Renal- Diuretics Flashcards
What are the clinical applications for amiloride
Counteracts the potassium loss of other diuretics during edema or hypertension
What is the effect of the potassium sparing diuretics on the levels of bicarbonate loss
Significant bicarbonate loss by interfering with the distal H+ secretion
At what location do sodium channel blockers work
Cortical collecting duct
What class of drug is metolazone
Thiazide diuretics
At what location do thiazide diuretics work
Distal convoluted tubule
What class of drug is acetazolamide
Carbonic anhydrase inhibitor
IN the case of cardiac failure, where digitalis is used, what drugs must also be monitored and what is the reason
-Potassium losing diuretics because hypokalemia increases the toxicity of digitalis, so the levels of potassium must be watched
What class of drug is hydrochlorothizide
Thiazide diuretics
What are the adverse effects of carbonic anhydrase inhibitors
Hyperchloemic metabolic acidosis
Renal stones:nephrolithiasis
Potassium wasting
What class of drug is torsemide
Loop diuretic
What is the mechanism of action for eplerenone
Blocks aldosterone from being able to bind to its receptor, meaning that more sodium is excreted and more potassium reuptaken
At what location do loop diuretics work
Thick ascending loop of Henle
What class of drug is spironolactone
Aldosterone blocking, potassium sparing diuretic
What class of drug is furosemide
Loop diuretic
What is the class of drug for triamterene
Sodium channel blocker, potassium sparing diuretic
What is the condition of the urine with a loop diuretic
Isotonic urine
What are the urine effects of giving a loop diuretic
-Loss of water, sodium, potassium, chloride, magnesium, and calcium
What is the clinical applications of aldosterone blocker, potassium sparing diuretics
Counteracts potassium loss of other diuretics usually used with hypertension and edema.
- Reduced fibrosis in post-MI heart failure
- Primary hyperaldosteronism
At what location do osmotic diuretics work
Proximal tubule
Thin descending limb of Henle
What is the relation of the loop diuretics with regards to their benefits
Torsemide-Longer half life, works better in heart failure
Bumetanide-more predicatable Oral Absorption
Ethacrynic acid- Used in sulfa allergies
How do thiazides decrease the risk of kidney stones
Decreases the calcium excretion (as opposed to the loop diuretics) because more is absorbed in the proximal tubules due to volume contraction
What is the result of action potentials during hyperkalemia
Depolarizers membranes and increases firing
What is the treatment for nephrogenic diabetes insipidus if the cause is not lithium
Thiazides
What are the toxicities assocaited with loop diuretics
Low levels of:Mg, Cl, Na, K, Ca
- Hypochloremic metabolic alkalosis
- Hyperglycemia
- Hyperuricemia
- ototoxicity
What is the mechanism of action in thiazides
Blocks the sodium calcium transporter in the distal convoluted tubule
What is the mechanism of action for spironolactone
Blocks aldosterone from being able to bind to its receptor, meaning that more sodium is excreted and more potassium reuptaken
What class of drug is chlorthalidone
Thiazide diuretics
What must be considered in the use of torsemide
Sulfa drug, so watch for allergies
What are the main toxicities of the sodium blocker, potassium sparing diuretics
- Hyperkalemia (main one)
- Hyponatremia
- hyper chloremic metabolic acidosis
What is the mechanism of action for Triamterene
Blocks the luminal ENaC channels in the collecting ducts, which decreases reuptake of sodium and increases the amount in urine, while decreasing the amount of potassium loss
What are the therapeutic uses
-Prophylaxis of renal failure (keeps water in the tubules)-Reduction in intracranial and intraocular pressures
What is the mechanism of action of the thiazides
Sodium/Chloride cotransporter blocker in the distal convoluted tubule
What is a major side effect of furosemide with regards to organ systems
Causes ototoxicities
At what location do the aquaretics known as -Vaptans work
Collecting duct
What are the effects of hypokalemia on the heart
- Flattened T waves
- Tall U waves
- Prolonged QT
What is a serious side effect on a different receptor in the use of aldosterone blocker diuretics
Partial agonist at androgen receptors
What are the clinical applications of using a loop diuretic
Edema from CHF
To decrease ECF volume
Hypertension
What class of drug is amiloride
Sodium channel blocker, potassium sparing diuretic
What class of drug is mannitol
Osmotic diuretic
What class of drug is ethacrynic acid
Loop diuretic
What is the mechanism of action for the aquaretics known as the -Vamptans
Block the ADH receptor in the collecting duct, so there is more water excreted
What class of drug is spironolactone
Aldosterone antagonist, potassium sparing diuretic
What are the toxicities of using aldosterone blocking potassium sparing diuretics
Hyperkalemia
-amenorrhea, hirtutism, hynocomastia, impotence, tumorgenic
At what location do carbonic anhydrase inhibators work
Proximal Tubule
How do loop diuretics lead to a loss of magnesium and calcium
Potassium is not allowed to leak back in, which normally pulls calcium and magnesium in with it.
What are the clinical applications for thiazides
- Hypertension (does not work if there is low GFR)
- Edema
- Calcium nephrolithiasis
- Nephrogenic diabetes insipidus
What are the adverse effects of mannitol
-ECF is increased because it pulls water our of the cells, with fluid and electrolyte imbalanced
What is a main thing hydrochlorothiazide is used to treat
Nephrogenic diabetes insipidus
What are the effects of using a thiazide
Increases the urinary excretion of:
-Water, sodium, potassium, and magnesium
What is a diuretic
Promotes excretion of urine
What must be considered in the use of butetanide
Sulfa drug, so watch for allergies
What is the mechanism of action for amiloride
Blocks the luminal ENaC channels in the collecting ducts, which decreases reuptake of sodium and increases the amount in urine, while decreasing the amount of potassium lost
What are the toxicities associated with thiazides
Low levels of:K, Mg, Na, Cl
-Hypochloremic metabolic alkalosis
Hyperglycemia, hypercalcemia, hyperuricemia
What are the pharmacokinetics of aldosterone blocker potassium sparing diuretics
Because not directly blocking receptors, can take 24 hours to take effect
What is a aquaretic
Substance that produces free water clearance
At what location does spironolactone work
Cortical collecting duct
What are the toxicities of the -Vamptans
Orthostatic hypotension
Thirst
Fatal hepatotoxicitiy
What is a crucial aspect to loop diuretics with regards to patients with hypertension
Given when others have failed because can be used in cases where RBF and GFR are low
What class of drug is triamterene
Sodium channel blocking potassium sparing diuretic
What is the mechanism of action for the conivaptan
Non-peptide arginine vasopressin receptor antagonist
What is the clinical application of triamterene
Counteracts the potassium loss of other diuretics during edema or hypertension
What is the treatment for nephrogenic diabetes insipidus if the cause is lithium
Amiloride (blocks the influx of lithium into the CCD cells)
What is the effect seen if someone ingests too much real licorice
Contains glycyrrhizic acid, with can potential aldosterone effects and lead to kidney and increases in systolic blood pressure
What must be considered in the use of furosemide
A sulfa drug, so watch for allergies
What is the result of action potentials in the case of hypokalemia
Hyperpolarizes the membranes and decreases firing
What are the clinical applications of conivaptan and tolvaptan
Treatment of hypervolemia and euvolemia in patients who are hyponatremic (only in those who are in the hospital so they can be closely monitored)
-Can slow progression of adult polycystic kidney disease
What is a natriuretic
Substance that promotes the renal excretion of sodium
What drug interactions must be avoided with the use of aldosterone blocking potassium sparing diuretic
Drugs that increase plasma potassium levels or ACE inhibitors
What class of drug is conivaptan
Auaretics
What are the pharmacokinetics of the -vamptans
Product of CYP3A4, so must be watched with the inducers or inhibitors of it
What is the mechanism of the loop diuretics
Sodium/potassium/chloride co transporter blocker in the loop of Henle (ascending thick)
What is the mechanism of action for tolvaptan
Selective V2 receptor antagonist administered of organs
In the cause of a patient with a sulfa allergy, which loop diuretic must be given
Ethacrynic acid
What is a caution when using hydrochlorothiazide in some patients
A sulfa drug, so watch for allergies
What class of drug is tolvaptan
Aquaretics
What class of drug is amiloride
Sodium channel blocker, potassium sparing diuretic
What is the characteristic of urine while used a thiazide
Dilute urine
What class of drug is eplerenone
Aldosterone antagonist, potassium sparing diuretic
What class of drug is bumetanide
Loop diuretic
What are the effects of Hyperkalemia on the heart
Tall T waves Prolonged PR Widened QRS Flat P Bradycardia
