Loop and Thiazide Diuretics Flashcards
Half lives
All short
Site and mech (loop)
Must first be secreted in the proximal tubule
Then block the Na, K, Cl synporter in the TALH
Decrease in reabsorptiion of Mg and Ca
Effects on renal function (loop)
Profound diuretic effect
Significant loss of Na and K and some loss of Ca and Mg
Therapeutic uses of loops
Renal failure, asictes, neprhotic syndrome, Pulm edema, and HF for removal of edematous fluid
Can also be used to tx hypercalcemia and 2nd line for HTN
Side effects and toxocity of loops
Hypotension and volume depletion
Hyponatremia, kalemia, and calcemia
Drug interactions of loops
Ototoxicyt
Aminoglycoside, vancomycin or cisplatin are also ototoxic so do not prescribe together
Thiazide half lives
Chlorthalidone has much longer half life than HCTZ
Site and mech of thiazides
Seceeted into tubular fluid by proximal cells
Act on DCT and block Na Cl symporter on luminal membrane
thiazide effect on renal function
Na and Cl excretion enhanced
Diuresis is modest
Hypokalemia
Uses of Thiazides
1st line for HTN
Reduce plasma volume to produce hypotension
Long term use associated with decreased in peripheral vascular resistance
Can be used alone or with others
Side effect and toxicities of thiazxide
Hypotension and volume depletion (not as bad as loops) and impotence
Loop AND thiazide side effects
HS reactions due to similarity to sulfonamides
Hypokalemia (arrythemias)
Hyperuricemia - secretion of uric acid reduced so gout drugs have decreased efficacy
Drug interactions to both Loop and Thiazides
NSAIDs can blunt
Increase in lithium blood levels increase likelihood of lithium toxicity
Causes of diuretic induced hypokalemia
Increase N adelivery to collecting duct which increases K secretion
Metabolic effects of thiazide and loops
Hyperglycemia and decrease in glucose tol
Increased tirglyceride, cholesterol (LDL)
Decreased HDL
