Diuretics Flashcards
Sulfonamide loop diuretics examples
Furosemide
Bumetanide
Torsemide
*TBR: to be fr
MoA of loop diuretics
Act on the ———– and it inhibits the ——- carrier –> ———
(increase ——–)
Act in the thick ascending limb and it inhibits the Na+/K+/Cl- carrier –> Vasodilation
(increase Ca2+ secretion)
Non-Sulfonamide loop diuretics
Ethacrynic acid
clinical uses of Sulfonamide loop diuretics
°Acute pulmonary oedema
°Chronic HF,
°Cirrhosis of liver with ascites
°Nephrotic syndrome,
°Renal failure.
*Hypertension complicated by renal impairment
AE of Sulfonamide loop diuretics
related to Renal action:
1) Hypokalaemia and hypotension
2) Hypovolaemia,
3) Metabolic alkalosis,
4) Hyperuricaemia,
5) Renal impairment,
6) Hypocalcaemia
7) Hypomagnesaemia
8) Hyponatraemia
AE not related to renal action: (rare)
° Dose-related hearing loss
° Sulfa allergy (rashes, bone marrow depression)
Contraindications of loop diuretics?
- Severe hypovolemia
- Dehydration
- Hypokalaemia
- Hyponatraemia
- Hepatic encephalopathy (imapired liver -> toxins in blood)
- Gout (because hyperuricemia)
- Osteoporosis
Clinical uses of Non-Sulfonamide loop diuretics
Used for diuresis in patients allergic to sulfa drugs
AE of Non-sulfonamide loop
diuretics
Ototoxic
*Ototoxicity : hearing or balance problems due to a medicine
Thiazide Diuretics examples
*note: less powerful than loop diuretics
Bendroflumethiazide
Hydrochlorothiazide
Chlortalidone
Indapamide
Metozalone
- Be Here Cause I Matter
MoA of Thiazide diuretics
Inhibit the distal tubular Na+/Cl- co-transport by binding to the Cl- site: this causes
1) natriuresis w/loss of sodium and chloride ions in the urine
2) reduced blod volume –> ↓ bp
Clinical uses of Thiazide diuretics
- Uncomplicated hypertension.
AE of Thiazide diuretics
°Higher urinary frequency,
° erectile dysfunction,
°hyponatremia,
°hypomagnesaemia,
° Hyperuricemea
°alkalosis —> hypokalemia
° imapired glucose intolerance –>hyperglycaemia
° hyperlipidaemia
° Hepatic encephalopathy
GLUC (HyperGlyceamia, HyperLipedeamia, HyperUricaemia, HyperCalcemia)
Contraindications of Thiazide Diuretics
1) Do not give to people with hyperuricemia
because they compete for uric acid secretion
2) HYpokalaemia (drug interactions)
Potassium sparing diuretics (aldosterone antagonists) Examples
Spironolactone
Eplerenone
-one
clinical uses of Potassium sparing diuretics (aldosterone antagonists)
-
Prolong survival in heart failure
-Primary hyperaldosteronism (Conn’s sy).
-Resistant essential hypertension (low renin
hypertension)
-Secondary hyperaldosteronism (caused by
hepatic cirrhosis complicated by ascites)- When drugs such as thiazide or loop diuretics
cause K+ loss, you can give these aldosterone
antagonists to prevent K+ secretion.
- When drugs such as thiazide or loop diuretics
AE of Potassium sparing
diuretics (aldosterone antagonists)
- Hyperkalaemia!!
- GI upsetting.
- Gynecomastia,
- menstrual disorders,
- testicular atrophy
*Gynecomastia: enlarged breasts in males
Contraindicaiton of Potassium sparing
diuretics (aldosterone antagonists)
Hyperkalaemia
indication of Potassium sparing
diuretics (aldosterone
antagonists)
*how are they normally used?
Usually combined with loop diuretics or
thiazides because their action alone is not
that effective.
Can be used in female hirsutism.
*female hirsutism : excessive face,chest,back hair in women (like males)
Examples of potassium sparing diuretics (not aldosterone antagonists)
Triamterene
Amiloride
MoA of potassium sparing diuretics (not aldosterone antagonists)
Act on collecting tubules and collecting ducts
(inhibit Na+ reabsorption by decreasing
Na+/H+ antiport)
Clinical uses of potassium sparing diuretics (not aldosterone antagonists)
may be given with loop diuretics / thiazides to maintaine potassium balance
AE of potassium sparing diuretics (not aldosterone antagonists)
1) Hyperkalaemia
2) Kidney stones (Triamterene)
Carbonic Anhydrase inhibitors examples
Acetazolamide
Dorlozamide
-zolamide
MoA of Carbonic anhydrase
inhibitors
- Decrease H+ formation in proximal
convoluted tubule cell→increasinng the excretion of Bicarbonates (HCO-3) w/ NA+/ K+ and water - increase the flow of alkaline urine –> metablic acidosis
Clinical uses of Carbonic anhydrase
inhibitors
-Glaucoma (reduces aqueous humour)
-Idiopathic intracranial hypertension
-Metabolic alkalosis
NOT USED AS A DIURETIC
AE of Carbonic anhydrase
inhibitors
- Bicarbonaturia, hypokalemia,
- hyperchloremia,
- Paraesthesia,
- renal stones,
- NH3 toxicity (alkaline urine , dangerous for brain)
Acetazolamide only
- rashes,
- blood dyscrasias,
- interstitial nephritis.
- Cross-allergenicity with: all loop diuretic (except ethacrynic acid), thiazides, sulfa Abx, celecoxib.
