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D&T3 Cardiology > Diuretics > Flashcards

Diuretics Flashcards

1
Q

What are the uses of diuretics?

A
  1. Mobilize fluid
  2. Excrete fluid (edema)
  3. Excrete electrolytes
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2
Q

What are the six classes of diuretics?

A
  1. Carbonic Anhydrase Inhibitors
  2. Thiazides and related drugs
  3. Loop Diuretics
  4. K+ Sparing Diuretics
  5. Osmotic Diuretics
  6. Miscellaneous
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3
Q

What is Acetazolamide?

A

A Carbonic Anhydrase Inhibitor

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4
Q

Where is the site of action for carbonic anhydrase inhibitors?

A

Proximal Tubule

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5
Q

What are the effects of inhibiting the intracellular Carbonic Anhydrase enzymes?

A

Results in: Decreased H+ and HCO3- in cell –> Decreased Na+/H+ luminal exchange–> Decreased Na+/HCO3- basolateral cotransport –> DECREASED Na+ REABSORPTION

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6
Q

What is the result of inhibiting the luminal carbonic anhydrase enzyme?

A

Increased Luminal HCO3-

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7
Q

What are the effects of CA inhibitor use?

A
  1. Weakly diuretic (only 5% increase in Na+ excretion)
  2. Large increase in HCO3- excretion (problem for metabolic acidosis)
  3. Increased K+ excretion
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8
Q

What are the therapeutic uses of CA Inhibitors?

A
  1. Decreasing IOP for Glaucoma- OA
  2. Urinary Alkalinization
  3. Mountain Sickness
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9
Q

What are the adverse effects of CA Inhibitors?

A
  1. Metabolic Acidosis
  2. Hypokalemia
  3. Drowsiness
  4. Hypersensitivity
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10
Q

What are the Thiazide Drugs?

A
  1. Hydrochlorothiazide
  2. Chlorothiazide
  3. Polythiazide
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11
Q

What are the Thiazide Related Drugs?

A
  1. Chlorthalidone
  2. Indapamide
  3. Metolazone
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12
Q

Where is the site of action of Thiazides and Related Drugs?

A

Distal Convoluted Tubule

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13
Q

What is the MOA of Thiazides?

A

Inhibition of luminal Na/Cl Cotransport –> Decreased Na+ Reabsorption

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14
Q

How do Thiazides inhibit sodium reabsorption?

A

By binding to the Cl- site of the luminal Na/Cl cotransporters, thus preventing symport of Na+

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15
Q

Describe the effect Thiazides have on urine composition

A
  1. Increased Na+, H20, K+, Cl- and HCO3-

2. Decreased Ca++ and Uric Acid

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16
Q

Which drugs are bad for patients with gout?

A

Thiazides and related drugs

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17
Q

What are the therapeutic uses of Thiazides?

A
  1. HTN
  2. CHF or Edema
  3. Hypercalciuric Renal Stones
  4. Nephrogenic DI
  5. Nephrotic Syndrome (+SP)
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18
Q

What condition causes Thiazides to become ineffective?

A

A GFR

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19
Q

Which Thiazides/Related drugs are effective at GFRs less than 40mL/min?

A

Metolazone and Indapamide

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20
Q

What are adverse effects of Thiazides?

A
  1. Decreased K+ (potential Digitalis Interaction –> MI)
  2. Elevated Uric Acid, Glucose, Calcium and Lipids
  3. Hypovolemia
  4. Hypersensitivity to other Sulfonamide drugs
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21
Q

What are the Loop Diuretic Drugs?

A
  1. Furosemide
  2. Bumetanide
  3. Torsemide
  4. Ethacrynic Acid*
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22
Q

Which loop diuretic is not a Sulfa drug?

A

Ethacrynic Acid

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23
Q

What are the most efficacious diuretics?

A

Loop Diuretics

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24
Q

What is the MOA of Loop Diuretics?

A

Inhibit Na+-K+-2Cl- cotransport in the ascending limb of the loop of Henle; resulting in a decrease in Na+ reabsorption

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25
Q

At what site does the loop diuretic bind to the symporter?

A

At the Cl binding site

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26
Q

Why would a person develop muscle cramps when using a loop diuretic?

A

Hypokalemia (may need to give a supplement)

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27
Q

By what percent do loop diuretics increase Na and H2O excretion?

A

25%

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28
Q

What is the net effect of loop diuretics?

A

Increased Excretion of- Na, H2O, K, Cl and Ca

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29
Q

What are the therapeutic uses of Loop Diuretics?

A
  1. Acute Pulmonary Edema
  2. CHF, Renal or Hepatic Edema
  3. HTN (with a low GFR)
  4. Hypercalcemia
30
Q

Which class of diuretics would be bad for patients with osteoporosis?

A

Loop Diuretics

31
Q

What are potential side effects of loop diuretics?

A
  1. Ototoxicity (worsens that caused by amino glycosides)
  2. Hyperuricemia
  3. Hyperglycemia
  4. Hypersensitivity
  5. Hyperlipidemia
32
Q

What are the 4 Potassium Sparing Diuretics?

A
  1. Triamterene
  2. Amiloride
  3. Spironolactone
  4. Eplerenone
33
Q

Which Potassium Sparing Diuretics are sodium channel inhibitors?

A
  1. Triamterene

2. Amiloride

34
Q

What Potassium Sparing Diuretics are Aldosterone Receptor Antagonists?

A
  1. Spironolactone

2. Eplerenone

35
Q

Describe the MOA and effect of Spironolactone and Eplerenone

A

MOA- competitive antagonists at renal Aldosterone Receptors –> decreased Na and K exchange in distal tubule
**Ineffective in absence of Aldosterone

36
Q

What are the effects of Aldosterone?

A
  1. Activates and increases synth of Na channels and moves them to the luminal membrane
  2. Activates and increases synth of Na/K ATPases and moves them to membranes
  3. Alters permeability of Tight JXNs
  4. Increases ATP synthesis
37
Q

How does Aldosterone effect urine composition?

A
  1. Increases Na, Cl and H2O excretion

2. Decreases K+ and H+ excretion

38
Q

What is the therapeutic use of Eplerenone?

A

HTN, CHF and post-MI

39
Q

What is the therapeutic use of Spironolactone?

A
  1. Primary Hyperaldosteronism
  2. Prevention of hypokalemia
  3. **Edema from hepatic cirrhosis and nephrotic syndrome
  4. CHF
40
Q

What are the side effects of the Aldosterone Receptor Antagonists (Eplerenone and Spironolactone)?

A
  1. Hyperkalemia

2. Gynecomastia and menstrual irregularities

41
Q

How can hyperkalemia effect the heart?

A

If levels of K+ get too high, they can affect the contractility of the heart and cause an MI

42
Q

What is the MOA of Triamterene and Amiloride?

A

MOA- Block Na channels and decrease Na+/K+ exchange in the distal tubule and collecting duct

43
Q

Why could Triamterene and Amiloride cause an increase in urine pH?

A

Because they inhibit Na from coming into the cell, so there is not as much excretion of H+ into the lumen to maintain electroneutrality

44
Q

What are the net effects of Triamterene and Amiloride?

A
  1. Decreased K+ and H+ Secretion

2. Increased NaCl excretion by 2-3%

45
Q

What are the therapeutic uses of Triamterene and Amiloride?

A
  1. Secondary Hyperaldosteronism

2. Prevent Hypokalemia

46
Q

What are osmotic Diuretics?

A

Freely filtered substances that are not reabsorbed and work by increasing osmotic pressure in the lumen and causing passive decreases in H2O and Na+ reabsorption

47
Q

What are the osmotic diuretic drugs?

A
  1. Mannitol
  2. Glycerol
  3. Isosorbide
  4. Urea
48
Q

What are the effects of Osmotic Diuretics?

A
  1. Increased urinary flow
  2. Slight increase in Na+ excretion
  3. Decreased urine osmolarity
49
Q

How are osmotic diuretics given?

A

IV

50
Q

What are therapeutic uses of Osmotic Diuretics?

A
  1. Maintain urine flow rate
  2. Acute Renal Failure
  3. Reduced intracranial pressure
  4. Glaucoma (decreased IOC)
51
Q

What are side effects of osmotic diuretics?

A
  1. Increased ECF volume (problem in patients with CHF)

2. Altered Na+, K+ blood levels

52
Q

Which diuretics increase urine volume the most?

A

Loop Diuretics

**CA, Thiazides and K-Spar also increase

53
Q

Which diuretic increases Na+ Excretion the most?

A

Loop Diuretics

**CA, Thiazides and K-Spar also increase

54
Q

Which diuretic decreases K+ excretion?

A

K-Sparing

55
Q

Which diuretics increase K+ excretion?

A

CA, Thiazides and Loops

56
Q

Which diuretics decrease Ca++ excretion?

A

Thiazides

57
Q

Which diuretics increase Ca++ excretion?

A

CA, Loops and K-Spar

58
Q

Which diuretic has a risk for hypovolemia?

A

Loops

59
Q

Which diuretics could cause hyperkalemia?

A

K-Sparing

60
Q

Which diuretics cause hyperuricemia?

A

CA, Thiazides and Loops

61
Q

Which diuretics cause hyperglycemia?

A

Thiazides

62
Q

Which diuretics cause Hyperglycemia?

A

Thiazides

63
Q

Which diuretics cause hypercalcemia?

A

Thiazides

64
Q

Which diuretics cause ototoxicity?

A

Loops

65
Q

Which diuretics cause Hypersensitivity?

A

CA, Thiazides and Loops

66
Q

Which diuretics are teratogens?

A

CA and Loops

67
Q

Which diuretics can treat Pulmonary Edema?

A

Loops

68
Q

Which diuretics can treat acute renal failure?

A

Osmotics and Loops

69
Q

Which diuretics can treat hypercalcemia?

A

Loops

70
Q

Which diuretics are used to treat cerebral edema?

A

Osmotic DIuretics

D&T3 Cardiology (7 decks)

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