Diuretics

Question 1

What are two main types of diuretics?

Answer 1

Thiazide and Loop diuretics

Question 2

What are thiazide diuretics used for?

Answer 2

Oedema (due to chronic HF) and hypertension

Question 3

Name a thiazide diuretic. Explain what dose is used for which condition.

Answer 3

Bendroflumethiazide.
2.5mg OM is used for hypertension
Anything higher - its used for chronic HF.

Question 4

Name some loop diuretics. What are they normally used for?

Answer 4

Furosemide
Bumetanide

Used for pulmonary oedema due to left ventricular failure and CHD

Question 5

Can more than 1 diuretic be used at the same time?

Answer 5

Yes, if the patient is not getting relief from using one of them.

Question 6

Which patients would be using two diuretics at the same time?

Answer 6

Resistance oedema patients

Question 7

What dose would you normally give to elderly patients and why?

Answer 7

Lower doses as they’re more susceptible to S/E. Shouldn’t be used on long-term to treat gravitational oedema - this can be treated by raising the legs, using compression stockings and increasing movement

Question 8

What is the main S/E of diuretics? How would you overcome this S/E?

Answer 8

Hypokalaemia.

With the use of potassium-sparing diuretic.

Question 9

Should the potassium-sparing diuretic and the diuretic be prescribed in combination?

Answer 9

Preferably no. They should be prescribed separately. But if compliance is a problem for the patient, they can be used in a combination therapy for example co-amilofruse and co-amilozide

Question 10

Where in the nephron do both diuretics work on?

Answer 10

Loop - ascending loop of Henle

Thiazide - act on distal convoluted tubule and inhibit Na reabsorption

Question 11

What is the onset of action and duration of thiazide diuretics?

Answer 11

1-2 hours onset

12-24 hours duration

Question 12

When would you take thiazide diuretics?

Answer 12

OM - so diuresis does not interfere with sleep

Question 13

Which thiazide diuretics are preferred for hypertension?

Answer 13

Chlortalidone and indapamide

Question 14

Why would you give chlortalidone on alternate days?

Answer 14

Longer duration than other thiazines

Question 15

What are conditions can diuretics exacerbate?

Answer 15

GOUT, diabetes, systemic lupus erythematosus

Question 16

What would you monitor if patients are on diuretics?

Answer 16

ELECTROLYTES

Question 17

If patient has moderate, established, severe kidney failure, which diuretic would you avoid?

Answer 17

Avoid thiazides as these are affected.

Question 18

What else could loop diuretics be used for?

Answer 18

Resistant HTN

Question 19

What are S/E of furosemide?

Answer 19

Deafness when it is infused too quickly and it exceeds 4mg/min

Question 20

What are S/E of bumetanide ?

Answer 20

Myalgia + deafness

Question 21

What are both drugs ONSET and duration of action?

Answer 21

act within an hour and last 6 hours and can be given twice a day without affecting sleep

Question 22

Name a potassium sparing diuretic. Can this be given with thiazide? What is a side effect of amiloride?

Answer 22

Amiloride. Yes as it’s weak on its own.

Urine can appear BLUE.

Question 23

Name an aldosterone antagonist.

Answer 23

Spironolactone

Question 24

IF potassium sparing diuretics are given with ACEI or an angiotensin II antagonist, what is their a severe risk of?

Answer 24

HYPERKALAEMIA.

Question 25

What are symptoms of hyperkalaemia?

Answer 25

Fatigue
Palpitations
N/V
Chest pain