Diuretics

Question 1

Sulfonamide loop diuretics examples

Answer 1

Furosemide
Bumetanide
Torsemide

*TBR: to be fr

Question 2

MoA of loop diuretics
Act on the ———– and it inhibits the ——- carrier –> ———
(increase ——–)

Answer 2

Act in the thick ascending limb and it inhibits the Na+/K+/Cl- carrier –> Vasodilation
(increase Ca2+ secretion)

Question 3

Non-Sulfonamide loop diuretics

Answer 3

Ethacrynic acid

Question 4

clinical uses of Sulfonamide loop diuretics

Answer 4

°Acute pulmonary oedema
°Chronic HF,
°Cirrhosis of liver with ascites
°Nephrotic syndrome,
°Renal failure.

*Hypertension complicated by renal impairment

Question 5

AE of Sulfonamide loop diuretics

Answer 5

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)

Question 6

Contraindications of loop diuretics?

Answer 6

• Severe hypovolemia
• Dehydration
• Hypokalaemia
• Hyponatraemia
• Hepatic encephalopathy (imapired liver -> toxins in blood)
• Gout (because hyperuricemia)
• Osteoporosis

Question 7

Clinical uses of Non-Sulfonamide loop diuretics

Answer 7

Used for diuresis in patients allergic to sulfa drugs

Question 8

AE of Non-sulfonamide loop
diuretics

Answer 8

Ototoxic

*Ototoxicity : hearing or balance problems due to a medicine

Question 9

Thiazide Diuretics examples

*note: less powerful than loop diuretics

Answer 9

Bendroflumethiazide
Hydrochlorothiazide
Chlortalidone
Indapamide
Metozalone

• Be Here Cause I Matter

Question 10

MoA of Thiazide diuretics

Answer 10

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

Question 11

Clinical uses of Thiazide diuretics

Answer 11

• Uncomplicated hypertension.

Question 12

AE of Thiazide diuretics

Answer 12

°Higher urinary frequency,
° erectile dysfunction,
°hyponatremia,
°hypomagnesaemia,
° Hyperuricemea
°alkalosis —> hypokalemia
° imapired glucose intolerance –>hyperglycaemia
° hyperlipidaemia
° Hepatic encephalopathy

GLUC (HyperGlyceamia, HyperLipedeamia, HyperUricaemia, HyperCalcemia)

Question 13

Contraindications of Thiazide Diuretics

Answer 13

1) Do not give to people with hyperuricemia
because they compete for uric acid secretion
2) HYpokalaemia (drug interactions)

Question 14

Potassium sparing diuretics (aldosterone antagonists) Examples

Answer 14

Spironolactone
Eplerenone

-one

Question 15

clinical uses of Potassium sparing diuretics (aldosterone antagonists)

Answer 15

• 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.

Question 16

AE of Potassium sparing
diuretics (aldosterone antagonists)

Answer 16

• Hyperkalaemia!!
• GI upsetting.
• Gynecomastia,
• menstrual disorders,
• testicular atrophy

*Gynecomastia: enlarged breasts in males

Question 17

Contraindicaiton of Potassium sparing
diuretics (aldosterone antagonists)

Answer 17

Hyperkalaemia

Question 18

indication of Potassium sparing
diuretics (aldosterone
antagonists)

*how are they normally used?

Answer 18

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)

Question 19

Examples of potassium sparing diuretics (not aldosterone antagonists)

Answer 19

Triamterene
Amiloride

Question 20

MoA of potassium sparing diuretics (not aldosterone antagonists)

Answer 20

Act on collecting tubules and collecting ducts
(inhibit Na+ reabsorption by decreasing
Na+/H+ antiport)

Question 21

Clinical uses of potassium sparing diuretics (not aldosterone antagonists)

Answer 21

may be given with loop diuretics / thiazides to maintaine potassium balance

Question 22

AE of potassium sparing diuretics (not aldosterone antagonists)

Answer 22

1) Hyperkalaemia
2) Kidney stones (Triamterene)

Question 23

Carbonic Anhydrase inhibitors examples

Answer 23

Acetazolamide
Dorlozamide

-zolamide

Question 24

MoA of Carbonic anhydrase
inhibitors

Answer 24

• 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

Question 25

Clinical uses of Carbonic anhydrase
inhibitors

Answer 25

-Glaucoma (reduces aqueous humour)
-Idiopathic intracranial hypertension
-Metabolic alkalosis

                NOT USED AS A DIURETIC

Question 26

AE of Carbonic anhydrase
inhibitors

Answer 26

• 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.