Test2: Wk7: 5 Diuretics - Rankin Flashcards
3 uses of diuretics
- mobilize fluid
- excrete fluid (edema, extracellular fluid)
- excrete electrolytes
6 Classes of Diuretics
- carbonic anhydrase inhibitors
* 2. thiazides and related agents
* 3. loop diuretics
* 4. potassium-sparing diuretics - osmotic diuretics
- miscellaneous (xanthines, ethanol)
Carbonic Anhydrase Inhibitors prototypic drug is
acetazolamide
Carbonic Anhydrase Inhibitors MOA
inhibit carbonic anhydrase
Carbonic Anhydrase Inhibitors uses
open angle glaucoma
prophylaxis of acute mountain sickness
not normally used as diuretic
Carbonic Anhydrase Inhibitors Adverse Effects
metabolic acidosis, hypokalemia,
drowsiness, tingling of extremities
Thiazides prototypic agents
chlorothiazide (Diuril)
hydrochlorothiazide (Hydrodiuril, others)
polythiazide (Renese)
Thiazides related drugs
chlorthalidone (Hygroton)
metalozone (Diulo)
indapamide (Lozol)
Thiazides MOA
inhibition of sodium-chloride cotransporter on the luminal membrane of distal tubular cells
Thiazides urine composition: increase excretion of
Na, K, HCO3, H2O
Thiazides urine composition decrease excretion of
Ca
Thiazides therapeutic uses (5)
hypertension CHF, cirrhosis Hypercalciuria Nephrogenic Diabetes Insipidus Nephrotic Syndrome
Thiazides Adverse Effects (7)
- Hypokalemia
- hypercalcemia
- Hyperuricemia
4Hyperglycemia - Hypovolemia
- Hypersensitivity to sulfonamides
- increased LDL, cholesterol and TG
most effective diuretics
Loop
Loop Dietetics prototypic drugs (4)
Furosemide (Lasix)
Bumetanide (Bumex)
Torsemide (Demodex)
Ethracrynic Acid (Edecrin)
Loop Dietetics MOA
inhibit Na-K-2Cl cotransporter in the luminal membrane of ascending limb
Loop Dietetics effect on urine increase excretion of
Na, K, Ca, Cl, H2O
+/- HCO3 Low dose increase HCO3 PO4 High Dose
Loop Dietetics effect on urine HCO3
+/- low dose
increase HCO3 and PO4 at high doses
Loop Dietetics uses (4)
acute pulmonary edema
edema of cardiac, haptic, or renal region
hypertension
hypercalcemia
Loop Dietetics Adverse Effects (7)
a. fluid and electrolyte disturbances
1. hypovolemia
2. hypokalemia (hypokalemic alkalosis)
3. hyponatremia
4. hyperuricemia gout
5. hyperglycemia
6. Ototoxicity
7. Increase LDL, Cholesterol, and TG
Potassium Sparing Diuretics drugs (2)
spironolactone (Aldactone) and eplerenone (Inspra)
Potassium Sparing Diuretics Spirolactone MOA
competitively inhibits the binding of aldosterone to the mineralocorticoid receptor in late distal tubule and collecting duct cells.
Potassium Sparing Diuretics urine composition increase excretion of
Na, Cl, H2O
Potassium Sparing Diuretics urine composition decrease excretion of
K, H
Potassium Sparing Diuretics - Spironolactone uses
primary hyperaldosteronism
prevent hypokalemia caused by thiazide or loop diuretics
hepatic cirrhosis
Potassium Sparing Diuretics - Eplerenone uses
hypertension
CHF post-MI
Potassium Sparing Diuretics adverse effects
hyperkalemia
altered hormonal activity
Potassium Sparing Diuretics - triameterene and amiloride MOA
inhibit luminal Na+ channel in late distal tubule and collecting duct. Inhibition may be competitive or noncompetitive
Potassium Sparing Diuretics - triameterene and amiloride uses
secondary hyperaldosteronism and prevention of hypokalemia
Potassium Sparing Diuretics - triameterene and amiloride adverse effects
hyperkalemia
Osmotic Diuretics drugs
Mannitol
Mannitol MOA
freely filtered at the glomerulus, but poorly
reabsorbed from the luminal fluid. As they are excreted in the urine, water associated
with the drug provides the diuresis.
Mannitol therapeutic uses
maintain urine flow
oliguric acute renal failure
reduce intracranial or intraocular pressure
not useful for mobilizing edema
Mannitol adverse effects
overexpansion of the extracellular fluid
alteration of Na+, K+ levels in blood
K Sparing Triameterene and Amiloride MOA
inhibit Na Channels in the late distal tubule and collecting duct
