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Diuretics Flashcards
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1
Q
what type of drug do you use in heart failure
A
loop
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2
Q
what drug do you use in hypertension
A
thiazide
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3
Q
acetazolamide
A
CA inhibitor
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4
Q
brinzolamide
A
CA inhibitor
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5
Q
dichlorphenamide
A
CA inhibitor
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6
Q
Dorzolamide
A
CA inhibitor
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7
Q
Methazolamide
A
CA inhibitor
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8
Q
Bumetanide
A
Loop
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9
Q
Furosemide
A
loop
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10
Q
ethacrynic acid
A
loop
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11
Q
torsemide
A
loop
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12
Q
amiloride
A
K sparing
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13
Q
eplerenone
A
K sparing
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14
Q
spironolactone
A
K sparing
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15
Q
triamterene
A
K sparing
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16
Q
bendroflumethiazide
A
thiazide
17
Q
chlorothiazide
A
thiazide
18
Q
hydrochlorothiazide
A
thiazide
19
Q
hydroflumethiazide
A
thiazide
20
Q
methylclothiazide
A
thiazide
21
Q
polythiazide
A
thiazide
22
Q
trichlormethiazide
A
thiazide
23
Q
chlorthalidone
A
thiazide like agent
24
Q
indapamide
A
thiazide like agent
25
Q
metolazone
A
thiazide like agent
26
Q
quinethazone
A
thiazide like agent
27
Q
dapagliflozin
A
SGLT2 inhbitor
28
Q
canagliflozin
A
SGLT2 inhbitor
29
Q
empagliflozin
A
SGLT2 inhibitor
30
Q
mannitol
A
osmotic diuretic
31
Q
conivaptan
A
32
Q
tolvaptan
A
33
Q
carbonic anhydrase inhibitors
A
- Carbonic anhydrase inhibitors
- Oral preparations
- Acetazolamide
- Dichlorphenamide
- Methazolamide
- Ophthalmic preparations
- Brinzolamide
- Dorzolamide
- mech
- Blocks Na and HCO3 reabsorption (co transporter so when you block HCO3 you block Na)
- uses
- Used for glaucoma - the ciliary body secretes bicarb into aq humor - water follows - inhibit the secretion = less humor
- Other uses: urinary alkalization, correction of metabolic alkalosis, prevention of mountain sickness - CSF formation involves bicarb secretion
- Tox
- Hyperchloremic metabolic acidosis
- Remal stones - calcium phosphate salts are less soluble in alkaline pH
- Renal K wasting - whenever there is more Na delivery to collecting duct it absorbs Na while excreting K -> more K in the urine
- Oral preparations
34
Q
Sodium glucose cotransporter 2 (SGLT2) inhibitors
A
not used as diuretics
- Dapagliflozin, canagliflozin, empagliflozin
- Used in third line therapy for DM type 2
- Block Na and glucose transporter = excrete more glucose in the urine = less glucose in the blood
35
Q
loop diuretics
A
- sulfonamides
- Furosemide
- Bumetanide
- Torsemide
- Ethacrynic acid - use if pt is allergic to sulfonamides
- Mech
- Inhibits NKCC transporter = decresaed in Na Cl reabsorption (because there is more Na in the lumen when it gets to collecting ducts you lose K)
- Decreases the potential diff generated by recycling K = less divalent reabsorption (increased excretion of Ca and Mg
- It is excreted by the same transporters that excrete NSAIDs - taking these may interact with secretion = longer HL
- Direct vascular effects due to increased prostaglandin synthesis may increase renal blood flow
- Powerful stimulators of renin - the mac dense uses the same NKCC transporter - so it can’t sense the Na = thinks there is no Na = increased secretion of prostaglandins on JG cells = more renin
- Uses
- Relief of pulm edema (usually assoicated with heart failure)
- Other uses
- Hypertension if thiazides don’t work
- Severe hyperkalemia
- Acute renal failure - can convert oliguric to nonoliguric failure
- Can secrete water from the tubules (even if GFR is down you can still get volume excretion)
- AE
- Dehydration/hyponatremia
- Hypokalemia
- Ototoxicity - usually reversible
- NKCC is used in endolymph production
- Hyperuricemia and gout attacks - due to hypovolemia = increased Uric acid concentration
- Allergic reactions - more common in sulfonamides than with ethacrynic acid
36
Q
thiazide diuretics (and thiazide like agents)
A
- Basics
- All are sulfonamides
- drugs
- Thiazides (end in thiazide)
- Chlorothiazide
- Hydrochlorothiazide
- Methyclothiazide
- Polythiazide
- Trichlormethiazide
- Thiazide like drugs
- Chlorthalidone
- Indapamine
- Metolazone
- Quinethazone
- Thiazides (end in thiazide)
- Mech
- Inhibitors of Na Cl transport
- Enhanced Ca reabsorption because of increased Na gradient basolaterally (no Na in the cell) - so the Na Ca exchanger works well
- More Na in collecting ducts = more K excretion
- Only moderatley effective in increaseing NaCl excretion (most has already been reabsorbed before it reaches the tubule)
- Uses
- Used to be first line agents for hypertension
- Still used at a low dose
- Can be used at high dose for CHF
- Neophrolithiasis - reduces urine Ca concentration so stones may disolve
- Neophrogenic diabetes insipidus - reduce polyuria and polydipsia
- This is counterintuititve - we don’t know why it works (we thing because it decreases reabsorption of Na = less Na = less blood vol = decrease GFR = increased Na reabsorption in prox tubule ) - we really just don’t know
- Works better in african americans and elderly
- Not effective when GFR is low (unlike loops)
- Used to be first line agents for hypertension
- AE
- Excreted by organic acid secretory system (also excretes uric acid) = hyperuricemia
- Hypokalemia
- Reduced Ca excretion (opposite of loops)
- Hyperglycemia - decreases pancreatic release of insulin and diminished tissue utilization of glucose
- Hyperlipidemia - increase total serum cholesterol (may return to normal after prolonged use)
- Allergic reactions (sulfonamides)
- ED (probably due to volume depletion)
37
Q
K sparing agents
A
- Drugs
- Aldosterone antagoinsts
- Eplerenone, pironolactone
- Blocks aldosterone (normally makes more ENAC )
- Na channel blockers
- Amiloride, triameterene
- Blocks the ENAC itself
- Aldosterone antagoinsts
- mech
- Both drugs decrease the amount of Na absorbed - therefore less K gets excreted
- Uses
- These are generally weak diruetics - seldom used alone but used to counteract hypokalemia in loop or thiazide diuretics
- Primary mineralocorticoid hypersecretion (as in conns syndrome or ectopic ACTH production) - in this case you have too much aldosterone
- Secondary aldosetonism - due to congestive HF, heptic cirrhosis, nephrotic syndrome, and other conditions assoicated with salt tertention and reduced fluid volume
- Tox
- Hyperkalemia
- Hyperchloremic metabolic acidosis - inhibition of H+ secretion with reduced K secretion
- Gynecomastica - due to steroid chemical structure of spironolactone
- Acute renal failure may occur when triamterene is combined with indomethacin
- Kidney stones may occur with triamterene which is poorly soluble
38
Q
vaptans
A
ADH antagonists
- Drugs
- Conivaptan - IV
- Tolvaptan - oral
- Mech
- Blocks ADH receptors = less aquaporin 2 = collecting tubule not perm to water
- Use
- Manage syndrome of inappropriate ADH secretion (SIADH) when water restriction can’t correct the abnormality
- Congestive heart failure when ADH is elevated due to low blood volume (helps you not retain water)
- Need to monitor serum Na to look out for hypernatremia and nephrogenic diabetes insipidus
39
Q
osmotic diuretics
A
- Mannitol
- Filtered by glom but not reabsorbed - increased osmolarity of the inter tubular fluid - less reabsorption
- Used primarily for rapid (emergency) reduction in intracranial pressure (pulls fluid into the BV and then transports it to kidney)
- Poorly absorbed orally - can cuase osmotic diarrhea
