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Drug Classes > Diuretics > Flashcards

Diuretics Flashcards

1
Q

Thiazide diuretics MOA

A

Inhibits sodium re absorption and so water, at the beginning of the distal convoluted tube

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2
Q

How do diuretics affect urine output

A

Increases urine output

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3
Q

What are examples of thiazides
Thiazide like

A

Bendroflumethiazide

Chlortalidone
Indapamide

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4
Q

Whats the onset and duration of action of thiazides of oral administration

A

Onset is 1-2 hours
Duration is 12-24hrs

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5
Q

What time of day do you give diuretics and why

A

Morning, to avoid diuresis at night interfering with sleep

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6
Q

Whats the potency of bendroflumethiazide, indapamide and chlortalidone

A

Moderate potency

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7
Q

When are lower doses of thiazides used and when are higher doses used

A

Lower doses are used in hypertension and higher doses are used in oedema due to congestive HF

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8
Q

Do higher or lower doses of thiazides have more affect on biochemical balance (electrolytes)

A

Higher doses

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9
Q

When is bendroflumethiazide used? Conditions

A

Mild or moderate HF or hypertension , oedema

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10
Q

Which thiazide can be given on alternate days and why?

Whats it’s indication?

A

Oedema and hypertension and HF
Chlortiladone
Because its long acting

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11
Q

Indication for indapamide

A

Hypertension
It is now first line
Bendroflumethiazide can be used first line if already stable on it

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12
Q

Why is indapamide preferred in comparison to bendro in hypertension

A

Less aggravation of diabetes and lowers BP without having a great affect on electrolytes

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13
Q

What are thiazides contraindicated in.

Hint: electrolytes

A

Hypokalaemia, addisons disease,
Hyponatraemia, hypercalcaemia, hyperuricaemia

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14
Q

Which diuretic has greater risk of hypokalaemia?

A

Thiazides

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15
Q

Which drug interacts with thiazides and what can you give instead?

A

Thiazides interact with cardiac glycosides such as digoxin due to hypokalaemia risk

Give potassium sparing diuretic or potassium supplements

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16
Q

Hypokalaemia is dangerous in ….

A

Severe cardiovascular disease

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17
Q

In liver disease hypokalaemia can lead to ….. especially in ……. Hence avoid using …… in liver disease

A

Encephalopathy

Alcoholic cirrhosis

Thiazides

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18
Q

What thiazide doses would you initially give to elderly and why

A

Low doses

More prone to SE

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19
Q

What are the SE of thiazides

A

Skin reactions, constipation, electrolyte imbalance, PH

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20
Q

Dont use thiazides in long term treatment of ….. instead recommend …..

A

Gravitational oedema

Raise legs, increased movement, stockings

21
Q

What do thiazides exacerbate. Why?

A

Diabetes
Gout

Due to hyperuricaemia and hyperglycaemia

22
Q

In gestational hypertension can we give thiazides? Why?

A

No
Can cause malformations, neonatal thrombocytopenia, electrolyte imbalance, bone marrow suppression and jaundice

23
Q

Can we use thiazide diuretics in severe liver disease? Why?

A

No
Causes hypokalaemia which in liver disease causes encephalopathy

24
Q

Dont use thiazides if eGFR ….. because…..

A

<30ml/min/1.73
Ineffective

25
Q

What are examples of loop diuretics?

A

Furosemide
Bumetanide

26
Q

Loops MOA

A

Inhibits reabsorption of Na and water from the ascending loop of henle

27
Q

Indications of loops (furosemide, bumetanide)

A

Pulmonary Oedema in HF, and in Resistant hypertension

28
Q

Which diuretics are stronger and which can be used for resistant oedema?

A

Loop diuretics are stronger and can be used for resistant oedema

29
Q

Hyperglycaemia is more likely in loops or thiazide diuretics?

A

Thiazides

30
Q

Which diuretic is more powerful? Loop or thiazide

A

Loop

31
Q

Loop diuretics can exacerbate…..

A

Diabetes and gout

Diabetes more exacerbated in thiazide use

32
Q

Onset of furosemide and bumetanide and duration

A

1 hour
Diuresis is complete within 6 hours hence can be given BD without interfering with sleep

33
Q

CI of loop (furosemide and bumetanide)

A

Renal failure (eGFR <30), severe hypokalaemia, hyponatraemia, liver cirrhosis

34
Q

In ….. impairment, loops can cause ……. At higher doses or IV administration

A

Renal impairment

Ototoxic - deafness and tinnitus

35
Q

Why are loops CI in renal impairment

A

Higher doses cause deafness/ ototoxic

36
Q

What colours the urine blue

A

Triamterene and furosemide

37
Q

Which diuretics are classed as ‘weak’ and which are classed as powerful

A

Amiloride and triamterene - weak

Bumetanide, furosemide are powerful

38
Q

Can you give spironolactone and potassium supplements

A

No because of hyperkalaemia risk

39
Q

Which drug is CI with potassium sparing diuretics

A

ACEi/ARBs

40
Q

Which potassium sparing diuretics are strong

A

Spironolactone and epleronone

41
Q

What is a SE of spironolactone

A

Gynaecomastasia (breast tenderness)

42
Q

When is combination diuretic therapy used?

A

When oedema is resistant to one diuretic

43
Q

Whats an example of an osmotic diuretic and whats its indications?

A

Mannitol
Cerebral oedema and raised ocular pressure

44
Q

Give an example of a carbonic anhydrase inhibitor

Whats its indication

A

Acetazolamide - weak diuretic
Glaucoma, epilepsy

45
Q

Dont give acetazolamide if pt is allergic to….

A

Sulfonamide

46
Q

Can you give acetazolamide in renal and hepatic impairment?
Explain

A

No
Hepatic - hypokalaemia causes encephalopathy

Renal- risk of metabolic acidosis

47
Q

Whats the drug class of brinzolamide and dorzolamide? Indications?

A

Used in open angle glaucoma and raised intraocular pressure when BB ineffective or CI
and inhibits formation of aq humour

48
Q

Can you give NSAIDS with diuretics

A

No
Increased Risk of acute renal failure

49
Q

Which is more potent furosemide ir bumetanide

A

Bumetanide

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