Diuretics

Question 1

Thiazide Diuretics

Answer 1

Includes hydrochlorothiazide, indapimide, metolazone, and chlorthalidone

-Inhibit the Na+/Cl- symporter in the DCT; will also increase the K+ content of the urine since Na+ and K+ go thru symport

⭐️need GFR >40ml/min to be effective unless using metolazone/indapimide

ADRs: Hypokalemia, Hyponatremia, Hypercalcemia

*USED for HTN, CHF, Hypercalcuric renal stones?

Question 2

Acetazolamide

Answer 2

Carbonic Anyhdrase inhibitor that functions by inhibiting the breakdown of H2CO3
=»Decreased reabsorption of H20 from lumen and decreased H+ reabsorption of Na+ thru Na+/H+ antiporter on DCT cell

ADR: Metabolic acidosis (hyperchloremic)

*Therapeutically used in glaucoma and as a mountain sickness prophylactic; not as a diuretic

Question 3

Furosemide, torsemide

Answer 3

Most efficacious loop diuretic; inhibits Na+/K+/Cl- transport in the ascending limb of Henle

-Used for Acute pulmonary edema, HTN

ADRs: Hypovolemia (works too well), ***OTOTOXICITY, hypokalemia

Question 4

Spironolactone/Eplerone

Answer 4

Aldosterone antagonist (K+-sparing diuretic) that inhibits the binding of aldosterone to the mineralcorticoid receptor in the DCT; will also cause

ADRs: Hyperkalemia (can be utilized), gynecomastia (males) or menstrual irregularities (also males if it’s Brad)

**Spironolactone indications: Hepatic Cirrhosis, Primary aldosteronism, Hypokalemia

Question 5

Triamterene/Amiloride

Answer 5

Na+ channel inhibitors the work in the DCT or collecting duct; very modest diuretic

Indications: Secondary hyperaldosteronism or hypokalemia caused by diuretics

Question 6

Mannitol

Answer 6

Can be used as an osmotic diuretic to prevent the reabsorption of molecules and maintain urine flow

-Commonly used w/ increased ICP