Q

What are the side effects of osmotic diuretics?

A
  • Headache, nausea, vomiting due to hyponatraemia
  • Extracellular volume expansion - complicates heart failure and pulmonary oedema
  • Contraindicated in chronic heart failure
  • Excessive use needs to dehydration and hypernatraemia
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16
Q

What is the action of loop diuretics?

A
  • Inhibit Na+/K+/2Cl- transporter
17
Q

Give examples of loop diuretics

A
  • Bumetanide
  • Furosemide
18
Q

How are loop diuretics administered?

A
  • Orally or via IV
  • Have a fast onset of action
  • Increase urine volume
  • Suitable for emergency situations
19
Q

What do we use loop diuretics to treat?

A
  • Severe oedema associated with congestive heart failure
  • Treatment for Oliguric ARF
  • Treatment of hypercalcaemia
  • Acute pulmonary oedema
  • Acute hyperkalaemia
  • Acute hypercalcaemia
  • Toxicity of Br, F and I
20
Q

What are the side effects of loop diuretics?

A
  • Hypovolaemia
  • Hyponatraemia
  • Hypokalaemia - dietary supplementation or K-sparing diuretics should be used
  • Hypomagnesaemia
  • Metabolic alkalosis
  • Postural hypotension
21
Q

What is the action of thiazide and thiazide like diuretics?

A
  • Inhibit Na+/Cl- transporter
  • 1st line antihypertensive
22
Q

What are the effects of thiazide and thiazide like diuretics?

A
  • Increase urinary NaCl excretion
  • Increase urinary K+ excretion
  • Increase urinary Mg2+ excretion
  • Increase Ca2+ reabsorption
  • Decrease urinary Ca2+ excretion
  • Decrease uric acid excretion
23
Q

Give some examples of thiazide and thiazide-like diuretics

A
  • Bendroflumethiazide
  • Indapamide
24
Q

What are thiazide and thiazide-like diuretics used to treat?

A
  • Essential hypertension
  • Mild heart failure
  • Calcium nephrolithiasis due to hypercalciuria
  • Osteoporosis
  • Nephrogenic diabetes insipidus polyuria
25
Q

What is the action of potassium sparing diuretics?

A
  • Blocks ENac channel
  • No change in electrochemical gradient (because no movement of Na+)so no K+ is lost
25
Q

What is the action of potassium sparing diuretics?

A
  • Blocks ENac channel
  • No change in electrochemical gradient (because no movement of Na+) so no K+ is lost
26
Q

What is the action of aldosterone antagonists?

A
  • Acts as a competitor for the aldosterone receptors
  • No increase in ENac channels or ROMK channels
  • No loss of K+ or Na+
27
Q

Give an example of a potassium sparing diuretic?

A
  • Amiloride
28
Q

Give an example of an aldosterone antagonist

A
  • Spironolactone
29
Q

What are the effects of potassium sparing diuretics and aldosterone antagonists?

A
  • Increase urinary Na+ excretion
  • Decrease urinary K+ excretion
  • Decrease H+ excretion
30
Q

What are the uses of potassium sparing diuretics and aldosterone antagonists?

A
  • Secondary hyperaldosteronism
  • CHF, hepatic cirrhosis, nephrotic syndrome
  • Treatment of hypertension (combined with thiazide or loop diuretics)
31
Q

Which patients are potassium sparing diuretics and aldosterone antagonists contraindicated in?

A
  • Hyperkalaemia (chronic renal failure, k+ supplementation, beta-blockers, ACE inhibitors)
  • Liver disease

Urinary system (22 decks)

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