Diuretics Flashcards
Carbonic Anhydrase Inhibitors
Rx
Acetazolamide
PCT
Osmotic Diuretics
Mannitol
*glycerin, isosorbide, urea
PCT
Na/K/2Cl Blockers
Rx
- Furosemide
- Ethacrynic acid
*bumetanide
TALH
Na/Cl Blockers
“thiazide-like diuretics”
Rx
HTCZ
*chlorthalidone, indapamide
DCT
ENaC Inhibitors
Rx
Amiloride
triamterene
DCT
Aldosterone blockers
Rx
- Spironolactone
- Eplerenone
CD
Vasopressin (ADH) Blockers
Rx
*Tolvaptan
Conlvaptan
CD
K wasting
Rx
- Furosemide
- ethacryinic acid
- HCTZ
K Sparring
Rx
- Amiloride
- Spironolactone
- Eplerenone
Best 1st choice HTN/?
HCTZ
Best 1st choice Edema?
Loop Diuretic
How to decrease extra-cellular fluid?
Increase sodium excretion
CAI urine pH?
Alkaline (UP)
CAI effect on glomerular filtration
- constrict afferent
* lessen constriction of efferent (lower renin/ang 2)
CAI
Steady state
Lowered,, “diuretic braking”
CAI
Effect on Cl
Serum Hyperchloremia (no bicarb for bicarb/Cl transporter in CD)
Acetazolamide
- Site of action
- Mech
- Urine
- Plasma electrolytes
- Interactions
- renal PT, eye (aqueous h.)
- Blocks Carb. Anhydrase (UP tubular Na, Activates TGF)
- Alkaline Urine (pH 8) =>Renal Stones
- DOWN Bicarb, UP Cl-
- Cross-rxn w/ Sulfonamides
CAI
Acetazolamide
Uses
- Metabolic Acidosis
- LOWER intraocular pressure
- Acute Mountain Sickness
Which are best at lowering Blood volume?
Loop
NaK2Cl
Loop Diuretics
Which channel?
TALH. NaK2Cl
Loop diuretic braking (neg feedback)
macula not sensing Na cuz turned off, releasing renin
Loop
Furosemide, Ethacrynic Acid
- Where
- Mech
- Urine
- Plasma
- S.E.
- TALH
- NaK2Cl block, abolish osmotic gradient, UP Renal BF, UP Renin = diuretic braking
- Excrete all ions
- hypoK
- HypoK = arrythmia, hypoTN, Ototoxicy, Hyperuricemea (gout)
Loop
Furosemide, Ethacryinic acid
Uses
- Edema = peripheral, pulm
* HTN W/ CHF = 1st line
Loops LOWER mortality/morbidity in
HF
How do diuretics enter glomerulus ?
Secreted into PCT by anion transporters
HCTZ
- Where
- Mech
- Urine
- Plasma
- S.E.
- DCT
- STOP Na/Cl co-transporter
- DOWN Ca excretino
- HypoK , Combine w/ ACEI! (Combat diuretic break)
- HypoK, HyperCa, HyperUricemia, HypoTN, Hyperglycemia (DM!!), Hyperlipid
HCTZ
Uses
- HTN (simple essential)
- Congestive HF
- HyperCalciuria
- Nephrogenic Diabetes Insipidus (ADH insensitivity)
Thiazides LOWER mortality/morbidity in
HF
HTN
Loops + thiazides both lead to loss of
- K+ (principle cell-CD)
- H+ (a-intercalated cell-CD)
HYPOK ALKALOSIS
What is true for loops but not for thiazides
Loops can abolish corticomedullary osmotic gradient
K sparing ENaC
Amiloride , triamterene
- Where
- Mech
- Urine
- Plasma
- Late DCT + CD
- ENaC
- DOWN K/H excretion
- HyperK
K Sparring ENaC Amiloride + HCTZ LOWERS morbidity in
(Stroke) Elderly w/ HTN
K sparring ENaC
Amiloride, triamterene
Uses
*ADJUNCT w/ Thiazide/Loop to prevent K LOSS
K Sparring
Spironolactone, Eplerenone
- Where
- Mech
- Urine
- Plasma
- S.E.
- Late DCT + CD
- Na/K aldosterone receptor, need adequate natural aldosterone level
- DOWN K excretion
- HyperK (Monitor!)
- HyperK, Gynecomastia
Spironolactone + loop/thiazide LOWERS mortality/morbidity in
HF
K Sparing
Spironolactone, Eplerenone
Uses
ADJUNCT w/ thiazide/loop to prevent K LOSS
Osmotic
Mannitol, isosorbide
- PK
- Where
- Mech
- Urine
- Plasma
- S.E.
- NOT gi, IV ONLY, short t1/2
- Water permeable nephron sites (PCT, tDLH, CD)
- UP plasma osmolality, UP ECFV (intravascular volume) , UP renal BF
- UP Mg+ loss
- HyperK
Osmotic
Mannitol, isosorbide
Uses
Reduce intracranial or intraocular pressure b/f + after surgery
Vasopressin ADH Blocker
Tolvaptan, conivaptan
- Where
- Mech
- CD
* ADH antag at V2 ADH receptor
Vasopressin Blocker
tolvaptan conivaptan
*SIADH
Combo therapy
- STRONG = Loop + thiazide
* NORMAL = K wasting (thiazide/loop) + K sparring (spironolactone)
