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Cardiology > Diuretics > Flashcards

Diuretics Flashcards

1
Q 
Osmotic Diuretics 
(Site and Mechanism of action)
A

Inhibit water absorption throughout the nephron tubules especially PCT and descending limb of Henle’s loop (because these are freely permeable to water)

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2
Q

Carbonic Anhydrase inhibitors

Site and Mechanism of action

A

Inhibit carbonic anhydrase enzyme on the luminal membrane and inside the cells of PCT (where 60% of Na+ is being absorbed), which results in
- Decrease H+ formation inside the cell
- Decrease Na+/H+ antiport
- Increase Na+ and bicarbonates in lumen
- Increase diuresis
Also they inhibit carbonic anhydrase enzyme inside the intercalating cells of collecting ducts which leads to decrease in production and excretion of H+

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3
Q 
Loop Diuretics
(Site and Mechanism of action)
A

Inhibit Na+/K+/2Cl- transporter on the membrane of thick ascending limb of Henle’s loop (where 25% of Na+ is being absorbed), which results in:

  • Decrease intracellular K+ and its back diffusion through basolateral membrane
  • Decrease +ve membrane potential that is responsible for Ca++ and Mg++ reabsorption which leads to decrease in their reabsorption
  • Increase diuresis
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4
Q 
Thiazide Diuretics 
(Site and Mechanism of action)
A

Inhibit Na+/Cl- transporter on the luminal membrane of DCT (where 10% of Na+ is being absorbed), which results in:

  • Increase luminal Na+ and Cl-
  • Increase in Ca++ transport through basolateral membrane (Na+/Ca++ antiport) which may cause hypercalcemia
  • Increase diuresis
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5
Q

K+-Sparing Diuretics

Site and Mechanism of action

A
  • Block Na+ channels on the luminal membrane of principal cells in the collecting duct (where 5% of Na+ is being absorbed) [like amiloride and triamterene] which results in:
  • Decrease Na+ absorption and Increase diuresis
  • Decrease K+ and H+ excretion
  • Aldosterone-receptor antagonists in the principal cells of the collecting ducts (like spironolactone and eplerenone) which results in:
  • Decrease Na+ absorption and Increase diuresis
  • Decrease K+ and H+ excretion
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6
Q

Osmotic Diuretics

Drugs

A
  • Mannitol

- Isosorbide

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7
Q

Carbonic Anhydrase inhibitors

Drugs

A
  • Acetazolamide

- Dorzolamide

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8
Q

Loop Diuretics

Drugs

A
  • Furosemide
  • Torsemide
  • Bumetanide
  • Ethacrynic acid
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9
Q

Thiazide Diuretics

Drugs

A
  • Hydrochlorothiazide
  • Chlorthalidone
  • Indapamide
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10
Q

K+-Sparing Diuretics

Drugs

A
  • Amiloride
  • Triamterene
  • Spironolactone
  • Eplerenone
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11
Q

Osmotic Diuretics

Clinical Uses

A
  • Glaucoma (to decrease IOP)
  • In Decreasing intracranial pressure
  • Oliguric states like rhabdomyolysis
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12
Q

Carbonic Anhydrase inhibitors

Clinical Uses

A
  • Glaucoma (decrease aqueous humor formation)
  • Acute mountain sickness (prophylaxis prior to climb [acidosis is protective])
  • Metabolic alkalosis
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13
Q

Loop Diuretics

Clinical Uses

A
  • Acute pulmonary edema
  • CHF
  • Hypertension
  • Refractory edemas
  • Acute renal failure
  • Anion overdose
  • Hypercalcemic states
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14
Q

Thiazide Diuretics

Clinical Uses

A
  • Hypertension
  • CHF
  • Nephrolithiasis (calcium stones)
  • Nephrogenic diabetes insipidus
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15
Q

K+-Sparing Diuretics

Clinical Uses

A
  • Spironolactone
  • Hyperaldosteronic states
  • Adjunctive to K+ wasting diuretics
  • Antiandrogenic uses (female hirsutism)
  • CHF
  • Eplerenone same as above except antiandrogenic uses
  • Amiloride and triamterene:
  • Adjunct to K+ wasting diuretics
  • Lithium induced nephrogenic DI (amiloride)
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16
Q

Osmotic Diuretics

Adverse effects

A

Acute hypovolemia

17
Q

Carbonic Anhydrase inhibitors

Adverse effects

A
  • Bicarbonaturia and acidosis
  • Hypokalemia
  • Hyperchloremia
  • Paresthesias
  • Renal stones (calcium phosphate stones due to alkaline urine)
  • Sulfonamide hypersensitivity
18
Q

Loop Diuretics

Adverse effects

A
  • Sulfonamide hypersensitivity (use ethacrynic acid in case of allergy to sulfas)
  • Hypokalemia and alkalosis
  • Hypocalcemia and hypomagnesemia
  • Hyperuricemia (actively secreted by OAT in PCT)
  • Ototoxicity (ethacrynic acid > furosemide)
  • Interactions include:
  • Aminoglycosides (enhance ototoxicity)
  • Lithium (chronic loop administration decrease its clearance)
  • Digoxin (increase its toxicity due to electrolyte disturbances)
19
Q

Thiazide Diuretics

Adverse effects

A
  • Sulfonamide hypersensitivity
  • Hypokalemia and alkalosis
  • Hypercalcemia
  • Hyperuricemia (actively secreted by OAT in PCT)
  • Hyperglycemia (hypokalemia decrease insulin secretion)
  • Hyperlipidemia (except indapamide)
  • Interactions include:
  • Digoxin (increase its toxicity due to electrolyte disturbances)
  • Avoid in patients with diabetes mellitus
20
Q

K+-Sparing Diuretics

Adverse effects

A
  • Hyperkalemia and acidosis

- Antiandrogen like gynecomastia (just spironolactone)

Cardiology (8 decks)

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