Rx Files Diuretics Flashcards
What early diuretic class is no longer used and why?
Mercuric: severe ADRs
Osmotic diuretic mechanism of action
prevent reabsorption of sodium and water from the proximal tubules
What route is mannitol administered?
IV
When might mannitol be used?
reduce ICP
How should mannitol always be administered?
in-line filter
What are the osmotic diuretics?
- glycerin
- urea
- mannitol
What are the aquaretic diuretics?
demeclocycline
Aquaretic mechanism of action
interferes with the activity of ADH
Carbonic anhydrase inhibitors can cause severe what?
hypokalemia
What disease state is the main role of treatment for carbonic anhydrase inhibitors?
glaucoma
How can carbonic anhydrase inhibitors effect the excretion of other drug products?
altering blood and urine pH level
Carbonic anhydrase inhibitors have potential cross-sensitivity with
sulfonamides
What are the carbonic anhydrase inhibitors?
acetazolamide
Acetazolamide brand
Diamox
What dosage form is acetazolamide available in?
IV and PO
Thiazide diuretics mechanism of action
act in the distal tubule to prevent reabsorption of sodium and water
Where must thiazides be present in order to exert their effects?
luminal fluid
At what CrCl are thiazide’s efficacy questionable?
< 30 mL/min
What is the only thiazide with CAI activity?
Chlorothiazide
What cross-sensitivity is possible with thiazides?
sulfonamides
Tiazide onset of action
1-2 hours
What are possible electrolyte imbalances that can occur with thiazide use?
- hypokalemia
- hypomagnesemia
- hyperuricemia
- hyperglycemia
- hypercalcemia
What drug concentrations should be monitored closely with concomitant use of thiazides?
Lithium
Thiazides should be taken no later than __:___.
5:00 pm
What are the thiazide diuretics?
HCTZ
What are the loop diuretics?
- ethacrynic acid
- furosemide
- bumetianide
- torsemide
1 mg of bumetanide = ____ mg of torsemide = ___ mg of furosemide
1 mg B = 10 - 20 mg T = 40 mg F
Loop diuretic mechanism of action
Blocks sodium reabsportion in the ascending loop of Henle
Loop diuretic duration of action
6-8 hours
(T/F) Only torsemide is available IV.
False, all loop diuretics are available IV
What electrolyte imbalances may result from loop diuretic use?
- hypokalemia
- hypocalcemia
- hyperuricemia
- hyperglycemia
How would you circumvent loop diuretic resistance?
Add a diuretic with a different MOA 30 min prior to loop diuretic dose
Aldosterone antagonist mechanism of action
binds to receptors in distal tubules to stimulate the reabsorption of of sodium/water and conserving of potassium
Spironolactone acts only when _______ are present.
mineralocorticoids
What is the active metabolite of spironolactone?
canrenone
Patients on spironolactone should be closely monitored for __________.
hyperkalemia
Describe the condition that may develop due to estrogenic effects.
Reversible and painful gynecomastia may develop. This is directly related to dose and duration of therapy.
Spironolactone indications
- HTN
- hirsutism
- excess aldosterone secretion
- cirrhosis
Second generation aldosterone antagonist with reduced affinity for estrogen receptors
Eplerenone
Eplerenone brand
Inspra
What are the nonsteroidal potassium sparing diuretics
- triamterene
- amiloride
triamterene brand
Dyrenium
amiloride brand
Midamor
Triamterene/HCTZ brand
Maxzide
Dyazide
Amiloride/HCTZ brand
Moduretic
Triamterene patient counseling point
may turn urine a blueish color
Thiazide-like diuretic
indapamide
Indapamide brand
Lozol
Indapamide is potassium (sparing/wasting).
Wasting
