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CPT > Session 3 Diuretics > Flashcards

Session 3 Diuretics Flashcards

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1
Q

What does a diuretic do?

A

increases production of urine

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2
Q

What does a natriuretic do?

A

increases the loss of sodium in urine

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3
Q

What does an aquaretic do?

A

increases the loss of water without electrolytes

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4
Q

What part of the tubule do carbonic anhydrase inhibitors work on?

main usage?

A

PCT

main usage = glaucoma, altitude sickness

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5
Q

MoA of Carbonic Anhydrase Inhibitors

drug name?

A
  • effect is due to its action in the kidney on the reversible reaction involving hydration of carbon dioxide and dehydration of carbonic acid

= loss of bicarbonate which carries out sodium, water and potassium with it

drug name = acetazolamide

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6
Q

disadvantages of carbonic anhydrase inhibitors?

A

hypokalemic metabolic acidosis
renal stones
tolerance develops after 2-3 days

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7
Q

Where do osmotic agents act?
give an example of drug name
main usage?

A

PCT and descending loop of Henle

  • mannitol
  • main usage = reduce high intracerebral pressure
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8
Q

MoA of osmotic agents (mannitol)

A

promote loss of water so reduce intracellular volume

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9
Q

disadvantages of osmotic agents?

A

risk of hyPERnatremia

also associated with allergic reactions

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10
Q

Where do SGLT2 inhibitors act?

A

PCT

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11
Q

MoA of SGLT2 inhibitors?

A

reduce glucose by stimulating urinary glucose excretion
while simultaneously improving other risk factors in a glucose-independent manner
* decrease:
plasma glucose
body weight
BP
plasma uric acid (increase uric acid secretion)
glomerular hyperfiltration

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12
Q

where do loop diuretics act?

main usage?

A

thick ascending limb

main usage = oedema (+/- hypertension in advanced CKD)

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13
Q

MoA of loop diuretics

A

promote loss of Na and water by inhibiting NaK2Cl

* enhanced Na delivery results in loss in K+ in collecting duct

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14
Q

other things you may get with loop diuretics / side effects

A

hypokalemic metabolic alkalosis
increased Ca2+ loss
increase urate and lipids

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15
Q

where do thiazide diuretics act?
drug name?
main usage?

A

DCT
thiazide = bendroflumethiazide
thiazide-like = indapamide
main usage = hypertension

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16
Q

MoA of thiazide diuretics?

A

loss of Na and water
inhibit the Na/Cl cotransporter
* enhanced Na+ delivery results in K+ loss in the collecting duct
* lower Na in interstitium facilitates Ca reabsorption by Na/Ca exchange

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17
Q

other things associated with thiazide diuretics

A

hypokalemic metabolic alkalosis
increased Ca2+ reabsorption
metabolic effects = increased urate, glucose, lipids, impotence

18
Q

what does aldosterone do?

A

increases the expression of ENaC and Na/K/ATPase in principal cells of the collecting duct

19
Q

What is the drug Tolvaptan classed as?

A

ADH antagonist (aquaretics) - blocks V2 receptors

so is a diuretic but not natriuretic

NB: lithium also does this but has unwanted side effects

20
Q

what is tolvaptan used to treat?

A

hyponatraemia (and prevent cyst enlargement in APCKD)

21
Q

diuretic action of alcohol?

A

inhibits ADH release

22
Q

diuretic action of caffeine?

A

increases GFR and decreases tubular Na reabsorption

23
Q

what are the generic adverse drug reactions of diuretics?

A 
hypovolaemia and hypotension 
* activates RAAS but can lead to AKI 
electrolyte disturbances 
metabolic abnormalities 
anaphylaxis / photosensitivity rash (rare)
24
Q

ADR of thiazides

A 
gout
hyperglycaemia 
erectile dysfunction 
increased LDL and increased TG
hypercalcaemia
25
Q

ADR of spironolactone

A

hyperkalaemia
impotence
painful gynaecomastia

26
Q

ADR of frusemide

A

ototoxicity
alkalosis
increased LDL and increased TG
gout

27
Q

ADR of bumetanide

A

myalgia

28
Q

DDI:

ACEi with K+ sparing drugs

A

increased hyperkalaemia can lead to cardiac problems

29
Q

DDI:

aminoglycosides with loop diuretics

A

ototoxicity and nephrotoxicity

30
Q

DDI:

digoxin with thiazide and loop

A

hypokalaemia can lead to increased digoxin binding and toxicity

31
Q

DDI:

beta blockers with thiazide

A

hyperglycemia, hyperlipidemia, hyperuricaemia

32
Q

DDI:

steroids with thiazide and loop

A

increased risk of hypokalaemia

33
Q

DDI:

lithium with thiazide and loop

A 
lithium toxicity (thiazides) 
reduced lithium levels (loop)
34
Q

DDI:

carbamazepine with thiazide

A

increased risk of hyponatraemia

35
Q

What would you use to treat hypertension?

A

thiazide (cause vasodilation as well as diuresis)
spironolactone
(loop diuretics)

plus non-diuretics:

  • ACEi / ARB
  • beta blockers
36
Q

What are the traditional methods and novel methods of treating HF?

A

Traditional

  • loop diuretics
  • spironolactone (had non-diuretic benefits)
  • ACEi / ARB / beta-blockers

novel

  • SGLT2 inhibitors
  • tolvaptan
37
Q

what are the traditional and novel methods of treating decompensated liver diseases?

A

traditional

  • spironolactone
  • loop diuretics

novel
* tolvaptan

38
Q

treatment of nephrotic syndrome?

A

loop diuretics (big doses needed)
+/- thiazides
+/- potassium sparing diuretic / potassium supplements

39
Q

what should you generally avoid prescribing with CKD?

A

K+ sparing diuretics

40
Q

steps in managing refractory oedema?

A
  1. check salt intake
  2. give furosemide IV if gut oedema is likely
  3. find minimum effective dose
  4. give repeated bolus or infusion as shot half life
41
Q

potassium sparing diuretics
name?
usage?
side effects?

A

name = amiloride
usage = HF, ascites, hypertension and hyperadrenalism
side effects = hyperkalaemia, hynaecomastia (spironolactone)

42
Q

ADH antagonist
usage?
side effects?

A

usage = hyponatraemia

side effects = hypernatraemia, deranged liver function

CPT (23 decks)

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