Diuretics Flashcards
Effects of Hyperkalemia (4) and Hypokalemia (4)
Hyperkalemia
Tall T waves
Wide QRS
Flat P waves
Bradycardia
Hypokalemia
Flat T waves
ST depression
Tall U waves
Atrial arrhythmia
Loop Diuretics
- Furosemide
- Torsemide
- Bumetanide
- Ethacrynic Acid
Thiazide Diuretics
- Hydrochlorothiazide
- Metolazone
- Chlorthalidone
K+ Sparing Diuretics
-
Na+ Channel blockers
- Amiloride
- Triamterene
-
Aldosterone ANT
- Sprinonolactone
- Eplerenone
Carbonic Anhydrase Inhibitors
Acetazolamide
Aquaretics
- Conivaptan
- Tolvaptan
Osmotic Diuretics
MOA:
Drug:
SE:
TX:
- Increase urine flow b bc it cannot be reabsorbed, so pulls water from cells in PT and LoH
- Mannitol
- SE:
- Volume overload
- Acute increase in extracellular volume bc sucks out of cells; can worsen HF
- Dehydration
- HA, N/V
- Electrolyte imbalance
- Volume overload
- TX:
- Decrease ICP
- Decrease in intraocular pressure
- Prophalx against renal failure; keeps fluid in tubules to prevent collapse when GFR is low
K+ sparing diuretics (often used …)
Act on what part of the nephron?
- combo with others to enhance effects and counteract hypokalemia bc loop diurects and thiazides cause hypokalemia
- only cause slight dluresis.
- Cortical CD
Potassium Sparing Diuretics
MOA (2) Examples for Each MOA (2)
- Na+ channel blockers (ENaC) in CD: Less Na+ into the cell => decreased Na/K exchange via Na/K ATPase on BL side => increased retention of K+ and SMALL increase in Na+ secretion
(Amiloride and Triamterene)
- Aldosterone ANT (competitive) in principal cells: Blocks aldosterone receptor => prevents transcription of Na+ channel and Na/K ATPase => prevents reabsorption of Na+ and water
(Spironolactone and Eplerone)
Amiloride/Triamterene
Use and Adverse Effects (6)
How is triamterene different?
Uses: Counteract K+ loss in other tx for HTN, HF
- Hyperkalemia (BBW) /Hyperchloremia (high K and Cl)
- Hyponatremia
- Metabolic Acidosis
- Dizziness
- Fatigue
- N/V/D
Spironolactone/Eplerone
Uses (3) and Adverse (4)
Uses: counteract K+ loss in HTN, HF, ascities
- Primary Hyperaldosteronism
- Post-MI/ reduce Fibrosis
- Hyperkalemia
- Hyponatremia
- Can + receptors for testosterone and progesterone (partial androgen AGO)
- W: Amenorrhea and hirsutism
- M: Gynecomastia and Impotence
*
how is eplerenone different from spironolactone
more selective aldosterone ANT
lacks sulfure
Use: tx fibrosis in post MI or combo with HTN
Less gynocostoma
10x more expensive
Carbonic Anhydrase Inhibitor
MOA: Example, Uses (3) and Adverse Effects (3)
Acetazolamide: weak diuretic
MOA: Bicarb is maintained in lume => cannot power the Na+/H+ exchanger (reabsorbs Na+ and secretes H+) => decrease absorption of Na+ => more Na+ in the urine => more water in urine
Treats:
- Metabolic alkalosis
- Glaucoma
- Acute Mountain Sickness (alt sickness)
Causes:
- Hypokalemia
- Hyperchloremic acidosis
- Nephrolithiasis
Which two diuretic classes are contraindicated in pregnancy?
Loop and thiazide
__________, which work in the _____, have the greatest diuretic effect by blocking what receptor?
- Loop diuretics
- TAL
- Na/K/2Cl Cotransporter
Normally, how does the NK2Cl co-transporter work in the TAL?
-
Na/K/Cl are present in urine and reabsorbed via the NK2Cl co-transporter. This (+) charge in lumen allows paracellular reabsorption of Mg/Ca2+ into the urine.
- Cl- moves into the blood via Cl- channel on the BL side
- Na/K ATPASe will move Na+ into the blood
- K+ leaks back into urine via K+ channels
Loops diuretics cause excretion of ____
- Na
- K
- Cl
- Ca
- Mg
Loop Diuretics
MOA and Adverse Effects (7)
- Largest Na+ loss (also K+/Ca2+/Mg2+/Cl- lost) - electrolyte imbalance
- Metabolic Alkalosis
- Acute hypovolemia => shock, hypotension, cardiac arrhythmia;
- Ototoxicity
- Sulfa Allergies
- Hyperglycemia
- Furosemid and ethycrinic acid can cause: Hyperuricemia => worsen gout
Loop Diuretics (all sulfa drugs)
Examples with Uses (4)
- Furosemide: Pulmonary edema, HTN, liver disease and low GFR pts.
-
Torsemide: edema w Heart failure
- better oral absortption and longer 1/2 life
- Bumetanide: predictable oral absorption
- Ethacrynic acid: non-sulfa (use in case of allergy)
Do NOT use ______ in patients with low GFR
thiazides
_______ are Ca2+ Sparing drugs
Thiazides
Thiazides act on _______ in the ________ to cause weak diuresis
- Na/Cl Co-transporter
- early DT
Thiazides inhibit _________ to cause ________.
- Na/Cl Cotransporter in the early DT
- Increase Na, Cl- excretion => increase urine output
Thiazides Adverse Effects (4)
- Hypokalemia (d/t increased delivery of Na+ to distal)
- LARGEST Mg2+ LOSS!!!!
- Metabolic alkalosis
- Sulfa allergies
- Hypercalcemia/Hyperglycemia/Hyperuricemia (worsen gout)/ hyperlipdemia d.t decrease insulin secretion and increased hepatic glucose production
Thiazide uses:
- Hydrocholorthiazide (most widely used; not useful w people w low GFR but treats NDI, Ca+ nephrolithiasis/kidney stones)
- chlorothalidone (best for HTN)
- Metolozone
