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Pharm U4 > Diuretics > Flashcards

Diuretics Flashcards

1
Q

What is the mechanism of action of the carbonic anhydrase inhibitors?

A

Inhibit luminal carbonic anhydrase at the proximal tubule –causes less activity of Na/H antiporter–decreased HCO3 and Na+ (and water) reabsorption

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2
Q

What are the three carbonic anhydrase inhibitors?

A

Acetazolamide
Methazolamide
Dichlorphenamide

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3
Q

What are the uses of carbonic anhydrase inhibitors–acetazolamide, methazolamide, dichlorphenamide?

A

Decrease intraocular volume/pressure

Prevention and tx of mountain sickness

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4
Q

What are the side effects of the carbonic anhydrase inhibitors?

A

Increased K+ excretion and metabolic acidosis

ONLY diuretic causing hypokalemia and acidosis
Normally hyperkalemia and acidosis

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5
Q

Carbonic anhydrase inhibitors are contraindicated in?

A

Cirrhotic patients

Alkalization of urine– increased serum ammonia–> hepatic encephalopathy

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6
Q

What is the mechanism of action of aminophylline, a bronchodilator?

A

Phosphodiesterase inhibition and enhanced signaling via increased cAMP and cGMP–works at proximal tubule–decreased HCO3 and Na+ (and water) reabsorption

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7
Q

What are the uses of aminophylline?

A

Reduce inflammation and bronchospasm in moderate to severe asthma

NOT used as diuretic

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8
Q

What is the mechanism of action of mannitol?

A

Opposes water and sodium reabsorption at proximal tubule–increased osmolarity of tubular fluid

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9
Q

What are the uses of mannitol?

A

Increased clearance of drugs
Minimize renal faillure–shock or surgery
Decrease intraocular or intracranial pressures
Diagnose oliguria

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10
Q

What is the major side effect of mannitol?

A

Risk of pulmonary edema

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11
Q

What is the mechanism of action of the loop diuretics?

A

Inhibit Cl portion of Na-K-2Cl cotransporter in luminal membrane at medullary and cortical (proximal) talH

Decreased K+, Ca2+, and Na+ reabsorption

Resultant K+ loss

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12
Q

What are the uses of the loop diuretics?

A

Crisis edema–pulmonary, CHF, cirrhosis
Hypercalcemia
Drug toxicity/OD
Severe HTN in setting of CHF or cirrhosis

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13
Q

What loop diuretic should be given when pt has sulfa allergy?

A

Ethacrynic acid

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14
Q

What are the 4 main loop diuretics?

A

Furosemide
Bumetanide
Torsemide
Ethacrynic acid

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15
Q

What are the major side effects of loop diuretics?

A 
Hypokalemia/hypocalcemia/hypomagnesemia--arrhythmia 
Contraction alkalosis
Increased BUN and creatinine
Ototoxicity--esp with aminoglycoside 
Hyperglycemia 
Gout
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16
Q

What is the mechanism of action the the thiazide and thiazide like diuretics?

A

Inhibits Cl portion of the Na-Cl cotransporter in the luminal membrane at the early distal tubule

Decreased Na+ (and water) reabsorption
Increased Ca++ reabsorption
Resultant K+ loss

17
Q

What are the uses the the thiazide diuretics?

A

HTN–intravascular contraction
Chronic edema–cardiac insufficiency
Idiopathic hypercalciuria (stones)
Nephrogenic diabetes insipidus

18
Q

What are the 2 main thiazide diuretics?

A

Chlorothiazide

Hydrocholorothiazide

19
Q

What are the 4 major thiazide-like diuretics?

A

Chlorthalidone
Quinethazone
Metolazone
Indapamide

20
Q

Which thiazide-like diuretic has additional uses and what are they?

A

Chlorthalidone

Besides
HTN--intravascular contraction
Chronic edema--cardiac insufficiency
Idiopathic hypercalciuria (stones)
Nephrogenic diabetes insipidus

It also reduces stroke risk and CHF events

21
Q

What are the side effects of the thiazide and thiazide like diuretics?

A 
Hypokalemia/hypercalcemia
Contraction alkalosis
Increased BUN and creatinine 
Hyperglycemia 
Gout
22
Q

What drug has a lethal interaction with the thiazide diuretics?

A

Quinidine–v. tach–fib–> due to hyperkalemia

23
Q

What do the thiazide diuretics do to free water clearance

A

decreases positive free water clearance

24
Q

What do the loops do to free water clearance?

A

Decrease positive and negative free water clearance

25
Q

What is the mechanism of action of amiloride and triamterene?

A

K+ sparing diuretics–renal ENaC inhbiitor

Blocks Na channel and Na/H antiproton in lumenal membrane at the late distal tubule and collecting duct

Decreased K+ secretion and distal tubule acid secretion
Increased Ca++ absorption

26
Q

What are the uses of amiloride?

A

Combination with other diuretics to prevent hypokalemia
Edema
Idiopathic hypercalciuria (stones)
Lithium-induced polyuria and toxicity
Liddle syndrome– high blood pressure associated with low plasma renin activity, metabolic alkalosis, low blood potassium, and normal to low levels of aldosterone
Mucociliary clearance

27
Q

What are the side effects of amiloride and triamterene?

A

Hyperkalemia in pts with renal failure or on ACE inhibitors

28
Q

The use of amiloride and triamterene are contraindicated in pts with?

A

renal failure and ACEi/ARB use

29
Q

What are the uses of triamterene?

A

Combination with other diuretics to prevent hypokalemia

Edema

30
Q

What is the K+ sparring diuretic that is an aldosterone receptor antagonist?

A

Spironolactone

31
Q

What is the mechanism of action of spironolactone?

A

Competes for aldosterone receptor–inhibiting mRNA transcription and translation

Decreased Na and K channels
Decreased number and activity of Na-K-ATPase pumps in the late distal tubule and collecting duct–> decreased K+ secretion and distal tubule acid secretion

32
Q

What are the uses of spironolactone?

A 
Reduction in CHF mortality
Combination with other diuretics to prevent hypokalemia
Edema
Primary and secondary aldosteronism
HTN
Anti-testosterone agent
33
Q

What are the side effects of spironolactone?

A

Hyperkalemia in pts with renal failure or on ACE inhibitors
Male pts–may have gynecomastia, ED, and loss of libido
Female pts–may have amenorrhea, breast soreness, and oligomenorrhea

34
Q

The use of spironolactone is contraindicated in pts with?

A

Renal failure– can cause hyperkalemia

Requires a salt-restricted diet–so aldosterone is present to compete with

35
Q

What are the 2 vasopressin (ADH) receptor antagonist and where is there site of action?

A

Conivaptan
Tolvaptan

Works at collecting duct–increased free water excretion

36
Q

What are conivaptan and tolvaptan used for?

A

hyponatremia–SIADH and CHF

Pharm U4 (8 decks)

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