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DIT Nephrology > Ren 4 - Diuretics > Flashcards

Ren 4 - Diuretics Flashcards

1
Q

When do we use acetazolamide?

A
  1. Altitude sickness: Breathing faster and deeper blows off CO2, causing resp alkalosis; body compensates this by getting rid of bicarbonate but this takes days. Giving this med does it faster. 2. Alkalinize the urine. 3. Metabolic alkalosis. 4. Chronic glaucoma: because bicarbonate production draws water into the eye to form aqueous humor.
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2
Q

What are the side effects of acetazolamide?

A
  1. Metabolic acidosis. 2. Sulfa allergies (it is a sulfa drug).
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3
Q

Where does Mannitol work on and what does it do?

A

It works on the proximal convoluted tubule, and works as an osmotic diuretic; causes an osmolar load that stays in the filtrate, preventing reabsorption of free water, causing excretion of free water.
-It raises serum osmolarity, raising serum Sodium.

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4
Q

What are the side effects of manitol?

A

Dehydration.

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5
Q

Which conditions make the use of mannitol prohibited?

A
  1. Anuric renal failure. 2. Congestive Heart Failure.
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6
Q

What are the 2 diuretics that are used in glaucoma? Which one is used in acute cases and which one for chronic cases?

A
  1. Mannitol is used in acute angle-closure cases of glaucoma. 2. Acetazolamide in chronic cases of glaucoma.
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7
Q

When do we use mannitol?

A
  1. Shock. 2. Drug overdose. 3. Acute angle-closure glaucoma. 4. Elevated ICP (intracranial pressure) (in IV).
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8
Q

What are three loop diuretics?

A
  1. Furosemide. 2. Bumetanide. 3. Torsemide. 4. Ethancrynic acid. (1 to 3 are sulfonamide diuretics. Ethacrynic acid is not a sulfonamide.)
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9
Q

What is the mechanism of loop diuretics?

A

They inhibit the Na+/2Cl-/K+ symporter in the thick ascending limb, making the urine more dilute.
-They cause loss of calcium. “Loops lose calcium” (thiazides retain calcium).

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10
Q

When are loop diuretics indicated?

A

CHF. Pulmonary edema. Nephrotic syndrome. Cirrhosis. (Use thiazides to treat hypertension).

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11
Q

What are the side effects of loop diuretics?

A

Ototoxicity. Nephrotoxicity. Hypokalemia. Dehydration. Gout. Sulfa allergy.

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12
Q

What are some Thiazide diuretics? Which one is the most widely used?

A
  1. Chlorothiazide. 2. Hydrochlorothiazide (HCTZ). 3. Chlorthalidone. 4. Metolazone. HCTZ is the most used.
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13
Q

How do thiazides work?

A

They work by inhibiting the sodium and chloride reabsorption in the early distal convoluted tubule by inhibiting the Na+/Cl- symporter. They retain thiazides retain Ca2+.

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14
Q

When are thiazides indicated for?

A
  • Hypertension.
  • Idiopathic hypercalciuria.
  • Nephrogenic diabetes insipidus.
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15
Q

What are the side effects of thiazide use?

A
  • Hypokalemia.
  • Hyponatremia.
  • Hyperglycemia.
  • Hyperlipidemia.
  • Hyperuricemia.
  • Hypercalcemia. “Loops lose calcium, thiazides retain calcium”.
  • Sulfa allergies.
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16
Q

What are some potassium-sparing diuretics?

A

[Potassium, please have a SEAT]

Spironolactone. Eplerenone. Amiloride. Triamterene.

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17
Q

Which of the potassium-sparring drugs are aldosterone antagonists?

A

Spironolactone and Eplerenone.

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18
Q

What are the three drugs given to patients with CHF?

A
  1. Specific beta-blocker.
  2. ACE inhibitor (or and ARB: angiotensin receptor inhibitors).
  3. Aldosterone antagonists.
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19
Q

What are the side effects of potassium-sparing drugs?

A
  • Hyperkalemia.
  • Spiranolactone can antagonize androgen and cause gynecomastia.
  • Menstrual irregularities.
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20
Q

Almost all diuretics will increase urinary sodium chloride except?

A

Acetazolamide.

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21
Q

Almost all of the diuretics will increase urinary potassium except?

A

Potassium-sparing diuretics.

22
Q

Which types of diuretics will cause acidosis?

A

Carbonic anhydrase inhibitors and potassium-sparing diuretics.

23
Q

Which type of diuretics will cause alkalosis and why?

A

Loops and thiazides: loss of sodium chloride causes hypochlorimia, which in turn causes reduced excretion of bicarbonate, causing the alkalosis.

24
Q

What type of diuretic is tiramterene?

A

Potassium-sparing diuretic.

25
Q

What type of diuretic is Acetazolamide?

A

Carbonic anhydrase inhibitor.

26
Q

What type of diuretic is Hydrochlorothiazide?

A

Thiazide diuretic.

27
Q

What type of diuretic is Bumetanide?

A

Loop diuretic.

28
Q

What type of diuretic is Spironolactone?

A

Potassium-sparing diuretic (aldosterone antagonist).

29
Q

What type of diuretic is Chlorothiazide?

A

Thiazide diuretic.

30
Q

What type of diuretic is Ethacrynic acid?

A

Loop diuretic (not a sulfa drug).

31
Q

What type of diuretic is Mannitol?

A

Osmotic diuretic.

32
Q

What type of diuretic is Metolazone?

A

Thiazide diuretic.

33
Q

What type of diuretic is Chlorthalidone?

A

Thizaide diuretic.

34
Q

What type of diuretic is Furosemide?

A

Loop diuretic.

35
Q

What type of diuretic is Amiloride?

A

Potassium-sparing diuretic.

36
Q

What type of diuretic is Torsemide?

A

Loop diuretic.

37
Q

What class of diuretic would be useful for acute pulmonary edema?

A

Loop diuretic.

38
Q

What class of diuretic would we use in Idiopathic hypercalciuria?

A

Thiazide diuretic.

39
Q

What class of diuretic would we use in glaucoma?

A

Acetazolamide or mannitol.

40
Q

What class of diuretic would we use in mild to moderate CHF with expandede ECV (extra cellular volume)?

A

Loop diuretic.

41
Q

What class of diuretic would we use in conjunction with loop or thiazide diuretics to retain calcium?

A

Potassium-sparing diuretic.

42
Q

What class of diuretic would we use in edema associated with nephrotic syndrome?

A

Loop diuretic.

43
Q

What class of diuretic would we use in increased ICP?

A

Mannitol.

44
Q

What class of diuretic would we use in mild to moderate HTN?

A

Thiazide diuretic.

45
Q

What class of diuretic would we use in hypercalcemia?

A

Loop diuretic.

46
Q

What class of diuretic would we use in altitude sickness?

A

Acetazolamide

47
Q

What class of diuretic would we use in hyperaldosteronism?

A

Spironolactone or eplerenone.

48
Q

What is the site of action for thiazide?

A

Distal convoluted tubule.

49
Q

A patient with CHF needs a diuretic but is allergic to sulfas. What can we use?

A

Ethacrynic acid.

50
Q

If a patient has calcium stones, which kind of diuretics should he avoid?

A

Loop diuretics. “Loops lose calcium” Increasing renal calcium excretion will exacerbate the problem.
-Use thiazide diuretic since they reduce calcium excretion.

51
Q

Where does acetazolamide work on and what does it do?

A

A diuretic that works on the proximal convoluted tubule. It inhibits carbonic anhydrase inhibitor. It is mainly used to excrete bicarbonate rather than as a diuretic.

DIT Nephrology (9 decks)

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