Diuretics Flashcards
- More effective in patients w/ impaired renal function
- Diuretic resistance (used w/ loop diuretics)
Metolazone
Chlorthalidone
Thiazide
What do diuretics do?
- manage edema associated w/ renal, HF, and cirrhosis, as well as glaucoma and HTN
- Act on various sites in the nephron to cause diuresis
- natriuresis (inhibits reabsorption of Na from nephron)
- increase kaliuresis (increases excretion of K)
- affects excretion of magnesium, bicarbonate, and chloride
- Sulfonamide compounds
- Renally excreted (do not use CrCl < 30ml/min
Thiazide pharmacokinetics
Hydrochlorthiazide
Thiazide
Indapamide
Thiazide
Thiazide indications
- HTN
- Edema associated w/ HF, cirrhosis, renal disorders (nephrotic syndrome)
- Nephrolithiasis (kidney stones): increases Ca reabsorption, reducing urinary calcium levels (mainly Hydrochlorothiazide)
Thiazide Interactions
- w/ Lithium: Increase toxicity/levels of lithium
- w/ NSAIDs: decrease effects of diuretics and antihypertensive effects, decreases renal function
- DO NOT USE W/ CRCL <30 ML/MIN
Thiazide Adverse Effects
- Hypokalemia
- Hypomagnesemia
- Hypotension (may predispose to falls)
- Hyperglycemia
- Hyperuricemia
- Hyperlipidemia
- Metabolic alkalosis
Increases calcium reabsorption, reducing urinary calcium levels. (drug is indicated for nephrolithiasis)
Hydrochlorothiazide
Torsemide
Loop diuretic
Loop diuretic: MOA
act on loop of Henle
- Inhibit Na and Cl reabsorption
- Potassium is excreted (hypokalemia)
Loop diuretic indications
- HTN
- Edema associated w/ HF (DOC), cirrhosis, RENAL IMPAIRMENT (PREFERRED DIURETIC IN PATIENTS W/ CRCL <30 ML/MIN
- HYPERCALCEMIA (opposite of thiazides because they EXCRETE calcium)
Loop diuretic adverse effects
Same as thiazide adverse effect except loop diuretics cause OTOTOXICITY
Loop diuretics interactions
Same as thiazides; except that loop diuretics CAN be used w/ patients who have renal impairment
Furosemide
Loop diuretic
Metolazone
Thiazide
How does Triamterene work?
Works at the LATE DISTAL TUBULE and COLLECTING DUCT
- REDUCES POTASSIUM EXCRETION
- mild natriuresis effect
- used to PREVENT HYPOKALEMIA
Triamterene adverse effects
Hyperkalemia
Triamterene drug interactions
- ACEIs increase potassium
- ARBs increase potassium
- Potassium supplements
Triamterene
Potassium-sparing diuretics
Spironolactone MOA
- inhibits binding aldosterone to mineralcorticoid receptor in distal tubule and collecting duct
- Has anti-androgen activity by binding to androgen receptor
- Reduces potassium excretion (increases potassium)
- Mild natriuresis effect
act on early portion of DISTAL TUBULE
- inhibits Na and Cl reabsorption
- Potassium is excreted (hypokalemia)
Thiazide MOA
Used for primary hyperaldosteronism, HF and cirrhosis
Spironolactone
Spironolactone contraindications
- Hyperkalemia
- Severe renal impairment
Spironolactone adverse effects
- Hyperkalemia
- GYNECOMASTIA (enlarged breasts in males)
Spironolactone
Aldosterone antagonist
Spironolactone drug interactions
- ACEIs (increase potassium)
- ARBs (increase potassium)
- Potassium supplements
- TRIMETHOPRIM (increase potassium)
weak diuretic
Acetazolamide
Acetazolamide
Carbonic Anhydrase Inhibitor
high altitude sickness
Acetazolamide
Ophthalmic drops
Dorzolamide
Carbonic anhydrase inhibitors: adverse effects
- drowsiness
- parasthesia (tingling)
- Hypokalemia
- Hyperglycemia
- Metabolic acidosis
Acetazolamide and Dorzolamide are both used in…?
Glaucoma
Carbonic anhydrase inhibitors: drug interactions
w/ amphetamines: increase serum levels and toxicity of WEAK BASES
Dorzolamide
Carbonic Anhydrase Inhibitor
Which has greater diuretic effect than other?
Loop diuretics
