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Renal II Med 215 > Diuretics > Flashcards

Diuretics Flashcards

1
Q

What are the Thiazides diuretics?

A

hydrochlorothiazide Metolazone Chlorthalidone

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2
Q

What are the loop diuretics (edema, hypertension)?

A

-semide

  • Furosemide (biggy)
  • Torsemide
  • Bumetanide
  • Ethacrynic Acid (only one that isn’t a sulfa drug)
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3
Q

What are the K+ sparing diuretics (edema, hypertension). Specifically, Na+ channel blockers?

A

Amiloride Triamterene

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4
Q

What are the K+ sparing diuretics (edema, hypertension), specifically aldosterone antagonists?

A

(Also as antifibrotic in heart failure)

  • Spironolactone
  • Eplerenone
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5
Q

What are the aquaretics (hyponatremia)

A

-vaptan Conivaptan Tolvaptan MOA: Inhibit ADH receptors

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6
Q

What are the Carbonic Anhydrase inhibitors? What are the used to treat?

A

Acetazolamide

  • urinary alkalinization (ex. ASA overdose trapping in lumen)
  • Mountain sickness (you blow off CO2 because of altitude, acetazolamide gets ride of bicarbonate to balance things out)
  • Glaucoma
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7
Q

Osmotic diuretics maintain urine flow by pulling water from cells for excretion. What are their names?

A

Mannitol

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8
Q

What’s the difference between a natriuretic and an aquaretic?

A

Natriuretic: diuretic that promotes renal excretion of sodium Aquaretic: diuretic that promotes free water clearance

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9
Q

Where do osmotic diuretics act within the nephron?

A

Proximal tubule Thin descending limb of Henle

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10
Q

Where do carbonic Anhydrase inhibitors act within the nephron?

A

Proximal tubule

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11
Q

Where do loop diuretics act on in the nephron?

A

Thick ascending limb of Henle

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12
Q

Where do thiazide diuretics act in the nephron?

A

Distal convoluted tubule

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13
Q

Where do Na+-channel blockers act on the nephron?

A

Cortical collecting duct

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14
Q

Where do vaptans act on the nephron?

A

Collecting duct:

  • Prevents ADH-mediated insertion of aquaporins into the membranes of principle cells
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15
Q

The majority of diuretics are of what type?

A

Natriuretics

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16
Q

What are common clinical reasons for administering diuretics?

A
  • Essential hypertension
  • Edema (CHF, liver failure, kidney failure)
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17
Q

What are the K+ sparing diuretics?

A
  • Triamterene (Na+ channel blocker)
  • Amiloride (Na+ channel blocker)
  • Spironolactone (aldosterone antagonist)
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18
Q

What are the K+ losing diuretics?

A
  • Thiazides (Na+ Cl- cotransporter blockers)
  • Loop diuretics (Na+ K+ 2Cl- cotransporter blockers)
  • Carbonic Anhydrase inhibitors (seldom used)
  • Osmotic diuretics (non reabsorbable solutes)
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19
Q

What are two concerns of hyperkalemia?

A

Tall T waves

Arrhythmias:

  • Bradycardia
  • Ventricular tachycardia Fibrillation
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20
Q

Gives the greatest amount of diuresis. Sulfa type drugs.

A

Loop diuretics

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21
Q

What is the mechanism of action of loop diuretics?

A

MOA: Blocks the Na+-K+-2Cl- cotransporter in the thick ascending limb of Henles’s Loop

22
Q

Diuretic that causes the greatest HCO3- loss?

A

Thiazide diuretics

23
Q

What are the therapeutic uses of Thiazides?

A

Hypercalcemia:

  • osteoporosis tx
  • recurrent calcium kidney stone tx
  1. Primary hypertension (combined w/ other drugs)
  2. Paradoxically treats nephrogenic diabetes insipidus
  3. Synergistic effects w/ loop diuretics
24
Q

What type of urine do Loop Diuretics (Furosemide) produce regardless if the patient is excreting concentrated or already dilute urine?

A

Large volumes of isotonic urine

max doses produce profound diuresis

25
Q

What is another common name for Furosemide a loop diuretic?

A

Lasix

26
Q

What are the indications for Loop Diuretics?

A
  • Edema of hepatic, cardiac, or renal origin
  • Acute pulmonary edema (removes EC fluid <30 min)
  • Furosemide produces a prostaglandin effect (venodilation —> reduced preload)

When rapid and massive fluid removal is needed

27
Q

What is an additional benefit of Furosemide aside from its actions as a diuretic?

A

Thought to mediate prostaglandin-mediated venodilation reducing preload

28
Q

Pt presents hypertensive and a thiazide diuretic is indicated, but GFR is too low (< 30mL/min) and a thiazide diuretic won’t work. What can you use instead?

A

Loop Diuretic (Furosemide)

Still works when RBF and GFR are low

29
Q

What are the adverse effects of Loop Diuretics?

A
  • Hyponatremia
  • hypochloremia
  • Hypovolemia & hypotension
  • Hypocalcemia (result of hypokalemia) —> kidney stone formation
  • Hypomagnesemia (result of hypokalemia)
  • hyperglycemia

​

Hypokalemia (potassium losing diuretic):

  • Na+ reabsorbed using a K+/H+ exchanger leading to hypochloremic metabolic alkalosis
30
Q

What are drug interactions to loop diuretics?

A
  • Digoxin (Digoxin and LDs lower K+) digoxin is a competitive inhibitor of K+ in the heart
  • ototoxic drugs - risk of hearing loss
  • potassium-sparing diuretics
31
Q

What is the MOA of thiazides?

A

Blocks the Na-Cl cotransporter in the distal convoluted tubule

  • Thiazides result in severe magnesium wasting
32
Q

What diuretic doesn’t function well with a low GFR (< 30 mL/ ) and low RBF?

A

Thiazide diuretics

33
Q

What are the adverse effects of Thiazide diuretics?

A
  • hypochloremic metabolic alkalosis
  • hypomagnesia
34
Q

What are the drug interactions to be conscious of with Thiazide diuretics?

A

increases risk of digoxin and lithium toxicity

35
Q

in terms of ion excretion what are the major differences between thiazides and loop diuretics?

A

Thiazides as compared to loop diuretics:

  • less Na+ excretion
  • less K+ excretion
  • more bicarbonate excretion
36
Q

What is the MOA of amiloride and triamterene?

A

K+ sparing diuretics (Na+ channel blockers)

blocks luminal Na+ channels (ENaC) in the collecting duct

37
Q

What is the MOA of spirinolactone and eplerenome?

A

K+ sparing diuretic (aldosterone receptor blocker)

blocks aldosterone receptors in the colleting duct

38
Q

What is the therapeutic use of triamterene?

A

K+ sparing diuretic (Na+ channel blocker)

  • tx: hypertension
  • tx: edema
39
Q

What are the adverse effects of triamterene?

A

K+ sparing diuretic (Na+ channel blocker)

  • hyperkalemia
  • nausea, vomiting, leg cramps, and dizziness
40
Q

What’s the key difference between K+ sparing diuretics: Na+ channel blockers vs aldosterone antagonists?

A

aldosterone antagonisits such as spironolactone is a steroid and can take 48 hours to work.

Na+ channel blockers are much more immediate

41
Q

Known to greatly reduce mortality rate in patients with severe heart failure due to decreasing myocardial fibrosis and reducing early morning rises in heart rate

A

Spironolactone

42
Q

What are adverse effects of the K+ sparing diuretic Spironolactone?

A
  • Hyperkalemia

Endocrine effects:

  • Gynecomastia - major differentiation from Eplerenone (not seen w/ eplerenone use)
  • Impotence
  • menstrual irregularities
  • hirsutism (abnormal hair growth)
  • deepening voice
43
Q

What are drug interactions of K+ sparing diuretics, Spironolactone?

A
  • DO NOT give w/ drugs increasing plasma potassium
  • use cautiously w/ ACE (-) in heart failure
  • combined w/ thiazides & loop diuretics to counteract their potassium loss
44
Q

What are the therapeutic uses of Spironolactone?

A

K+ sparing diuretic (aldosterone antagonist)

  • Primary hyperaldosteronism
  • severe heart failure (anti-fibrotic agent)
  • Combined with K+ losing diuretics to counteract potassium loss
45
Q

What is the MOA of aquaretics? What’s the goal of their use?

A

-vaptans (Conivaptan, Tolvaptan)

Increase free water clearance by selective V2 receptor antagonism

the purpose being to correct for a proper Na+:free water

46
Q

What is a major consideration with the oral administration of aquaretics such as Tolvaptan?

A

can cause hyponatremia and should be used for less than 30 days or the patient runs the risk of developing hepatotoxicity

47
Q

Non-peptide arginine vasopressin receptor antagonists w/ affinity for receptor subtype V1A and V2

A

Aquaretics: Conivaptan, Tolvaptan

48
Q

Which aquaretic is given orally and which is administered by IV?

A

Tolvaptan - oral

Conivaptan - Intravenously

49
Q

What are the clinical applications of Aquaretics (Conivaptan, Tolvaptan)

A
  1. Euvolemic/hypervolemic hyponatremia (correcting Na+:free water)
  2. slows progression of adult polycystic kidney disease (must monitor liver)
50
Q

What is the typical dose for an osmotic diuretic (mannitol)?

A

50-200 grams over 24 hours

51
Q

If you’re presented with a patient with: renal insufficiency, nephrotic syndrome, or severe congestive heart failure what is your first choice diuretic?

A

Loop diuretic (Furosemide)

then add thiazide if you need to

(these are acute patients that need to lose fluid fast)

52
Q

What is a major difference between Spironolactone and Eplereonone?

A

Both K+ Sparing (Aldosterone antagonists)

Eplerenone - does not cause gynecomastia

Spironolactone - has been correlated w/ gynecomastia

Renal II Med 215 (3 decks)

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