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Diuretics Flashcards

1
Q

In fluid homeostasis, dilute urine is produced if what happens?

A

Water intake is excess

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2
Q

In fluid homeostasis, concentrated urine is produced if what happens?

A

Large amounts of water are loss

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3
Q

What are the two key players in fluid homeostasis?

A

Hormones

  1. Aldosterone
  2. Antidiuretic Hormone (ADH)
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4
Q

Fill in the blank:

ADH functions primarily by its influence on ________ ____ and ______ ___________ via urine excretion.

A

fluid loss; fluid retention

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5
Q

What functions primarily by its influence on the sodium content of the extracellular fluid?

A

Aldosterone

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6
Q

Besides sodium, what is another trigger for aldosterone?

A

Renin-Angiotensin-Aldosterone Axis

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7
Q

What are the three effects of Angiontensin II?

What is the net result of these three effects?

A

Effects

  1. Increased thirst
  2. Increased ADH from posterior pituitary
  3. Increased aldosterone from adrenal gland

Net Result

  • Increased fluid volume
  • Increased BP
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8
Q

What three things must decrease in order for ADH to be released from the posterior pituitary?

A
  1. Blood volume drops
  2. Arterial blood pressure drops
  3. Amount of filtrate (GFR) drops
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9
Q

What picks up the signal from kidneys of GFR decrease?

Where are they located?

A

Osmoreceptors

Hypothalamus

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10
Q

What releases ADH?

A

Posterior pituitary

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11
Q

ADH causes the renal tubules to increase what?

This causes what two things to occur?

A

Water reabsorption

  1. Blood volume comes back up
  2. Blood pressure comes back up
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12
Q

ADH impacts blood pressure in two ways.

  • In smaller amounts, it does what?
  • In large amounts it acts as what? Which causes?
A
  • In smaller amounts, it inhibits urine production.
  • In large amounts, it acts as a vasoconstrictor ⇢ BP goes up
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13
Q

When aldosterone levels are sufficient, an adequate number of Na+ ions are what?

A

Reabsorbed

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14
Q

For each Na+ ion reabsorbed, what two things happen?

A
  1. 1 Cl- ion follows it (reabsorbed)
  2. 1 K+ ion secreted into filtrate and excreted via urine
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15
Q

As aldosterone levels increase, what happens to

  • serum Na+ levels?
  • serum K+ levels?
A
  • serum Na+ increases
  • serum K+ decreases

This restores balance for both Na+ and K+

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16
Q

What happens when there are rising K+ or falling Na+ levels in ECF?

A

Adrenal gland releases aldosterone

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17
Q

What happens to water when Na+ is reabsorbed into filtrate?

A

Water follows it passively into blood

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18
Q

Renin-Angiotensin-Aldosterone Axis is a system of chemical reactions that help to regulate what two things?

A
  1. Blood pressure
  2. Fluid balance
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19
Q

What enzyme does the juxtaglomerular apparatus secrete in response to a decrease blood flow to kidneys?

This sets a series of rections called what?

A

Renin

Renin-Angiotensin-Aldosterone Axis

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20
Q

What is creatinine clearance?

A

How much creatinine / drugs you clear from kidneys over a measurement of time.

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21
Q

What is glomerular filtration rate (GFR)?

A

How much urine your kidneys make over a measurement of time.

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22
Q

What are diuretics?

A

Drugs that accelerate the rate of urine production

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23
Q

Diuretics are responsible for the removal of what?

A

Sodium and water

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24
Q

What are the five classes of diuretics?

A
  1. Carbonic anhydrase inhibitors (CAIs)
  2. Loop diuretics
  3. Osmotic diuretics
  4. Potassium-sparing diuretics
  5. Thiazide and thiazide-like diuretics
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25
Q

Finish this sentence:

Where Na+ goes ⇢ _____________

A

water follows

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26
Q

What percentage of sodium is reabsorbed at the loop of Henle?

A

20 to 25%

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27
Q

What percentage of sodium is reabsorbed in the distal tubules?

A

5 to 10%

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28
Q

What percentage of sodium is reabsorbed in the collecting ducts?

A

3%

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29
Q

What happens to the sodium not reabsorbed?

A

Excreted in urine

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30
Q

What are the two CAIs?

A
  1. Acetazolamide (Diamox)
  2. Methazolamide (Neptazane)
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31
Q

Which CAI is not indicated for a diuretic?

A

Methazolamide (Neptazane)

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32
Q

What are both CAIs indicated for?

A
  • Glaucoma
  • High altitude sickness
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33
Q

What is the route of Acetazolamide (Diamox)?

A

PO / IV

(CAI)

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34
Q

What is the route for Methazolamide (Neptazane)?

A

PO

(CAI)

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35
Q

What is the MOA for CAIs?

A
  • Block action of anhydrase enzyme
  • Reduces [] of H+ in proximal tubules
  • Prevents exchange of H+ and Na+ and water
  • Increases excretion of
    • HCO3-
    • Na+
    • H2O
    • K+
  • Resorption of water is decreased and urine output is increased
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36
Q

What does the enzyme carbonic anhydrase do?

A

Makes H+ ions available for exhange with Na+ and water proximal tubule

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37
Q

True or False:

CAIs are more potent than loops or thiazides.

A

False

(They are less potent)

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38
Q

How are CAIs used in the long-term management of open-angle glaucoma?

A

Adjunct agents

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39
Q

CAIs are sometimes used with miotics to do what?

A

Lower IOP (intraocular pressure) prior to ocular surgery

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40
Q

What are four other indications for CAIs other than glaucoma?

A
  1. High altitude sickness
  2. HF
  3. Edema
  4. Epilepsy (rarely)
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41
Q

Acute mountain sickness happens because, as barometric pressure decreases, % of O2 stays the same.

  • What happens to the number of O2 molecules per breath?
  • What happens because of this?
A
  • Decreases
  • Hypobaric hypoxia
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42
Q

What are eight adverse / side effects of CAIs?

A
  1. Photosensitivity
  2. Urticaria
  3. Metabolic acidosis
  4. Anorexia
  5. Hematuria
  6. Drowsiness
  7. Paresthesias
  8. Melena
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43
Q

What are the four loop diuretics?

A
  1. Furosemide (Lasix)
  2. Bumetanide (Bumex)
  3. Torsemide (Demadex)
  4. Ethacrynic acid (Edecrin)
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44
Q

What is the route for Bumetanide (Bumex)?

A

PO / IM / IV

(Loop)

45
Q

What is the route for Ethacrynic acid (Edecrin)?

A

PO / IV

(Loop)

46
Q

What is the route for Furosemide (Lasix)?

A

PO / IM / IV

(Loop)

47
Q

What is the route for Torsemide (Demadex)?

A

PO / IV

(Loop)

48
Q

What is the MOA of loop diuretics?

A
  • Act directly on the ascending limb of the loop of Henle
  • Inhibit resorption of Na+ and Cl-
  • Increases excretion of Na+ and H2O
49
Q

True or False:

Loop diuretics are potent diuresis.

50
Q

Because loop diuretics decrease fluid volume, what five things does it reduce?

A
  1. BP
  2. Pulmonary vascular resistance (PVR)
  3. Systemic vascular resistance (afterload)
  4. Central venous pressure
  5. Left ventricular end-diastolic pressure (preload)
51
Q

What are six indications for loop diuretics?

A
  1. Edema associated with HF
  2. Edema from hepatic disease
  3. Edema with renal disease
  4. Acute pulmonary edema
  5. Adjunct in Htn
  6. Hypercalcemia
52
Q

What are the four adverse / side effects of loop diuretics on the CNS?

A
  1. Dizziness
  2. Headache
  3. Tinnitus (ototoxicity)
  4. Blurred vision
53
Q

What are the two adverse / side effects of loop diuretics on the GI?

A
  1. Nausea and vomiting
  2. Constipation
54
Q

What is the adverse / side effect of loop diuretics on the GU?

A

Urinary frequency

55
Q

What are the three adverse / side effects of loop diuretics on the hematologic system?

A
  1. Agranulocytosis
  2. Neutropenia
  3. Thrombocytopenia
56
Q

What are the six adverse / side effects of loop diuretics on the metabolic system?

A
  1. Hypokalemia
  2. Hypomagnesmia
  3. Hypocalcemia
  4. Hyperglycemia
  5. Hyperuricemia
  6. Dehydration
57
Q

What is the loop diuretic prototype?

A

Furosemide (Lasix)

58
Q

What is the usual dose of Furosemide (Lasix)?

A
  • PO
    • 20-80 mg/day
    • (up to 600 mg/d)
  • IM / IV
    • 20-40 mg/day
    • (max 600 mg/d)
59
Q

How is Furosemide (Lasix) metabolized?

60
Q

How is Furosemide (Lasix) excreted?

61
Q

What kind of monitoring must you do with Furosemide (Lasix)?

A

Electrolytes - especially K+

62
Q

What is / are the precaution(s) of Furosemide (Lasix)?

A

Dehydration

63
Q

What are the two absolute drug interactions of Furosemide (Lasix)?

A
  1. Aminoglycosides
  2. Lithium
64
Q

How many drug interactions are there for Furosemide (Lasix)?

65
Q

What is the osmotic diuretic?

A

Mannitol (Osmitrol)

66
Q

How is Mannitol (Osmitrol) administered?

A

IV

(Osmotic)

67
Q

Where do osmotic diuretics act?

A

Proximal tubule

68
Q

What is the MOA of osmotic diuretics?

A
  • Non-absorable
  • Produce osmotic effect
  • Pulls water into the blood vessels and nephrons from the surrounding tissues
69
Q

What are the five drug effects of osmotic diuretics?

A
  1. Reduced cellular edema
  2. Increased urine production⇢ diuresis
  3. Rapid excretion of water and sodium and other electrolytes
  4. Excretion of toxic substances from kidney
  5. Reduces excessive intraocular pressure
70
Q

What are the four indications for osmotic diuretics?

A
  1. Treatment of cerebral edema
  2. Treatment of ARF in early oliguric phase
  3. Promote excretion of toxic substances
  4. Reduction of intracranial pressure
71
Q

What are the eight adverse / side effects of osmotic diuretics?

A
  1. Fever and chills
  2. Convulsions
  3. Chest pain
  4. Tachycardia
  5. Thrombophlebitis
  6. Pulmonary congestion
  7. Blurred vision
  8. Headaches
72
Q

What are the four potassium-sparing diuretics?

A
  1. Amiloride (Midamor)
  2. Spironolactone (Aldactone)
  3. Triamterene (Dyrenium)
  4. Eplerenone (Inspra)
73
Q

What is the route for Amiloride (Midamor)?

A

PO

(Potassium-sparing)

74
Q

What is the route for Spironolactone (Aldactone)?

A

PO

(Potassium-sparing)

75
Q

What is the route for Triamterene (Dyrenium)?

A

PO

(Potassium-sparing)

76
Q

What is the route for Eplerenone (Inspra)?

A

PO

(Potassium-sparing)

77
Q

Where do potassium-sparing diuretics act?

A
  • Collecting ducts
  • Distal convoluted tubules
78
Q

What is the MOA of potassium-sparing diuretics?

A
  • Competitively binds to aldosterone receptors
  • Blocks resorption of Na+ and H2O usually induced by aldosterone
  • Prevents K+ from being pumped into the tubule
  • Prevents K+ secretion
  • Excretion of Na+ and H2O (diuresis)
79
Q

What are the four indications for the potassium-sparing diuretics Spironolactone (Aldactone) and Triamterene (Dyrenium)?

A
  1. Hyperaldosteronism
  2. Hypertension
  3. End-stage HF
  4. Reversing K+ loss caused by potassium-losing drugs
80
Q

What is the indication for the potassium-sparing drug Amiloride (Midamor)?

A

Treatment of HF (not commonly used)

81
Q

What are the two adverse / side effects of potassium-sparing diuretics on the CNS?

A
  1. Dizziness
  2. Headache
82
Q

What are the three adverse / side effects of potassium-sparing diuretics on the GI system?

A
  1. Cramps
  2. Nausea and vomiting
  3. Diarrhea
83
Q

What are two adverse / side effects of potassium-sparing diuretics that do not effect the CNS or the GI?

A
  1. Weakness
  2. Hyperkalemia
84
Q

What are three adverse effects of Sprionolactone (Aldactone)?

A
  1. Gynecomastia
  2. Amenorrhea
  3. Irregular menses
85
Q

What are the three thiazide diuretics?

A
  1. Hydrochlorothiazide (HCT)
  2. Chlorothiazide (Diuril)
  3. Methyclothiazide
86
Q

What are the three thiazide-like drugs?

A
  1. Indapamide (Lozol)
  2. Chlorthalidone (Hygroton)
  3. Metolazone (Zaroxolyn)
87
Q

What is the route for Hydrochlorothiazide (HCT)?

A

PO

(Thiazide)

88
Q

What is the route for Chlorothiazide (Diuril)?

A

PO / IV

(Thiazide)

89
Q

What is the route for Methyclothiazide?

A

PO

(Thiazide)

90
Q

What is the route for Indapamide (Lozol)?

A

PO

(Thiazide-like)

91
Q

What is the route for Chlorthalidone (Hygroton)?

A

PO

(Thiazide-like)

92
Q

What is the route for Metolazone (Zaroxolyn)?

A

PO

(Thiazide-like)

93
Q

What is the MOA of thiazides and thiazide-like drugs?

A
  • Inhibit tubular resorption of Na+ and Cl- primarily in ascending loop of Henle and distal tubule
  • H2O, NA+, and Cl- excreted
  • K+ excreted (to a lesser extent)
  • Dilate the arterioles by direct relaxation
94
Q

What are the two drug effects for thiazide and thiazide-like drugs?

A
  1. Lowered peripheral vascular resistance
  2. Depletion of Na+ and H2O
95
Q

What are the six indications for thiazide and thiazide-like drugs?

A
  1. Hypertension
  2. Edematous states
  3. Idiopathic hypercalciuria
  4. Diabetes insipidus
  5. Adjunct agents in HF
  6. Adjunct agents in hepatic cirrhosis
96
Q

What are the four adverse / side effects of thiazide and thiazide-like drugs on the CNS?

A
  1. Dizziness
  2. Headache
  3. Blurred vision
  4. Paresthesias
97
Q

What are the three adverse / side effects of thiazide or thiazide-like drugs on the GI system?

A
  1. Anorexia
  2. Nausea and vomiting
  3. Diarrhea
98
Q

What are the two adverse / side effects of thiazide and thiazide-like drugs on the GU system?

A
  1. Impotence
  2. Decreased libido
99
Q

What are the two adverse / side effects of thiazide and thiazide-like drugs on the integumentary system?

A
  1. Urticaria
  2. Photosensitivity
100
Q

What are the three adverse / side effects of thiazide and thiazide-like drugs on the metabolic system?

A
  1. Hypokalemia
  2. Glycosuria
  3. Hyperglycemia
101
Q

What are three combination diuretics?

A
  1. Spironolactone / hydrochlorothiazide (Aldactazide)
  2. Amiloride / hydrochlorothiazide (generic)
  3. Triamterene / hydrochlorothiazide (Dyazide)
102
Q

All the combination diuretics are made up of what two type of diuretics?

A

Potassium sparing + Thiazide

103
Q

How are all combination diuretics administered?

104
Q

What are four blood pressure / diuretic combinations?

A
  1. Aliskiren / Amlodipine / Hydrochlorothiazide (Amturnide)
  2. Aliskiren / Hydrochlorothiazide (Tekturna HCT)
  3. Hydralazine / Hydrochlorothiazide (Hydra-Zide)
  4. Chlorthalidone / Clonidine (Clorpres)
105
Q

How are the blood pressure / diuretic combos administered?

106
Q

Where do carbonic anhydrase inhibitors and mannitol work?

A

Proximal tubule

107
Q

Where do loop diuretics work?

A

Ascending limb of loop of Henle

108
Q

Where do thiazide diuretics work?

A

Early distal tubule

109
Q

Where do potassium-sparing diuretics work?

A

Distal tubule and collecting duct

Pharmacology II (3 decks)

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