L12- Diuretics Flashcards
PCT has (high/low) water permeability and (2) are the main drug targets / transporters
1- very high
2- Na+/H+ (NHE3), carbonic anhydrase, acid/base transporters
thin descending loop of Henle has (high/low) water permeability and (2) are the main drug targets / transporters
1- high
2- aquaporins
thick ascending loop of Henle has (high/low) water permeability and (2) are the main drug targets / transporters
1- very low
2- Na+/K+/2Cl- symporter (NKCC2)
DCT has (high/low) water permeability and (2) are the main drug targets / transporters
1- very low
2- Na+/Cl- (NCC)
CT has (high/low) water permeability and (2) are the main drug targets / transporters
1- variable
2- ENaC, K+ channels, H+ transporters, aquaporins
In an edematous state there is (inc/dec) NaCl reabsorption, which leads to (2) and (3). Examples that cause this include the following: (4).
1- inc NaCl
2- H2O retention
3- inc blood volume
4- HF, hepatic ascites, nephrotic syndrome, premenstrual edema
list some examples of non-edematous states where diuretics may be required
- HTN
- hypercalcemia
- diabeted insipidus
define natriuretics and the 2 main clinical uses
-inhibits renal ion transported to dec Na+ reabsorption at different sites in the nephron
i) manage abnormal fluid retention (edema)
ii) treat HTN by reducing blood volume
Loop diuretics target (1) part of the nephron, acting on (2) transporter, to have (3) results.
(furosemide)
1- thick ascending LoH
2- inhibit NKCC2 (Na+/K+/2Cl- co-transporter)
3- inc Na, K, Cl in tubular lumen –> inc H2O excretion
Loop diuretic uses
(furosemide)
- manages edema in HF, hepatic/renal disease
- moderate-severe HTN
Loop-diuretic effects on:
(1) [Ca2+]
(2) [Mg2+]
(3) PGs
(4) renal vascular resistance
(5) renal blood flow
(furosemide) 1- inc Ca excretion 2- inc Mg excretion 3- inc PG synthesis 4- dec resistance 5- inc RBF
Loop diuretics are given in (1) fashion and have a (2) half-life
(furosemide)
1- orally, paraenterally
2- 2-4 hrs
loop diuretics have the following adverse effects
(furosemide)
- ototoxicity
- hyperuricemia
- acute hypovolemia
- hypokalemia
- hypomagnesemia
- allergic reactions
Loop Diuretics:
(1) dec urinary excretion of….
(2) inc urinary excretion of….
(furosemide)
1- dec uric acid excretion
2- inc Na, K, Mg, Ca, urine volume excretion
Thiazides target (1) part of the nephron, acting on (2) transporter, to have (3) results.
1- DCT
2- inhibits NCCT (Na+/Cl- co-transporter)
3- inc Na, Cl in tubular lumen –> inc H2O excretion
Thiazide uses (hint: 5)
- HTN (alone or in combination)
- HF (mild-moderate)
- hypercalciuria (inhibits Ca excretion, used for kidney stones)
- Diabetes Insipidus (=> hyperosmolar urine)
- premenstrual edema
Thiazide effects on:
(1) [K+]
(2) [Mg2+]
(3) [Na+ / Cl-]
(4) [Ca+]
(5) PVR
1- inc K excretion 2- inc Mg excretion 3- inc Na/Cl excretion 4- dec Ca excretion 5- dec peripheral vascular resistance (dec blood volume- which will recover although hypotensive effects remain)
Thiazides are given in (1) fashion and have a (2) half-life
1- orally
2- 40 hrs (1-3 wks for stable effects)
list the thiazides
- HCTZ
- Chlorthalidone
- Metolazone
thiazides should replace loop-diuretics in the what condition
moderate to severe CKD (GFR < 30 mL/min)
(1) thiazide has the longest duration of action
(2) is the most potent thiazide
1- chlorthalidone (40-60 hr half life, used qd for HTN)
2- metolazone (–> Na excretion in advance of kidney failure)
thiazides have the following adverse effects
- hypokalemia, hyponatremia
- hyperuricemia, hyperglycemia, hyperlipidemia
- hypersensitivity
- sexual dysfunction
Thiazides:
(1) dec urinary excretion of….
(2) inc urinary excretion of….
1- dec uric acid, Ca excretion
2- inc K, Na, Mg, urine volume excretion
list the K+-sparing diuretics (include categories)
Aldosterone antagonists: Spironolactone, Eplerenone
Na+ channel inhibitors: Triamteren, Amiloride
