Diuretics

Question 1

Where do the thiazides diuretics act?

Answer 1

NaCl channel in DCT

Question 2

Name a K sparing diuretic

Answer 2

Amiloride

Also technically spironolactone

Question 3

What channel does amiloride act on? Where in the tubule?

Answer 3

ENac in the CCD

Question 4

What condition might you use an osmotic diuretic for?

Answer 4

Cerebral oedema

Question 5

Generic diuretic ADRs

Answer 5

Anaphylaxis/rash etc
Hypovoleamia/ hypotension — acute renal failure?
Electrolyte disturbances
Metabolic abnormalities

Question 6

Thiazides specific ADRs

Answer 6

Gout

Erectile dysfunction

Question 7

Spironolactone specific ADRs

Answer 7

Hyperkalaemia

Painful gynaecomastia

Question 8

Furosemide specific ADR

Answer 8

Ototoxicity (hearing loss)

Amino glycosides increase this risk

Question 9

Bumetanide specific ADR

Answer 9

Myalgia

Question 10

ACEis and K sparing diuretics (ie low aldosterone effects)

Answer 10

Increases risk of hyperkalaemia (cardiac problems)

Question 11

Amino glycosides w loop diuretics ADR

Answer 11

Ototoxicity

Nephrotoxicity

Question 12

Thiazides/loop diuretics and Digoxin ADR

Answer 12

Thiazides/loop Ds can cause hypo kalemia
Increases Digoxin binding
So increased risk of digoxin toxicity

Question 13

Prescribing in chronic renal failure - key facts

Answer 13

Avoid nephrotoxins
Reduce dosages in line w GFR if renal metabolism/elimination
Monitor renal function and drug levels (esp. If narrow TW)
Hyperkalaemia risk more likely
Uraemic pts more likely to bleed

Question 14

Where do loop diuretics act ? (which channel as well as where in tubule)

Answer 14

Thick ascending loop of henle

Na/2Cl/K channel