Diuretics Flashcards
What drugs are used for decompensated liver disease?
Spironolactone
Loop diuretics
Give an example of a K+-sparing diuretic
Amiloride
Spironolactone
What is the action of amiloride?
Inhibits ENaC
Reduces action of ROMK - less potassium lost
Uses of amiloride?
Used when a patient has hypokalaemia and need a diuretic
ADRs of amiloride?
Hyperkalaemia
Action of spironolactone?
Aldosterone antagonist
Indirectly reduces ENaC activity
Reduces action of ROMK
Uses of spironolactone?
Heart failure Ascites Hypertension Hyperadrenalism Decompensated liver disease
ADRs of spironolactone?
Hyperkalaemia
Painful gynaecomastia
ED
What are the actions of ADH antagonists?
Inhibits ADH effect
More water lost
Uses of ADH antagonists?
Hyponatraemia
ADRs of ADH antagonists?
Hypernatraemia
Deranged liver function
Name some nephrotoxic drugs
Aminoglycosides e.g. gentamicin Vancomycin Aciclovir NSAIDs (Metformin - makes you acidotic - indirectly harms the kidneys)
Name some drugs causing hyperkalaemia
RAAS inhibitors (ACEi, spironolactone) NSAIDs ENaC blockers (amiloride, trimethoprim)
What is the action of thiazides?
Blocks Na-Cl transporter in DCT
Increases calcium reabsorption (in place of sodium)
Uses of thiazides?
Hypertension (vasodilation action)
Nephrotic syndrome (2nd line)
CKD
ADRs of thiazides?
Hyperkalaemia Increased urate (gout), glucose, lipids
Examples of loop diuretics?
Furosemide
Bumetanide
What is the action of loop diuretics?
Blocks NKCC transporters on loop of Henle
Filtrate becomes hyperosmotic
Less water is reabsorbed
Uses of loop diuretics?
Heart failure (oedema and breathlessness)
Decompensated liver disease
Nephrotic syndrome
CKD
ADRs of loop diuretics?
Alkalosis Gout Increased LDL Myalgia (bumetanide) Ototoxicity (large doses/renal issues)
Name an osmotic diuretic?
Mannitol
Action of osmotic diuretics?
Small, osmotically active molecules
Draws fluid into tubule
Uses of osmotic diuretics?
Cerebral oedema
ADRs of osmotic diuretics?
Allergic reactions
Excessive water loss
Hypernatraemia
Give an example of a carbonic anhydrase inhibitor
Azetazolamide
Action of carbonic anhydrase inhibitors?
Blocks sodium and bicarbonate reabsorption in the PCT
Uses of carbonic anhydrase inhibitors?
Glaucoma
Altitude sickness
*not used clinically as diuretics
ADRs of carbonic anhydrase inhibitors?
Metabolic acidosis
Renal stones
Hypokalaemia
Name an ADH antagonist
Tolvaptan
Lithium
What is the first line drug given for nephrotic syndrome?
Loop diuretic
What are the second line drugs for nephrotic syndrome?
Thiazides with potassium supplements
Potassium-sparing diuretic
What diuretic should be avoided in CKD?
Potassium-sparing diuretics
What diuretic is used for refractory oedema?
IV furosemide (loop) (Poor gut absorption due to oedema)
