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RENAL II Exam 3 > Diuretics > Flashcards

Diuretics Flashcards

1
Q

Carbonic anhydrase inhibitors

A 
(CAIs)
**Acetazolamide
Brinzolamide
Dorzolamide
Methazolamide

MOA: Inhibits CA -> no bicarb reabsorption -> increase diuresis
Urine pH increases, Body pH decreases
Not effective long term due to increased sodium reabsorption down the line

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2
Q

Acetazolamide

A

Prototype CAI

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3
Q

Brinzolamide

A

Topical ophthalmic CAI

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4
Q

Dorzolamide

A

Topical ophthalmic CAI

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5
Q

Methazolamide

A

CAI

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6
Q

Loop diuretics

A 
(Loops)
**Ethacrynic acid
**Furosemide
Bumetanide
Torsemide

MOA: Inhibit NKCC2 in TAL -> decrease absorption of Na, K, and Cl AND Mg and Ca -> increase diuresis
Increase acid and K secretion in DCT and CCT, Body pH increases

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7
Q

Ethacrynic acid

A

Prototype loop diuretic

**Only non-sulfa

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8
Q

Furosemide

A

Prototype loop diuretic (Lasix)

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9
Q

Bumetanide

A

Loop diuretic

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10
Q

Torsemide

A

Loop diuretic

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11
Q

Thiazide diuretics

A 
**Hydrochlorothiazide (HCTZ)
Bendroflumethiazide
Chlorothiazide
Chlorthalidone
Hydroflumethiazide
Indapamide
Methylclothiazide
Metolazone
Polythiazide
Trichlomethiazide

MOA: inhibit NCC -> increase lumen NaCl -> increase diuresis
Enhance reabsorption of Ca in PCT and DCT

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12
Q

HCTZ

A

Prototype thiazide diuretic

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13
Q

Bendroflumethiazide

A

Thiazide diuretic

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14
Q

Chlorothiazide

A

Thiazide diuretic

Need large dose, not given orally

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15
Q

Chlorthalidone

A

Thiazide diuretic

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16
Q

Hydroflumethiazide

A

Thiazide diuretic

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17
Q

Indapamide

A

Thiazide diuretic

Does not cause hyperlipidemia

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18
Q

Methylclothiazide

A

Thiazide diuretic

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19
Q

Metolazone

A

Thiazide diuretic

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20
Q

Polythiazide

A

Thiazide diuretic

21
Q

Trichlomethiazide

A

Thiazide diuretic

22
Q

Potassium-sparing diuretics

A 
Mineralocorticoid antagonists (aldosterone antagonists)
Inhibitors of renal sodium channels
23
Q

Mineralocorticoid antagonists (aldosterone antagonists)

A

**Spironolactone
Eplerenone

MOA: competitive inhibitor of aldosterone -> downregulate ENaC and Na/K ATPase
Reduce Na reabsorption and K, H, Ca, Mg secretion
**drug does not have to enter lumen

24
Q

Inhibitors of renal sodium channels

A

**Amiloride
Triamterene

MOA: directly inhibit ENaC
Reduce Na reabsorption and K, H, Ca, Mg secretion

25
Q

Spironolactone

A

Prototype mineralocorticoid antagonist

Potassium sparing

26
Q

Eplerenone

A

Mineralocorticoid antagonist
Most selective for MR
Increase blood levels with strong CYP3A4 inhibitors
Less androgenic effects vs spironolactone

27
Q

Amiloride

A

Prototype inhibitor of renal sodium channels

Longer half life

28
Q

Triamterene

A

Inhibitor of renal sodium channels

Shorter half life (liver metabolism)

29
Q

Agents that alter water excretion

A

Osmotic diuretics

ADH antagonists

30
Q

Osmotic diuretics

A

Mannitol
Isosorbide

MOA: Increase osmotic pressure of glomerular filtrate
Can lead to dehydration
Help to eliminate substances

31
Q

ADH antagonists

A

Conivaptan
Tolvaptan

MOA: Block increase water reabsorption
Reduce water retention (heart failure, SIADH)

32
Q

CAI Toxicity

A

Metabolic acidosis and bicarbonaturia
**Potassium wasting (only acidosis with hypokalemia)
Alkaline urine -> renal stones
Large dose -> Drowsiness and paresthesias
Hypersensitivity (sulfa allergy) = rare

33
Q

CAI contraindications

A

Liver cirrhosis - hyperammonemia and hepatic encephalopathy

Hyperchloremic acidosis or severe COPD: worsen metabolic or respiratory acidosis (no bicarb)

34
Q

CAI use

A 
Rarely used as diuretics
Glaucoma
Decreasing urine pH (to encourage acid excretion)
Metabolic alkalosis
Acute altitude sickness
35
Q

Loops and NSAIDs

A

Loops increase renal PG

36
Q

Loops toxicity

A

Over use: hyponatremia

Hypokalemia alkalosis, hyperurecemia (gout,) ototoxicity, hypomagnesemia, allergy

37
Q

Loops contraindications

A

Sulfa allergy
Liver cirrhosis, renal failure, heart failure
Osteoporosis
Drug interactions with aminoglycosides, lithium and digoxin

38
Q

Loops uses

A

Most effective!

Edema, heart failure, acute renal failure, HTN, anion overdose, hypercalcemia, mild hyperkalemia

39
Q

Thiazide toxicity

A 
Hypokalemic alkalosis and hyperuricemia
Decrease glucose tolerance (hyperglycemia)
Hyperlipidemia
Hyponatremia
Allergy
Weakness, paresthesias, impotence
40
Q

Thiazide contraindications

A

**DM
Effect may be reduced with NSAIDs
Cirrhosis, renal failure, heart failure

41
Q

Thiazide uses

A

HTN and heart failure
Nephrolithiasis
Nephrogenic diabetes insipidus

42
Q

Potassium sparing toxicity

A

Hyperkalemia
Acidosis
Antiandrogenic effects

43
Q

Potassium sparing contraindications

A

Chronic renal insufficiency
Use with B blockers, NSAIDs, ACEIs, ARBs
Liver disease

44
Q

MR antagonist use

A

Heart failure
Hyperaldosteronism
Hyperkalemia, acidosis, antiandrogenic use

45
Q

ENaC inhibitor use

A

Lithium induced nephrogenic DI

K wasting

46
Q

Loop and thiazide diuretics

A

Can combine if alone are minimally effective

Block Na reabsorption in all segments

47
Q

Potassium sparing and loop or thiazides

A

Avoid K wasting in loops or thiazides

48
Q

Edematous states treated with diuretics

A

Heart failure
Kidney disease
Hepatic cirrhosis

49
Q

Nonedematous states treated with diuretics

A

HTN
Nephrolithiasis
Hypercalcemia (loops)
DI

RENAL II Exam 3 (12 decks)

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