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MET2 > Diuretics > Flashcards

Diuretics Flashcards

1
Q

What are 5 classes of diuretic? [5]

A

Carbonic anhydrase inhibitors
Thiazide
Loop
Potassium sparing diuretics
Osmotic diuretics

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2
Q

Where do carbonic anhydrase inhibitors work? [1]

MoA of CA inhibitors?

A
  • CA inhibitors work at PCT
  • Causes more HCO3-, H+ & Cl- excreted in urine
  • Get less CO2 and water in cell
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3
Q

Which of the following is the most effective type of diuretic?

Carbonic anhydrase inhibitors
Thiazide
Loop
Potassium sparing diuretics
Osmotic diuretics

A

Which of the following is the most effective type of diuretic?

Carbonic anhydrase inhibitors
Thiazide
Loop: e.g. Frusemide
Potassium sparing diuretics
Osmotic diuretics

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4
Q

Where do loop diuretics work? [1]

How do they work? [1]

A

Loop diuretic: work at thick ascending limb

MoA:
- Block NaKCl2 transporter (competing with Cl- for binding site)
- Less Na into tubular cell: less Na into blood / more Na excreted in urine
- Results in less K+ reabsorbed
- Causes decreased Ca2+, Mg2+ absorption via paracellular transport

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5
Q

Explain two AEs of using loop diuretics? [3]

A

Hypokalemia: directly blocks K reabsorption through blockage of NaKCl2

Dehydration

Kidney stones: due to retained Ca in urine

Deafness

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6
Q

Thiazide diuretics work in which location of nephron? [1]

MoA of thiazide diuretics? [1]

A

Thiazide diuretics: work at DCT

MoA: Blocks Na/Cl transporter

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7
Q

Explain how thiazide diuretics impact K+ levels

A

Cause hypokalaemia:

  • Thiazied diuretics block Na/Cl transporter at DCT
  • Na is delivered to CD, where absorbed by ENaC channels
  • This causes the aldosterone-sensitive Na/K pump to increase Na reabsorption in the principal cells
  • This exchange increases Na transfer into the interstitium and increases K transfer into the collecting tubules and lumen.
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8
Q

What are the two type of K sparing diuretics? [2]

Name two examples of each xx [4]

A

Epithelial Na Channel antagonists
* Amiloride
* Triamterene

Aldosterone antagonists:
* Spironolactone
* Eplerenone

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9
Q

Where do potassium sparing diuretics, such as spironolactone or eplerenonework in nephron? [1]

MoA? [1]
How do they ensure K+ reabsorption? [1]

A

Spironolactone and eplerenone work at CD

Both: aldosterone antagonists (Na/K transporter)

Because Na doesn’t get reabsorbed into blood, K doesn’t have to be excreted in exchange

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10
Q

Where do Epithelial Na Channel antagonists
potassium sparing diuretics, like Amiloride or Triamterene work in the nephron? [1]

MoA? [1]
How do they ensure K+ reabsorption? [1]

A

Collecing Duct / Distal tubule

Work by blocking urine lumen side Na+ transporter: stops Na+ reabsorption; driving force for K+ secretion is eliminated

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11
Q

What is a osmotic diuretic and which is the most clinically important? [2]

A

Any osmotically active molecule that is freely filtered in the glomerulus, and is not reabsorbed by the tubules, stopping water reabsorption

Most important clinical osmotic diuretic: Mannitol

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12
Q

What is Acetazolamide mainly used for? [1]

A

Mountain sickness: try and reverse resp. alkalosis by creating metabolic acidosis (by increasing HCO3- excretion)

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13
Q

What are AEs of CA inhibitors like Acetazolamide? [3]

A

Metabolic acidosis
Sedation
Sulphonamide antibiotics

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14
Q

What is clinical use of thiazide diuretic? [1]

Why? [2]

A

Antihypertensive:
reduces plasma volume and peripheral resistance

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15
Q

AEs of thiazide diuretics? [3]

A

Hypokalaemia: K+excretion is enhanced due to the increase in Na+delivered to the distal tubule.

Hypercalcaemia: Ca2+excretion is decreased via a poorly understood mechanism

Hyponatraemia (particularly in old people)

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16
Q

Explain AEs of thiazide diuretics? [5]

A

Hypokalaemia: K+excretion is enhanced due to the increase in Na+delivered to the distal tubule / CD, where Na is reabsorped at expense of K+

Hypercalcaemia: Ca2+excretion is decreased via a poorly understood mechanism

Hyponatraemia (particularly in old people)

Hyperglycaemia: inhibits insulin secretion slightly

Hypercholesterolaemia: unknown mech

17
Q

Thiazide diuretics cause increase excretion of which electrolytes? [2]

A

K+, Na+

18
Q

Clinical use of loop diuretics? [3]

A
  • Most potent diuretic

Also for:
* HTN
* Heart failure
* Volume overload from CKD

19
Q

Loop diuretics cause increase excretion of which electrolytes? [4]

A

K+, Na+, H20, Ca, Mg.

20
Q

Explain how loop diuretics maintain renal blood flow

A

.Loop diuretics block the Na+, K+, Cl-symporter in the macula densa.

As a result the tubuloglomerular feedback mechanism is blocked

. Because of this loop diuretics maintain renal blood flow.

21
Q

Why can loop diuretics cause kidney stones?

A

Loop diuretics cause increase Ca2+ excretion: increases chances

22
Q

What are clinical uses of aldosterone inhibitors? [4]

A

Hyperaldosteronism (Conns)
Heart failure
Hypokalaemia (from other diuretics)
Cirrhosis

23
Q

AEs of aldosterone inhibitors? [3]

A

Hyperkalaemia
Hyperkalaemia –> can lead to cardiac arrythmias and death
Hyperkalaemia
Gynecomastia (not eplerenone)
Hyponatraemia (Cirrhosis)

24
Q

Why do aldosterone inhibitors lead to hyperkalaemia?

A

Na not excreted, so K kept

25
Q

Clinical uses of amiloride?

A

Heart failure
Hypokalaemia (from other diuretics)
Co-amilofruse
Co-amilozide
Cirrhosis

26
Q

AEs of amoliride? [2]

A

Hyperkalaemia
Hyponatraemia

27
Q

When would you use osmotic diuretic clinically? [1]

A

Clinical use:
* Cerebral odema

AEs:
* Transient fluid overload: pulmonary odema
* If using glucose: DKA/HHS
* If using urea: Disequilibrium syndrome

28
Q

When should you not use diuretics ! [5] key

A

When hypotensive
When dehydrated
When hypokalaemic (Loop/Thiazide)
When hyperkalaemic (Amiloride, aldosterone antagonists)
Post surgery, with a poor urine output

29
Q

Explain MoA of SGLT-2 inhibitors

A

Normally SGLT2 allows Na AND glucose to be reabsorbed at PCT

Blocking SGLT2 causes more Na to be delivered to macula densa: here it causes glomerulus afferent arteriole constriction, which normalises GFR. Also causes glucose to be excreted in urine

30
Q

Effects of SGLT2 inhibitors? [5]

A

Glycosuria: weight loss, reduction in blood glucose, HbA1c reduced

Uric acid reduced

Natuiresis: fall in BP

Reduced hyperinfiltration: reduced albuininuria

Reversible reduction in GFR

31
Q

Cardio protective effects of SGLT-2 inhibitors?

A

MET2 (52 decks)

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