Diuretics Flashcards
Diuretics is
The agents or drugs that increase urinary volume along with salt and electrolytes
Classification
Acc to site of action
Acc to potency
Acc to site of action
I) PCT
II) thick ascending loop of henle
III) DCT
IV) Collecting duct
PCT
Carbonic anhydrase : ACETAZOLAMIDE BRINZOLAMIDE DORZOLAMIDE. METHOZOLAMIDE
Osmotic diuretic. : Mannitol. Urea. Glucose Isosorbide
LOOP DIURETICS
Frusemide
Bumatanide
Torsemide
Ethacrynic acid
Thiazide diuretics
HYDRO CHLORO THIAZIDE
CHLORO THIAZIDE
POLY THIAZIDE
CYCLO PEN THIAZIDE
CHLOR THALIDONE
INDA PAMIDE
K+ sparing drugs
Spironolactone
Amiloride
Triamterene
Acc to potency
High potency / ceiling diuretics ( loop diuretics )
Moderate efficacy ( Thaizide )
Low efficacy : spironolactone mannitol acetazolamide
Indications of diuretics / frusemide
Oedema due to NS CCF
ALVF
ACUTE PULMONARY OEDEMA
ARF
Hyperkelemia
Hypercalcemia
As AHTN drug
Glaucoma
Cerebral oedema
Indications of diuretics / frusemide
Oedema due to NS CCF
ALVF
ACUTE PULMONARY OEDEMA
ARF
Hyperkelemia
Hypercalcemia
As AHTN drug
Glaucoma
Cerebral oedema
Loop diuretics // high ceiling diuretics
Blocks Na+-K+ - 2Cl- symporter in TAL of LOH
Why are loop diuretics called high ceiling diuretics
They cause forceful diuretics
Effective even after GFR below 10ml/min
They excrete 25% filtered Na+
They have rapid onset of action
Increase diuretic action with increasing dose
M/A of frusemide
Acts on thing ALLH
Inhibits Na+ K+ 2Cl- symporter => urinary excretion with electrolytes ==> diuresis
Increase renal blood flow ==> diuresis
(-) carbonic anhydrase ==> (-) HCO3- reabsorption ==> HCO3 excretion ==> diuresis
M/A of hydrochlorothaizide
Acts on DCT
(-) Na+-Cl- co- transport mechanism
(-) re absorption of Na+ and Cl-
Increase excretion of water and electrolytes
Diuresis
M/A of spironolactone
Binds with MINERALCORTICOID RECEPTOR
Forming a complex
This complex binds with DNA
(-) transcription and translation
(-) Na+ pump
No reabsorption of Na+
Diuresis with no loss of K+
Indications of frusemide
Oedema ( due to NS , CCF)
ALVF
Acute pulmonary oedema
Hyperkelemia
Hypercalcemia
As Anti HTN drug
A/E of frusemide
Hypotension
Loss of electrolytes ==> Hyponatremia Hypokelemia Hypocalcemia Hyperuricemia
Hyperglycemia
OTOTOXICITY
Headache
Dizziness
Xanthopsia
Libido
Contraindications
Hypovolume
Hypotension
Pregnancy
Liver cirrhosis
Thiazide criteria
GFR should be more than 20ml/min
Excrete 5-10 % filtered Na+
Thiazide criteria
GFR should be more than 20ml/min
Excrete 5-10 % filtered Na+
Indications of thiazide
Hypertension
CCF
Nephrolithiasis
Oedema due to NS CCF
Osteoporetic patient
Nephrogenic diabetic insipidus
Indications of thiazide
Hypertension
CCF
Nephrolithiasis
Oedema due to NS CCF
Osteoporetic patient
Nephrogenic diabetic insipidus
A/E of thiazide
Hypotension
Loss of electrolytes
Hypokelemia hyponatremia hypomagnesemia hypocalcemia
Hyperuricemia
Hyperglycemia
Metabolic alkalosis
Hypercholestroremia
Contraindications of thiazide
Hepatic and renal failure
DM
Gout
Anti hypertensive role of hydrocholoro thiazide
HTZ
(-) Na + Cl- co transport mechanism
Increase excretion of electrolytes and water
Decrease blood volume
Decrease venous return
Decrease CO
Decrease BP
Why thiazide is 1st line anti hypertensive drug
Anti hypertensive action occurs at low dose
Thiazide causes passive vasodilation by reducing the sensitivity of blood vessels to circulating catecholamines
Thiazide has advantage of minimising the retention of salt and water and causes diuresis without acid base imbalance
Clinical uses of acetazolamide
Glaucoma
Metabolic alkalosis
Epilepsy
Hyperkelemia
Urinary alkalisation in aspirin poisoning
M/A of acetazolamide
(-) carbonic anhydrase enzyme
Decrease Na+ and HCO3 reabsorption from PCT
Increase excretion of electrolytes and water
Diuresis
Indications of osmotic diuretics
Reduce ICP , cerebral Oedema
To produce diuresis
Glaucoma
Prevention of renal tubular necrosis
For gut sterilisation before operation orally
Contraindications of mannitol
Anuria
Cerebral hemmorhage
Dehydration
K + sparing drugs indications
Oedema with HTN
Given with K+ loosing diuretics
Oedema with cirrhosis of liver
Primary hyperaldosterenism
Secondary hyperaldosterenism
A/E of spironolactone
HYPERKELEMIA
GYNAECOMASTIA IN MALE
HIRSUTISM IN Female
Amennorhea
Metabolic acidosis
Deepening of voice
Impotency
Rash
Gastritis
CONTRAINDICATIONS of spironolactone
Hyperkelemia
ARF
PUD
Liver disease
PUD
Headache
