Diuretics

Question 1

What drugs are used for decompensated liver disease?

Answer 1

Spironolactone

Loop diuretics

Question 2

Give an example of a K+-sparing diuretic

Answer 2

Amiloride

Spironolactone

Question 3

What is the action of amiloride?

Answer 3

Inhibits ENaC

Reduces action of ROMK - less potassium lost

Question 4

Uses of amiloride?

Answer 4

Used when a patient has hypokalaemia and need a diuretic

Question 5

ADRs of amiloride?

Answer 5

Hyperkalaemia

Question 6

Action of spironolactone?

Answer 6

Aldosterone antagonist
Indirectly reduces ENaC activity
Reduces action of ROMK

Question 7

Uses of spironolactone?

Answer 7

Heart failure
Ascites
Hypertension
Hyperadrenalism
Decompensated liver disease

Question 8

ADRs of spironolactone?

Answer 8

Hyperkalaemia
Painful gynaecomastia
ED

Question 9

What are the actions of ADH antagonists?

Answer 9

Inhibits ADH effect

More water lost

Question 10

Uses of ADH antagonists?

Answer 10

Hyponatraemia

Question 11

ADRs of ADH antagonists?

Answer 11

Hypernatraemia

Deranged liver function

Question 12

Name some nephrotoxic drugs

Answer 12

Aminoglycosides e.g. gentamicin
Vancomycin
Aciclovir
NSAIDs
(Metformin - makes you acidotic - indirectly harms the kidneys)

Question 13

Name some drugs causing hyperkalaemia

Answer 13

RAAS inhibitors (ACEi, spironolactone)
NSAIDs
ENaC blockers (amiloride, trimethoprim)

Question 14

What is the action of thiazides?

Answer 14

Blocks Na-Cl transporter in DCT

Increases calcium reabsorption (in place of sodium)

Question 15

Uses of thiazides?

Answer 15

Hypertension (vasodilation action)
Nephrotic syndrome (2nd line)
CKD

Question 16

ADRs of thiazides?

Answer 16

Hyperkalaemia
Increased urate (gout), glucose, lipids

Question 17

Examples of loop diuretics?

Answer 17

Furosemide

Bumetanide

Question 18

What is the action of loop diuretics?

Answer 18

Blocks NKCC transporters on loop of Henle
Filtrate becomes hyperosmotic
Less water is reabsorbed

Question 19

Uses of loop diuretics?

Answer 19

Heart failure (oedema and breathlessness)
Decompensated liver disease
Nephrotic syndrome
CKD

Question 20

ADRs of loop diuretics?

Answer 20

Alkalosis
Gout
Increased LDL
Myalgia (bumetanide)
Ototoxicity (large doses/renal issues)

Question 21

Name an osmotic diuretic?

Answer 21

Mannitol

Question 22

Action of osmotic diuretics?

Answer 22

Small, osmotically active molecules

Draws fluid into tubule

Question 23

Uses of osmotic diuretics?

Answer 23

Cerebral oedema

Question 24

ADRs of osmotic diuretics?

Answer 24

Allergic reactions
Excessive water loss
Hypernatraemia

Question 25

Give an example of a carbonic anhydrase inhibitor

Answer 25

Azetazolamide

Question 26

Action of carbonic anhydrase inhibitors?

Answer 26

Blocks sodium and bicarbonate reabsorption in the PCT

Question 27

Uses of carbonic anhydrase inhibitors?

Answer 27

Glaucoma Altitude sickness *not used clinically as diuretics

Question 28

ADRs of carbonic anhydrase inhibitors?

Answer 28

Metabolic acidosis Renal stones Hypokalaemia

Question 29

Name an ADH antagonist

Answer 29

Tolvaptan | Lithium

Question 30

What is the first line drug given for nephrotic syndrome?

Answer 30

Loop diuretic

Question 31

What are the second line drugs for nephrotic syndrome?

Answer 31

Thiazides with potassium supplements | Potassium-sparing diuretic

Question 32

What diuretic should be avoided in CKD?

Answer 32

Potassium-sparing diuretics

Question 33

What diuretic is used for refractory oedema?

Answer 33

``` IV furosemide (loop) (Poor gut absorption due to oedema) ```