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DT3- EXAM 1 > Diuretics- Melissa (3)* > Flashcards

Diuretics- Melissa (3)* Flashcards

1
Q

Three primary uses for diuretic drugs:

A
  1. Mobilize Fluid (during increased ICP/ IOP)
  2. Excrete Fluid (edema)
  3. Excrete Electrolytes (Na+)
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2
Q

Acetazolamide:
Drug class
MOA + LOA*

A

Carbonic Anhydrase Inhibitor
*Acts on PROXIMAL TUBULE

  1. Decreases intracellular CA–>
    - Low intracellular H+ HCO3-
    - Decrease Na/H+ luminal XGE = low Na reabsorption
    - Decrease Na/HCO3- basolateral cotransport= low Na reabsorption
    - Decrease Na/K basolateral cotransport = low K reabsorption

Net effect:
2. Decrease luminal CA, Increase Luminal HCO3-, Na+, K+ for excretion

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3
Q

What are 3 effects of Acetazolamide use?

A
  1. Weak diuretic (^Na excretion, 5%* filtered load)
  2. ^^^ HCO3- excretion–> acidosis*
  3. ^ K+ excretion —> hypokalemia
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4
Q

3 Therapeutic uses for acetazolamide:

When is it NOT used?

A

Open angle glaucoma, Mountain sickness, Urinary alkalization (rid acidic toxins)

*NOT used as diuretic

Note: treats mountain sickness by acidifying blood, which stimulates respiration. Else, due to ^^^ bicarbonate in blood, patients will lose respiratory drive at night/ maybe die in their sleep.

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5
Q

What is Hyperchloremic Acidosis? Why is it important to acetazolamide use?

A

Acidosis resulting from acetazolamide use: excretion of HCO3- causes acidosis with ^ Cl-

Compensatory mechanisms will respond to acidosis–> negate the diuretic effects–> ineffective diuretic

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6
Q

3 important side effects to acetazolamide use:

A

Hyperchloremic acidosis, Hypokalemia, HYPERSENSITIVITY (Sulfadrug)

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7
Q

List Three Thiazide Drugs:

MOA (2) / LOA

A
  1. Hydrochlorothiazide***
  2. Chlorothiazide
  3. Polythiazide
    (Most end in thiazide, except special renal ones and chlorthalidone)

MOA DISTAL TUBULE :

  1. Binds Cl- binding site–> STOP luminal Na/Cl cotransport
  2. Decrease Na Reabsorption by 10%
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8
Q

List two Thiazide related drugs:
MOA/ LOA
When are these particularly useful?

A
  1. Metolazone
  2. Indapamide

MOA DISTAL TUBULE :

  1. Binds Cl- binding site–> STOP luminal Na/Cl cotransport
  2. Decrease Na reabsorption

***TX PATIENTS WITH POOR RENAL FXN

Give to indaPAMide + METOOlazone, (Pam and Me too) cause we have jacked up kidneys.

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9
Q

What do thiazides/ related drugs do to the urine (4)?

What patients would these be good to treat?

What patients would these be bad to treat?

A
  • Modest Diuretic (^ Na excretion 10% Filtered load)
  • ^ K /Cl /HCO3 excretion
  • DECREASE Ca+ excretion–> GOOD for OSTEOPEROSIS***
  • DECREASE URIC ACID excretion–> BAD for GOUT***
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10
Q

5 Clinical indications for thiazide/ related drug use

A

HTN, Edema States (CHF, Cirrhosis), Ca2+ Kidney Stones, Nephrogenic DI (^ +feedback), Nephrotic Syndrome (+SP)

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11
Q

SE of Thiazides/ related drugs (5-hyper, 1 hypo)

A
  • Excessive MOA, HYPERSENSITIVITY (sulfa), Hyperglycemia (Diabetes)/ Hyperlipidemia (long term tx), Hyperuricemia
  • Hypovolemia (rare)
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12
Q

Describe the drug-drug interaction between thiazides/related drugs and digitalis

A

Hypokalemia induced by thiazides/ related drugs will ^ efficacy of the digitalis–> toxicity

Careful with CHF patients!

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13
Q

What is the relationship between thiazides/ related drugs and the GFR?

A

GFR must be GREATER THAN or EQUAL to 30-40 ml/min for drug to work!
(EXCEPT for IndaPAMide + METOOlazone )

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14
Q

Which two thiazide related drugs are effective in patients with GFR LESS than 40 ml/min

A

Metolazone, Indapamide

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15
Q

Which diuretics are the most effective?

A

Loop diuretics

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16
Q

List three loop diuretics that are sulfa drugs

A
  1. Furosemide
  2. Bumetanide
  3. Torsemide
    (All of the IDEs)

LOOPY FURry BUM TORtoise
(FURuity LOOPS BUMp TOgether in my cereal)

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17
Q

Which loop diuretic can be used to treat patients with sulfa allergy?

A

Ethacrynic Acid

18
Q

Loop Diuretics:

MOA (2) / LOA

A

MOA TAL Loop of Henle:

  1. Bind Cl- receptor –> Stop Na/K/2Cl cotransport
  2. Stop Na+, K and Cl reabsorption
19
Q

3 effects of Loop Diuretics:

A 
#1 EFFECTIVE DIURETIC (^Na /H2O 25%)
 ^^^K /Cl excretion, ^^Ca++ excretion
20
Q

3 Therapeutic uses for loop diuretics

A
  1. Acute pulm edema (IV)**/ edema in acute organ failure
  2. HTN (ok with LOW GFR**)
  3. Hypercalcemia

(NOTE: loop diuretics are actively secreted into lumen, so they are good for HTN with poor renal fxn!)

21
Q

Adverse effects of loop diuretics:
2 high yield?

4 side effects shared w/ thiazides?

A
  1. HYPOVOLEMIA** (vascular collapse)
  2. OTOTOXICITY*** (additive with aminoglycosides)
    (The LOOPY furry bum tortoise can’t HEAR!!!)

Hypokalemia (digitalis tox)
Hyperuricemia
hyperglycemia
hyperlipidemia

22
Q

Two drug classes that are K+ sparing diuretics:

+ Where do they work?

A
  1. Aldosterone receptor inhibitors
  2. Na+ / Ca++ Channel blockers
    Both work in late distal tubule/ collecting ducts

“Take a SEAT potassium”
(spirolactone, eplerenone, amiloride, triamterene)

23
Q

Spirolactone + Eplerenone:
Drug Class
MOA (2) / LOA

A 
Aldosterone Receptor Antagonists 
MOA 
*LATE DISTAL TUBULE + COLLECTING DUCT*: 
1. Competitive inhibition Aldosterone-R 
(not effective w/o aldosterone!) 
2. Inhibits Na+/K+ XGE --> K+ SPARING EFFECT
24
Q

Two effects of Aldo-R inhibitors on urine:

A
  1. ^ Na/ Cl/ H2O

2. DECREASE K+, H+

25
4 Uses Spironolactone
#1 DOC: Hepatic Cirrosis! 2. Prevent hypokalemia (coadmin w/ K+ depleting diuretic) 3. CHF 4. Primary Hyperaldosteronism (Treats Hormonal acne! I take this.)
26
2 Uses Eplerenone:
HTN; CHF post-MI
27
Two side effects of K+ sparing diuretics:
1. HYPERkalemia 2. Altered Hormonal Activites*** Gynecomastia (M), Menstrual irregularities (F)
28
Triamterene + Amiloride: Drug Class? MOA/ LOA?
Na+/ Ca+ Channel Inhibitors MOA: *LATE DT + COLLECTING DUCT* Decrease Na+/K+ XGE
29
What are three effects of Na+/ Ca+ Channel Inhibitors? How are they used clinically?
1. Modest Diuresis (Combination use!) 2. INCREASE NaCl secretion 3. Decrease K+, H+ secretion
30
2 therapeutic uses for Na+/ Ca+ Channel Inhibitors: What happens when it reaches toxic doses?
1. Secondary hyperaldosteronism 2. Prevention of hypokalemia (coadmin) *HYPERKALEMIA in toxic doses
31
Most commonly used osmotic diuretic? How is it administered? MOA?
``` #1: Mannitol Administered IV in HYPEROSMOTIC soln ``` ``` MOA: 1. Freely filtered 2. Not reabsorbed 3. Not Metabolized ^ Osmotic pressure in tubular lumen--> Decrease reabsorption H2O, Na+ ```
32
3 overall effects osmotic diuretics:
1. ^^^ urinary flow 2. ^ Na+ excretion 3. DECREASE URINE OSMOLALITY
33
4 therapeutic uses for osmotic diuretics
Maintain urine flow (drug tox/trauma), Acute renal failure (shock), DECREASE ICP / IOP (Glaucoma)
34
What are two SE of osmotic diuretics and which patient population is most at risk?
^ ECF volume (pts. with poor cardio fxn), Alteration Na+, K+ levels
35
Which drugs cause ototoxicity?
loop diuretics; esp with aminoglycosides
36
Which drugs cause hypercalcemia?
thiazides/ related drugs
37
Which drugs cause hyperglycemia?
thiazides/ related drugs; Loops
38
Which drug is especially important for coadministration with K+ depleting drugs in patients with cirrhosis/ ascites?
spirolactone
39
Which drug increases Cl- levels?
CAi! | They can hyperchoremic acidosis
40
``` Which drug class increases excretion of all of the following: Na, Cl, K, HCO3-, and Ca ```
Loop Diuretics - CAi spares Cl - Thiazids spare Ca - AldoR/ amiloride spare K+
41
Diuretics that are good options to treat hypertensive patients with poor renal function (2):
1. Thiazide related drugs (Indapamide, Metolazone) | 2. Loop diuretics--they are actively secreted (furosemide, bumetanide, torsimide, ethacrynic acid)
42
What do loops, thiazides and nicotinic acid all have in common?
All cause HYPERURICEMIA and ^^^^ glucose.

DT3- EXAM 1 (26 decks)

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