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Cardiovascular Module > Pharmacology Diuretics > Flashcards

Pharmacology Diuretics Flashcards

1
Q

Diuretic

A

Agent that increases urine volume

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2
Q

Natriuretic

A

Agent that increase renal sodium excretion

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3
Q

Aquaretic

A

Increases amount of solute free water in urine

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4
Q

Diuretics alter the excretion of …

A

Na+

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5
Q

Diuretics alter the handling of …

A 
K+
H+
Ca2+
Mg2+
Cl-
HCO3-
H2PO4-
Uric acid
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6
Q

Classes of diuretics

A

Carbonic anhydrase inhibitors

Osmotic diuretics

Loop diuretics

Thiazides and thiazide like diuretics

Potassium sparing diuretics

Adenosine A1 receptor antagonists

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7
Q

The high efficacy diuretics / high ceiling diuretics

A

Loop diuretics

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8
Q

Moderate efficacy diuretics / low ceiling effect

A

Thiazide and thiazide like diuretics

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9
Q

Low efficacy diuretics

A

K sparing and osmotic diuretics

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10
Q

What is filtered at the proximal tubule

A

66% Na+

85% NaHCO3

65% K+

60% water

Glucose

Amino acids

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11
Q

Are carbonic anhydrase inhibitors used a lot as diuretics ?

A

Rarely used as diuretics

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12
Q

Site of action of carbonic anhydrase inhibitors

A

Proximal tubule

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13
Q

Types of carbonic anhydrase inhibitors

A

Acetazolamide (diamox)

Methazolamide (glauctabs)

Dichlorphenamide (daranide)

Brinzolamide (azopt)

Dorzolamide (trusopt)

Ethoxzolamide (not used anymore)

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14
Q

MOA of carbonic anhydrase inhibitors

A

Na+ H+ antiporter => H+ goes to lumen in exchange of Na+

H+ reacts with HCO3- => H2CO3

Breakdown of H2CO3 to CO2 accelerated

CO2 gets fast into epithelial cell react with H2O to form H2CO3 by cytoplasmic CA

H2CO3 then form H+ and HCO3-

NaHCO3 transported into interstitial space
Water follows it

Cl trapped into lumen

So if enzyme altered , no réabsorption of water and NaHCO3
Chloride gets into blood and makes it acidic

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15
Q

When taking CA inhibitors , why is blood acidic and urine alkaline ?

A

Chloride gets into blood making it acidic

NaHCO3 and water accumulate In urine making it alkaline

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16
Q

Route of administration of CA inhibitors

A

Oral

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17
Q

Should you reduce Ca inhibitors in renal insufficiency ?

A

Yes because of excretion done by proximal tubule

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18
Q

How can CA inhibitors help with glaucoma

A

ÇA help form carbonate for aqueous humour which increases intra orbital pressure

So CA inhibitor can help reduce it and help in glaucoma

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19
Q

Topical CA anhydrase for glaucoma

A

Dorzolamide

Brinzolamide

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20
Q

Management of metabolic alkalosis using CA inhibitors

A

Acetazolamide can correct alkalosis as well as diuretics action in patients that require both

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21
Q

How can CA inhibitors help with acidic urine

A

Can alkalinate urine containing excess uric acids and cystine which can form stones

Should monitor closely pH because too much alkalinization can also cause stones

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22
Q

How can CA inhibitors help in acute mountain sickness

A

CA helps produce cerebral spinal fluid Which increases at high altitude

Giving CA inhibitors will decrease PH & CSF volume preventing risk of edema in the brain

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23
Q

Uses of CA inhibitors

A 
Glaucoma
Metabolic alkalosis 
Urine acidosis
Mountain sickness
Epilepsy
Cerebral spinal fluid leakage
Hyperphosphatemia
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24
Q

Side effects of CA iInhibitors

A

Hyperchloremic metabolic acidosis

Renal stones due to first for cheerio and hypercalciuria

Renal potassium wasting

Drowsiness paresthésia

Nervous system toxicity

Hypersensitivity reactions

25
Q

CA inhibitors contra indications

A

Not recommended in the first trimester of pregnancy because of teratogenic effects

Hepatic cirrhosis

26
Q

Osmotic diuretics

A

Glycerin (OSMOGLYN) oral topical

Isosorbide (ISMOTIC) oral

Mannitol (OSMITROL) IV

Urea (UREAPHIL) IV

27
Q

Sites of action of osmotic diuretics

A

Proximal tubule and descending limb of loop of Henle

28
Q

Mechanism of action of osmotic diuretics

A

Increase extracellular fluid volume
Decrease blood viscosity
Inhibits renin release by removing water from intracellular compartments

All of this increase the renal blood flow which removes sodium chloride and urea from the renal medulla

Decrease of medullary tenacity

Decrease in extraction of water from the distal tubule

Decrease reabsorption of sodium chlorate in the ascending limb

So Natriuresis and water diuresis

29
Q

Why is Mannitol only given through IV

A

Because when taken orally it can lead to diarrhea

30
Q

How is Manitol excreted

A

Glomerular filtration

So should ou athentikn when renal insufficiency

31
Q

Asthmatic diuretics toxicity

A

Risk of Franck Pulmonary Edema in Patients with heart failure or pulmonary congestion

Hypernatremia
dehydration

32
Q

Osmotic diuretics ContraIndication

A

Anuric patient due to renal disease

Patients who are unresponsive to test doses of the drugs

Patients with impaired liver function can’t take urea because of risk of Thrombosis

Patients with intracranial bleeding can’t take mannitol and urea

Hyperglycemia if patient takes glycerin

33
Q

Some uses of mannitol

A

Reduction of Cerebral edema during neurosurgery

Reduce intraocular pressure before glaucoma surgery
MEliminates ingested toxic substances

34
Q

Some uses of Glycerin

A

Reduce Corneal Edema

Reduce intraocular pressure and vitreous volume before ocular surgery

35
Q

Why is urea not use so much anymore

A

Bad taste and increased use of mannitol for same purposes

36
Q

Isosorbide use

A

Emergency treatment of acute angle closure glaucoma

37
Q

Adenosine A1 receptor antagonist Mode of action

A

Normally when adenosine is released => decrease in sodium chloride leading to decrease in water leading to less diuresis

So if adenosine receptor is blocked, diuresis will increase

38
Q

Type of Adenosine receptor antagonist

A

Less specific :
Caffeine
Theophylline

Very specific:
Rolofylline (too toxic so was removed )

39
Q

Loop diuretics mechanism of action

A

Inhibits sodium chloride reabsorption in the thick ascending limb

40
Q

Most efficacious diuretic agents

A

Loop diuretics

41
Q

Type of loop diuretics

A 
Sulphonamide derivatives :
Furosemide 
Bumetanide
Torsemide 
Piretanide

Non sulphonamide
Ethacrynic acid

42
Q

Elimination of loop diuretics

A

By kidney by glomerular filtration and tubular secretion

43
Q

What agent can reduce secretion of loop diuretics

A

NSAIDs or probenecid

Compete for weak acid secretion

44
Q

What loop diuretics Increase his renal blood flow via the prostaglandin action on the kidney vasculature

A

Furosemide

45
Q

Clinical indication of loop diuretics

A 
Acute pulmonary edema 
edematous conditions 
Acute hypercalcemia
 hyperkalemia 
acute renal failure 
anion overdose
46
Q

Loop diuretics adverse effects

A 
Hypokalemic metabolic alkalosis 
otoxicity
 hyperuricemia 
hypomagnesemia 
allergic reaction’s
47
Q

Loop diuretics contraindications

A

Severe sodium and volume depletion
hypersensitivity to sulfonamides
anuria unresponsive to a trial dose

48
Q

Loop diuretics drug Interactions

A 
Aminoglycosides 
anticoagulants 
cardiac glycosides 
antiarrythmic drugs class iii 
 lithium
Propranolol
Sulfonylureas 
Cisplatin
NSAIDs
Probenecid
Thiazide diuretics 
Amphetorecin b
49
Q

Thiazide drugs diuretics

A 
Chlorothiazide 
Hydroflumethiazide
Chlortalidone
Bendroflunethiazide 
Indapamide
Metolazone
Polythiazide
Quinethazone
Trichlormethiazide
50
Q

Thiazide diuretics mechanism of action

A

Can you beat sodium chloride transferred into the distal convoluted tubule

Decreased calcium excretion

51
Q

Side effect of thiazide diuretic’s

A 
Erectile dysfunction 
extracellular volume depletion 
hypotension 
hypokalemia 
hyponatremia 
hypochloremia
Metabolic alkalosis 
hypomagnesemia
 hypercalcemia
 hyperuricemia
Hyperglycemia
Increase LDL and triglycerides
52
Q

Drug interactions of thiazides diuretics on other agents

A

Diminish effects of
anticoagulants uricosuric agents
Sulfonylureas
insulin

Increase effects of 
Anesthetics 
Diazoxide 
Cardiac glycosides 
lithium 
loop diuretics 
vitamin D
53
Q

Other drugs impact on thiazide diuretic’s

A

Amohoterecin b and corticosteroids increase risk of hypokalemia

Effect of thiazide reduced by NSAIDs and bile acids

Drug that prolong QT (quinidine) have lethal interaction

54
Q

therapeutic uses ofThiazide diuretics

A

Eczema associated with hurts disease
Liver cirrhosis
Renal disease
hypertension

55
Q

Potassium sparing diuretics

A 
Spironolactone 
Eplerenone 
Amiloride 
Triamterene
Nesiritide
Ularitide
56
Q

Clinical indication of potassium sparing diuretics

A

Spironolactone cowdministered with thiazide for edema and hypertension

Spironolactone uses :
Hyperaldosteronism
Refractory edema
hepatic cirrhosis

Eplerenone in hypertension

57
Q

Drug of choice in hepatic cirrhosis

A

Spironolactone

58
Q

Side effects of potassium sparing diuretics

A

Hyperkalemia
Megaloblastosis if cirrhotic patient

Amiloride causes ( nausea, vomiting , diarrhea , headache)

Triamterene ( nausea , vomiting , leg cramps , diziness

Cardiovascular Module (21 decks)

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