Loop diuretics Flashcards
Osmotic diuretic
Mannitol
Clinical use of mannitol
Drug overdose, elevated intracranial/intraocular pressure
Toxicity of mannitol
Pulmonary edema, dehydration
Contraindications of mannitol
Anuria, HF
CA inhibitor in proximal tubule
Acetazolamide
Effect of acetazolamide on HCO3- stores
Self-limited HCO3- diuresis, decrease in total body stores. Is unable to leave tubule (can’t be converted)
Use for acetazolamide
Glaucoma, urinary alkalinization, metabolic alkalosis, altitude sickness, pseudotumor cerebri
Acetazolamide toxicity
Hyperchloremic metabolic acidosis, paresthesias, NH3 toxicity, sulfa allergy
Loop diuretics
Furosemide, bumetanide, torsemide, ethacrynic acid
Sulfa loop diuretics
Furosemide, bumetanide, torsemide
Loop diuretic, NOT a sulfa
Ethacrynic acid
MOA of loop diuretics
Inhibition of NKCC transport system (thick ascending loop of Henle). Prevents concentration of urine
Effect of loop diuretics on Ca2+ conc.
Increases calcium excretion.
Loops LOSE Ca2+.
Inhibitor of loop diuretics
NSAIDs
Clinical use of loop diuretics
Edematous states (HF, cirrhosis, nephrotic syndrome, pulm edema), HTN, hypercalcemia
Clinical use of ethacrynic acid
Diuresis in pts with sulfa allergies
Toxicity of loop diuretics
OH DANG
Ototoxicity, hypokalemia, dehydration, allergy, nephritis, gout
Thiazide diuretics (examples)
Chlorthalidone, HCTZ
MOA of thiazide diuretics
Inhibit NaCl reabsorption in early DCT, decreasing diluting capacity of nephron. Decreases Ca2+ excretion.
Site of thiazide action
Distal tubule
Clinical use of thaizides
HTN, HF, idiopathic hypercalciuria, nephrogenic diabetes insipidus, osteoporosis
Don’t use with renal insufficiency
Toxicity of thiazides
sulfa allergy; HyperGLUC hyponatremia, hyperGlycemis hyperLipidemia hyperUricemia hyperCalcemia
K+ sparing diuretics (examples)
Spironolactone/eplerenone
Triamterene
Amiloride
K+ STAys
K+ sparing MOA
-one blocks aldosterone binding
Spironolactone/eplerenone thus increase Na+ and H2O excretion
Triamterene and amiloride act in corticol collecting tubule by blocking Na+ channels in cortical collecting tubule
Use of K+ sparing agents
Hyperaldosteronism, K+ depletion, HF
Toxicity of K+ sparing agents
Hyperkalemia (arrhythmias)
spironolactone causing endocrine effects
Main overarching fxn of diuretics
Reduce volume by increasing Na+ and Cl- excretion
Water permeable limb of the Loop of Henle
Thin descending limb
ADH antagonists (name)
Demeclocycline, lithium, tolvaptan, conivaptan, mozavaptan
Proximal tubule CA inhibitors
Acetazolamide, dichlorphenamide, methazolamide,
dorzolamid
Use of metolazone
Strongest inhibitor of Na+ and water reabsorption within thiazide class. May be used in renal insufficiency. Can also be used in combination with a loop diuretic.
