Diuretics Flashcards
What are the side effects of carbonic anhydrase inhibitors?
Metabolic acidosis
Hypokalaemia
Renal stones
What are the side effects of osmotic diuretics?
Hypernatraemia
Allergic reaction
What are the side effects of Loop diuretics?
Hypokalaemia Raised TAG and LDL Ototoxicity Alkalosis Gout
What type of diuretic can be used to treat hypercalcaemia?
Loop diuretics
What are the side effects of thiazide diuretics?
Hypercalcaemia Raised TAG and LDL Erectile dysfunction Hyperuciaemia -> gout Hypokalaemia
What are the side effects of Spironolactone?
Painful gynaecomastia
Impotence
Hyperkalaemia
What are the side effects of ADH antagonist, Lithium?
Hypernatramia
Liver function compromised
Which diuretics are recommended in hypertension?
Thiazide - vasodilation
Spironolactone
Which diuretics are indicated for heart failure?
Loop - relieve symptoms from fluid overload
Spironolactone - reduce mortality
Which diuretics are recommended for liver disease?
Spironolactone
Loop
Which diuretics are recommended for nephrotic syndrome?
Loop
Which diuretics are recommended in CKD?
Loop +/- thiazide (not thiazide alone)
Which diuretics should be avoided in CKD and why?
K+ sparing - already risk of K+ retention in kidney disease.
Which diuretic for glaucoma?
CA inhibitor
Which diuretic for cerebral oedema?
Mannitol - osmotic
What is the risk of ACE-I + K+ sparing diuretic?
Hyperkalaemia
What is the risk of gentamicin + loop diuretic?
Nephrotoxicity + ototoxicity
What is the risk of digoxin + thiazide/loop?
Thiazide/loop induce hypokalaemia which increases digoxin binding -> digoxin toxicity.
What is the risk of steroids + loop/thiazide?
Hypokalaemia
What is the effect of lithium + loop?
Loop diuretic decreases lithium levels
What is the effects of lithium + thiazide?
Thiazide increases lithium concentration
What is the risk of beta blocker + thiazide?
Hyperglycaemia
Hyperlipidaemia
Hyperuricaemia
What is the risk of carbamezepine + thiazide?
Hyponatraemia
What 4 things might contribute to diuretic resistance?
- Gut function - oedema from nephrotic syndrome
- Circulation
- Albumin - delivery to kidney. Hypoalbuminaemia decreases delivery.
- Kidney function - PT for transport of diuretic into lumen via OAT.
Name some nephrotoxic drugs.
Gentamicin
Vancomycin
NSAIDs
Aciclovir
Which diabetic drug can cause acidosis if renal function is compromised?
Metformin
Explain why thiazides lead to hypokalaemia and hyponatraemia whereas loop diuretics do not.
Thiazides - increased delivery of NaCl, RAAS activated and ADH released. Hypertonic medulla causes increased water reabsorption and plasma dilution.
Loop - also cause RAAS activation and ADH release but ADH less effective as tonicity of intersitium decreased.
What 3 steps are key in the management of hyperkalaemia?
- Calcium gluconate - stabilise myocytes
- Dextrose and Insulin - K+ uptake
- Diuretic or calcium resonium - K+ excretion
What ECG changes indicate worsening hyperkalaemia?
Tall T waves P waves flatten/dissapear PR lengthened Wide QRS Sine wave pattern Aystole
