Diuretics Flashcards
Furosemide Adverse Effects
Loop, NKCC2 **Ototoxicity** Hyperuricemia Acute Hypovolemia **Hypokalemia** Hypomagnesemia Allergies (Sulfa)
Furosemide Indications
Loop
NKCC2
DOC for acute pulmonary edema with heart failure
Hypercalcemia
Hyperkalemia
Ethacrynic acid is non-sulfa but more ototoxic
Torsemide indications
Loop, NKCC2
DOC for acute pulmonary edema with heart failure
Hypercalcemia
Hyperkalemia
Torsemide adverse effects
Loop, NKCC2 **Ototoxicity** Hyperuricemia Acute hypovolemia **Hypokalemia** Hypomagnesemia Allergies (sulfa)
Loop Diuretics Mechanism
NKCC2
Site-ascending LOH
Blocks Na/Cl/K co transporter
Increased prostaglandin synthesis (COX2)
Ethacrynic acid is non sulfa but more ototoxic, furosemide and torsemide are sulfa
Loop Diuretic Urine Composition
Increased calcium, sodium, potassium, magnesium
Increased volume
Thiazides Mechanism
NCCT
Site - DCT
Block Na/Cl co transporter
ceiling-saturates at low dose
Loop Effects
NKCC2
Ascending LOH Na/Cl/K cotransporter
Most effective DOC for acute pulmonary edema with heart failure
Produces a lot of urine
Increases renal blood flow via decreased resistance
Thiazide Effects
NKCC2
Site - DCT
Decreases PVR and BP even after volume recovery
Thiazide Indication
HTN
Mild heart failure
Hypercalciuria
Diabetes Insipidus
Thiazide Urine composition
Increased sodium, potassium, Chloride, Magnesium
Decreased Calcium
Increased volume
Thiazide Adverse effects
Give oral only NKCC2 Hypokalemia Hyponatremia Hyperuricemia Volume depletion **Hyperglycemia** **Hyperlipidemia**
Takes 1-3 week to obtain stable effects
Thiazides
Chlorthalidone
Hydrchlorothiazide
Metolazone
(Sulfa derivatives)
Loops
Furosemide
Torsemide
Ethacrynic Acid
Aldosterone Agonists
Spironolactone
Eplerenone
Aldosterone Agonist Mechanism
Antagonizes aldosterone at cytoplasmic receptors (preventing translocation)
Acts at collecting duct
Used in combination with other diuretics
Aldosterone Antagonist Indication
Primary hyperaldosteronism
Edema
Aldosterone Antagonist PK
Oral and strongly protein bound
Induces CYP450
Aldosterone Antagonist Adverse Effects
GI upset and peptic ulcers **Endocrine->irregular menstrual cycles, gynecomastia, impotence** Hyperkalemia Nausea, Lethargy Mental Confusion
ENaC K sparing Drugs
Amiloride
Triamterene
ENaC K Sparing Mechanism
Blocks Na transport channels
Decreases sodium/potassium exchange
Acts at collecting duct
ENaC K sparing indications
Primary hyperaldosteronism
Heart failure
Hypokalemia
ENaC K sparing Adverse effects
Same as spironolactone -GI upset and peptic ulcers, Endocrine issues (gynecomastia, impotence, irregular menstrual), Hyperkalemia, nausea, lethargy, mental confusion
Plus leg cramps**
Increased BUN, uric acid
CAH inhibitor Drug
Acetazolamide
CAH inhibitor Mechanism
Acts mainly in the PT
Prevents formation of H+ needed for Na+ reabsorption in the PT
CAH inhibitor Indication
Glaucoma (decreases production of aqueous humor)
Treat metabolic alkalosis
Mountain sickness prophylaxis
Epilepsy
CAH inhibitor Adverse effects
Metabolic acidosis
K depletion (rare)
Renal stones
Contraindicated in hepatic cirrhosis due to decreased NH4+ excretion
Osmotic Drug
Mannitol
Osmotic Effect
Does not affect sodium excretion
Osmotic drug mechanism
Filtered into glomerulus, draws H2O into tubular fluid
Osmotic drug indications
Increased ICP
Acute renal failure (shock)
Drug toxicity
Trauma (maintain urine)
Osmotic PK
IV only
Osmotic Adverse
Extracellular H2O expansion ->Dehydration
Hypo or hypernatremia
Oral->osmotic diarrhea
ADH antagonist
Conivaptan
Conivaptan
Inhibits CYP3A4
ADH antagonist Effect
Renders CT impermeable to H2O
ADH antagonist mechanism
Inhibit ADH
Decrease aquaporins in the collecting duct
ADH antagonist indication
SIADH
Hyponatremia
ADH antagonist Urine composition
Increased plasma Na
Decreased H2O reabsorption ->dilute urine
ADH antagonist PK
IV only
ADH antagonist adverse
Nephrogenic diabetes insipidus
Renal failure
Diuretic main uses
Management of edema and hypertension
