Kidney-Diuretics Flashcards
Which drugs target the PCT? Which are sulfa drugs?
Acetazolamide-carbonic anhydrase inhibitor
**sulfa drug
Mannitol-osmotic diuretic
What does acetazolamide do to the blood chem?
Increases Urinary K+ excretion
metabolic acidosis
DOES NOT cause increase in NaCl excretion
**hyperchloremic metabolic acidosis
What does mannitol do to blood chem?
Increases NaCl urinary excretion
increases urinary K+ excretion
What are the indications for acetazolamide?
glaucoma urinary alkalinization metabolic alkalosis altitude sickness (resp alkalosis) pseudotumor cerebri
What are the side effects of acetazolamide?
hyperchloremic metabolic acidosis
paresthesias
NH3 toxicity
sulfa allergy
What is the MOA of mannitol?
osmotic diuretic inhibits H2O reabsorption causes excretion of H2O increases serum osmolarity increases serum Na+
What is the indication for mannitol?
drug OD
elevated intracranial or intraocular pressure
acute closed angle glaucoma
What are the SE of mannitol?
contraindicated in anuria, CHF
can cause pulmonary edema, dehydration
What are the loop diuretics? Which are sulfa drugs?
furosemide
torsemide
bumetanide
ethacrynic acid (only non-sulfa)
What is the MOA of the loop diuretics?
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++.
What is the clinical use for loop diuretics?
Edema (CHF, cirrhosis, nephrotic syndrome, pulmonary edema).
Less often HTN
Hypercalcemia
What are the SE of loop diuretics?
OH DANG Ototoxicity Hypokalemia Dehydration Allergy (sulfa) Nephritis Gout (inhibits uric acid excretion)
Which drugs make you worried about ototoxicity?
aminoglycosides
vancomycin
loop diuretics
What are the thiazide diuretics? Where do they act? MOA?
chlorthalidone HCTZ metalozone DCT, inhibit NaCl reabsorption Decrease Ca++ excretion. Thiazides retain calcium.
What are the indications for thiazide diuretics?
HTN CHF (usu loop first) idiopathic hypercalciuria (but not w/ hypercalcemia) nephrogenic Diabetes Insipidius Osteoporosis (b/c retain Ca++)
What are the SE of thiazide diuretics?
HyperGLUC hypokalemic metabolic alkalosis w/ hyponatremia hyperglycemia hyperlipidemia hyperuricemia hypercalcemia **think about sulfa allergy
What do loop and thiazide diuretics do to the blood chem?
Loop: increase urinary NaCl and K+ Metabolic alkalosis (via hypochloremia)
Thiazide: increase urinary NaCl & K+ metabolic alkalosis via hypochloremia. Also get hyponatremia.
What are the SE of K+ sparing diuretics?
hyperkalemia (can lead to arrhythmias)
Spironolactone only-endocrine effects–gynecomastia, anti androgen, anti-progesterone-menstrual irregularity
Why does eplerenone not have the anti-androgen effects?
b/c it mainly just binds to mineral corticoid receptors
Which indications for spironolactone take advantage of its anti-androgen effects?
PCOS
acne
Which diuretics do you use in the case of CHF?
if volume overload. Strong effect: loop. Less effect: thiazide.
+ K-sparing to prevent hypokalemia
Which drugs are used in CHF patients to decrease mortality?
beta blocker
ACE inhibitor or ARB
aldosterone antagonists
strong diuretic if a lot of fluid retention
What do K+-sparing diuretics do to blood chem?
increase in NaCl in urine
do NOT increase K+ in urine
cause metabolic acidosis
Which diuretic do you use w/ acute pulmonary edema?
loop
Which diuretic do you use w/ glaucoma?
acetazolamide, mannitol
Which diuretic do you use w/ edema associated w/ nephrotic syndrome?
loop
