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SEM3: CLIP30230 GI/GU Therapeutics > L15 Hypervolemia and Edematous States > Flashcards

L15 Hypervolemia and Edematous States Flashcards

1
Q

Natriuresis vs. Diuresis

A

Natriuresis: Sodium Excretion

Diuresis: Water excretion

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2
Q

Loop Diuretics/MOA/Indications?

A

Furosemide (Lasix), Bumetanide, Ethacrynic acid, Torsemide

MOA: Na+/K+/2Cl-symporter inhibition in thick ascending loop

Main Indications
SEVERE Edematous states (Major Use of Loop Diuretics)
Hypercalcemia: Loop diuretics Increase calcium excretion

Other Indications
Hyperkalemia: Helps manage hyperkalemia in kidney failure
Hyponatremia

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3
Q

Pharmacodynamics of Loop Diuretics

A

Maximum antagonization is ~25% as that is the maximum amount of Na+ reabsorbed in Thick Ascending Loop

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4
Q

Loop Diuretic Drugs/Pharmacodynamics/Side Effects?

A

Bumetanide: More reliable oral absorption than Furosemide

Torsemide: Even more reliable in its absorption, occasionally used in heart failure pts

Ethacrynic Acid: RARELY Used due to ototoxicity, only used in cases of Sulphatoxicity towards other diuretics

Adverse Effects
○ Hypovolemia
○ Electrolyte depletion
○ Hyperuricemia (High Uric Acid in Blood, can worsen GOUT)
○ Metabolic Alkalosis
○ Sulfonamide Allergy: Ethacrynic Acid used in this case
○ Ototoxicity

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5
Q

Thiazide Diuretics/MOA/Indications?

A

Chlorothiazide, Indapamide, Metolazone

MOA
Blocks Na/Cl Cotransporter in distal convoluted tubule
Increases calcium retention (OPPOSITE of Loop)

Indications
Hypertension (Major use of Thiazides)

Minor Edematous states

Hypercalciuria (nephrolithiasis): Increases calcium back into the system, decreasing calcium in urine preventing stone formation

Nephrogenic Diabetes Insipidus: Increase in urine output due to problems with water absorption (Issue w/ ADH production/Action)

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6
Q

Thiazide Diuretic Drugs/Pharmacodynamics/Side Effects

A

Chlorothiazide: longer half-life, available IV and orally

Indapamide: Fewer metabolic Side effects

Metolazone: used in edematous patients in tandem w/ loop diuretics

Adverse Effects
○ Hypovolemia (WORSE than loop agents)
○ Electrolyte depletion (Hypokalemia, hypomagnesemia, hyponatremia (> loop agents))
○ Metabolic Effects (Glucose Intolerance, Hyperlipidemia)
○ Hyperuricemia
○ Hypercalcemia
○ Impotence
○ Sulfonamide Allergy

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7
Q

Diuretics Used in Sulfonamide Allergies?

A

Thiazide Diuretics (Chlorothiazide, Indapamide, Metolazone)

Ethacrynic Acid (No Other Loops)

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8
Q

Loop Diuretics vs. Thiazide Diurectics on calcium excretion?

A

Loop: Increases calcium excretion

Thiazide: Increases calcium retention=> Hypercalcemia

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9
Q

Potassium-Sparing Diuretics/MOA/Indications/Side Effects?

A

MOA:
Spironolactone/Eplenerone: Aldosterone antagonist

Amiloride: Principal cell Na+ channel blockade

Triamterene :Principal cell Na+ channel blockade

Indications:
Diuresis while preventing or Treatment of Hypokalemia: all

Treatment of edematous states (CHF, Cirrhosis): Spironolactone/Eplenerone (Aldosterone antagonists)

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10
Q

Side Effects of Potassium Sparing Diuretic?

A

Side Effects
Hyperkalemia: Interaction with ACE inhibitors, ARBs

Spironolactone: Gynecomastia, impotence, menstrual effects, Metabolic acidosis

Eplerenone: Newer aldosterone antagonist, fewer SEs, improves CHF survival

Triamterene: Renal stones

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11
Q

What should be blocked for the most profound diuresis?

A

FOR MOST PROFOUND DIURESIS BLOCK PROXIMAL TUBULE
(65% of Na Reabsorption)

Carbonic Anhydrase Inhibitors (Acetazolamide)

Osmotic Diuretics (Mannitol)

Sodium/Glucose (SGLT2) Inhibitors (Flozins)

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12
Q

Indications/Side effects of Mannitol?

A

Osmotic diuretic
Administered intravenously (EMERGENCY DRUG)

Indications
raised intracranial pressure
acute glaucoma
Flush away harmful substances due to Renal transplant, rhabdomyolysis

Adverse Effects
pulmonary edema
hyperosmolality
Volume/electrolyte depletion
AKI (“osmotic nephrosis”)

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13
Q

Indications for Acetazolamide?

A

Carbonic anhydrase inhibitor (FeNa <5%)

Indications
glaucoma
metabolic alkalosis with volume overload

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14
Q

Causes of Diuretic Resistance?

A

Kidney failure patients require HIGHER doses of diuretics to achieve the same effect

Nephrotic Syndrome (excessive protein excretion in urine): Low albumin in the blood =>Diuretics not effective as albumin in urine binds to diuretic limiting its effectiveness => Edema

ACEI/ARB => ↓proteinuria

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15
Q

Potency of Diuretics?

A

Loop diuretics MORE POTENT continue to increase with increased dose (Suitable for concerning Pulmonary edema)

Thiazides less potent, max out sooner

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16
Q

Consequence of Nephron Remodeling?

A

Remodeling degrades the effectiveness of loop diuretics => resistance

Loop PLUS Thiazides more effective (Diuretic Synergy)

17
Q

Recommended delivery of Loop/Thiazide Diuretics?

A

Diuretic Synergy: Loop PLUS Thiazides more effective

18
Q

Diuretics acting on the proximal tubule?

A

Carbonic Anhydrase Inhibitors (Acetazolamide)
Osmotic Diuretics (Mannitol)
Sodium/Glucose (SGLT2) Inhibitors (Flozins)

19
Q

Diuretics acting on the thin descending/ascending limb?

A

Osmotic Diuretics (Mannitol)

20
Q

Diuretics acting on the thick ascending limb?

A

Loop Diuretics (Furosemide (Lasix), Bumetanide, Ethacrynic acid, Torsemide)

Na+/K+/2Cl-symporter inhibition in thick ascending loop

21
Q

Diuretics acting on the distal convoluted limb?

A

Thiazide Diuretics (Chlorothiazide, Indapamide, Metolazone): Block Na/Cl Cotransporter increasing calcium retention

Potassium-Sparing Diuretics (Amiloride/ Triamterene): Principal cell Na+ channel (ENaC) blockade

22
Q

Diuretics acting on the Cortical Collecting Ducts?

A

K+ Sparing Diuretics
Spironolactone/Eplenerone: Aldosterone antagonist
Amiloride/Triamterene: Principal cell ENaC blockade

23
Q

Diuretics acting on the medullary collecting tubule?

A

Vasopressin (ADH) Antagonists: Aquaretics (-Vaptins)

24
Q

Diuretic indicated for Volume Overload?

A

Loop > Thiazides

25
Q

Diuretic indicated for Hypertension?

A

Thiazides > Loop

26
Q

Diuretic indicated for Hypokalemia

A

K-Sparing

27
Q

Diuretic indicated for Hyperkalemia?

A

Loop

28
Q

Diuretic indicated for Cerebral edema, Acute Glaucoma?

A

Mannitol

29
Q

Diuretic indicated for Hypercalcemia?

A

Loop

30
Q

Diuretic indicated for Calcium kidney stones?

A

Thiazides

31
Q

Diuretic indicated for Hyponatremia?

A

Loop

32
Q

Diuretic indicated for Metabolic alkalosis?

A

Carbonic Anhydrase Inhibitors

SEM3: CLIP30230 GI/GU Therapeutics (19 decks)

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