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Exam 1 Electrolytes: Renal: Diuretics: CKD & ESRD > Diuretics > Flashcards

Diuretics Flashcards

1
Q

what are diuretics, what do they do and what are they used for?

A
  1. help get extra fluid off (h2O & Na+)
  2. decrease BP due to dec. in plasma volume
  3. used for HTN, Heart Failure, ARF, Edema
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2
Q

what are drug targets for how they get moved across the membrane?

A
  • anything with a protein
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3
Q

what are the different classes of diuretics on general?

A
  1. SOA (loops)
  2. Efficacy (high ceiling)
  3. structure (thiazide)
  4. effect K+ excretion (potassium-sparing)
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4
Q

what are classes based off of MOA?

A
  1. inhibit CA
  2. osmotic
  3. inhibit Na/K/Cl symport
  4. inhibit Na/Cl symport
  5. inhibit renal epithelial Na+ channel
  6. MAR
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5
Q

where does high protein binding occur?

A
  • not filtered through bowmans capsule
  • transport/secretion in proximal tubule
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6
Q

where does drug get secreted?

A

PT

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7
Q

where does drug get reabsorped?

A

DT

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8
Q

what is filtered in the glomerulus?

A

unbound protein

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9
Q

what is the major route of elimination for drugs and what percent?

A
  1. renal excretion
  2. 25-30%
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10
Q

what drugs are OATs?

A

diuretics
penicillin
cephalosporin
probenecid
NSAIDs

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11
Q

what are OATs and what do they do?

A
  1. diffusion out of capillary into interstitial space
  2. transport across basolateral membrane
  3. secretion across luminal membrane
    – COMPETITION; NON_SELECTIVE
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12
Q

what does active secretion depends on?

A
  1. amount of plasma protein binding
  2. the rate of delivery
  3. degree of saturation of transporters
  4. presence of competitive drugs
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13
Q

what is penicillin and mechanism?

A
  1. inhibit transpeptidase
  2. block crosslinking
  3. dec. cell wall synthesis
  4. extracted and used with competition of probenacid to slow excretion and prolong activity
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14
Q

what do inhibitors of carbonic anhydrase doing?

A
  1. inhibit both cytoplasm and membrane-bound
  2. block reabsorption of NaHCO3
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15
Q

what does the sulfanilamide group in CA inhibitors and other diuretics?

A

show to produce mild diuresis

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16
Q

what is a common diuretics that inhibits CA?

A

acetazolamide

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17
Q
A
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17
Q

how is acetazolamide good for acute mountain sickness?

A
  1. used before going above 10.000 ft
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18
Q

what percent hav an occurance of sulfonamide induced drug rash?

A

5-10% but rare

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19
Q

what are osmotic diuretics?

A
  1. inert
  2. major site PCT & descending loop of henle
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20
Q

what is mannitol?

A
  1. loss of water
  2. reduced intracellular volume
  3. hypernatremia risk
21
Q

what osmotic diuretics are IV?

A

mannitol
urea

22
Q

what osmotic diuretics are orally active?

A
  • isosorbide
  • glucose
  • glycerine
23
Q

what are inhibitors of Na/K/1Cl symport diuretics?

A
  • loop diuretics and high ceiling diuretics
  • act on luminal symport and must be in lumen for diuretic activity
  • reduce uric acid secretion
24
Q

what is ethacrynic acid?

A

a loop diuretic not derived from sulfonamides

25
Q

what are some in the loops class?

A
  • lasix
  • bumentanide
  • torsemide
26
Q

what are toxicities of loop diuretics?

A
  1. hypokalemic metabolic alkalosis
  2. ototoxicity
27
Q

what class is inhibitors of Na/Cl symport?

A

thiazides

28
Q

where do thiazides act?

A

on the distal tubule, proximal tubule second

29
Q

how do you make thiazides from basic structure?

A

by an acylating agent

30
Q

how do you make hydrothiazide from basic strucutre?

A

aldehydes or ketones

31
Q

what are some drugs in the thiazide class?

A
  • chlorothiazide
  • hydrochlorothiazide
  • chlorthalidone
  • metolazone
32
Q

where do potassium sparing diuretics act?

A

on the late distal tubule and collecting duct

33
Q

what are toxicities and contraindications for potassium sparing diuretics?

A
  1. toxic:
    - hyperkalemia
  2. contraindications
    - K+ supps
    - ACE inhibitors
34
Q

what are MRA diuretics?

A
  • aldosterone antagonists, potassium sparing
  • only diuretics that do not act within the tubular lumen
  • some toxic and contraindications as above
35
Q

what drugs are in this class of MRA?

A
  1. spironolactone
  2. eplerenone
36
Q

what is the braking phenomenon?

A
  1. activation of RAAS and SNS
    – Na excretion exceeds intake = ECFV dec. = new SS
    – when diuretic D/C, ECFV&BW rise where Na+ exceeds excretion and new SS achieved activating Breaking Phenomenon
37
Q

what drugs are in the K+ sparing duiretics
– Na+ channel inhibitors class?

A
  1. amiloride
  2. triamterine
38
Q

what diuretics are used in combos with others since they are weak normally?

A
  1. potassium sparing Na+ channel inhibitors
39
Q

what does adding more that diuretics from a different class with differ MOA do?

A

is more effective

40
Q

what is the excretion pattern of triamterene like with electrolytes?

A

has Na and Cl but no K

41
Q

what is the excretion pattern of lasix like with electrolytes?

A

all across the board

42
Q

what is the excretion pattern of spironolactone like with electrolytes?

A

no calcium and some bicarb

43
Q

what is the excretion pattern of spironolactone like with electrolytes?

A

no potassium

44
Q

what is the excretion pattern of isosorbide like with electrolytes?

A

lots of bicarb

45
Q

what is the electrolyte distribution like and body ph for diuretics?

A
46
Q

how do you draw a thiazide?

A
47
Q

how do you draw lasix?

A
48
Q

how do you draw bumetanide?

A
49
Q

how do you draw ethancrynic acid?

A
50
Q

how do you draw osmotic diuretics

A
51
Q

how do you draw acetazolamide

A

Exam 1 Electrolytes: Renal: Diuretics: CKD & ESRD (5 decks)

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