Diuretics

Question 0

Mannitol

Answer 0

Osmotic diuretic,
Use: rapid volume loss, renal transplant, cerebral edema
*fast onset, short duration of action

Question 1

general mechs for diuresis

Answer 1

Goal = decrease H2O reabsorption => increase h2o excretion

1. increase oncotic P of urine
2. block Na+ reabsorption
   - Na/K/Cl = Loop diuretics
   - NaCl = thiazides
   - ENaC = amiloride, triamterene
3. block ADH = vaptans

Question 2

Acetazolamide

Answer 2

diuretic, inhibits carbonic anhydrase –> increase HCO3- excretion
Use: altitude sickness (*fast onset)
SE: metabolic acidosis

Question 3

furosemide

Answer 3

Loop diuretic,
–l TAL Na/K/Cl transporter = increase Na & H2O excretion
Use: edema, HTN *strong! (use w/ caution)
SE: hypoK+, metabolic alkalosis, ototoxicity

Question 4

x Bumetanide, Torsemide, Piretanide

Answer 4

Loop diuretics,
–l TAL Na/K/Cl transporter = increase Na, Cl and H2O excretion
Use: edema (strong!)
SE: hypoK+, metabolic alkalosis

Question 5

Hydrochlorothiazide (HCTZ)

Answer 5

Thiazide diuretic,
–l NaCl symporter (early distal tubule) = increase Na, Cl & H2O excretion
Use: HTN
SE: hypoK+, metabolic alkalosis

Question 6

Metolazone, Indapamide

Answer 6

Thiazide diuretics,
–l NaCl symporter (early distal tubule) = increase Na, Cl & H2O excretion
Use: HTN
SE: hypoK+, metabolic alkalosis

Question 7

Chlorthalidone

Answer 7

Thiazide diuretic,
–l NaCl symporter (early dist. tubule) = increase Na, Cl & H2O excretion
Use: HTN LONG t1/2 (40-60 hrs)!
SE: hypoK+, metabolic alkalosis

Question 8

Spironolactone (also Canrenone, Eplerenone)

Answer 8

Aldosterone (mineralcorticoid) antagonist,
=> decrease transcription of ENaC & K+ channels
* K+ sparing!
Use: diuresis, HTN, CHF, hyperaldosteronism, & hirsutism (only spironolactone)
SE: gynecomastia, hyperK+, metabolic acidosis

Question 9

Amiloride, Triamterene

Answer 9

ENaC blockers, –> increase Na, Cl, H2O excretion
* K+ sparing!
Use: diuresis
SE: hyperK+

Question 10

Nesirtide

Answer 10

recombinant BNP, –> increase GFR (aff. art. vasodilation), block NaCl reabsorption
Use: reduce dyspnea & PCWP in acute CHF
$$$ & short duration, but better than Lasix

Question 11

Tolvaptan (#1) … also Conivaptan, Lixivaptan

Answer 11

V2R (vasopressin) antagonist, @ late distal tub. & collecting duct;
Use: diuresis for hyper/euvolemia, NOT if hypOvolemic!
*conivaptan = IV only, Tolvaptan, Lixivaptan = oral
SE: hypernatremia