Diuretics Flashcards
What’re some thiazide diuretics?
Hydrochlorothiazide and chlorthalidone
Side effects of thiazide diuretics?
Hypokalemia and metabolic alkalosis
Hyponatremia
Hypercalcemia
Hyperglycemia
Hyperlipidemia
Hyperuricemia
Allergic reactions
Indications of thiazides?
HTN
edema secondary to CHF
Cirrhosis
Prevention of calcium kidney stones
Nephrogenic diabetes
Contraindications of thiazides consist of:
Hypersensitivity to any sulfonamide medications
Gout
Anuria
Severe hypokalemia
What’re some interactions with the following if combined with thiazides?
-glucocorticoids
-Carbamazepine
-Lithium
-ACEI’s
-Digitalis
Gluco:-Increased hypokalemia
Carbs: Increased hyponatremia
Lith: Increased hyponatremia
ACE: hypotension
Dig: increased effects of digitalis
Loop diuretic agents:
-Sulfonamides
-other
-sulfon: furosemide, torsemide, and bumetanide
-other: ethacrynic acid
Loop diuretics cause increased _____ of calcium
Excretion
Indications of loop diuretics
HTN
Cardiac, renal, and hepatic edema
Forced diuresis
Side effects of of loop diuretics?
Metabolic imbalances
Ototoxicity (hearing damage)
Dehydration
Rash
Potassium sparing diuretic agents:
-Aldosterone receptor antagonists
-Epithelial sodium channel blockers
- Spironolactone and eplerenone
- Trianterene and amiloride
What is the general side effect of K+ sparing diuretics?
Hyperkalemia
What is the specific side effects for spironolactone in men and women
Men: antiandrogenic effects (gymecomastia, ED)
Women: amenorrhea
K+ sparing diuretics indicated for what conditions?
HTN
Hyperaldosteronism
Hypokalemia
What are contraindications for these specific drugs?
-Eplerenone
-Amiloride
- use of strong CYP3A4 inhibitors and hypertensions with concomitant type 2 diabetes and microalbuminuria
- Diabetic nephropathy
Osmotic diuretic agent?
Mannitol
What is the MOA of osmotic diuretics?
Increases the osmolality of serum and glomerular filtrate
What occurs as serum increases by osmotic diuretics?
(What happens to intravascular space, water, and the pressures?)
Increased shift of water into the vasculature space, increased binding of water, and decreased intracranial and intraocular pressures
What happens when glomerular filtrate increases?
Increased urine production
Side effects of osmotic agents?
Dehydration
Pulmonary edema
Hypo or hyper natremia
Indications of osmotic diuretics?
Elevated ICP (e.g. cerebral edema)
Acute glaucoma
Forced renal excretion (e.g. drugs, toxins)
Contraindications of osmotic diuretics
Anuria and progressing HF
Carbonic anhydrase inhibitor agent?
Acetazolamide
MOA of carbonic anhydrase inhibitors on the following organs:
-kidney
-Eyes
-Brain
-Acid-base effects
Kidney: increased HCO3- elimination
Eyes: decreased production of aqueous humor
Brain: decreased CSF production
Acid base effects: alkalinizes urine and acidifies blood
Side effects of carbonic anhydrases?
Hyperammonemia with paresthesias (pins and needles sensation)
Proximal renal tubular acidosis —> hyperchloremic, nonanion gap metabolic acidosis
Hypokalemia
Sulfonamide hypersensitivity
Calcium phosphate stone formation
Indications of carbonic anhydrase inhibitors?
Acute glaucoma
Altitude sickness
Idiopathic intracranial hypertension
Metabolic alkalosis
Contraindications of carbonic anhydrase inhibitors?
Hyperchloremic metabolic acidosis
Severe renal insufficiency
