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HSHD Block 2 > Diuretics > Flashcards

Diuretics Flashcards

1
Q

What are the most common uses for diuretics

A

Edema

Hypertension

Congestive Heart Failure

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2
Q
A
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3
Q

Primary site of action of carbonic anhydrase inhibitors

A

Within the proximal tubule

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4
Q

Carbonic anhydrase examples

A

Acetozolamide (Diamox)

Methazolamide (Neptazane).

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5
Q

Use of CA inhibitors

A

Used for glaucoma and As a prophylactic for Acute mountain sickness

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6
Q

Side effects of CA inhibitors

A

Hyperchloremic Metabolic Acidosis

Renal Stones (increased pH in lumen causes Ca+2 to ppt out of sol’n)

Renal Potassium Wasting - hypokalemia (increased Na+ in lumen causes K+ excretion via a Na+/K+ antiporter in the collecting duct

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7
Q

Site of action of osmotic diuretics

A

proximal tubule and thin descending and ascending limbs of the loop of Henle

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8
Q

Osmotic diuretic example

A

Mannitol (Osmitrol)

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9
Q

MOA of osmotic diuretics

A
  • Produce an osmotic gradient and pull water into the lumen from surrounding tissues
  • prevent reabsorption of water and solutes

Osmotic diuretics expand the extracellular fluid volume by pulling water from intracellular compartments. Thus, they decrease the viscosity of blood and prevent release of renin. One important thing to remember is that the above effects on expanded extracellular volume, decreased blood viscosity and less renin release is that the renal blood flow is increased, which results in more NaCl removal from the renal medulla. Reduces water and NaCl reabsorption

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10
Q

When should osmotic diuretics not be used

A

Should not be used in patients with peripheral edema

Can cause pulmonary edema in patients with heart failure or pulmonary congestion

Contraindicated in patients with active cranial bleeding

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11
Q

When are osmotic diuretics most useful

A
  • Can reduce intracranial pressure, cerebral edema, can be used before and after neurosurgery
  • They can be used to reduce intraocular pressure short term for acute glaucoma and pre- and post- ocular surgery
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12
Q

Side effects of osmotic diuretics

A

convulsions, thrombophlebitis, severe dehydration, headaches, chest pains, tachycardia, blurred vision, fever, chills

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13
Q

Loop diuretics site of action

A

Thick ascending limb

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14
Q

Examples of loop diuretics

A

Bumetanide (Bumex)

Furosemide (Lasix)

Torsemide (Demedex)

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15
Q

Loop diuretics MOA

A

Inhibit the Na+-K+-2Cl- symporter on the apical membrane of the thick ascending limb epithelial cells

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16
Q

Loop side effects

A

Hypokalemic metabolic alkalosis

Ototoxicity (NKCC2 transporter in ear)

Hyperuricemia, gout attacks (hypovolemia increases reabsorption of uric acid)

Hypomagnesemia- inhibiting Na+-K+-2Cl- symporter impacts potential difference across membrane which prevents Mg+2 reabsorption

Allergic reactions

Interference with calcium reabsorption

Kidney stones are concern with loop diuretics

17
Q

When to use loop diuretics

A

They work very well and quickly at diuresis so they are often used when the GFR is low

acute pulmonary edema and other edematous conditions

  • acute hypercalcemia: enhance Ca+2 excretion
  • hyperkalemia- loop diuretics can significantly enhance urinary excretion of K+ , which is enhanced by simultaneous administration of NaCl

-acute renal failure- increased rate of urine flow and enhancement of K+ excretion is thought to be helpful

-anion disease: for treatment of toxic ingestions of bromide, fluoride, and iodide (normally reabsorbed in the thick ascending limb)

18
Q

Contraindication of loop diuretics

A

Patients with sensitivities to sulfonamides

19
Q

Thiazide diuretics MOA

A

Major - Distal convoluted tubule

Minor - Carbonic Anhydrase in the proximal tubule

20
Q

Examples of thiazide diuretics

A

Hydrochlorothiazide (Esidrix, HydroDIURIL)

Chlorothiazide (Diuril)

Trichloromethiazide (Metahydrin)

Metolazone (Mykrox, Zaroxolyn)

21
Q

Diuretics that shouldnt be taken with NSAIDs

A

Loops, thiazides

22
Q

Thiazides MOA

A
  • inhibit Na/Cl symporter from the luminal side of the distal convoluted tubule
  • enhance Ca+2 reabsorption in the DCT because the Na/Ca exchanger is more active (low Na inside cell)

secreted by the organic acid secretory system in the proximal tubule to the lumen and compete with secretion of uric acid, elevate serum uric acid

23
Q

Side effects of thiazides

A

As with loop diuretics, hypokalemic metabolic alkalosis, hyperuricemia

increased calcium reabsorption, can be used for kidney stones

Impaired carbohydrate tolerance

Hyperlipidemia

Hyponatremia

Allergic reactions

24
Q

Contraindications of thiazides

A

Patients with hepatic cirrhosis, borderline renal failure, or acute heart failure

25
Q

Thereapeutic uses of thiazides

A

edema associated with congestive heart failure, nephroticsyndrome, chronic renal failure, and glomerulonephritis (as long as GFR is >30-40 mL/min)

Since they decrease blood pressure in hypertensive patients, they are used alone or in combination with other antihypertensive drugs to treat hypertension

Since they reduce Ca+2 excretion, they can be used to treat Ca+2 nephrolithiasis or osteoporosis

They are used for treatment of diabetic nephropathy, but GFR must be above 30-40 mL/ min

26
Q

What is unique about loop vs thiazide dosing

A

Loops have a rapid increase in efficacy with small changes in dosing. Thiazides plateau in efficacy

27
Q

Site of action of K+ sparing diuretics

A

Collecting tubules

28
Q

MOA of K+ sparing diuretics

A

Prevent K+ secretion by antagonizing the effects of aldosterone in the collecting tubules

Amiloride and Triamterene directly decrease the sodium channel activity without altering the mineralocorticoid receptor

Spinonolactone competitively inhibits the mineralocorticoid receptor

29
Q

Examples of K+ sparing diuretics

A

Amiloride

Triamterene

Spironolactone

30
Q

K+ sparing diuretics indications

A

Amiloride and Triamterene SPECICIFALLY INDICATED for treatment of polyuria and polydipsia due to lithium

Spironolactone SPECIFICALLY INDICATED in patients with primary aldosteronismor heart failure because blocking the mineralocorticoid receptor decreases the adverse effects of aldosterone on the heart.

-preferred in patients with cirrhosis

31
Q

Side effects of K+ sparing diuretics

A

Amiloride is well tolerated, few side effects other than hyperkalemia

Triamterene is not as well tolerated as amiloride. It is potentially nephrotoxic and in half of patients leads to crystalluria and cast formation

Spironolactone may cause menstural abnormalities, gynecomastia, impotence, reduced libido

32
Q

What diuretics can exacerbate gout

A

Loops, thiazides

HSHD Block 2 (10 decks)

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