Diuretics Flashcards
Thiazide & T like diuretics name ??
- chlorthiazide
chlorthalidone
hydro-chlorthiazide
metolazone
indapamide
Bendro & Hydro Flumethiazide
318
Loop D name ??
frusemide
torsemide
ethacrynic acid
bumetanide
T diuretics site ??
DCT
block Na Cl transporter
L D site ??
thick ascending limb of loop of henle
K sparing D name ??
Aldosterone receptor antagonists namne ??
spironolactone
eplerenone
K sparing drugs site >??
C T
Na channel blockers anem ??
a
amiloride
triamterene
carbonic anhydrase inhibitors name ??
Aceta-dorzo-metha-brin–ZOLAMIDE
319
CAI site ??
PCT
SGLT-2 name ??
empagliflozin
cana-dapa=gliflozin
Osmotic D name ??
MUI Gu
mannitol
urea
inulin
glucose
high efficacy D name ??
Loop D `
why high efficacy ??
- high dose = increase diuresis effect
25% filtered Na to be excreted
Block Na K 2 Cl channel
322
M/A of loop D ??
322
Indications of Loop D ??
HF
acute pulmonary edema
& other edematous condition
hypercalcaemia
hyperkalaemia
anion overdose
acute renal failure
A/E of Loop D ??
Hyperuricemia
Hypovolemia
Hypokalaemia
H Metabolic alkalosis
Ototoxicity
Hypo-Mg & Ca
allergic reaction
324
A/E of T D ??
Hyponatremia
Hypokalemia
other- HYPER
contraindication of Loop D ??
HF
RF
Heaptitic cirrhosis
ALVF & CCF physiology ??
=pulmonary congestion
=edema
impair oxygenation
=rrespiratory distress
why gout after Frusemide ??
hypovolemia
inc absorption of uric acid in PCT
Indications of T diuretics ??
HTN
HF
nephrolithiasis due to idiopathic hypercalciuria
nephrogenic DI
326
M/A of T D ??
326
T +Spironolactone = ??
T = hypokalaemia
S = hyperkalaemia
pharmacological potentiation
T + ARB = ??
Same
T + CCB = ??
Both Anti-HTN drugs
why Hyponatremia ??
328
why Hypokalaemia in T D ??
329
Why T diuretics in kidney stone ??
330
T like analogue ??
lack of T structure - sulfonamide group present + same M/A
330
Indications of Spironolactone ??
- HF
HYPERALDOSTERISM
diuretics
spironolactone M/A ??
333
types of hyperaldosterinism ??
primary - conns syndrome ‘
secondary - HF liver cirrhosis nephrotic syndrome
333
spironolactone effect on CT ??
N excretion
K H retention
333`
A/E of spironolactone ??
hyperkalemia
endocrine abnormality
PUD
Hyperchloremic metabolic acidosis
gynecomastia
impotence
BPH
Mnestrual irregulrity kidney stone
skin rashes
CNS Adverse effect
334
which one doesnot cause gynecomastia >?
eplernone
334
indication of acertazolamide ??
glaucoma’
metabolic alkalosis
urinary alkalization
acute moiuntain sickness
epilepsy
osmotic D M/A ??
- inc conc of osmotically active molecules
inc osmolarity of tubular fluid in PCT
INC osmotic pressure
dec H2O reabsorption
diuresis
indications of osmotic D ??
inc urine volume
reduction ICranial P
reu]duction IOP
338
Mild to Moderate which D ??
Spironolactone
chronic HTN drug ??
Thiazide
why not frusemide in chronic HTN ??
Chronic HTN - e sob hypo hote hote Hypotension e pt mara jabe
cerebral in jury te edema dec korar jonno which D >??
Osmoptic D
Which D preganancy safe >?/
T
Digoxin + Diuretics = ??
T+Loop + D = Digoxin toxicity
D+ spironolcatone = can be used
D toxicity = precipitate D toxicity
Alkalosis by which D»_space;>
T + Loop
other glaucoma drugs >
dec aquous secretion
-diuretics
-beta blockers
-selective alpha-2 blockers
inc A secretion
-prostaglandin
-cholinomimetic
Management of hypokalemia ?
stop the drug
K sparing diuretics should be used
correct hypovolemia
K containing foods - banana guava green cocnut
which prostgalndin analogous in glaucoma
PROF
Latano-Bimato-Travo=PROST
698
Which D in hyperkaemia pt ?
spironolactone
jar K level normal take kon D >
T LD
renal disease e kon diuretics
T LD
Frusemide which hypersensitivity?
anaphylactic
HTN emergency which D ?
??
thiazide M/A of Nephrogenic DI ?
🔹 Thiazide Diuretics 🏜️ Nephrogenic DI - MOA
1️⃣ Blocks Na+/Cl- symporter → ⬇ Na+ reabsorption (DCT)
2️⃣ ⬇ ECF volume → ⬆ RAAS activation
3️⃣ ⬆ Proximal Na+/H2O reabsorption (PCT compensatory)
4️⃣ ⬇ Distal delivery of filtrate → ⬇ Urine output
5️⃣ ⬆ Aquaporin expression (via ⬆ ADH sensitivity)
6️⃣ ⬇ GFR → ⬆ Tubular fluid contact time → ⬆ Water reabsorption
🛑 Final Effect: ⬆ Urine osmolality, ⬇ Polyuria
@usmlereviews
which one in hypertensive emergency >
🔹 Diuretic for Hypertensive Emergency (📖 Katzung)
✅ Loop Diuretics (Fast-acting, potent)
- Ex: Furosemide, Bumetanide, Torsemide
- MOA: Inhibits Na+/K+/2Cl- (TAL) → ⬇ Volume, ⬇ Preload & Afterload
- Use: HTN Emergency + Volume Overload (CHF, CKD, Pulmonary Edema)
- Effect: Rapid venodilation (↓ preload) + diuresis
🛑 Thiazides & K+-sparing diuretics NOT used (slower onset)
📖 Ref: Katzung’s Basic & Clinical Pharmacology
@usmlereviews
why indapamide is more in use ?
🔹 Why Indapamide > Other Thiazides? (📖 Katzung)
✅ Longer Half-life → Once-daily dosing (⬆ Compliance)
✅ More Potent than HCTZ → Better BP control
✅ No Significant ⬆ in Lipids (Unlike HCTZ)
✅ ⬆ Vasodilation (Ca2+ channel modulation → ⬇ PVR)
✅ Renal-sparing in CKD (Less GFR reduction than other thiazides)
✅ Less Hypokalemia & Hyperglycemia (Metabolically neutral)
📖 Ref: Katzung’s Basic & Clinical Pharmacology
@usmlereviews
why indapamide in use ?
significant anti-HTN effect
with minimum diuretic effect
excreted and metabolized by GI & kidney
331
mild HTN ?
T
331
which one in HF ?
frusemide
M/A of frusemide in HF ?
406
dec venous pressur e
dec ventricular preload
reduction of cardiac size
🔹 Polyuria in 🍬 Diabetes Mellitus - Exact MOA
1️⃣ ⬆ Plasma Glucose (>180 mg/dL) → Exceeds SGLT2 Capacity (PCT)
2️⃣ Glucosuria → ⬆ Tubular Osmolarity
3️⃣ Osmotic Gradient Prevents H2O Reabsorption (PCT & CD)
4️⃣ ⬆ Urine Output (Polyuria) → ⬆ Na+/K+ Excretion
5️⃣ Hypovolemia → ⬆ Thirst (Polydipsia) via Hypothalamic Osmoreceptors
🛑 End Effect: Volume Depletion, Hyperosmolarity, ⬆ ADH Release
📖 Ref: Katzung’s Basic & Clinical Pharmacology
@usmlereviews
lllllll
different failure diuretics name ?
🔹 Diuretics for Organ Failures (📖 Katzung)
✅ Liver Failure (Cirrhosis, Ascites)
- Spironolactone, Eplerenone (Aldosterone Antagonists) → ⬇ Na+/H2O retention
- Furosemide (Adjunct, if severe ascites)
✅ Renal Failure (CKD, AKI, Nephrotic Syndrome)
- Loop Diuretics (Furosemide, Torsemide, Bumetanide) → ⬆ Na+/H2O excretion
- Metolazone (Synergistic with loops in CKD)
✅ Heart Failure (HFrEF, HFpEF)
- Loop Diuretics (Furosemide, Torsemide) → ⬇ Preload, Pulmonary Edema
- Spironolactone, Eplerenone → ⬇ Mortality (Anti-aldosterone)
📖 Ref: Katzung’s Basic & Clinical Pharmacology
@usmlereviews
How to reduce hyponatremia in Thiazide ?
reduce dose of the drug + limiting water intake `
why Hyponatremia in Thiazide drug >
elevations of ADH
inc thirst
reduce in the diluting capacity of the kidney
ARB + Thiazide = ?
1.minimize A/E
2.pharmacological potentiation
how to inc druation of action of Thiazide >
T + secondary acting - digitalis alkaloids
T + CCB = ?
good control of BP
Drug resistant HTN = Tx ?
spironolactone
Management of T induced hypokalemia /
stop the drug
K sparing drugs
banana guava green coconut
Hyperurecemia by T ?
inhibit uric acid secretion
Hypokalemia by T ?
329
can T be used in emergency HTN ??
why ? why not /
T - duration of action prolonged – 10-12 hr
indapamide ??
lipid soluble
non-thiazide diuretics
Metabolism & excretion of indapamide <
GIT & kidney
which Loop D is not sulfonamide ?
ethacrynic acid
why ototoxicity in Loop D <
inhibition of symport mechanism in the endolymph
which one is emergency Diuretics /
loop
2-3 min
why metabolic acidosis in spironolactone /
inhibition of H secretion
why endocrine abnormality in spironolactone ?
steroid receptors actions
male manifestation ?
impotence
BPH
gynecomastia
female manifestation >
mens irregularity
24.2.2025
2.10AM
