Diuretics Flashcards
what are the two main toxicities of acetazolamide?
metabolic acidosis and hypokalemia
what is the MoA of acetazolamide?
blocks action of carbonic anhydrase in the PCT and therefore you get less reabsoprtion of Na and secretion of H+
name the two most common toxicities of loop diuretics?
hypokal
met alk
name the four loop diuretics
furosemide
torsemide
bumetanide
ethacrynic acid
what is another toxicity that loop diuretics cause in the loop?
hypocalcemia or hypercalciuria
why do loop diuretics lead to hypercalciuria?
in the loop…potassium usually leaks into lumen through ROMK but since it is blocked the potassium does not…and this doesnt create the gradient for calcium to flow back in paracellulary
how do loop diuretics cause gout? or hyperuricemia?
the diuretics are cleared using the same channels that pump urea out basolaterally and the same channels that pump urea in the epithelial surface…so not as much urea out and more urea in
name the three thiazide diuretics
chlorthalidone
hydrochlorothiazide
metolazone
what are the two common toxicities caused by thiazides
hypokal
met alk
name the three other toxicities associated with thiazide?
hypercalcemia or hypocacliuria
hyperuricemia/gout
hyperglycemia
how do thiazides cause hyperglycemia?
increased K+ secretion and less insulin release so higher blood sugar levels
how do thiazides cause hyperuricemia and gout?
thiazides compete with urea export channels for clearance in kidneys
how do thiazides cause hypercalcemia?
there is a calcium channel that works more in the DCT when the NCC channel is blocked by the thiazides
what are the two ENaC blockers?
triamterene and amiloride
what are the two aldosterone receptor blockers?
spironolactone and epleronone
what are the two toxicities associated with ENaC blocker and also receptor blockers?
hyperkalemia and metabolic acidosis
what is a random toxicity associated with spironolactone?
gynecomastia
how does mannitol work as a diuretic?
it just gets filtered into the lumen and is increasing the luminal osmolality so it pulls a ton of water out…pretty much solute diuresis
what are two toxicities of mannitol administration?
hypokalemia and metabolic alkalosis
why does mannitol cause hypokal and met alk?
because of the huge amount of H2O pulled into lumen…lowers conc of H+ and K+ in the lumen and this leads to a favorable excretion gradient for these two ions
what two classes of diuretics cause metabolic acidosis?
K+ sparing and carbonic anhydrase inhibitors
