Ren 4 - Diuretics Flashcards
When do we use acetazolamide?
- 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.
What are the side effects of acetazolamide?
- Metabolic acidosis. 2. Sulfa allergies (it is a sulfa drug).
Where does Mannitol work on and what does it do?
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.
What are the side effects of manitol?
Dehydration.
Which conditions make the use of mannitol prohibited?
- Anuric renal failure. 2. Congestive Heart Failure.
What are the 2 diuretics that are used in glaucoma? Which one is used in acute cases and which one for chronic cases?
- Mannitol is used in acute angle-closure cases of glaucoma. 2. Acetazolamide in chronic cases of glaucoma.
When do we use mannitol?
- Shock. 2. Drug overdose. 3. Acute angle-closure glaucoma. 4. Elevated ICP (intracranial pressure) (in IV).
What are three loop diuretics?
- Furosemide. 2. Bumetanide. 3. Torsemide. 4. Ethancrynic acid. (1 to 3 are sulfonamide diuretics. Ethacrynic acid is not a sulfonamide.)
What is the mechanism of loop diuretics?
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).
When are loop diuretics indicated?
CHF. Pulmonary edema. Nephrotic syndrome. Cirrhosis. (Use thiazides to treat hypertension).
What are the side effects of loop diuretics?
Ototoxicity. Nephrotoxicity. Hypokalemia. Dehydration. Gout. Sulfa allergy.
What are some Thiazide diuretics? Which one is the most widely used?
- Chlorothiazide. 2. Hydrochlorothiazide (HCTZ). 3. Chlorthalidone. 4. Metolazone. HCTZ is the most used.
How do thiazides work?
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+.
When are thiazides indicated for?
- Hypertension.
- Idiopathic hypercalciuria.
- Nephrogenic diabetes insipidus.
What are the side effects of thiazide use?
- Hypokalemia.
- Hyponatremia.
- Hyperglycemia.
- Hyperlipidemia.
- Hyperuricemia.
- Hypercalcemia. “Loops lose calcium, thiazides retain calcium”.
- Sulfa allergies.
What are some potassium-sparing diuretics?
[Potassium, please have a SEAT]
Spironolactone. Eplerenone. Amiloride. Triamterene.
Which of the potassium-sparring drugs are aldosterone antagonists?
Spironolactone and Eplerenone.
What are the three drugs given to patients with CHF?
- Specific beta-blocker.
- ACE inhibitor (or and ARB: angiotensin receptor inhibitors).
- Aldosterone antagonists.
What are the side effects of potassium-sparing drugs?
- Hyperkalemia.
- Spiranolactone can antagonize androgen and cause gynecomastia.
- Menstrual irregularities.
Almost all diuretics will increase urinary sodium chloride except?
Acetazolamide.
Almost all of the diuretics will increase urinary potassium except?
Potassium-sparing diuretics.
Which types of diuretics will cause acidosis?
Carbonic anhydrase inhibitors and potassium-sparing diuretics.
Which type of diuretics will cause alkalosis and why?
Loops and thiazides: loss of sodium chloride causes hypochlorimia, which in turn causes reduced excretion of bicarbonate, causing the alkalosis.
What type of diuretic is tiramterene?
Potassium-sparing diuretic.
What type of diuretic is Acetazolamide?
Carbonic anhydrase inhibitor.
What type of diuretic is Hydrochlorothiazide?
Thiazide diuretic.
What type of diuretic is Bumetanide?
Loop diuretic.
What type of diuretic is Spironolactone?
Potassium-sparing diuretic (aldosterone antagonist).
What type of diuretic is Chlorothiazide?
Thiazide diuretic.
What type of diuretic is Ethacrynic acid?
Loop diuretic (not a sulfa drug).
What type of diuretic is Mannitol?
Osmotic diuretic.
What type of diuretic is Metolazone?
Thiazide diuretic.
What type of diuretic is Chlorthalidone?
Thizaide diuretic.
What type of diuretic is Furosemide?
Loop diuretic.
What type of diuretic is Amiloride?
Potassium-sparing diuretic.
What type of diuretic is Torsemide?
Loop diuretic.
What class of diuretic would be useful for acute pulmonary edema?
Loop diuretic.
What class of diuretic would we use in Idiopathic hypercalciuria?
Thiazide diuretic.
What class of diuretic would we use in glaucoma?
Acetazolamide or mannitol.
What class of diuretic would we use in mild to moderate CHF with expandede ECV (extra cellular volume)?
Loop diuretic.
What class of diuretic would we use in conjunction with loop or thiazide diuretics to retain calcium?
Potassium-sparing diuretic.
What class of diuretic would we use in edema associated with nephrotic syndrome?
Loop diuretic.
What class of diuretic would we use in increased ICP?
Mannitol.
What class of diuretic would we use in mild to moderate HTN?
Thiazide diuretic.
What class of diuretic would we use in hypercalcemia?
Loop diuretic.
What class of diuretic would we use in altitude sickness?
Acetazolamide
What class of diuretic would we use in hyperaldosteronism?
Spironolactone or eplerenone.
What is the site of action for thiazide?
Distal convoluted tubule.
A patient with CHF needs a diuretic but is allergic to sulfas. What can we use?
Ethacrynic acid.
If a patient has calcium stones, which kind of diuretics should he avoid?
Loop diuretics. “Loops lose calcium” Increasing renal calcium excretion will exacerbate the problem.
-Use thiazide diuretic since they reduce calcium excretion.
Where does acetazolamide work on and what does it do?
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.
