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Pharm OTL > Diuretics > Flashcards

Diuretics Flashcards

1
Q

Give two examples of loop diuretics

A

Furosemide

Bumetanide

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2
Q

What is the MoA of loop diuretics?

A

Blocks the NA/K/2Cl transporter in the thick ascending limb of the LoH
Therefore NaCl isn’t reabsorbed
Very potent

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3
Q

What effects to thiazide and loop diuretics have on potassium levels?

A

Hypokalaemia

  • Action of the Na/K pump
  • Faster flow rate of filtrate in the tubule, washes away K+ and creates a concentration gradient
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4
Q

What other ions are affected by loop diuretics?

A

Ca2+ and Mg2+ can’t be absorbed
Cl- isn’t reabsorbed, so the electrical potential of the filtrate doesn’t become +ve enough to repel the ions into the blood

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5
Q

What is the MoA of thiazide diuretics?

A

Blocks the Na/Cl transporter in the DCT

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6
Q

Name two thiazude diuretics

A

Bendroflumethiazide
Indapamide
Hydrochlorthiazide

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7
Q

What other ion is affected by thiazide diuretics

A

More Ca2+ is absorbed

Due to the build up of K+ in the lumen repelling the Ca2+ into the blood

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8
Q

Name an ENaC inhibitor

A

Amiloride

Triamterene

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9
Q

Name an aldosterone antagonist

A 
Spironolactone
Eplerenone (when above causes gynaecomastia)
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10
Q

What is the MoA of potassium sparing diuretics?

A

Reduction of the activity of ENaC either:
Directly (ENaC inhibitors) or
Indirectly (by antagonising the effects of aldosterone on Na/K pump which reduces the effect of ENaC)

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11
Q

Name a carbonic anhydrase inhibitor

A

Acetazolamide

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12
Q

What is the MoA of carbonic anhydrase inhibitors?

A

Stops HCO3- from reacting with H+, so the HCO3- stays with Na+, so Na+ stays in the lumen

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13
Q

What are carbonic anhydrase inhibitors used for?

A

Motion sickness
Méniere’s disease
Glaucoma (rarely used)

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14
Q

Name an osmotic diuretic

A

Mannitol

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15
Q

State three common side effects of diuretics in general

A

Hypovolaemia
Hypotension
Electrolyte disturbances

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16
Q

State two side effects of thiazide diuretics

A 
Gout
Hyperglycaemia (insulin regime may need adjusting)
Erectile dysfunction
Increased LDL and TG levels
Hypercalcaemia
17
Q

State two side effects of loop diuretics

A 
Ototoxicity (inhibs Na/K/2Cl in the ear => reduced potassium in the endolymph .·. ↓APs => hearing loss)
Alkalosis
Increased LDL and TG levels
Gout
Hypocalcaemia and hypomagnesaemia
18
Q

State two side effects of spironolactone

A

Hyperkalaemia
Impotence
Painful gynaecomastia

19
Q

In which condition are thiazides commonly used?

A

Hypertension, late in the treatment pathway

Useful for fluid loss and vasodilation effects

20
Q

In which five conditions are loop diuretics commonly used?

A 
Hypertension secondary to fluid overload
Heart failure for symptomatic relief
Cirrhosis for ascites and peripheral oedema
Nephrotic syndrome
CKD with hypertension
21
Q

In which three conditions is spironlactone used?

A

Decompensated liver disease (first line)
Heart failure to reduce mortality
Hypertension secondary to excess aldosterone

22
Q

When are osmotic diuretics used?

A

To reduce high intracerebral pressure

23
Q

Why may furosemide struggle in:
A) Heart failure
B) Nephrotic syndrome
C) CKD

A

A) reduced perfusion to the kidneys therefore reduced arrival of furosemide
B) reduced albumin therefore less carrying capacity for furosemide
C) fewer nephrons, so the OATs that are needed to transport furosemide into the nephron are occupied with more important substances

24
Q

Name an ADH antagonist

A

Tolvaptan - used to treat hyponatramia

Lithium - side effect of the drug

25
Q

What is the effect of the drug-drug interaction between aminoglycosides and loop diuretics?

A

Ototoxicity

Nephrotoxicity

26
Q

What is the effect of the drug-drug interaction between ACEIs and K+ sparing diuretics?

A

Hyperkalaemia => arrhythmias

27
Q

What is the effect of the drug-drug interaction between digoxin and thiazide/loop diuretics?

A

Hypokalaemia from diuretics => ↓K+ able to bind to the outside of the Na/K pump .·. ↑binding of digoxin (compete for the same site) => ↑inhibition of the Na/K pump => digoxin toxicity

28
Q

What is the effect of the drug-drug interaction between steroids and thiazide/ loop diuretics?

A

Risk of hypokalaemia

Pharm OTL (18 decks)

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