DIURETICS Flashcards
picture of electorlyte diuretics
Drug samples of Carbonic Anhydrase Inhibitors
What is MOA?
- Acetazolamide
- Methazolamide
USED TO HELP METABOLIC ALKALOSIS
What is the max dose for pushing on Acetazolamide
Administration (Inj)
- IV push (max rate: 500 mg/min); infusion
- NOT as great of a diuretic
What are the SE of acetazolaminde
- Metabolic acidosis
- Hyperchloremia
- Hypokalemia
- Hyponatremia (mild)
- Hyponatremia
Not as common as other diuretics Hypophosphatemia
MOA and samples of Loop Diuretics
• Ethacrynic acid • Furosemide • Bumetanide • Torsemide
used for: heart failure, liver failure, renal failure
all sort of edema, hyperkalemia..
How do you get delivery to the loop of henle for patients that has bad kidney functions?
for pts with Cr<10 you probably need to give large doses of loop diuretics.
Loop diuretic only available PO
Torsamide
Adverse SE of Loop diuretics:
higher with Ethacrynic Acid
Ototoxicity and Nausea
Adverse SE of loop diuretics
How to manage loop diuretic tolerance?
Loop diuretic tolerance
• “Braking phenomenon”
• Possible mechanism
– Low dose/secretion into tubule lumen
– Pronounced reabsorption at distal nephron sites
– Compensatory hypertrophy of renal tubules
– Pronounced post diuretic effect
• Greater amount of sodium may be reabsorbed once the
diuretic wears off
– Activation of renin angiotensin system
Patients that have higher chance of ototoxicity when loop diuretics is administered fast
Loop diuretic comparison:
Loop diuretic: Equivalent dosing
What are samples of Thiazide diuretics?
what is the MOA?
IS IT AS GOOD as loops when it comes to removing volume?
Thiazide diuretics
• Chlorothiazide
- Metolazone
- Hydrochlorothiazide
- Chlorthalidone
- Indapamide
–> works on the covulated tubules. NOT as effective as loops in volume management
Only IV thiazide available in the US
IV: Chlorothiazide
Thiazide that is more effective in patients with renal injury but has a good gut function
Metolazone
What are the SE of thiazide diuretics
Thiazide diuretic comparison
Equivalent dosing
Osmotic Diureses: Mannitol
MOA
What do you need to have to use Mannitol?
filter
dont use it with crystals
you can use warmers
Adverse SE of Mannitol
Pulmonary Edema and Volume overload is unique.
It has a nephrotoxicity SE. It can cause structural damage to the kidneys
know osmolar gap** if you are giving a lot of mannitol or your AKI is worsening.
*tissue injury and extravasation
Clinical Implication of osmotic diuretics
Samples of Potassium -sparing diuretics
Pteridine analogs
Aldosterone receptor blockers
MOA of potassium sparing diuretics
- Adjunct diuretic if you will start it – optimization of diuretic regimen
SE: of potassium sparing
what is greater in eplerenone?
boobies with spironolactone
** Rhabdo patients have higher chance of hyperkalemia
*watch out for hyperK dyrhythmias
Samples of Dopamine receptor agonist
whats the MOA?
what is more potent?
Dopamine
Fenoldopam
– Fenoldopam 6x more potent than dopamine
Adverse effects of Dopamine
Hypertension
Tachycardia
Arrhythmias
If your patient has nausea and vomiting will Tolvaptan be effective to use?
NO.
What is the MOA of Vasopressin receptor antagonists
What is the SE?
Vasopressin receptor antagonists
-
Indications
- Hypervolemic hyponatremia
- Euvolemic hyponatremia
-
Side effects of vasopressin antagonists
- Hypovolemia
- Hypotension (more with conivaptan)
- Muscle weakness
- Liver dysfunction
What should you monitor for the patient on Vasopressin antagonist
Monitor Na more frequently as compared to other patient
When should you avoid the use of diuretics?
- Avoid diuretic use in patients with hypovolemia
What are the indication for vasopressin
Hypervolemic Hyponatremia
Euvolemic hyponatremia
– if you do not have this you probably do not need vasopressin antagonist
Side effects of Vasopressin antagonist
- Hypovolemia
- Hypotension
- Muscle weakness
- Liver dysfunction
Drug interactions with diuretics
concurrent nephrotoxins
Drug interactions
Digoxin + Diuretics
leads to hypokalemia
may increase digoxin toxicity
Diuretic + Lithium
leads to
Hyponatremia –> increased lithium toxicity
Diuretic + Corticosteroids
leads to
Hypokalemia
Drug interactions
Aminoglycoside + Diuretics
Ototoxicity
Drug Interactions
ARB/ ACE-I + Diuretics
Hyperkalemia
(potassium sparing diuretic)
General considerations for diuretics in anesthesiology
