Diuretics

Question 1

What are the uses and side effects of carbonic anhydrase inhibitors

Answer 1

Uses: glucoma, altitude sickness

Side effects: acidosis, renal stones

Question 2

What are osmotic diuretics used for and what are the side effects of using them

Answer 2

Used for raised intra-cranial pressure

Side effects: decreased intracellular volume, hypernatraemia, allergic reactions

Question 3

Name some adverse effects of using loop diuretics and name some ADRs of furosemide and bumetanide

Answer 3

Hypokalaemia

Metabolic alkalosis

Increased Ca and Mg loss

ADRs of furosemide - ototoxicity, alkalosis, increased LDL, increased TAG, gout

ADRs of bumetanide - myalgia

Question 4

Name some adverse effects of using thiazides

Answer 4

Hypokalaemia

Metabolic alkalosis

Increased Ca reabsorption - hypercalcaemia

Gout

Hyperglycaemia

Erectile dysfunction

Increased LDL and TAG

Question 5

Name some ADRs of spironolactone

Answer 5

Hyperkalaemia

Impotence

Painful gynaecomastia

Question 6

Name two ADH antagonists and the use of ADH antagnoists

Answer 6

Used for hyponatraemia but can cause hypernatraemia and deranged liver function

Lithium

Tolvaptan

Question 7

Name some generic ADRs of using diuretics

Answer 7

Hypovolaemia

Hypotension

Electrolyte disturbances

Metabolic abnormalities

Anaphylaxis

Photosensitivity rash

Question 8

What drugs do loop diuretics interact with and what does this result in

Answer 8

Aminoglycosides and loop - ototoxicity and nephrotoxicity

Digoxin and loop - hypokalaemia resulting in decreased digoxin binding causing toxicity

Steroids and loop - increased risk of hypokalaemia

Lithium and loop - reduced lithium levels

Carbamazepine and loop - increased risk of hyponatraemia

Question 9

What drugs do thiazide diuretics interact with and what does this result in

Answer 9

Beta-blockers and thiazides - hyperglycaemia, hyperlipidaemia and hyperuricaemia

Digoxin and thiazide - hypokalaemia resulting in decreased digoxin binding causing toxicity

Steroids and thiazide - increased risk of hypokalaemia

Lithium and thiazide - lithium toxicity

Carbamazepine and thiazide - increased risk of hyponatraemia

Question 10

What drug do potassium sparing diuretics interact with and what does this cause

Answer 10

ACEi and K-sparing diuretics - increased risk of hyperkalaemia

Question 11

What are diuretics used for and which diuretics are used to treat what

Answer 11

Hypertension - thiazide, spironolactone, loop diuretics (+ ACEi/ARCs and beta-blockers)

Heart failure - loop diuretics, spironolactone (+ ACEi/ARCs and beta-blockers)

Decompensated liver disease - spironolactone then loop diuretics

Nephrotic syndrome - loop diuretics, +/- thiazides, +/- K-sparing diuretics

CKD - loop diuretics

Question 12

Name some nephrotoxic drugs

Answer 12

Aminoglycosides, e.g. gentamicin

Vancomycin

Acyclovir

NSAIDs

Question 13

Name some drugs that can cause problems with renal dysfuction

Answer 13

ACEi

Diuretics

NSAIDs

Metformin

Question 14

When prescribing drugs in patients with CKD, what must you do to make sure you are not harming the patinet

Answer 14

Avoid nephrotoxins

Dose gentamicin and vancomycin very carefully

Always check with a pharmacist before prescribing

Be wary of some drugs whose side effects increase with renal disease, e.g. morphine/opiates, nitrofurantoin, statins

Question 15

Describe the management of hyperkalaemia

Answer 15

Protect the heart first by using Ca gluconate

Then lower serum K - use insulin and dextrose

Then remove K from the body - e.g. Ca resonium