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Renal > Diuretics > Flashcards

Diuretics Flashcards

1
Q

What is the mechanism of action of acetazolamide?

A

Acetazolamide inhibits proximal tubule carbonic anhydrase -> increased HCO3- excretion

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2
Q

What are the effects of carbonic anhydrase inhibitors (acetazolamide) on renal function? (list 4)

A

Prevents the reabsorption of bicarb and Na.

Causes modest diuresis, loss of bicarb and Na.

Metabolic alkalosis

Renal compensatory mechanisms limit both the diuretic effect and Na loss

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3
Q

What are the therapeutic uses of Acetazolemide (Carbonic anhydrase inhibitors)? list 3

A
  1. Glaucoma, to reduce intraocular pressure.
  2. Epilepsy
  3. Altitude sickness

Not often used for diuretic effect.

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4
Q

What are the drug interactions of carbonic anhydrase inhibitors (acetazolamide)?

A

Decreases the elimination of amphetamines due to increase in urinary pH

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5
Q

What are the toxicities of carbonic anhydrase inhibitors (acetazolamide)? list 4

A
  1. Metabolic acidosis (renal effect)
  2. sedation and paresthesias (CNS effects)
  3. Bone marrow suppression
  4. Allergic rxn

3 and 4 due to structural similarity to sulfa drugs

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6
Q

What is the mechanism of action of Furosemide?

A

Blocks Na/K/Cl symporter in the thick ascending loop of Henle.

Note: must be secreted in the proximal tubule to be effective. Also there is a decrease in Mg and Ca reabsorption

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7
Q

What are the effects of high ceiling (loop) diuretics on renal function?

A
  1. Profound diuretic effect
  2. Significant loss of Na and K
  3. Loss of Ca and Mg
  4. Hypokalemia due to actions at distal nephron
  5. Uric acid excretion is reduced (competes for proximal tubule secretion)
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8
Q

What are the therapeutic uses of loop diuretics (furosemide)? List 5 primary, 2 secondary

A
  1. Edema associated with renal failure
  2. Ascites
  3. Nephrotic syndrome
  4. Pulmonary edema
  5. Heart failure
  6. HTN, secondline
  7. Hypercalcemia
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9
Q

List 5 electrolyte effect and 2 side effects of loop diuretics.

A
  1. Hyponatremia
  2. Hypokalemia
  3. Hypocalcemia
  4. hypochloremia
  5. hypomagnesemia
  6. Hypotension
  7. Volume depletion
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10
Q

What are side effects and toxicities of loop diuretics (furosemide)

A
  1. Hypotension
  2. Volume depletion
  3. Ventricular arrhythmias due to hypokalemia
  4. Ototoxicity
  5. Muscle weakness due to hypokalemia
  6. Hypersensitivity rxn due to similarity to sulfa drugs.
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11
Q

List 5 potential metabolic side effects of furosemide.

A
  1. Hyperuricemia
  2. Hyperglycemia
  3. Increased triglyceride and cholesterol levels
  4. increased LDL cholesterol
  5. Decreased HDL cholesterol
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12
Q

List 5 drug interactions of furosemide.

A
  1. Antiarrhythmic drugs and cardiac glycosides
  2. Aminoglycoside antibiotics (cisplatin) - increase likelyhood of ototoxicity
  3. NSAIDs blunt action of loop diuretics
  4. Loop diuretics reduce efficacy of gout drugs.
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13
Q

Thiazide Mechanism of action (Hydrochlorothiazide, Chlorthalidone)?

A

Block Distal Tubule Na/Cl symporter. Must be secreted in proximal tubule.

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14
Q

What are renal effects of Hydrochlorothiazide and Chlorthalidone?

A
  1. Na and Cl excretion
  2. Modest diuresis
  3. Hypokalemia
  4. Uric acid excretion is reduced.
  5. Ca excretion is decreased.
  6. Mg excretion is increased.
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15
Q

What are therapeutic uses of Hydrochlorothiazide and Chlorthalidone?

A

HTN

intially thiazides decrease plasma volume.
long term use is associated with a decrease in peripheral vascular resistance.

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16
Q

What are side effects of Thiazides? (Hydrochlorothiazide and Chlorthalidone)

A
  1. Hypotension
  2. Volume depletion
  3. Hypokalemia
  4. Hyponatremia
  5. hypochloremia
  6. hypercalcemia
  7. hypomagnesemia.
17
Q

What are the metabolic side effects of Thiazides? (hint lipid profile)

A
  1. Hyperuricemia
  2. Hyperglycemia
  3. Increased TGs and Cholesterol
  4. Increased LDL
  5. Decreased HDL
18
Q

What are drugs interactions of Thiazides?

A
  1. Antiarrhymthmic drugs and cardiac glycosides
  2. NSAIDs blunt action of thiazides
  3. Increase plasma Lithiium levels
  4. Reduced efficacy of gout drugs.
19
Q

Are are the 2 classes of K sparing diuretics?

A
  1. Na channel inhibitors: amiloride, triamterene

2. Aldosterone receptor antagonists: spironolactone, eplerenone

20
Q

What are the therapeutics uses of Na-Channel inhibitors? (amiloride, triamterene)

A
  1. Modest diuretic effect
  2. Used to minimize K loss and potentiate the actions of diuretics used to treat HTN or edema
  3. Not used alone to treat edema or HTN
21
Q

What is a potential toxicity of Amiloride and Triamterene?

A

Hyperkalemia

22
Q

What are the therapeutic uses of Aldosterone antagonists? (spironolactone and eplerenone)

A
  1. Modest diuretic action
  2. Minimize K losses and potentiate actions of other diuretics used to treat edema and HTN
  3. Improve outcomes in heart failure
23
Q

What are potential toxicities of Spironolactone and Eplerenone?

A

Hyperkalemia
Spironolactone: gynecomastia, decreased libido, impotence in men, menstrual irreg./hair growth in women
Eplerenone: ^ SE less likely

24
Q

Name 2 ACE inhibitors

A

Lisinopril, Captopril

25
Q

Therapeutic uses for ACE-inhibitors and AT1 antagonists

A

Heart failure and HTN

Reduce M&M in patients after MI

26
Q

Contraindications for ACE-inhibitors and AT1 antagonists?

A

Women who are pregnant or plan to become pregnant. Teratogen

27
Q

Side effects of ACE-inhibitors?

A

Persisent cough due to inability to break down bradykinin

28
Q

Side effects of both ACE-inhibitors and AT1 antagonists?

A
  1. Modest elevation in serum K
  2. Angioedema
  3. Loss of taste
  4. Hypotension
29
Q

Mechanism of action for Aliskiren

A

Aliskerin binds to the active site of renin and blocks its catalytic activity. Angiotensin II is decreased.

30
Q

Therapeutic uses of Aliskerin?

A

Decrease systemic arterial blood pressure

31
Q

Contraindications for Aliskerin?

A

Do not use Aliskerin with ACE inhibitors or AT1-blockers in diabetic patients.

32
Q

Mechanism of action for Mannitol

A

Mannitol (and other osmotic diuretics) are freely filterable but not reabsorbed and prevent water reabsorption from the renal tubule. Can also extract H2O from systemic body compartments.

33
Q

Therapeutic uses of Mannitol?

A

Maintain renal blood flow in patients with acute renal failure.

Glaucoma and cerebral edema

Renal (6 decks)

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