Kidney-Diuretics

Question 1

Which drugs target the PCT? Which are sulfa drugs?

Answer 1

Acetazolamide-carbonic anhydrase inhibitor
**sulfa drug

Mannitol-osmotic diuretic

Question 2

What does acetazolamide do to the blood chem?

Answer 2

Increases Urinary K+ excretion
metabolic acidosis
DOES NOT cause increase in NaCl excretion
**hyperchloremic metabolic acidosis

Question 3

What does mannitol do to blood chem?

Answer 3

Increases NaCl urinary excretion

increases urinary K+ excretion

Question 4

What are the indications for acetazolamide?

Answer 4

glaucoma
urinary alkalinization
metabolic alkalosis
altitude sickness (resp alkalosis)
pseudotumor cerebri

Question 5

What are the side effects of acetazolamide?

Answer 5

hyperchloremic metabolic acidosis
paresthesias
NH3 toxicity
sulfa allergy

Question 6

What is the MOA of mannitol?

Answer 6

osmotic diuretic
inhibits H2O reabsorption
causes excretion of H2O
increases serum osmolarity
increases serum Na+

Question 7

What is the indication for mannitol?

Answer 7

drug OD
elevated intracranial or intraocular pressure
acute closed angle glaucoma

Question 8

What are the SE of mannitol?

Answer 8

contraindicated in anuria, CHF

can cause pulmonary edema, dehydration

Question 9

What are the loop diuretics? Which are sulfa drugs?

Answer 9

furosemide
torsemide
bumetanide
ethacrynic acid (only non-sulfa)

Question 10

What is the MOA of the loop diuretics?

Answer 10

inhibit Na+/2Cl-/K+ cotransport
cause dilute urine b/c they abolish the hypertonicity of the medulla
also stimulate PGE release and dilate the afferent arteriole
cause Ca++ excrétion. Loops lose Ca++.

Question 11

What is the clinical use for loop diuretics?

Answer 11

Edema (CHF, cirrhosis, nephrotic syndrome, pulmonary edema).
Less often HTN
Hypercalcemia

Question 12

What are the SE of loop diuretics?

Answer 12

OH DANG
Ototoxicity
Hypokalemia
Dehydration
Allergy (sulfa)
Nephritis
Gout (inhibits uric acid excretion)

Question 13

Which drugs make you worried about ototoxicity?

Answer 13

aminoglycosides
vancomycin
loop diuretics

Question 14

What are the thiazide diuretics? Where do they act? MOA?

Answer 14

chlorthalidone
HCTZ
metalozone
DCT, inhibit NaCl reabsorption
Decrease Ca++ excretion. Thiazides retain calcium.

Question 15

What are the indications for thiazide diuretics?

Answer 15

HTN
CHF (usu loop first)
idiopathic hypercalciuria (but not w/ hypercalcemia)
nephrogenic Diabetes Insipidius
Osteoporosis (b/c retain Ca++)

Question 16

What are the SE of thiazide diuretics?

Answer 16

HyperGLUC
hypokalemic metabolic alkalosis w/ hyponatremia
hyperglycemia
hyperlipidemia
hyperuricemia
hypercalcemia
**think about sulfa allergy

Question 17

What do loop and thiazide diuretics do to the blood chem?

Answer 17

Loop: increase urinary NaCl and K+
Metabolic alkalosis (via hypochloremia)

Thiazide: increase urinary NaCl & K+ metabolic alkalosis via hypochloremia. Also get hyponatremia.

Question 18

What are the SE of K+ sparing diuretics?

Answer 18

hyperkalemia (can lead to arrhythmias)

Spironolactone only-endocrine effects–gynecomastia, anti androgen, anti-progesterone-menstrual irregularity

Question 19

Why does eplerenone not have the anti-androgen effects?

Answer 19

b/c it mainly just binds to mineral corticoid receptors

Question 20

Which indications for spironolactone take advantage of its anti-androgen effects?

Answer 20

PCOS

acne

Question 21

Which diuretics do you use in the case of CHF?

Answer 21

if volume overload. Strong effect: loop. Less effect: thiazide.
+ K-sparing to prevent hypokalemia

Question 22

Which drugs are used in CHF patients to decrease mortality?

Answer 22

beta blocker
ACE inhibitor or ARB
aldosterone antagonists
strong diuretic if a lot of fluid retention

Question 23

What do K+-sparing diuretics do to blood chem?

Answer 23

increase in NaCl in urine
do NOT increase K+ in urine
cause metabolic acidosis

Question 24

Which diuretic do you use w/ acute pulmonary edema?

Answer 24

loop

Question 25

Which diuretic do you use w/ glaucoma?

Answer 25

acetazolamide, mannitol

Question 26

Which diuretic do you use w/ edema associated w/ nephrotic syndrome?

Answer 26

loop