Diuretics Flashcards
What are the three renal dilators?
Dopamine, Fenoldopam, and Atriopeptin
How do renal dilators work?
Decreases filter fraction and GFR stays the same. There is increased blood flow in the peritubular capillaries, which has less oncotic pressure, causing less Na/H20 to be reabsorbed and more to be “leaked” back into the tubule. Weak diuretic.
What is the diuretic used to treat edema in an inpatient setting?
Mannitol.
What kind of diuretic is Mannitol and how does it work?
Osmotic Diuretic. Freely Filtered, prevents reabsorption of water from the tubule.
Uses are for edema, acute renal failure, and glaucoma. Can cause volume overload in the vasculature.
What diuretic works in the proximal tubule and what kind is it?
Acetazolomide - Carbonic Anhydrase Inhibitor
What is the mode of function of a carbonic anhydrase inhibitor?
Prevents the production of carbonic acid from CO2 and H20, which produces a H+ ion that is used to convert Bicarbonate into Carbonic acid in the lumen. Causes decrease reabsorption of bicarb due to rest of tubule unable to compensate. Increased Na+, K+, Bicarb, and H20 excetion.
What are therapeutic uses of Acetazolamide?
Alkalizes urine, helping with toxicity. Altitude sickness. Reduces aqueous humor formation
What kind of diuretics are the most potent and fastest acting with short duration?
Loop Diuretics. Furosemide. Bumetanide, and Ethacrynic Acid.
What type of transporter is targeted with loop diuretics?
Na-K-2Cl Symporter in the ascending loop.
What are extra effects of loop diuretics?
Increases renal blood flow and GFR, enhances Calcium excretion, and causes increased urate absorption.
What are the main therapeutic uses for loop diuretics?
Treating edema due to cardiac, hepatic, or renal disease. Acute pulmonary edema. HTN
What is unique about Furosemide adverse effects?
Can cause hyperglycemia.
What are possible side effects of loop diuretics?
Hypokalemia, Alkalosis, Hypovalemia, and Ototoxicity.
Where do thiazide diuretics work and name them?
Chlorothiazide, Hydrochlorothiazide, and Metolazone. Distal Tubule, inhibiting the Na+/Cl- co-transporter.
What are the effects of a thiazide diuretic?
Moderate potency, long duration/fast acting, increases excretion of K+ and decreases calcium excretion. Causes hypertonic urine.
What are therapeutic uses for thiazide diuretics?
First line for HTN treatment, CHF, and used to treat renal calculi (increases absorption of Ca+2).
What are adverse side effects from thiazide diuretics?
Hypokalemia, Alkalosis, Too much urate in blood, and HYPERGLYCEMIA, and Lowered GFR.
What are the two types of potassium sparing diuretics and what are they?
Aldosterone Antagonist: Spironolactone, Eplerenone
Sodium Channel Inhibitors: Amiloride and Triamterene
Where do potassium sparing diuretics work?
Collecting tube, either inhibiting the channels or the aldosterone receptors.
How are potassium sparing diuretics used?
They are always used with unison with another diuretic to prevent hyperkalemia. Used to treat HTN, Edema, and used with CHF to increase survival. Also treats aldosteronemia.
What is a unique side effect of aldosterone inhibitors?
Gynecomastia due to Spironolactone»Eplerenone
Weak progesterone agonist
What can a high dose of Triamterene cause?
Decreased Renal blood flow and GFR
What diuretics work the fastest?
Loop Diuretics - Furosemide, Bumetanide, and Ethacrynic Acid
What type of diuretics are the cheapest?
Thiazide Diuretics: Chlorothiazide, Hydrochlorothiaze, Metolazone
What type of diuretics have the greatest effect?
Loop Diuretics: Furosemide, Bumetanide, Ethacrynic Acid
What is ceiling dose and how is it effected by renal disease?
Ceiling effect is the dose at which there is no further effect in the kidney, the more diseased state the higher the dose to have the same effect.
What body compartment do diuretics act the most slowly on?
Intracellular Fluid - Body Compartment
Diuretics act directly on vascular compartment
What is a consideration when treating HTN with diuretics?
When treating with diuretics, due to the fluid loss there is an increase in renin, so helpful to prescribe ACE inhibitor as well.
What is the main purpose of CHF therapy?
Decrease fluid volume - thus lower preload. Prevent hypertrophy, maintain stroke volume. Improve survival by using Spironolactone and Eplerenone.
What are two ways Thiazide diuretics can help hypertension?
Reduces fluid volume and has a mild effect on arterial smooth muscle relaxation decreasing peripheral resistance.
