Diuretucs Flashcards
What is the first line therapy of HF
Diuretics
What are the effects of all diuretics
Decrease plasma volume and cardiac output, increase HR, increase plasma renin, increase SNS
What are the thiazide diuretics names?
Metazalone, chlorthalidone, indapamide, HCTZ, chlorothiazide
What are the loop diuretics?
Furosemide, bumetanide, torsemide
What are the potassium sparing diuretics?
Amiloride, spironolactone, triamterene
Where do TZDs work
Distal consulates tubule
Where do loop diuretics work
Ascending loop of henle
Where do potassium sparing work
Late distal tubule and collecting duct
What are the carbonic anhydrase diuretics work
Proximal tubule
What are the carbonic anhydrase diuretics
Acetazolamide, methazolamide
What are the most common osmotic diuretics
Mannitol
What can mannitol treat?
Increased ICF
How much mmhg do TZDs lower BP by
10-15
When are TZDs not effective
In creatinine clearance less than 30
Which TZD is often used for benign essential HTN
HCTZ
How do TZDs work
They decrease plasma volume by increasing sodium and water excretion in distal tubules.
They also reduce contraction of the arterial smooth muscle cells causing a reduction in response to vasopressors like norepinephrine and angiotensin
What is the adverse effects of TZDs
Increase in LDL and triglycerides and impaired carbs tolerance in patients with type 2 DM
Lowers electrolytes of potassium, sodium, and magnesium
Raises uric acid, calcium, sugar, and hyperlipidemia
Which diuretics can patients with a sulfa allergy not take?
TZDs and Loop and carbonic anyhdrase inhibitors
What effect do TZDs have with loop diuretics?
They lower the dose needed of loop
When edema is present which diuretic is indicated?
Aldosterone receptor antagonists
Which patients should use caution with TZDs
Renal function, electrolyte abnormalities, volume depletion, elderly, seizures, diabetes, gout, and pancreatitis
What does TZDs do to uric acid
They increase the excretion of uric acid
When are TZDs contraindicated in pregnancy
During the last trimester, and people with reduced placental perfusion like pre eclampsia or intrauterine growth retardation
What are the best diuretics to use in patients with poor renal function
Loop
How do loop diuretics work
Inhibit sodium potassium chloride pump in the ascending loop of henle
What do loop diuretics decrease
HCO3 and urate excretion, calcium and magnesium , potassium, sodium, and chloride
When are loop diuretics most commonly used
Pulmonary edema, hyperkalemia, chronic HF, HTN, and emergent hypercalcemia
What are the AEs of loop diuretics
Low electrolytes, metabolic alkalosis, ototoxicity, hypovolemia, gout
When are loop contraindicated
Sulfa allergy, Anuria, hepatic coma, severe electrolyte depletion
Which loop causes the worst ototoxicity
Ethycrinic acid
What effects and reduces all Diuretics
NSAIDs
What are the aldasetrone antagonists/ potassium sparing diuretics
Spironolactone, eplerenone, triathlete, amiloride
Where do potassium sparing diuretics work
Collecting tubule
How do potassium sparing work
They compete with aldosterone receptors and reduce sodium absorption and secretion of potassium
How is eplerenone different than spironolactone
It does not have the adverse effects of gynocomastia and impotence. It’s used with ACE or ARB in HF
How does amiloride differ from other potassium sparing
More potent and less toxic
Patients with a hypersensitivity to anuria should avoid what class of diuretics
Potassium sparing
How does the carbonic anhydrase inhibitor acetazolamide work
Acts at the proximal tubule and secondarily at the collecting duct
Which diuretic is also used as a sulfonamide antibiotic
Carbonic anhydrase inhibitor acetazoamide
When is acetazolamide used other than diuresis
Glaucoma, metabolic acidosis. Elevation sickness, and adjuvant in seizure disorders
When is acetazolamide contraindicated
Hepatic cirrhosis and sulfa allergy
What can mannitol be used for
Oliguria, elevated intraoccular pressure, elevated ICF, peripheral edema, forced diuresis
How do osmotic diuretics work
Elevate GFR and increase urinary output
When are osmotic diuretics contraindicated
Renal disease, dehydration, active intracranial bleeding, pulmonary edema
What a diuretic class acts on the thick, ascending limb
Loop
Which direct class acts on the distal ambulated tubule
TZD
What diuertic class acts on the cortical collecting tube?
Potassium sparing
At what site do carbonic anhydrase inhibitors act
Proximal convoluted tubule
Which class of diuretics are the most effective?
Loop diuretics, but they also caused the most electrolyte imbalances
What diuretic should you monitor blood sugar with regularly?
TZD
