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Diuretics Flashcards

1
Q

diuretics acting in the PCT

A

acetazolamide

mannitol

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2
Q

diuretics acting in the LOH

A

furosemide
bumetanide
torsemide

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3
Q

diuretics acting in the DCT

A 
hydrochlorothiazide
chlorthalidone
metolazone
quinothazone
indapamide
spironolactone
eplenerone
amiloride
triamterene
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4
Q

carbonic anhydrase inhibitors (CAIs)

A

acetazolamide

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5
Q

osmotic diuretics

A

mannitol

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6
Q

loop diuretics

A

furosemide
bumetanide
tosemide

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7
Q

benzothiadiazides (thiazide diuretics)

A 
hydrochlorothiazide
chlorthalidone
quinethazone
metolazone
indapamide
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8
Q

class I thiazide diuretics

A

hydrochlorothiazide
chlorthalidone
quinethazone

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9
Q

class II thiazide diuretics

A

metolazone

indapamide

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10
Q

aldosterone antagonists

A

spironolactone

eplenerone

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11
Q

K-sparing diuretics

A

triametrene

amiloride

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12
Q

CAI MOA

A

inhibit carbonic anhydrase:

  • bicarb not reabsorbed
  • H+ not regenerated inside the cells
  • Na+/H+ antiporter inhibited
  • Na+ reabsorption also inhibited
  • increased delivery of NaHCO3, NaCl, & H2O to distal tubule
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13
Q

CAI effect on electrolyte excretion

A 
increased excretion:
-Na & HCO3- (moderate)
-H2O (UF)
-K+
increased reabsorption:
-Cl-
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14
Q

CAI clinical uses

A 
alkalinize urine (cysteinurea)
reduce intraocular pressure
seizures (MOA unknown)
mountain sickness prophylaxis 
diuresis (limited)
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15
Q

CAI ADEs

A 
metabolic acidosis (HCO3- loss in urine)
hypokalemia (K+ loss in urine)
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16
Q

osmotic diuretics characteristics

A

small molecules are filtered but not reabsorbed

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17
Q

osmotic diuretics MOA in PCT

A

osmotically inhibit Na+ & H2O reabsorption

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18
Q

osmotic diuretics MOA in peripheral tissues

A 
increase osmolarity of plasma
extract H2O from peripheral tissues
decrease blood viscosity
increase RBF
decrease RBF tonicity
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19
Q

osmotic diuretics MOA in LOH

A

thin descending limb: impair H2O reabsorption
thin ascending limb: impair NaCl & urea reabsorption
thick ascending limb: interfere with transport

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20
Q

osmotic diuretics effect on electrolyte excretion

A

increase excretion:

  • H2O
  • NaCl
  • K+
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21
Q

acetazolamide ROA

A

oral

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22
Q

mannitol ROA

A

injection

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23
Q

osmotic diuretics clinical uses

A

dialysis disequilibrium syndrome

reduce intracranial/intraocular pressure

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24
Q

osmotic diuretics ADE

A

volume overload

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25
Q

osmotic diuretics contraindications

A

cardiac failure

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26
Q

loop diuretics MOA

A 
inhibit NK2C
inhibit macula densa NaCl sensation
stimulate prostaglandin biosynthesis
increase RBF
regulate extraction fraction (maintain GFR)
increase renin release
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27
Q

loop diuretics effect on electrolyte excretion

A

increased excretion:

  • Na+ (potent NaCl loss)
  • K+
  • H+
  • Ca2+
  • Mg2+
  • H2O
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28
Q

loop diuretics effect on RAAS

A

increase renin release:

  • inhibit macula densa
  • reflexively activate SNS
  • stimulate intrarenal baroreceptors
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29
Q

loop diuretics clinical uses

A 
edema
pulmonary edema (acute IV)
hypercalcemia
protection against renal failure
washout of toxins
severe HTN (+ other drugs), esp. w/renal insufficiency, cardiac failure, cirrhosis
HTN crisis (IV)
30
Q

furosemide ROA

A

orally
IV
IM

31
Q

furosemide characteristics

A

loop diuretic
secreted by organic acid transporter: impaired secretion in renal disease
wide margin of safety

32
Q

furosemide pharmacokinetics

A 
onset = 30 min
duration = 8hr
half-life = 1.5 hr
extensively protein bound
65% renal excretion
33
Q

furosemide ADEs

A 
hypokalemia
pH disorders (alkalosis)
high BUN
hyperglycemia
hyperuricemia
ototoxicity
sialadentitis
34
Q

da fuk is sialadentitis

A

inflammation of salivary glands

35
Q

furosemide interactions

A 
lithium
indomethacin
probenecid
warfarin
NSAIDS (will cause diuretic resistance)
36
Q

bumetanide characteristics

A

loop diuretic
40x more potent than furosemide
can be used with warfarin

37
Q

bumetanide ROA

38
Q

torsemide characteristics

A

loop diuretic
vasodilator: also lowers BP
longer half-life than other loop diuretics

39
Q

thiazide diuretic MOA

A

inhibit Na+Cl-cotransporter (NCCT) in Na+/K+/aldosterone independent segment of distal tubule

40
Q

thiazide diuretics effect on electrolyte excretion

A 
increase excretion:
-Na+
-Cl-
-K+
-Mg2+
-titratable acid
decrease excretion:
-Ca2+
41
Q

thiazide diuretics clinical uses

A 
diuretic
hypercalciurea
antihypertensive (+/- other drugs)
osteoporosis
nephrogenic diabetes insipidus
mild/moderate HTN
"volume dependent" HTN (low renin levels)
HTN w/impaired renal fxn (metolazone&indapamide)
42
Q

thiazide characteristics

A

require secretion into tubular fluid

ineffective if GFR less than 30 mL/min

43
Q

class I thiazide diuretic clinical uses

A

GFR >60mL/min

44
Q

class II thiazide diuretic clinical uses

A

GFR b/t 30-60mL/min

45
Q

hydrochlorothiazide (HCTZ) ROA

A

oral

half-life = 2.5h

46
Q

chlorthalidone ROA

A

oral

half-life = 47h

47
Q

quinethazone ROA

48
Q

metolazone characteristics

A

10x more potent than HCTZ

49
Q

indapamide characteristics

A

20x more potent than HCTZ

50
Q

thiazide diuretics ADEs (overall)

A

depletion phenomena
retention phenomena
metabolic changes
hypersensitivity&other

51
Q

thiazide diuretics depletion phenomena

A

hypokalemia
hypochloremic alkalosis
dilutional hyponatremia
hypomagnesemia

52
Q

thiazide diuretics retention phenomena

A

hyperuricemia

hypercalcemia

53
Q

thiazide diuretics metabolic changes

A

hyperglycemia
hyperlipidemia
hyper secretion of renin
hyper secretion of aldosterone

54
Q

thiazide diuretics hypersensitivities&other ADEs

A 
fever
rash 
pupura
pancreatitis
sialadentitis
withdrawal edema
55
Q

aldosterone antagonists MOA

A

bind to aldosterone receptor in the cytoplasm and prevent its translocation to the nucleus: reduce ENAC channels

56
Q

aldosterone antagonists effect on electrolyte excretion

A 
increase excretion:
-Na+
decrease excretion:
-K+ (K sparing)
-H+
57
Q

spironolactone characteristics

A

aldosterone antagonist
pro-drug
extensively metabolized into canrenone (longer half-life)

58
Q

spirinolactone ADEs

A

hyperkalemia (combo w/thiazide)
gynecomastia
hirsutism
uterine bleeding

59
Q

eplenerone characteristics

A

aldosterone antagonist

less ADEs than spironolactone

60
Q

aldosterone antagonists clinical uses

A

diuretic (combo w/HCTZ)
CHF
cirrhosis

61
Q

K-sparing diuretics MOA

A

inhibit ENAC in sodium load segment of distal tubule

62
Q

K-sparing diuretics effect on electrolyte excretion

A 
increase excretion:
-Na+
decrease excretion
-K+
-H+
63
Q

K-sparing diuretics clinical uses

A

diuretic (combo w/HCTZ)
hyperuricemia
risk of K+ depletion

64
Q

K-sparing diuretics ADEs

A

hyperkalemia

megaloblastic anemia in patients w/cirrhosis

65
Q

Tx of cirrhosis

A

spirinolactone

add loop diuretic if GFR50mL/min

66
Q

K-sparing diuretics contraindications

A

significant renal insufficiency

K+ retaining conditions

67
Q

Tx of chronic renal failure

A

loop diuretic

68
Q

Tx of nephrotic syndrome

A

loop diuretic

69
Q

Tx of moderate/severe CHF

A

loop diuretic

70
Q

Tx of mild CHF w/GFR>50

71
Q

Tx of mild CHF w/GFR

A

loop diuretic

Renal (5 decks)

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