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Pharma > Potassium Excreting (wasting) Diurectics > Flashcards

Potassium Excreting (wasting) Diurectics Flashcards

1
Q

What are the extra renal diuretics?

A 
Water
Alcohol
Digitalis
Dopamine (low dose)
Colloids
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2
Q

Which are the K+ excreting diuretics?

A

CAIs
Loops
Thiazides

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3
Q

Name the CAIs

A

Acetazolamide
Dorzolamide
Brinzolamide

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4
Q

Name the loop diuretics

A

Furosemide
Bumetanide
Torsemide
Ethacrynic acid

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5
Q

What are the clinical indications of loop diuretics?

A 
Acute pulmonary Edema
CHF
Refractory Edema
Acute/chronic kidney failure
Hypertension
Poisoning
Anion overdose
Hypercalcemic states
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6
Q

What are the adverse effects of loop diuretics?

A 
Hypokalemia
Metabolic alkalosis
Hypocalcemia
Hypomagnesemia 
Hyperuricemia
Transient deafness
Secondary hyperaldosteronism
Sulphonamide hypersensitivity
Ototoxicity
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7
Q

What are the drug interactions of loops diuretics?

A

NSAIDs decrease their effect
Aminoglycosides may enhance their effect
They enhance the effects of muscle relaxants

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8
Q

How are loops administered?

A

Oral

Parenteral

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9
Q

What is the dose of furosemide?

A

20-40mg in the morning

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10
Q

What is the dose of furosemide when the GFR <20 (kidney insufficiency)?

A

500mg

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11
Q

What is the half life of loops?

A

Short half life

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12
Q

What is the half life of Furosemide?

A

2-3h

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13
Q

What are the pharmakinetic features of loops?

A

They act on the luminal side therefore their activity correlates with GFR

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14
Q

What are the clinical uses of CAIs?

A 
Glaucoma
Acute mountain sickness prophylaxis
Metabolic alkalosis
Urinary alkalisation
Severe hyperphosphatemia
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15
Q

What are clinical indications of CAIs when used as adjacent therapy?

A

Epilepsy
Refractory Edema
CSF leakage

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16
Q

When would we use CAIs in case of poisoning?

Why?

A

We would use CAIs when we are trying to eliminate a weak acid. E.g., aspirin poisoning

Because CAIs promote the Alkalisation of the urine which promotes the excretion of weak acids

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17
Q

Why are CAIs indicated in glaucoma?

A

CA is involved in the production of aqueous humour. Therefore there is decreased AH production which reduces the IOP.

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18
Q

In which type of glaucoma do we use CAIs?

A

Chronic open angle glaucoma

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19
Q

How are CAIs administered?

A

Oral

IV

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20
Q

How are CAIs eliminated?

A

Renal elimination - active tubular secretion + passive reabsorption

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21
Q

What is the percentage of protein bound CAIs?

A

90%

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22
Q

What are the extra-renal actions of CAIs?

A

Decreased production of aqueous humour
Decreased production of CSF
Decreased production of gastric and pancreatic juice

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23
Q

What are the contraindications of CAIs?

A

Sulphonamide sensitivity

Severe kidney or hepatic disorders

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24
Q

What are the adverse effects of CAIs?

A 
Hyperchloremic metabolic acidosis
Hypokalemia 
Paresthesia
Somnolence
Renal stones (Ca-phosphate, cysteine)
Sulphonamide sensitivity
25
Q

Name the Thiazides

A

Bendroflumethiazide

Hydrochlorothiazide

26
Q

What are the clinical indications of Thiazides?

A 
CHF
Hypertension (1st line)
Edema
Idiopathic hypercalciuria (kidney stones) 
Nephrogenic diabetes insipidus 
Nephrolithiasis
27
Q

What are the adverse effects of thiazides?

A 
Hypokalemia 
Hypercalcemia
Hypomagnesemia
Hyperuricemia
Metabolic alkalosis
Impaired glucose tolerance
Weakness
Hypersensitivity
Secondary hyperaldosteronism
28
Q

Why is hyperuricemia an adverse effect of thiazide usage?

A

Thiazides increase serum Uric acid by decreasing acid secreted by the organic acids secretory system which can result in gout.

29
Q

Which side of the nephron do Thiazides work on?

A

The luminal side

30
Q

How is Indapamide eliminated?

A

Partly via bile

31
Q

How are thiazides administered?

A

Orally

32
Q

Do Thiazides have a longer or shorter half life?

A

Longer half life

33
Q

What is the dose of Hydrochlorothiazide in hypertension?

A

6.25-25mg

34
Q

What is the dose of Hydrochlorothiazide in CHF?

A

25-100mg

35
Q

Which CAIs can be used in epilepsy?

A

Dorzolamide

Brinzolamide

36
Q

Why do we never use CAIs alone?

A

They are very weak and tolerance develops very quickly. Use only for short term application

37
Q

Where in the nephron do CAIs act?

A

PCT

38
Q

Where in the kidney do loop diuretics work?

A

Thick ascending loop

39
Q

Where in the kidney do thiazides act?

A

Distal tubule

40
Q

How are CAIs administered in the treatment of glaucoma?

A

Topically

41
Q

Why are renal stones a side effect of CAIs use?

A

CAIs creates alkalisation of the urine. Calcium phosphate stones are more likely to form in alkaline urine.

42
Q

Which loop can we use if the patient has a sulphonamide hypersensitivity?

A

Ethacrynic acid

43
Q

Why are thiazides used in nephrolithiasis?

A

Because thiazides lower the amount of urinary calcium

44
Q

Why are calcium phosphate stones likely to form in CAI usage?

A

Because calcium phosphate stones are more likely to form in an alkaline urine

45
Q

What is the mechanism of action of loops?

A

they inhibit the sodium/potassium/2 chloride transporter

46
Q

Where do loops work?

A

thick ascending limb

47
Q

Where do CAI work?

A

PCT

48
Q

Where do thiazides work?

A

Distal nubile

49
Q

Do loops loose or reabsorb calcium?

A

Loops loose calcium

50
Q

When shouldn’t loops be used and why?

A

Should not be used in osteoporosis because they loose calcium

51
Q

Do thiazides promote or decrease calcium excretion?

A

Thiazides decrease calcium excretion

52
Q

what is the effect of thiazides on on smooth muscle cells?

A

They hyperpolarize smooth muscle cells causing vasodilation

53
Q

What is the effect of thiazides on beta cells of the pancreas?

A

they decrease insulin release - hyperglycaemia

54
Q

Why do thiazides cause hyperglycaemia?

A

Because they prevent insulin release from beta cells of the pancreas

55
Q

What is the mechanism of action of thiazides?

A

they inhibit the Sodium/Cl co-transporter in the distal tubule

56
Q

What is the result of thiazide use?

A

Sodium and chloride loss

57
Q

What are thiazide drug interactions?

A

They interact with digitoxin leading to increased toxicity due to electrolyte disturbances

58
Q

When should thiazides be avoided and why?

A

In patients with DM

Because they inhibit insulin release from beta cells of the pancreas

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