Diuretics: DS Flashcards
Monday 8/5
Where in the nephron do carbonic anhydrase inhibitors work?
PCT
what do CAI inhibit?
Carbonic anhydrase (enzyme)
how does CAI effect reabsorption or secretion of ions?
Increase excretion of HCO3, Na, and K
Carbonic anhydrase inhibitors?
acetazolamide
dorzolamide
brinzolamide
metazolamide
Loop diuretics?
furosemide
torsemide
bumetanide
ethancrynic acid
Thiazide diuretics?
hydrochlorothiazide indapamide chlorthalidone metolazone chlorothiazide methyclothiazide
Potassium sparing diuretics?
Trametere
Amiloride
Spironolactone
Eplerenone
Acid/Base disorder caused by CA inhibitors?
Hypercholermic metabolic acidosis
Acid/Base disorder caused by Loop diuretics?
Hypokalemic metabolic alkalosis
Acid/Base disorder caused by Potassium sparing diuretics?
Hyperkalemic Metabolic Acidosis
Acid/Base disorder caused by Thaizide diuretics?
Hypokalemic metabolic alkalosis
how do thiazides effect reabsorption or secretion of ions?
increase K, CL, and Na excretion
increase Ca reabsorbtion
how does loops effect reabsorption or secretion of ions?
increase Ca, Cl, Mg, Na, and K excretion
how does K sparing effect reabsorption or secretion of ions
Increase Na excretion
Increase K reabsorption
Which diuretics cause alkalosis?
Loops and thiazides
Which diuretics cause hypokalemia?
Loops and thiazides
Which diuretics cause hyperkalemia?
k sparing
Overproduction of aldosterone does what?
lose K- hypokalemia
Lose H- Metabolic alkalosis
Retain Na- hypertension
Heart- increased risk of CV disease
Determine between secondary or primary aldosteronism?
look at renin levels
an increase renin means secondary from decrease effective circulating blood volume, from splanchnic vasodilation, portal hypertension, cirrhosis
a decrease in renin is primary aldosteronism, increase in aldosterone from adenoma, cause increase in BP,etc
Treat primary aldosteronism?
Spironolactone
Eplerenone
Important with acetazolamide?
getting rid of bicarb
Difference between ethacrynic acid and furosemide?
Furosemide- sulfonamide derivative
Ethacrynic acid- ototoxicity
Effect do loops and thiazides have on serum K and pH?
can cause hypokalemia
can cause metabolic alkalosis
Important with loop diuretics?
very potent diuretics, lose Ca
Important about thiazide diuretics?
moderately potent diuretics
retain Ca
Why might a patient taking spironolactone complain of painful, enlarged breasts?
Spironolactone blocks androgen receptors on breast tissue
What else can spironolactone be used for as treatment in women?
Acne, Hirsutism, Polycystic ovary syndrome
Side effect of sprionolactone on women?
menstrual irregularities
Why does eplerenone have a low incidence of gynecomastia?
it doesn’t block the androgen receptors
What do loop diuretics inhibit?
Na/K/2Cl NKCC2 in the TAL
How potent are loop diuretics?
most potent (0.5 to 15-25% Na)
What do thiazides do?
inhibit Na/Cl NCC channel in the DCT
How potent are thiazides?
Moderate potency (from 0.5% to 5% Na)
How do K sparing diuretics work?
Antagonize aldosterone in the collecting tubules
How potent are K sparing diuretics?
least potent (from 0.5% to 2-3% Na)
Clinical uses of CAI?
Glaucoma
urinary alkalinization
metabolic alkalosis
acute mountain syndrome
Clinical uses of thiazides?
Hypertension
heart failure
nephrolithiasis
nephrogenic diabetes insipidus
Clin use of loops?
hyperkalemia
acute renal failure
anion overdose
Heart failure
Clin use of aldosterone antagonists?
mineralcorticoids excess hyperaldosteronism Conn's syndrome (primary) Secondary Hyperaldosteronism reduce albuminuria in diabetic patients
side effects with loop and thiazides?
hyperkalemic metabolic alkalosis
allergic rxns
hyponatremia
