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m1 > renal - diuretics > Flashcards

renal - diuretics Flashcards

1
Q

name the major classes of diuretic drugs

A
  1. loop diuretics
  2. thiazide diuretics
  3. potassium-sparing diuretics
  4. osmotic diuretics
  5. carbonic anhydrase inhibitors
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2
Q

how do diuretics generally work

A

decrease Na+ reabsorption, increasing Na+ in the tubule → increased urine production

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3
Q

2 eg of loop diuretics

A
  1. furosemide
  2. bumetanide
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4
Q

moa of loop diuretics

A
  • inhibit Na+/K+/2Cl- cotransporter in ascending limb of the Loop of Henle → prevents reabsorption of Na+, K+, Cl- → increased urine prodn
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5
Q

clinical indications for loop diuretics

A
  • oedema assoc w HF, nephrotic syndrome, renal faliure
  • acute pulm oedema
  • hypertension in pts w renal failure
  • acute hyperkalemia
  • acute hypercalcemia
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6
Q

adverse effects of loop diuretics

A
  • hypovolemia
  • hypokalemia
  • hyperglycemia
  • ototoxicity
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7
Q

contraindications for loop diuretics

A
  • severe hypovolemia
  • severe hyponatremia
  • hypersensitivity to sulfonamides
  • anuria
  • postmenopausal osteopenic women
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8
Q

DDIs for loop diuretics

A
  • aminoglycosides and carbo/cisplatins (synergism of ototoxicity)
  • sulfonylureas (hyperglycemia)
  • NSAIDs (blunted diuretic response)
  • thiazide diuretics (synergism → profound diuresis)
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9
Q

moa of thiazide diuretics

A

inhibit Na+/Cl- symporter in distal convoluted tubules → prevent reabsorption of Na+ and Cl- → Na+ excreted, water follows and is excreted as well

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10
Q

2 eg of thiazides

A
  1. hydrochlorothiazide
  2. chlorthalidone
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11
Q

clinical uses of thiazide diuretics

A
  1. hypertension
  2. oedema
  3. nephrolithiasis
  4. nephrogenic diabetes insipidus
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12
Q

how thiazides can help in nephrolithiasis

A
  • enhances Ca2+ reabsorption in DCT → reduce urinary Ca2+ conc → prevent stone formation
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13
Q

how thiazides can help in diabetes insipidus

A
  • paradoxically reduce urine output by inducing mild diuresis → to compensate, PCT increases Na+ and water reabsorption → reduces amt of fluid reaching collecting duct → treat excessive urination
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14
Q

adverse effects of thiazides

A
  1. hypokalemia
  2. hypercalcemia
  3. hyperglycemia
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15
Q

contraindication for thiazides

A
  1. hypersensitivity to sulfonamides
  2. anuria
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16
Q

4 eg of K+ sparing diuretics

A
  1. amiloride
  2. triamterene
  3. spironolactone
  4. eplerenone
17
Q

moa of amiloride and triamterene

A

inhibit Na+ channels

18
Q

moa of spironolactone and eplerenone

A

antagonists of aldosterone receptors

19
Q

clinical uses of K+ sparing diuretics

A
  • HF (prevent remodelling and decrease mortality)
  • hypertension
  • pri/sec hyperaldosteronism
20
Q

adverse effects of K+ sparing diuretics

A
  • hyperkalemia
  • metabolic acidosis
21
Q

contraindications for K+ sparing diuretics

A
  • hyperkalemia
  • pts taking ACE inhibitors, angiotensin receptor blockers, beta-blockers
  • pts on K+ supplements
22
Q

1 eg of carbonic anhydrase inhibitor

A

acetazolamide

23
Q

moa of carbonic anhydrase inhibitor

A
  • act on PCT
  • inhibit carbonic anhydrase → increase HCO3- excretion, accompanied by Na+, K+, water → diuresis
24
Q

clinical uses of acetazolamide

A
  • chronic open-angle glaucoma
  • prophylaxis of acute mountain sickness
  • metabolic alkalosis
25
Q

adverse effects of acetazolamide

A
  • metabolic acidosis
  • hypokalemia
  • renal stone formation
26
Q

contraindication for acetazolamide

A

sulfa allergy

27
Q

1 eg of osmotic diuretic

28
Q

moa of osmotic diuretics

A
  • act on PCT and descending loop of Henle
  • physical presence causes higher osmolarity of tubular fluid → water retained in these segments → diuresis
29
Q

clinical use of mannitol

A
  • renal failure
  • increased intracranial pressure
  • increased intraocular pressure
30
Q

adverse effects of mannitol

A
  • extracellular vol expansion
  • severe dehydration

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