Diuretics Flashcards
Furosemide
Class: Loop
Effects: Most Effective → produces a lot of urine
↑ renal blood flow via decreased resistance
↑ PG synthesis [COX2]
MOA: Inhibits Na+/K+/2Cl cotransporter in the
ascending loop of Henle
Uses:DOC for mgmt. of edema associated with heart
failure or renal/hepatic disease Acute pulm edema
HTN (moderate-severe)
Hypercalcemia Hyperkalemia
Urine Comp: ↑ Ca2+, ↑Na+, ↑K+, ↑Mg2+ Increased Volume
AE:Ototoxicity,hypomagnesemia,Hyperuricemia,Hypocalcemia,Acute hypovolemiaContraindicated in post-menopausal osteopenic women d/t ↓Mg and ↓Ca
Hydrochlorothiazide
Class: Thiazides[Sulfa derivatives] ORAL Only
Effects: ↓ PVR and BP
even after volume
recovery All have equal
maximum effects
MOA: Block Na/Cl cotransporter in DCT
Uses: HTN Mild heart failure Premenstrual edema Hypercalciuria (useful for kidney stones) Diabetes Insipidus! hyperosmolar urine
Urine Comp: ↑Na+, ↑K+, ↑Cl-, ↑Mg2+ ↓ Ca2+ Increased volume
AE:Hypokalemia Hyponatremia Hyperuricemia Volume Depletion Hyperglycemia Hyperlipidemia HSN
Metalazone
Class: Thiazides[Sulfa derivatives] Most potent , Na excretion in advanced kidney failure
Effects: ↓ PVR and BP
even after volume
recovery All have equal
maximum effects
MOA: Block Na/Cl cotransporter in DCT
Uses: HTN Mild heart failure Premenstrual edema Hypercalciuria (useful for kidney stones) Diabetes Insipidus! hyperosmolar urine
Urine Comp: ↑Na+, ↑K+, ↑Cl-, ↑Mg2+ ↓ Ca2+ Increased volume
AE:Hypokalemia Hyponatremia Hyperuricemia Volume Depletion Hyperglycemia Hyperlipidemia HSN
Chlorthalidone
Class: Thiazides[Sulfa derivatives] Long duration of action, only given ones daily
Effects: ↓ PVR and BP
even after volume
recovery All have equal
maximum effects
MOA: Block Na/Cl cotransporter in DCT
Uses: HTN
Urine Comp: ↑Na+, ↑K+, ↑Cl-, ↑Mg2+ ↓ Ca2+ Increased volume
AE:Hypokalemia Hyponatremia Hyperuricemia Volume Depletion Hyperglycemia Hyperlipidemia HSN
Spironolactone
Class: K+ sparing, Aldosterone antagonist, Induces CYP450
Effects: Spironolactone
to active canrenone
MOA: Competitively inhibit aldosterone at cytoplasmic receptors [preventing translocation] Acts at collecting duct Used in combination with other diuretic
Uses: 1° hyperaldosteronism Edema HTN Liver cirrhosis Nephrotic syndrome Adjunct to prevent cardiac remodeling in HF and in acne/hirsutism
Urine Comp: ↑ Na+
↓ K+
increase urine
volume
AE:GI upset & peptic ulcers Endocrine → irregular menstrual cycles gynecomastia, impotence Hyperkalemia (monitor levels closely) Nausea Lethargy Mental confusion
Eplerenone
Class: K+ sparing, Aldosterone antagonist, Induces CYP450
Effects: Spironolactone
to active canrenone
MOA: Competitively inhibit aldosterone at cytoplasmic receptors [preventing translocation] Acts at collecting duct Used in combination with other diuretic
Uses: 1° hyperaldosteronism Edema HTN Liver cirrhosis Nephrotic syndrome Adjunct to prevent cardiac remodeling in HF and in acne/hirsutism
Urine Comp: ↑ Na+
↓ K+
increase urine
volume
AE:GI upset & peptic ulcers Endocrine → irregular menstrual cycles gynecomastia, impotence Hyperkalemia (monitor levels closely) Nausea Lethargy Mental confusion
Amiloride
Class: K+ sparing
ENaC
Effects: ↓glucose tolerance induce photosensitization, interstitial nephritis and renal stone
MOA: Blocks Na+ transport
channels→ ↓Na/K exchange Acts at collecting duct
Uses:1° hyperaldosteronism Heart failure Hypokalemia (prevent K+ loss associated with thiazides and loop)
Urine Comp: ↑ Na+
↓ K+
increase urine
volume
AE:Hyperkalemia Hyponatremia Leg cramps GI upset Dizziness, pruritus, HA, visual changes
Triamterene
Class: K+ sparing
ENaC
Effects: ↓glucose tolerance induce photosensitization, interstitial nephritis and renal stone
MOA: Blocks Na+ transport
channels→ ↓Na/K exchange Acts at collecting duct
Uses:1° hyperaldosteronism Heart failure Hypokalemia (prevent K+ loss associated with thiazides and loop)
Urine Comp: ↑ Na+
↓ K+
increase urine
volume
AE:Hyperkalemia Hyponatremia Leg cramps GI upset Dizziness, pruritus, HA, visual changes
Acetazolamide
Class: Carbonic Anhydrase(CA) inhibitor
Effects: Acts mainly in
the PT Less efficacious
than others
MOA: Prevents formation of H+ needed for Na+
reabsorption in the PT
Uses:Glaucoma [↓production of aqueous humor] Mountain sickness prophylaxis Epilepsy Metabolic Alkalosis
Urine Comp: ↑Na+, ↑K+,
↑HCO3- ↑urine volume
AE:Metabolic acidosis Hyponatremia Hypokalemia Crystalluria! Renal stones Malaise, fatigue, depression, HA, GI upset, drowsiness and paresthesia
Contraindicated in hepatic cirrhosis due to ↓ NH4+ excretion
Mannitol
Class: Osmotic (IV only)
Effects: Does not affect
Na+ excretion directly
Only drug to truly ↑urine volume
MOA: Filtered into glomerulus and act everywhere
↑Osmotic pressure!draws
H2O into tubular fluid
Uses:↑urine flow in pts w/ acute renal failure ↓ICP & cerebral edema promote excretion of toxic substances
Urine Comp: Nearly all
electrolytes
AE:Extracellular H2O expansion→ hyponatremia
Tissue dehydration
Oral → osmotic diarrhea
Contraindicated in CHF, pulm edema & pts w/ active chronic bleeding
Conivaptan
Class: ADH
antagonist V1 & V2 (IV only, Potent CY3A3 inhibitor)
Effects: Renders CT
impermeable to H2O
MOA: Inhibits ADH
↓aquaporins in the collecting duct
Uses:SIADH Euvolemic hyponatremia Hypervolemic hyponatremia HF (only if benefits>risk)
Urine Comp: ↑ Plasma
Na+
↓ H2O reabsorption→ dilute urine
AE:Nephrogenic diabetes insipidus Infusion site rxns Thirst Atrial fibrillation GI and electrolyte disturbances Contraindicated in Renal failure & hypovolemic hyponatremia
