L55

Question 1

4 reasons to use acetazolamide

Answer 1

1. Glaucoma
2. Metabolic alkalosis
3. Altitude sickness
4. Periodic paralysis - hypo + hyperK

Question 2

4 SE of acetazolamide

Answer 2

Drowsiness
Dizziness
Headache
Fatigue

Question 3

Is the diuresis from mannitol water or osmotic?

Answer 3

Large vol WATER - ↓U Na

Osmotically active - don’t block specific ion transport channels

Question 4

3 reasons to use IV mannitol

Answer 4

1. ↓ICP
2. Forced diuresis - lose water
3. Free radical scavenger (rhabdo)

Question 5

SE of mannitol

Answer 5

Intravasc expansion - might increase ICP or worsen CHF/pulm edema before starts working… be careful

Question 6

What disease state induces an osmotic diuresis?

Answer 6

Diabetes
Excess glucose in urine -> diuresis
Why diabetics so thirsty!!

Question 7

Which diuretics are ceiling diuretics?

Answer 7

Loop: must achieve lower threshold [ ] to achieve diuresis

If increase drug dose above therapeutic window, no additional effects

Question 8

Type of diuresis caused by loop diuretics

Answer 8

Isosthenuric

Question 9

4 loop diuretics you need to know

Answer 9

Furosemide - variable oral availability, sulfa allergy, weak CA inhibitor (PCT), direct vasodilator
Torsemide - more avail but still sulfa allergy
Bumetanide “ “
Ethacrynic acid - no allergy and good avail but no one makes it

Question 10

4 uses for loop diuretics

Answer 10

1. Edema to due intravasc vol depletion: CHF, acute pulm cong, cirrhosis, nephrotic syndrome
2. HTN
3. ↑Ca
4. Forced diuresis

Question 11

5 SE of loops

Answer 11

1. Lose too much vol = intravasc vol depletion: circulatory collapse, ↑BUN
2. ↓K - arrhythmia
3. ↓Ca
4. ↓Mg
5. Ototox - blocks 2Cl/K/Na in the ear!

Question 12

U osm created by thiazides

Answer 12

Urine is either isotonic or hypertonic

Inhibits ability to produce a dilute urine

Question 13

Added benefits of thiazides

Answer 13

Direct vasodilator

Question 14

What drug do you use to treat nephrogenic diabetes insipidus (kidney doesn’t respond to ADH)?

Answer 14

Volume depletion inhibits polyuria
You’re wasting Na and thus water, as your body realizes your hypoNa, it starts to find ways to hold onto water in other ways

Question 15

2 thiazides you need to know

Answer 15

HCTZ - limit to vasodilation and diuretic effects

Metolazone - larger diuresis b/c also has sign prox tubular effects

Question 16

Which pts do you NEVER give thiazides to?

Answer 16

HypoNa

Also ineffective if GFR

Question 17

4 indications to give thiazides

Answer 17

1. HTN - 1st choice!!!
2. Edema
3. Nephro DI
4. Hyper-Ca-URIA aka ↑risk kidney stones - works by ↑volume of urine, more dilute

Question 18

SE of thiazides

Answer 18

HypoNa
HypoK
High cholesterol and diabetes - benefits out weigh risks
HyperCa
Hyper-uricemia
↑BUN

Question 19

Indication + 2 SEs for amiloride and triamterene

Answer 19

ENAC blockers
Use = ascites due to cirrhosis 
SE:
- Hyper K 
- Hypotension

Question 20

What do you add to HCTZ to prevent hypoK?

Answer 20

Triamterene = ENAC blocker

Question 21

3 indications for spironolactone

Answer 21

1. Cirrhosis (ascites)
2. CHF - SURVIVAL benefit proven
3. Hyperaldo

Question 22

SE spironolactone

Answer 22

HyperK
Hypotension
Gynecomastia + erectile dysfxn

Question 23

What is the theory for synergistic use of diuretics?

Answer 23

No benefit by using 2 of the same type
Use those that sequentially block the nephron
Ex:
- Loop + thiazide
- Loop + K sparing

Question 24

What organ is the primary target of toxicities due to diuretic therapy?

Answer 24

Kidney - b/c drugs really only build up in [ ] in the tubular fluid
Otherwise, vestibular fluid -> hearing SEs

Question 25

Why not use loop or thiazides w/ digitalis?

Answer 25

HypoK -> dig tox

Question 26

Why not use ACE inhibitors w/ K sparing?

Answer 26

HyperK -> arrhythmia

Question 27

Why not use NSAIDs w/ loop or thiazide?

Answer 27

↓Diuretic effect

Question 28

Why not use probenecid (gout) with loop or thiazide?

Answer 28

↓Diuretic effect

Question 29

Which diuretics are hugely salt wasting?

Answer 29

Most = thiazide

Large salt waste from loop and K