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Met2 > Diuretics > Flashcards

Diuretics Flashcards

1
Q

What are the different types of diuretics?

A
  1. carbonic anhydrase inhibitors
  2. loop diuretics
  3. thiazide diuretics
  4. potassium-sparing diuretics
  5. osmotic diuretics
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2
Q

Where do carbonic anhydrase inhibitors work?

A

PCT

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3
Q

What is the MOA of carbonic anhydrase inhibitors?

A
  • affects the conversion of CO2 + H20 –> H2CO3 inside the cells
  • affects the conversion of H2CO3 –> H2O + CO2 in the lumen

Net result:

  • one molecules of HCO3- is reabsorbed and H+ is excreted when carbonic anhydrase is NOT being inhibited
  • with CAI HCO3- is NOT reabsored
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4
Q

What are the side effects of carbonic anhydrase inhibitors?

A
  • metabolic acidosis (contraindicated in chronic kidney disease)
  • sedation
  • bone marrow suppression
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5
Q

Give an example of a carbonic anhydrase inhibitors and its clinical uses.

A 
Acetazolamide 
Used for:
- glaucoma 
- epilepsy 
- mountain sickness
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6
Q

Where do loop diuretics work?

A

works in the thick ascending limb of loop of henle

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7
Q

What is the MOA of loop diuretics?

A
  • inhibits the Na/K/2Cl channel –> prevents these ions passing from lumen to cell
  • sodium stays in the urine = more urine
  • reduced absorption of Ca2+, Mg2+ into blood –> no K+ excretion into lumen to generate a positive voltage
  • no K+ excretion = Na/K antiporter is dysfunctional
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8
Q

What are the side effects of loop diuretics?

A
  • hypokalaemia (dysfunction of Na/K/2Cl)
  • dehydration –> acute renal failure
  • kidney stones (increased Ca2+ and Mg2+ in urine)
  • deafness (Na/K/Cl channel in inner ear –> only at high doses)
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9
Q

Give examples of loop diuretics and their clinical uses?

A
  • frusemide
  • bumetanide

Clinical uses:

  • most potent diuretic
  • hypertension
  • heart failure
  • volume overload from chronic kidney disease
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10
Q

Where do the thiazide diuretics work?

A

DCT

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11
Q

What is the MOA of thiazide diuretics?

A
  • acts on Na/Cl symporter on the luminal surface
  • less Na+ reabsorption from the lumen
  • Na/K ATPase pump still pumps Na+ out of the cell and K+ into the clel
  • very little Na+ inside cells
  • stimulates more Na+ uptake from the blood via Ca2+/Na2+ antiporter
  • increase Ca2+ leaving cell and going into blood draws more Ca2+ from the lumen –> further promotes Na+/Ca2+
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12
Q

What are the side effects of thiazide diuretics?

A
  • hypokalaemia
  • hypercalcaemia
  • hyponatraemia
  • dizziness
  • hyperglycaemia
  • hypercholesterolaemia
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13
Q

Give examples of thiazide diuretics and their clinical uses.

A
  • bendroflumethiazide
  • hydrochlorothiazide

Clinical uses:

  • antihypertensive
  • reduced blood volume + peripheral resistance
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14
Q

Give examples of thiazide-like diuretics.

A

Chlorthalidone
Indapamide
Metolazone

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15
Q

What are the 2 different types of potassium-sparing diuretics?

A
  1. ENaC antagonists

2. Aldosterone antagonists

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16
Q

Where do ENaC antagonists act?

A

collecting tubules

17
Q

What is the MOA of ENaC antagonists?

A
  • inhibits Na+ channel that allows Na+ reabsorption (lumen –> urine)
  • K+ cannot move into cell via Na/K exchanger
  • -> K+ cannot be excreted

Water follows sodium ions and therefore more water in drawn into the lumen = increased diuresis

18
Q

What are the side effects of ENaC antagonists?

A
  • hyperkalaemia

- hyponatraemia

19
Q

Give examples of ENaC antagonists and their clinical uses.

A

amiloride
triamterene

clinical uses (amiloride):

  • heart failure
  • hyponatraemia
  • cirrhosis
20
Q

What is the MOA of aldosterone antagonists?

A
  • prevent aldosterone from upregulating ENaC
  • reduced Na+ reabsorption = diuresis
  • K+ is not affected
21
Q

What are the side effects of aldosterone antagonists?

A
  • hyperkalaemia
  • hyponatraemia
  • gynaecomastia
22
Q

Give examples of aldosterone antagonists and their clinical uses.

A
  • spironolactione
  • eplerenone

Clinical uses:

  • hyperaldosteronism
  • heart failure
  • hypokalaemia
  • cirrhosis
23
Q

What is the MOA of osmotic diuretics?

A
  • osmotically active molecule in the tubular lumen
  • reduced reabsorption of all solutes; Na+, K+ and urea
  • -> dragged out from interstitial space
24
Q

What are the side effects of osmotic diuretics?

A
  • pulmonary oedema
  • dehydration
  • disequilibrium syndrome –> can lead to swelling and seizures
25
Q

Give an example of an osmotic diuretic and its clinical uses.

A

Mannitol

Clinical uses:

  • cerebral oedema
  • oliguric acute renal failure

Met2 (26 decks)

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