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REGUB > L11: Diuretics > Flashcards

L11: Diuretics Flashcards

1
Q

What are the 2 main reasons that diuretics are used?

A
  1. Fluid Retention/Oedema

2. Hypertension

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2
Q

List from greatest to least - where the most sodium is reabsorbed and where the least sodium is reabsorbed in the nephron?

A
  1. Proximal Tubule
  2. Loop of Henle
  3. Distal Tubules
  4. Collecting Duct

As you go along, Na+ reabsorption decreases

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3
Q

List the 5 main classes of diuretic drugs

A
  1. Carbonic Anhydrase Inhibitors
  2. Loop Diuretics
  3. Thiazide Diuretics
  4. Potassium-Sparing Diuretics
  5. Osmotic Diuretics ac
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4
Q

What is Acetazolamide? What is the MOA?

A
  • carbonic anhydrase inhibitor
  • inhibits carbonic anhydrase enzyme (stops production of H+)
  • Na+/H+ exchanger in PCT interrupted (H+ usually excreted and Na+ reabsorbed)
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5
Q

Where in the nephron do carbonic anhydrase inhibitors work?

A

proximal convoluted tubule

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6
Q

Why do carbonic anhydrase inhibitors only have a weak effect/weak diuresis?

A
  • LOH reabsorbs a large amount of excess NaCL in tubular fluid
  • Na+ taken out of filtrate and back into blood
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7
Q

What are the 2 main uses (non-renal) of Acetazolamide?

A
  • Chronic Glaucoma

- Prophylaxis of Acute Mountain Sickness

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8
Q

What is glaucoma?

A
  • group of eye conditions that damage the optic nerve

- usually caused by high pressure in eye (e.g. excess aqueous humour)

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9
Q

What is another name for High-Ceiling Diuretics?

A

Loop Diuretics

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10
Q

What is the MOA of loop diuretics?

A
  • inhibit Na+/K+/2Cl- carrier in luminal membrane

- decreased reabsorption of Na+, K+ and Cl- from the filtrate into blood

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11
Q

Give examples of loop diuretics

A
  • Bumetanide

- Furosemide

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12
Q

What are the main 3 therapeutic uses of loop diuretics?

A
  1. Oedema
  2. Hypercalcaemia
  3. Reducing Intracranial Pressure
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13
Q

List the possible adverse effects of loop diuretics

A
  • Hypokalaemia
  • Hyponatraemia
  • Hypocalcaemia*
  • Acute Hypovolaemia
  • Hyperuricaemia
  • Hyperglycaemia
  • Ototoxicity (worsened with aminoglycoside antibiotics)
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14
Q

Which class of diuretics is the most effective?

A

Loop Diuretics

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15
Q

Where in the nephron do thiazide diuretics act?

A

distal tubule

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16
Q

Give some examples of thiazide diuretics

A
  • Chlorothiazide
  • Hydrochlorothiazide
  • Chlorothialidone
17
Q

What is the MOA of thiazide diuretics?

A
  • inhibit Na+/Cl- cotransporter

- stop reabsorption of both Na+ and Cl- from the tubular filtrate into the blood

18
Q

List the therapeutic uses of chlorothiazide diuretics [3]

A
  1. Hypertension (long-term management)
  2. Congestive Heart Failure
  3. Hypercalciuria (Ca2+ in urine)
19
Q

List the adverse/side effects of thiazide diuretics

A
  • Potassium Depletion (Hypokalaemia)
  • Hyponatraemia
  • Hyperuricaemia
  • Hypovolaemia
  • Hypercalcaemia*
  • Hyperglycaemia
  • Rare Hypersensitivity Rxn
20
Q

Which 2 classes of diuretics can lead to hypokalaemia (low K+ levels)?

A
  • loop diuretics

- thiazide diuretics

21
Q

Where in the nephron do potassium-sparing diuretics work?

A

distal tubule and collecting duct

22
Q

Give examples of potassium-sparing diuretics

A
  • Spironolactone
  • Triamterene
  • Amiloride
23
Q

What is the MOA of spironolactone?

A
  • synthetic aldosterone antagonist
  • competes w/ aldosterone
  • prevents Na+ reabsorption
  • prevents K+ excretion
24
Q

What are the 2 main uses of spironolactone?

A
  1. Diuretic - not efficient; used for retention of K+*

2. Secondary Hyperaldosteronism - fixes elevated levels of aldosterone

25
Q

What are the adverse/side effects of spironolactone?

A
  • hormonal activity (gynacomastia, menstrual irregularities)

- hyperkalaemia (nausea, lethargy + mental confusion)

26
Q

Spironolactone is a pro-drug. What is the active metabolite of spironolactone?

A

Canrenone

27
Q

Give 2 examples of osmotic diuretics

A
  • mannitol

- urea

28
Q

What is the MOA of osmotic diuretics?

A
  • pharmacologically inert substances
  • act directly
  • increase osmolarity of tubular filtrate
  • water remains in filtrate
  • increases urinary output w/ little Na+ excretion
29
Q

What are the main uses of osmotic diuretics? [2]

A
  • reduce intracranial pressure

- acute renal failure

30
Q

True or False: thiazide diuretics can cause hypocalcaemia

A

False

  • thiazide diuretics promote reabsorption of Ca2+
  • they can cause hypercalcaemia
31
Q

True or False: loop diuretics are used to treat hypocalcaemia

A

False

  • loop diuretics used to treat hypercalcaemia
  • stimulate tubular secretion of Ca2+
32
Q

Which diuretic can be used to treat hypercalciuria?

A

Thiazide Diuretics

- promote calcium reabsorption

REGUB (22 decks)

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