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Pharm 1 > Diuretics > Flashcards

Diuretics Flashcards

1
Q

What is a diuretic

A

Causes net excretion of H20 and Na

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2
Q

What do we use diuretics for

A

Hypertension –Blood volume down –Some diuretics also cause vasodilation Reduction of edema –in heart failure the kidney retains Na and H2O –H20 accumulates in interstitial space

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3
Q

Pitting edema

A

Due to so much fluid in interstitial space. When you push on your skin and blood does not return

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4
Q

What is freely permeable in renal tubule?

A

H20

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5
Q

Thiazide diuretics

A

Chlorothiazide and hydrochlorothiazide

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6
Q

Thiazide diuretics mechanism

A

Inhibits Na+ transport out of the DCT. H20 follows and both are excreted

High TI
works w/in 2 hours

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7
Q

Thiazide diuretics SE and other effects

A

Other effects:

  • Cause direct vasodilation
  • Often initial drugs for hypertension
  • Decrease Ca excretion

Side effects:

  • Hypokalemia
    • Lose K due to Na-K exchanger
  • Increase in serum LDL and triglycerides (atherosclerosis)
  • Decrease uric acid secretion→gout
  • Inhibit insulin secretion
  • Contain sulfur ions-may cause allergens
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8
Q

High ceiling diuretics

A

Furosemide, ethacrynic acid, bumetanide, torsemide

  • Orally or parenterally
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9
Q

High Ceiling diuretics mechanism

A

Mech of action:

  • Inhibit Na and Cl resorbtion from Asc. loop of Henle

More efficacious than thiazides

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10
Q

High Ceiling diuretics clinical use

A
  • Pts who dont respond to thiazides
  • Life threatening edema (pulmonary or cerebral)
  • Compromised renal fxn
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11
Q

High Ceiling diuretics SE

A
  • Dehydration
  • Hypokalemia
    • Used w/ K supplements or K sparing diuretics
  • Increased Ca excretion→Hypocalcemia
  • Decreased uric acid excretion→gout
  • Auditory nerve damage esp. if used w/ other ototoxic agents
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12
Q

Aldosterone antagonists

A

K sparing diuretics

Spironolactone

Eplerenone

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13
Q

Aldosterone antagonists mech

A

Blocks aldosterone receptor

Aldosterone is responsible for synth of Na-K exchanger

Takes days to be effective

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14
Q

Aldosterone antagonists clinical use

A
  1. Used w/ other diuretics to prevent K loss
  2. To treat excess aldosterone production
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15
Q

Aldosterone antagonists SE

A
  • hyperkalemia
  • Spironolactone is a steroid and can have anti-androgenic effect (breast growth,etc)
  • Eplerenone-fewer interactions w/ steroid receptors
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16
Q

Inhibitors of Na transport in DCT and collecting tubule

A

Triamterene

Amiloride

17
Q

Inhibitors of Na transport in DCT and collecting tubule mech

A

K sparing diuretic

Prevent Na from getting into the exchanger by blocking Na ion channel

-Effects more rapid and predictable than spironolactone

18
Q

Inhibitors of Na transport in DCT and collecting tubule SE

A

Hyperkalemia

19
Q

Acetazolamide

A

Carbonic anydrase inhibitors (enzyme inhibitor)

Inhibits HCO3- resorption in PCT

Short term effect

Not used primarily as diuretic

Other uses:

  • Treats open angle glaucoma
  • Mountain sickness (by lowering CSF volume)
  • Epilepsy
    • May be due to pH in CNS
20
Q

Mannitol

A

Osmotic diuretic

Not metabolized

Given IV

Mech: Draws H20 into tuble and is excreted w/ H20

Clinical use: Used to maintain renal flow after renal damage

21
Q

Methylxanthines

A

Caffeine

increase glomerular filtration rate

22
Q

Ethanol as a diuretic

A

Mech: decrease release of ADH

23
Q

(Hydro)Chlorothiazide

A

Inhibits Na+ transport out of the DCT. H20 follows and both are excreted

High TI
works w/in 2 hours

Other effects:

Cause direct vasodilation
Often initial drugs for hypertension
Decrease Ca excretion

Side effects:

  • Hypokalemia
    • Lose K due to Na-K exchanger
  • Increase in serum LDL and triglycerides (atherosclerosis)
  • Decrease uric acid secretion→gout
  • Inhibit insulin secretion
  • Contain sulfur ions-may cause allergens
24
Q

Furosemide

A

High ceiling diuretics

Orally or parenterally

Mech of action:

Inhibit Na and Cl resorbtion from Asc. loop of Henle

More efficacious than thiazides

Clinical use:

Pts who dont respond to thiazides
Life threatening edema (pulmonary or cerebral)
Compromised renal fxn

Side effects:

Dehydration
Hypokalemia

—Used w/ K supplements or K sparing diuretics

Increased Ca excretion→Hypocalcemia
Decreased uric acid excretion→gout
Auditory nerve damage esp. if used w/ other ototoxic agents

25
Q

Ethacrynic acid

A

High ceiling diuretics

Orally or parenterally

Mech of action:

Inhibit Na and Cl resorbtion from Asc. loop of Henle

More efficacious than thiazides

Clinical use:

Pts who dont respond to thiazides
Life threatening edema (pulmonary or cerebral)
Compromised renal fxn

Side effects:

Dehydration
Hypokalemia

—Used w/ K supplements or K sparing diuretics

Increased Ca excretion→Hypocalcemia
Decreased uric acid excretion→gout
Auditory nerve damage esp. if used w/ other ototoxic agents

26
Q

Bumetanide

A

High ceiling diuretics

Orally or parenterally

Mech of action:

Inhibit Na and Cl resorbtion from Asc. loop of Henle

More efficacious than thiazides

Clinical use:

Pts who dont respond to thiazides
Life threatening edema (pulmonary or cerebral)
Compromised renal fxn

Side effects:

Dehydration
Hypokalemia

—Used w/ K supplements or K sparing diuretics

Increased Ca excretion→Hypocalcemia
Decreased uric acid excretion→gout
Auditory nerve damage esp. if used w/ other ototoxic agents

27
Q

Torsemide

A

High ceiling diuretics

Orally or parenterally

Mech of action:

Inhibit Na and Cl resorbtion from Asc. loop of Henle

More efficacious than thiazides

Clinical use:

Pts who dont respond to thiazides
Life threatening edema (pulmonary or cerebral)
Compromised renal fxn

Side effects:

Dehydration
Hypokalemia

—Used w/ K supplements or K sparing diuretics

Increased Ca excretion→Hypocalcemia
Decreased uric acid excretion→gout
Auditory nerve damage esp. if used w/ other ototoxic agents

28
Q

Spironolactone

A

K sparing diuretic

Aldosterone antagonist

Mech:

Blocks aldosterone receptor

Aldosterone is responsible for synth of Na-K exchanger

Takes days to be effective

Clinical use

Used w/ other diuretics to prevent K loss
To treat excess aldosterone production

SE

hyperkalemia
Spironolactone is a steroid and can have anti-androgenic effect (breast growth,etc)
Eplerenone-fewer interactions w/ steroid receptors

29
Q

Eplerenone

A

K sparing diuretic

Aldosterone antagonist

_Mech: _

Blocks aldosterone receptor

Aldosterone is responsible for synth of Na-K exchanger

Takes days to be effective

Clinical use

Used w/ other diuretics to prevent K loss
To treat excess aldosterone production

SE

hyperkalemia
Spironolactone is a steroid and can have anti-androgenic effect (breast growth,etc)
Eplerenone-fewer interactions w/ steroid receptors

30
Q

Triamterene

A

K sparing diuretic

Inhibitors of Na transport in DCT and collecting tubule

Mech:

Prevent Na from getting into the exchanger by blocking Na ion channel

-Effects more rapid and predictable than spironolactone

SE:

Hyperkalemia

31
Q

Amiloride

A

K sparing diuretic

Inhibitors of Na transport in DCT and collecting tubule

Mech:

Prevent Na from getting into the exchanger by blocking Na ion channel

-Effects more rapid and predictable than spironolactone

SE:

Hyperkalemia

Pharm 1 (8 decks)

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