Pharmacology-Diuretics Flashcards
What is the primary therapeutic effect of diuretics
Inhibit Na+ reabsorption
(promotes loss of Na+ and H2O; reduces plasma volume and blood pressure)
What are the main uses for diuretics?
*HTN
*CHF
kidney/liver disease
ICP/IOP management
What two medications work in the glomerulus
NSAIDS and ACEI
Which medications work in the PCT?
Carbonic Anhydrase Inhibitors
Osmotic Diuretics
Which medication works in the Loop of Henle (thick ascending)
Loop Diuretics
Which diuretic works in the DCT?
Thiazides
Which medications work in the Collecting Duct?
Aldosterone Antagonists
ADH Antagonists
What medication is a carbonic anhydrase inhibitor
Acetazolamide
MOA of carbonic anhydrase inhibitor
block carbonic anhydrase activity
carbonic anhydrase inhibitor decrease the reabsorption of
Na+
HCO3-
H2O
(causing natriuresis, diuresis, alkaline urine)
carbonic anhydrase inhibitors increases the excretion of
K+
carbonic anhydrase inhibitors increase the reabsorption of
Cl-
carbonic anhydrase inhibitors cause the reabsorption of _________, causing metabolic acidosis
hydrogen (lose bicarb)
SIDE EFFECTS of carbonic anhydrase inhibitors
Metabolic Acidosis
HYPOkalemia
HYPERchloremia (excess chloride in the blood due to exchange of Cl- for bicarb
Kidney Stones
Fatigue
Paresthesias (tingling)
Which patients should not receive carbonic anhydrase inhibitors
renal insufficient patient
Can carbonic anhydrase inhibitors cause tolerance?
YES, after 2-3 days
Osmotic diuretics dont go under _______ and causes ________ in plasma & renal tubular fluid osmolarity
metabolism; increase
Osmotic diuretics decreases reabsorption of_______
water
What medications are osmotic diuretics
*Mannitol
Urea
Isosorbide
Glycerine
What diuretics do you give a patient with LV dysfunction?
Osmotic & Furosemide
What are the SIDE EFFECTS of osmotic diuretics?
Increased plasm volume
Caution w/LV dysfunction & pulmonary edema
HYPOVOLEMIA w/long-term use
HYPOkalemia/natremia
Thrombophlebitis
Mannitol not filtered with
renal insufficiency
What is the dose of mannitol
0.25-2g/kg
Mannitol is a ______ ______, meaning it does not _________cell membranes
sugar alcohol; cross
What is the duration of mannitol
6-8 hours
How does mannitol prevent perioperative renal failure in ATN?
Vasodilates (improves RBF)
Removes toxins & necrotic debris
Scavenger of free O2 radicals (prevent cellular injury)
Which is the most potent diuretic
loops
MOA of loop diuretics
block Na/K/2Cl co-transporter, decreasing the reabsorption of EVERYTHING
Loops cause
natriuresis, diuresis, and hyppokalemia
Which diuretic is 1st line for HTN
Thiazide
Loops are less effective ini
lowering HTN
Loops cause an increase in _________ formation, leading to vasodilation
prostaglandin
Loop diuretic medications
*Furosemide (Lasix)
Torsemide
Ethacrynic Acid
Bumetanide
Loops are used to treat
HTN
Edema
HYPERkalemia/calcemia
SIDE EFFECTS of Loops
HYPOkalemia/natremia/calcemia/magnesemia
Metabolic alkalosis
HOTN
Renal ischemic injury
Hyperuricemia
Gout
Ototoxicity
Tinnitus
Increased nephrotoxic effects of aminoglycosides & cephalosporins
Dose of Loop
20-40mg IV (200mg MAX)
Onset 5-10min
Duration 2-6 hrs
HF patients are often resistant to
Loops and may need thiazide
Loops can treat
pulmonary edema
Thiazide can treat
hypocalcemia
MOA of thiazides
block Na/Cl cotransporter and work in the DCT
Thiazides decrease the reabsorption of
Na/Cl/Water, causing natriuresis and diuresis
Thiazides increase the excretion of
K+
Thiazides increase the reabsorption of
Ca+
What medications are thiazide diuretics
*Hydrochlorothiazides
Chlorothiazide
Chlorthalidone
Indapamide
SIDE EFFECTS of Thiazides
HYPOkalemia/natremia/chloremia/magnesia/phosphate/volemia
Hypercalcemia/uricemia/glycemia
glucose intolerance & insulin resistance
Metabolic alkalosis
Cross-reactivity in sulfa allergy
2 types of Potassium Sparing Diuretics
Epithelial Na+ channel (ENaC blockers
Aldosterone receptor antagonist
Example of ENaC blockers
Triamterene
Amiloride
Examples of Aldosterone receptor antagonists
Spironolactone
Eplerenone
Where do potassium sparing drugs work
CD
Both ENaC and Aldosterone receptor antagonists decrease reabsorption of____________and decrease excretion of
Na+ and Water
K+
Aldosterone receptor antagonists (potassium sparing) work to inhibit
Na/K ATPase
Na/K pump and the ENaC channel promotes_______
Na+ loss
K+ reabsorption
SIDE EFFECTS of potassium sparing diuretics
HYPERkalemia
Hyponatremia
Metabolic Acidosis
Dehydration
HOTN
Gynecomastia
Decreased androgen levels
Dry Skin
Rash
Potassium Sparing is _____and usually given with a _______ to prevent________
weak;thiazide; hypokalemia
Medications of the Dopamine Receptor Agonist family
*Dopamine
Fenoldopam
D1 receptor activation inhibits
Na/H+ exchange
Na/K+/ATPase
D1 receptor activation increases
cAMP
D1 receptor activation causes_______ and maintains and increases ____and____
Natriuresis; RBF & GFR
Higher doses of D1 receptor activation can cause
Beta cardiac stimulation
Alpha vasoconstriction
D1 med Fenoldopam is ________, increases_______and decreases______
selective;RBF;SVR
(causes no vasoconstriction nor cardiostimulation due to moderate alpha-2 activity)
Fenoldopam is used for short term treatment of severe_____ and _____ ______
HTN: renal protection
Hypokalemia can ______muscle relaxant due to the cells being______
potentiate; hyperpolarized
renal ischemia may occur with
a normal MAP