Potassium wasting diuretics Flashcards

1
Q

List the classes of K wasting diuretics

A

Carbonic anhydrase inhibitors

Loop Diuretics

Thiazides

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the carbonic anhydrase inhibitors

A

Acetazolamide

Dorzolamide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How does Acetazolamide cause diuresis

A

Inhibits CA in both the lumen and inside the renal tubular cells at the PCT.

Inhibits resorption of both Na and HCO3-

Increases Na+ concentration in the lumen at collecting duct, increasing K+ excretion as well.

Causes Na, HCO3- and K+ excretion.
Diureses and metabolic acidosis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Indications for CA inhibitors

A

NOT typically used for HF, HTN, or diuresis

1) Glaucoma
2) Urinary alkalization in GOUT and CYTEINURIA to prevent renal stones.
3) Metabolic alkalosis
4) Urinary alkalinization to increase weak acid excretion - Aspirin, penicillin, cephalosporins, other diuretics.

5) Idiopathic intracranial hypertension
6) Meniere’s disease
7) Elevation sickness - Decreases CSF pH (causes mild intracranial acidosis) stimulating respiration.

8) Anti-epileptic. – CNS Acidosis increases the seizure threshold.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Acetazolamide SEs

A

1 ) Hyperkalemia

Calcium Phosphate urinary stones - are increased in alkaline urine.

Sulfa drug allergy

Interstitial Nephritis!!

Increased ammonia resorption (decreased ionization of ammonium)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Acetazolamide contraindications

A

Sulfa allergy

Pregnancy

Cirrhosis, liver insufficiency, Alkaline urine decreass ammonia excretion. (ammonium is a weak base)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

List the loop diuretics

A

Bumetanide

Furosemide

Torsemide

Ethycrynic acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the main loop diuretic used?

A

Furosemide

Ethacrynic acid only if pat has sulfa allergy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Furosemide dose

A

20-40mg

20 mg orally for chronic use, HTN

40 mg i.v. for acute edema states.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Furosemide indications

A

1) Pulmonary edema - life saving
2) Symptomatic, edematous heart failure
3) Edematous states associated with renal failre
4) Acute LV failure - relieves pulm edema, and also decreases preload to heart.
5) Chronic hypertension, a second line drug after thiazide diuretics or if there is HTN with renal failure
6) Chronic renal insufficiency - releives the hyperkalemia. Furosemide is the strongest drug at excreting potassium.
7) Excretion of alkaline, positively charged metals, Barium, Iodide. Doesn’t work for lithium.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Furosemide side effects

A

OHHH DAANG She fell

Ototoxicity
Hypomagnesemia
Hypokalemia
Hypotension (Hypovolemia)

Dehydration and (Hypovolemia)
Allergic reaction and Allergic interstitial nephritis
Alkalosis (from the hypokalemia)
Nephritis
Gout

Syncope

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Thiazide drugs, list

A

Chlorothiazide - archetype

Hydrochlorthiazide and Indipamide - main currently.
Hydrochlorthiazide is the most potent uses lowest dose, and is most common.

Chlorthalidone - longest acting

Metolazone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Thiazide mechanism

A

Inhibits the Na+Cl+ symporter in the Distal convoluted tubule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Effects of Thiazides

A

HyperGLUC
HypoNa HypoK

Increases:
Glucose --Hypokalemia --Decreased insulin release -- hyperglycemia
Lipids, cholesterol
Uric acid
Calcium
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Thiazide indications

A

Chronic Heart Failure, after NYHA stage 2

Hypertension: especially in elderly and black patients

Osteoperosis

HypercalciURIA and Calcium kidney stones

Nephrogenic diabetes insipidus (not responsive to ADH)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

When are thiazides contraindicated to treat Nephrogenic DI?

A

When it is caused by Lithium.

Thiazides increase lithium retention and toxicity.

17
Q

Thiazide SEs

A

HyperGLUC symptoms

Ortho Hypo

Worsens diabetes

Interstitial nephritis in rare cases
They are sulfa drugs