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Pharm II > Exam 2 - Diuretics > Flashcards

Exam 2 - Diuretics Flashcards

1
Q

The following medications belong to what class of diuretics?

  • Acetazolamide
  • Dorzolamide
  • Brinzolamide
A

Carbonic Anhydrase Inhibitors

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2
Q

What is the MOA of Carbonic Anhydrase Inhibitors?

A
  1. Inhibits CA enzyme in the proximal tubule
  2. Blocks the production of H2CO3
  3. Decreases the amount of H+ available (due to no H2CO3) to exchange with Na+, resulting in increased Na+ and H2O loss
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3
Q

What are some indications for use of Carbonic Anhydrase Inhibitors?

A
  • Glaucoma
  • Alkalinization of urine
  • Alkalosis
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4
Q

What are some adverse effects of Carbonic Anhydrase Inhibitors?

A
  • Hyperchloremic metabolic acidosis (Na+ loss is in the form of NaHCO3, not NaCl)
  • Hypokalemia (more Na+ in lumen –> increased Na+/K+ exchange)
  • Hyperuricemia (compete for uric acid excretion)
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5
Q

What are some contraindications for Carbonic Anhydrase Inhibitors?

A
  • Hepatic cirrhosis

- Sulfa hypersensitivity

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6
Q

What are examples of Loop Diuretics?

A
  • Furosemide (Lasix)

- Ethacrynic Acid

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7
Q

What is the MOA of Loop Diuretics?

A
  • Block the NKCC2 transporter which reduces the renal medulla concentration gradient and leads to impaired function in concentrating/diluting (Na+, K+, and Cl- remain outside the cell and in the lumen)
  • Induces kidney PGs which decreases salt transport and cause vasodilation
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8
Q

What is the most powerful class of diuretics?

A

Loop Diuretics

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9
Q

What are indications for using a Loop Diuretic?

A
  • HF
  • Pulmonary edema (relieves congestion by increasing systemic venous capacitance)
  • Hypercalcemia (loops decrease the reabsorption of Mg and Ca by reducing K+ gradient which is needed to drive Mg/Ca reabsorption)
  • Low GFR
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10
Q

What are some adverse effects from Loop Diuretics?

A
  • Hypokalemic metabolic acidosis (K+ still being exchanged/loss for Na+ via the Na-K+ pump, but no K+ is coming back into the cell due to the inhibited NKCC2)
  • Hypocalcemia and hypomagnesemia (Mg/Ca reabsorption are reduced as this is driven by an increased K+ concentration)
  • Hyperuricemia
  • Irreversible ototoxicity (ethacrynic acid is worse; all worse when given with aminoglycosides)
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11
Q

What are some contraindications to Loop Diuretics?

A
  • Sulfa hypersensitivity (except ethacrynic acid)
  • Drug interactions with aminoglycosides, Lithium, Digoxin
  • Overuse in those with cirrhosis, borderline renal failure, HF
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12
Q

Which loop diuretic has the highest risk of ototoxicity?

A

Ethacrynic acid

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13
Q

When would you give Ethacrynic acid over Furosemide?

A

If patient has a sulfa allergy

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14
Q

The following medications belong to what class of diuretics?

  • Hydrochlorothiazide
  • Metolazone
  • Indapamide
A

Thiazide Diuretics

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15
Q

What is the MOA of Thiazide Diuretics?

A
  • Inhibition of sodium reabsorption at the early distal tubule via inhibiting the Na+, Cl- co-transporter
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16
Q

What are some indications/therapeutic effects of Thiazide Diuretics?

A
  • HTN (one of recommended initial drugs)
  • HF
  • Lower BP and enhance antihypertensive action of other drugs
  • Nephrolithiasis (removes calcium from the tubules)
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17
Q

What makes Indapamide different from the other Thiazide Diuretics?

A

Excreted by biliary system and is therefore useful is patients with renal insufficiency

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18
Q

What are adverse effects of Thiazide Diuretics? (there are a lot)

A
  • Hypokalemic metabolic alkalosis (induce K+ and H+ loss at distal exchange sites for Na+; causes plasma volume contraction which stimulates aldosterone, further encouraging K+ loss)
  • Dizziness, leg cramps, weakness
  • Hyperuricemia (compete for uric acid excretion and may induce gouty attacks)
  • Hypomagnesemia (enhances Mg excretion)
  • Hyperglycemia (may decrease release of insulin and increase glucose intolerance)
  • Elevated serum lipid levels (due to decreased insulin levels - except Indapamide)
  • Lithium toxicity (clearance is reduced)
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19
Q

What are some contraindications/precautions of Thiazide Diuretics?

A
  • Sulfa allergy
  • Diabetics
  • Hypokalemia may precipitate digitalis toxicity in cirrhotic patients
  • Caution in those with hx of gout
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20
Q

What are three major differences associated with Indapamide compared to other Thiazide drugs?

A
  • Causes pronounced vasodilation
  • Does not increase plasma lipids
  • Metabolized in liver and kidney
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21
Q

What are the two classes of Potassium sparing diuretics?

A
  • Aldosterone antagonists (Spironolactone, Eplerenone)

- Direct inhibitors of Na+ flux (Amiloride, Triamterene)

22
Q

What is the MOA of Spironolactone and Eplerenone (Potassium sparing diuretics)?

A

1) Competitive inhibitor of aldosterone which causes the promotion of Na+ excretion and retention of K+
2) Less Na+ channels
3) Blocked Na+ conductance –> hyperpolarized cell –> decreased K+ excretion
4) Decreased Na+-K+-ATPase activity –> decreased K+ secretion and excretion

23
Q

What are indications/therapeutic effects of Spironolactone?

A
  • Edema associated wit HF, cirrhosis, and nephrotic syndrome
  • Hyperaldosteronism
  • Hirsutism (at high doses, can become an adrogen receptor antagonist)
24
Q

What are some adverse effects associated with Spironolactone?

A
  • GI upset, cramps, dizziness
  • Gynecomastia
  • Occasional hyperkalemia
25
Q

What are some contraindications/precautions for Spironolactone?

A
  • Hyperkalemia (burn patients)
  • Use caution with ACE or ARBs due to possible hyperkalemia
  • Chronic renal insufficiency
  • Liver damage
26
Q

What are some differences of Eplerenone when compared to Spironolactone?

A
  • Decreased incidence of endocrine related side effects due to decreased affinity for other steroid receptors
  • Metabolized by CYP3A4 leading to drug interactions
27
Q

What is the MOA for Amiloride and Triamterene (Potassium sparing diuretics)?

A

Inhibits the Na+/K+ ion exchange mechanism

1) Directly inhibits the aldosterone-sensitive Na+ channel
2) Leads to a decrease in K+ excretion

28
Q

What is the main use of Potassium sparing diuretics?

A

Combination with K+ losing diuretics

29
Q

What is the only class of diuretics that is not an acid and does not lead to hyperuricemia?

A

Potassium sparing diuretics

30
Q

What is the DOC for Li+-induced diabetes insipidus?

A

Amiloride (potassium sparing diuretics)

31
Q

What is a contraindication to using potassium sparing diuretics?

A

Hyperkalemia (burn patients)

32
Q

The following medications belong to what class of diuretics?

  • Mannitol
  • Isosorbide
  • Glycerin
  • Urea
A

Osmotic diuretics

33
Q

How are osmotic diuretics administered?

A

IV only

34
Q

What is the MOA for osmotic diuretics?

A

Keeps water in the tubules and produces water diuresis

35
Q

What are some indications/therapeutic effects of osmotic diuretics?

A
  • Prophylaxis of acute renal failure (keeps water moving through tubules)
  • Decrease intraocular pressure prior to eye surgery
  • Decrease intracranial pressure in brain edema
  • Protect kidney against nephrotoxic substances
36
Q

What are some adverse effects of osmotic diuretics?

A
  • HA, n/v/c, dizziness, polydipsia

- Extracellular volume expansion if excessive administration

37
Q

What are some contraindications to osmotic diuretics?

A

HF

38
Q

What drug is an example of an ADH agonist?

A

Desmopression

39
Q

What is the MOA for Desmopressin?

A
  • Synthetic ADH

- Activates V2 receptors and increases H2O absorption

40
Q

What is an indication for Desmopressin?

A

Central diabetes insipidus

41
Q

What is a adverse effect of Desmopressin?

A

Hyponatremia

42
Q

Conivaptan and Tolvaptan are associated with what class of diuretics?

A

ADH antagonists

43
Q

What is the MOA for Conivaptan?

A

Non-peptide V1a and V2 receptor antagonist (inhibits ADH)

44
Q

What are indications/therapeutic effects of Conivaptan?

A

Treatment of euvolemic or hypervolemic hyponatremia in hospitalized patients (SIADH)

(Increases Na+ concentrations by increasing H2O clearance/excretion)

45
Q

How is Conivaptan administered?

A

IV only

46
Q

What are some adverse effects of Conivaptan?

A
  • Hypokalemia
  • Injection site reactions
  • Hypotension
47
Q

What is a contraindication to Conivaptan?

A

Hyponatremia associated with hypovolemia

48
Q

How does Tolvaptan differ from Conivaptan?

A
  • Only V2 receptor antagonist
  • Administered orally
  • After initiation in the hospital, can be continued outpatient
49
Q

What are common diuretic combinations?

A
  • Loop and thiazides (may produce diuresis when none of them is effective alone)
  • Potassium sparing and loop OR thiazies (balance out potassium losses)
50
Q

What is the order of expected max diuretic effect?

A

Loop&raquo_space; Thiazides&raquo_space; CA Inhibitors&raquo_space; K+ sparing

51
Q

What is the most effective drug for treating hyperaldosteronism?

A

Spironlactone (Aldosterone Antagonist)

Pharm II (10 decks)

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