Diuretics

Question 1

What’re some thiazide diuretics?

Answer 1

Hydrochlorothiazide and chlorthalidone

Question 2

Side effects of thiazide diuretics?

Answer 2

Hypokalemia and metabolic alkalosis
Hyponatremia
Hypercalcemia
Hyperglycemia
Hyperlipidemia
Hyperuricemia
Allergic reactions

Question 3

Indications of thiazides?

Answer 3

HTN
edema secondary to CHF
Cirrhosis
Prevention of calcium kidney stones
Nephrogenic diabetes

Question 4

Contraindications of thiazides consist of:

Answer 4

Hypersensitivity to any sulfonamide medications
Gout
Anuria
Severe hypokalemia

Question 5

What’re some interactions with the following if combined with thiazides?
-glucocorticoids
-Carbamazepine
-Lithium
-ACEI’s
-Digitalis

Answer 5

Gluco:-Increased hypokalemia
Carbs: Increased hyponatremia
Lith: Increased hyponatremia
ACE: hypotension
Dig: increased effects of digitalis

Question 6

Loop diuretic agents:
-Sulfonamides
-other

Answer 6

-sulfon: furosemide, torsemide, and bumetanide
-other: ethacrynic acid

Question 7

Loop diuretics cause increased _____ of calcium

Answer 7

Excretion

Question 8

Indications of loop diuretics

Answer 8

HTN
Cardiac, renal, and hepatic edema
Forced diuresis

Question 9

Side effects of of loop diuretics?

Answer 9

Metabolic imbalances
Ototoxicity (hearing damage)
Dehydration
Rash

Question 10

Potassium sparing diuretic agents:
-Aldosterone receptor antagonists
-Epithelial sodium channel blockers

Answer 10

1. Spironolactone and eplerenone
2. Trianterene and amiloride

Question 11

What is the general side effect of K+ sparing diuretics?

Answer 11

Hyperkalemia

Question 12

What is the specific side effects for spironolactone in men and women

Answer 12

Men: antiandrogenic effects (gymecomastia, ED)
Women: amenorrhea

Question 13

K+ sparing diuretics indicated for what conditions?

Answer 13

HTN
Hyperaldosteronism
Hypokalemia

Question 14

What are contraindications for these specific drugs?
-Eplerenone
-Amiloride

Answer 14

1. use of strong CYP3A4 inhibitors and hypertensions with concomitant type 2 diabetes and microalbuminuria
2. Diabetic nephropathy

Question 15

Osmotic diuretic agent?

Answer 15

Mannitol

Question 16

What is the MOA of osmotic diuretics?

Answer 16

Increases the osmolality of serum and glomerular filtrate

Question 17

What occurs as serum increases by osmotic diuretics?
(What happens to intravascular space, water, and the pressures?)

Answer 17

Increased shift of water into the vasculature space, increased binding of water, and decreased intracranial and intraocular pressures

Question 18

What happens when glomerular filtrate increases?

Answer 18

Increased urine production

Question 19

Side effects of osmotic agents?

Answer 19

Dehydration
Pulmonary edema
Hypo or hyper natremia

Question 20

Indications of osmotic diuretics?

Answer 20

Elevated ICP (e.g. cerebral edema)
Acute glaucoma
Forced renal excretion (e.g. drugs, toxins)

Question 21

Contraindications of osmotic diuretics

Answer 21

Anuria and progressing HF

Question 22

Carbonic anhydrase inhibitor agent?

Answer 22

Acetazolamide

Question 23

MOA of carbonic anhydrase inhibitors on the following organs:
-kidney
-Eyes
-Brain
-Acid-base effects

Answer 23

Kidney: increased HCO3- elimination
Eyes: decreased production of aqueous humor
Brain: decreased CSF production
Acid base effects: alkalinizes urine and acidifies blood

Question 24

Side effects of carbonic anhydrases?

Answer 24

Hyperammonemia with paresthesias (pins and needles sensation)

Proximal renal tubular acidosis —> hyperchloremic, nonanion gap metabolic acidosis

Hypokalemia

Sulfonamide hypersensitivity

Calcium phosphate stone formation

Question 25

Indications of carbonic anhydrase inhibitors?

Answer 25

Acute glaucoma
Altitude sickness
Idiopathic intracranial hypertension
Metabolic alkalosis

Question 26

Contraindications of carbonic anhydrase inhibitors?

Answer 26

Hyperchloremic metabolic acidosis
Severe renal insufficiency