Pharm - Diuretics Flashcards

1
Q

Mannitol

A

Sketchy: Tall man

MOA:
Osmotic diuretic

USES:

  • Drug Overdose
  • Reduction of elevated intracranial pressure
  • Reduction of intraocular pressure

ADVERSE EFFECTS:
Pulmonary edema
Dehydration
Contraindicated in heart failure

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2
Q

Acetazolamide

A

Sketchy: race car track

MOA:
Inhibits carbonic anhydrase (CA) at the proximal tubule (Recall: Na+/H+ exchanger will excrete H+ into lumen to combine with HCO3- to produce H2CO3, which can be broken down by CA into H2O and CO2 and reabsorbed; Acetazolamide makes it so that HCO3- is stuck in the lumen so H+ cannot be recycled to be used again in the Na+/H+ exchanger)

EFFECTS:
Natriuresis
Diuresis

USES:

  • Glaucoma
  • Urinary alkalization (increased solubility of uric acid and cysteine - decreased stone formation in gout and cysteinuria)
  • Metabolic alkalosis (due to increased bicarb excretion)
  • Altitude sickness
  • Pseudotumor cerebri (idiopathic intracranial hypertension)

ADVERSE EFFECTS:

  • Renal tubular acidosis
  • Paresthesias
  • Sulfa allergy
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3
Q

Furosemide

A

Sketchy: furious kid in the roller coaster

MOA:
Inhibits Na+/K+/2Cl- (NKCC) cotransporter in the thick ascending loop

EFFECTS:

  • Decreases hypertonicity of medulla, preventing concentration of urine in the descending loop
  • Also induce the expression of COX-2, increasing PGE, causing vasodilation of afferent arteriole and enhancing diuretic action
  • Increase Ca2+ excretion (loss of the positive lumen potential which usually pushes Ca2+ and other cations out of the lumen and into the interstitium; positive potential usually caused by K+ being reabsorbed and then diffusing back into the lumen)

USES:

  • Edematous states (HF, cirrhosis, nephrotic syndrome, pulmonary edema)
  • HTN
  • Hypercalcemia

ADVERSE EFFECTS:

  • Hypokalemia (due to effects later on in nephron)
  • Dehydration
  • Sulfa allergy
  • Ototoxicity
  • Interstitial nephritis
  • Gout
  • Action of drug inhibited by NSAIDs
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4
Q

Ethacrynic acid

A

Sketchy: Ethics sign near roller coaster

MOA:
Non-sulfa inhibitor of Na+/K+/2Cl- cotransporter in the ascending loop

EFFECTS:

USES:
Diuretic effects in patients allergic to sulfa drugs

ADVERSE EFFECTS:

  • Hypokalemia (due to effects later on in nephron)
  • Dehydration
  • Sulfa allergy
  • Ototoxicity (worse than with Acetazolamide)
  • Gout
  • Action of drug inhibited by NSAIDs
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5
Q

Thiazides (Hydrochlorathiazide, Chlorthalidone, Metolazone)

A

Sketchy: pasty thighs

MOA:
Inhibits Na+/Cl- cotransporter in the early distal convoluted tubule

EFFECTS:

  • Decreased Na+ and Cl- absorption
  • Increased Ca2+ absorption (decreased intracellular Na+ will stimulate the basolateral Na+/Ca2+ exchanger, causing Ca2+ to be pushed into the interstitial space)

USES:

  • HTN
  • HF
  • Idiopathic hypercalciuria (prevention of calcium stone)
  • Nephrogenic DI
  • Osteoporosis (due to enhanced calcium reabsorption)
ADVERSE EFFECTS:
Hypokalemic metabolic acidosis
Hyponatremia
Hyperglycemia
Hyperlipidemia
Hyperuricemia (gout)
Hypercalcemia
Sulfa allergy
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6
Q

Spironolactone

A

Sketchy: inspector with spiral notebook

MOA:
K+ sparing duiretic; directly antagonizes mineralocorticoid receptor

EFFECTS:

  • Decreased activity of apical ENaC channel (decrease Na+ absorption)
  • Decreased activity of apical K+ channel (decreased K+ excretion)
  • Decreased activity of H+ ATPase in alpha-intercalated cell (decreased H+ excretion)

USES:

  • Hyperaldosteronism
  • Hypokalemia
  • HF
  • Hepatic ascites
  • Androgen excess in PCOS (spirinolactone blocks 17-a-hydroxylase)

ADVERSE EFFECTS:

  • Hyperkalemia (arrhythmias)
  • Gynecomastia (spirinolactone can antagonize androgen receptors)
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7
Q

Eplerenone

A

Sketchy: teacher with apple

MOA:
K+ sparing duiretic; directly antagonizes mineralocorticoid receptor

EFFECTS:

  • Decreased activity of apical ENaC channel (decrease Na+ absorption)
  • Decreased activity of apical K+ channel (decreased K+ excretion)
  • Decreased activity of H+ ATPase in alpha-intercalated cell (decreased H+ excretion)

USES:

  • Hyperaldosteronism
  • Hypokalemia
  • HF
  • Hepatic ascites

ADVERSE EFFECTS:
-Hyperkalemia (arrhythmias)

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8
Q

Triamterene

A

Sketchy: tangerine cart

MOA:
K+ sparing duiretic; Blocking of ENaC channel in the collecting duct

EFFECTS:
-Decreased activity of apical ENaC channel (decrease Na+ absorption)

USES:
-HF

ADVERSE EFFECTS:
-Hyperkalemia (arrhythmias)

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9
Q

Amiloride

A

Sketchy: almond cart

MOA:
K+ sparing duiretic; Blocking of ENaC channel in the collecting duct

EFFECTS:
-Decreased activity of apical ENaC channel (decrease Na+ absorption)

USES:

  • HF
  • Lithium-induced nephrogenic DI

ADVERSE EFFECTS:
-Hyperkalemia (arrhythmias)

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