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Diuretics Flashcards

1
Q

Name the Carbonic Anhydrase Inhibitors (AM)

A

Acetazolamide

Methazolamide

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2
Q

Acetazolamide

Methazolamide

MOA

A

Inhibits CA at PCT –> less activity of Na/H antiporter, decreased Na, H2O, and HCO3 reabsorption

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3
Q

Acetazolamide

Methazolamide

Uses

A

Glaucoma (dec IOP and vol by dec aqueous humor production in ciliary body);

Mountain Sickness (prevention & Tx)

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4
Q

Acetazolamide

Methazolamide

Impt SE

A

Inc K+ excretion

Metabolic Acidosis

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5
Q

Acetazolamide

Methazolamide

Other SE

A

Hepatic encephalopathy

BM depression

Skin toxicity

Allergic reactions

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6
Q

Carbonic Anhydrase Inhibitors

SEs (PAACES)

A

P otassium low

A cidosis

A llergy

C onstipation (BM dec)

E ncephalopathy

S kin toxicity

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7
Q

Acetazolamide

Methazolamide

Misc

A

Contraindicated in Cirrhotic pts

FeNa = 5%

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8
Q

Aminophylline

Class

A

Bronchodilator (Methylxanthine)

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9
Q

Aminophylline MOA

A

Phosphodiesterase inhibition and enhanced signaling via inc cAMP and cGMP; Works at PCT; Dec Na, H2O, and HCO3 reabsorption

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10
Q

Aminophylline Uses

A

Reduce inflammation and bronchospasm in moderate-severe asthma; night sxs; NOT as a diuretic

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11
Q

Aminophylline Impt SE

A

Larger doses: N/V CNS stimulation Seizures Tachycardia/Arrhythmias

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12
Q

Aminophylline Misc

A

FeNa = 5% Aminophylline = Theophylline + Ethyelenediamine (sol. agent); Metabolized by Liver; Cimetidine & Quinoline inc blood levels

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13
Q

Mannitol Class

A

Osmotic Diuretic

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14
Q

Mannitol MOA

A

Opposes Na and H2O reabsorption at PCT –> inc osmolarity of tubular fluid

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15
Q

Mannitol Uses

A

Inc drug clearance

Minimize renal failure (shock/surgery)

Dec IOP

Dec Intracranial pressure (Cerebral edema)

Dx Oliguria

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16
Q

Mannitol Impt SE

A

Risk of Pulmonary edema

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17
Q

Mannitol Misc

A

FeNa = 5%;

Must give IV;

Other osmotic diuretics = glucose, urea, isorbide

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18
Q

Name the Loop Diuretics (FBT)

A

Furosemide

Bumetanide

Torsemide

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19
Q

Loop Diuretics MOA

(Furosemide, Bumetanide, Torsemide)

A

Inhibits Cl portion of Na/K/2Cl cotransporter in tALH –> dec K+, Ca++, and Na reabsorption –> Inc K+ loss

20
Q

Loop Diuretics Uses

(Furosemide, Bumetanide, Torsemide)

A

Crisis edema (pulmonary, CHF, cirrhosis);

Hypercalcemia;

Drug toxicity/OD;

Severe HTN with CHF/Cirrhosis

21
Q

Loop Diuretics Impt SE

(Furosemide, Bumetanide, Torsemide)

A

HYPOkalemia/calcemia/magnesia (–> arrhythmia);

Contraction alkalosis;

Inc Bun/Cr;

Ototoxicity (esp w/aminoglycoside)

22
Q

Loop Diuretics Other SE

(Furosemide, Bumetanide, Torsemide)

A

HYPERglycemia/lipidemia/uricemia;

HYPOnatremia;

Gout;

Photosensitivity;

Nephrocalcinosis;

Drug interactions;

Erectile dysfunction

23
Q

Loop Diuretics SEs

(another way to remember)

A

HyperGlycemia

HyperLipidemia

HyperUricemia

HypOcalcemia

HypOkalemia

HypOnatremia

HypOmagnesia

24
Q

Loop Diuretics Misc

(Furosemide, Bumetanide, Torsemide)

A

FeNa = 25%; eventually causes inc in PT reasborption; decreases (+) and (-) free water clearance; dec cortex-medulla molarity gradient; avoid NSAIDs; take before salty meals; reduce salt intake; useful in Renal insufficiency (GFR<30-40)

25
Name the Thiazide Diuretics (HCMI)
Hydrochlorothiazide Chlorthalidone Metolazone Indapamide
26
Thiazide Diuretics MOA (Hydrochlorothiazide, Chlorthalidone, Metolazone, Indapamide)
Inhibits the Cl portion of the NaCl cotransporter in the early DCT causing: Decreased Na+ and H2O reaborption, Inc Ca++ reabsoption, & Resultant K+ loss (The thigh is a lg bone and needs the Ca)
27
Thiazide Diuretics Uses (HENN) (Hydrochlorothiazide, Chlorthalidone, Metolazone, Indapamide)
**H **TN (intravascular contraction); **E** dema (chronic from cardiac insufficiency); **N** ephrolithiasis (idiopathic hypercalciuria) **N** ephrogenic Diabetes Insipidus
28
Which Thiazide diuretic can also be used to reduce **stroke risk** and **CHF events**?
Chlorthalidone
29
Thiazide Diuretics Impt SEs (Hydrochlorothiazide, Chlorthalidone, Metolazone, Indapamide)
Hypokalemia; Hypercalcemia; Contraction alkalosis; Inc BUN/Cr
30
Thiazide Diuretics Other SEs (Hydrochlorothiazide, Chlorthalidone, Metolazone, Indapamide)
HYPERglycemia/lipidemia/uricemia/calcemia; HYPOnatremia/magnesia; Gout; Photosensitivity; Impotence; Drug interactions
31
Thiazides SEs | (way to remember)
Hyper**G**lycemia Hyper**L**ipidemia Hyper**U**ricemia Hyper**C**alcemia Hyp**O**kalemia Hyp**O**natremia Hyp**O**magnesia (+ Cont. Alkalosis; Inc BUN/Cr; Gout; Photosensitivity; Impotence)
32
Thiazide Diuretics Misc (Hydrochlorothiazide, Chlorthalidone, Metolazone, Indapamide)
FeNa = 8%; lethal interaction w/quinidine (v. tach --\> fib, may be due to hyperkalemia); avoid NSAIDs, bile sequestrants; increased risk of hypokalemia w/anti-inflammatory steroids or Amphotericin B; decreases positive free water clearance
33
What are the K+ Sparing Diuretics? | (ATS)
Amiloride Triamterene Spironolactone (Aldo receptor antagonist)
34
Amiloride Triamterene MOA
Blocks Na Channel and Na/H antiporter in late DCT and Collecting Duct --\> dec K+ and DCT acid secretion & inc Ca++ reabsorption
35
Amiloride Triamterene Uses
Combination with other Diuretics to prevent hypokalemia; Edema
36
Amiloride can also be used for...
Idiopathic hypercalciuria (stones); Lithium-induced polyuria & toxicity; Liddle syndrome; Mucocilliary clearnance
37
Amiloride Triamterene Impt SE
Hyperkalemia in pts with Renal failure or on ACEI
38
What is another SE of Triamterene?
Megaloblastic anemia in pts with Liver cirrhosis
39
Amiloride Triamterene Misc
Contraindication in pts with Renal failure (hyperkalemia) and those on ACEI/ARBs; FeNa = 2% (Triamterene doesn't list ACEI/ARBs as contraind.)
40
Sprionolactone Class
K+ Sparing Diuretic Aldosterone Receptor Antagonist
41
Sprionolactone MOA
Competes for Aldo receptor, inhibits mRNA transcription and translation --\> dec Na and K channels, dec number and activity of Na/K/ATPase pumps in late DCT and CD --\> dec K+ and DCT acid secretion
42
Sprionolactone Uses
Reduction in CHF mortality (30%); Combination with other diuretics to prevent hypokalemia; Edema; Primary/Secondary Aldosteronism; HTN; Anti-testosterone agent ## Footnote **H** TN/C**H**F **E** dema **L** ow K+ **P** rimary/secondary aldosteronism
43
Spironolactone Misc
Contraindicated in pts with renal failure; FeNa = 2%; Requires a salt-restricted diet; **only drug not requiring tubular lumen access**
44
Name the one Aquaretic we need to know
Conivaptan
45
Conivaptan MOA
Vasopressin (ADH) receptor antagonist working at the CD --\> Inc free water excretion
46
Conivaptan Uses
Hyponatremia (SIADH, CHF)
47
Conivaptan Misc
New drug class with unproven clinical benefit

Pharm (7 decks)

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