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MHD1/Pharm1 Exam 4 > (THER) Diuretics > Flashcards

(THER) Diuretics Flashcards

1
Q

What does it mean when we say a drug is natriuretic?

A

It increases Na+ excretion

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2
Q

SIte of action for Acetazolamide (and other Carbonic Anhydrase inhibitors)

A

PCT

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3
Q

Site of action for Mannitol (and other osmotic diuretics)

A

PCT, as well as thin descending limb and CT [in presence of ADH])

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4
Q

Site of action for Furosemide (and others in its class)

A

Thick ascending limb of the loop of Henle

(They are known as loop diuretics)

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5
Q

Site of action for the Thiazides

A

DCT

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6
Q

Site of action for the K+-sparing diuretics

A

CT

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7
Q

Site of action for ADH antagonists

A

The CT

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8
Q

The primary therapeutic goal of diuretic use is to ________ _________

A

Reduce Edema

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9
Q

Except for __________ and some __________ diuretics generally exert their effects from the _________ side of the nephron.

A

Spironolactone; ADH antagonists; luminal

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10
Q

How does mannitol get into the tubule fluid as compared to most of the other diuretics?

A

Mannitol: via filtration at the glomerulus

Others: via secretionacross the proximal tubule

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11
Q

How does carbonic anydrase inhibition cause diuresis?

A

By blocking the function of carbonic anhydrase, you decrease HCO3- reabsorption and therefore increase the amount which makes it to the distal nephron. Na+ is the most abundunt cation present in proximal tubule fluid and thus accompanies HCO3-. At the distal tubule, Na+ is reabsorbed but bicarb holds the water in the tube and you pee it out.

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12
Q

Name the carbonic anhydrase inhibitors (4)

A
  1. Methazolamide
  2. Acetazolamide
  3. Dichlorphenamide
  4. Dorzolamide

Princess is MADD about CA (california)

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13
Q

Name the osmotic diuretic (1)

A

Mannitol

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14
Q

Name the Loop Diuretics (4)

A
  1. Furosemide
  2. Bumetanide
  3. Torsemide
  4. Ethacrynic acid
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15
Q

Name the Thiazides (5)

A
  1. Metolazone
  2. Indapamide

Chlorthalidone

  1. Hydrochlorothiazide
  2. Chlorothiazide

MI CHC (chick) has nice Thiaz (thighs)

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16
Q

Potassium-sparing Diuretics (4)

A
  1. Amiloride
  2. Triamterene
  3. Eplerenone
  4. Spironolactone

I took a SEAT on my potASSium

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17
Q

Name the ADH antagonists (5)

A
  1. Demeclocyline
  2. Lithium
  3. Tolvaptan
  4. Conivaptan
  5. Mozavaptan
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18
Q

MOA of Carbonic Anhydrase Inhibitors

A

Inhibit CA in luminal membrane of proximal tubule, reducing proximal HCO3-reabsorption.

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19
Q

MOA of the Osmotic Diuretics

A

Act primarily on the proximal tubule to reduce the reabsorption of H2O and solutes including NaCl

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20
Q

MOA of the Loop Diuretics

A

Inhibit the Na+/ K+/ 2Cl- cotransport system in the thick ascending limb of Henle’s loop (ALH)

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21
Q

MOA of the Thiazides

A

Inhibit NaCl cotransport in early distal convoluted tubule (DCT).

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22
Q

MOA of the K+-sparing diuretics (2)

A
  1. Spironolactone & eplerenone competitively block the actions of aldosterone on the collecting tubules.
  2. Amiloride and triamterene reduce Na+ entry across the luminal membrane of the principal cells of the collecting tubules.
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23
Q

MOA of ADH Antagonists

A

Prevent ADH induced water reabsorption in the principal cells of the collecting tubule.

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24
Q

Main indications for use of Carbonic Anhydrase (3)

A
  1. To reduce intraocular pressure in glaucoma.
  2. To lower [HCO3-]p in “mountain sickness”.
  3. To raise urine pH in cystinuria.
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25
Q

What are some other uses for CA Inhibitors other than their main indications? (3)

A
  1. Hypokalemic periodic paralysis.*
  2. Adjunctive therapy in epilepsy.
  3. Solid hypoxic tumors?

PET

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26
Q

Main indications for Osmotic diuretics

A
  1. To treat or prevent Acute Renal Failure (ARF).
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27
Q

What are some other uses for Osmotic Diuretics other than its main one? (2)

A
  1. To reduce intra-cranial or intra-ocular pressure.
  2. To enhance urinary excretion of chemical toxins.
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28
Q

Main Indications for Loop Diuretics (4)

A
  1. Acute Pulmonary Edema.
  2. Hypertension.
  3. Congestive heart failure (CHF)—in the presence of renal insufficiency or for immediate effect).
  4. ARF, CRF, ascites, and nephrotic syndrome
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29
Q

Other use for loop diuretics other than main indication

A

Hyercalcemia

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30
Q

Main indications for thiazides (3)

A
  1. Hypertension.
  2. Edema due to CHF, hepatic cirrhosis, renal disease.
  3. Idiopathic Hypercalciuria (renal calculi).
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31
Q

What is another use for thiazides other than the main indication?

A

Nephrogenic Diabetes Insipidus (prevent further urine dilution from taking place in the DCT).

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32
Q

Main Indications of K+-Sparing Diuretics (2)

A
  1. Chronic liver disease: to treat secondary hyperaldosteronism due to hepatic cirrhosis complicated by ascites (spironolactone, eplerenone).
  2. To prevent the hypokalemic effects of other diuretics.
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33
Q

Name alternative uses for K+-sparing diuretics. Which specific drugs are involved?

A

Primary hyperaldosteronism (Conn’s syndrome)— spironolactone, eplerenone.

34
Q

Main Indications for ADH Antagonists (2)

A
  1. SIADH
  2. Euvolemic or hypervolemic hyponatremia
35
Q

Name alternative use for ADH antagonist

A

CHF

36
Q

AE of CA Inhibitors (3 main ones)

A
  1. Metabolic acidosis (due to HCO3- depletion with prolonged treatment)
  2. Hypokalemia (acute effect)
  3. Drowsiness, fatigue, CNS depression, and paresthesia.
37
Q

AE of Osmotic Diuretics (4)

A
  1. Acute expansion of ECF volume and increased risk of pulmonary edema
  2. Hhyponatremia (with impaired renal function)
  3. Hypernatremia (prolonged use with normal GFR).
  4. Nausea and vomiting; headache.
38
Q

AE of Loop Diuretics (4 general ones)

A
  1. Hypokalemia hypomagnesemia; hyponatremia; hypovolemia
  2. Hyperuricemia*
  3. Metabolic alkalosis
  4. Ototoxicity and diarrhea (mainly with ethacrynic acid)
39
Q

AE of Thiazides (6)

A
  1. Hypokalemia; hyponatremia; hypovolemia;
  2. Hyperuricemia due to enhanced urate reabsorption* and hypercalcemia due to enhanced Ca2+ reabsorption
  3. Metabolic alkalosis
  4. Hyperglycemia (insulin resistance); hyperlipidemia.
  5. Hypersensitivity (fever, rash, purpura, anaphylaxis);
  6. Interstitial nephritis
40
Q

AE of K+-sparing diuretics (Spironlactone?Amiloride?Triamterene?)

A
  • Spironolactone: hyperkalemia, gynecomastia, hirsutism; menstrual irregularities; testicular atrophy (with prolonged use).
  • Amiloride: hyperkalemia, glucose intolerance in diabetic pts.
  • Triamterene: hyperkalemia; megaloblastic anemia in pts with liver cirrhosis.

HYPERKALEMIA

41
Q

AE of ADH Antagonists (which drugs have which effects?)

A
  • Lithium, doxycycline: nephrotoxic
  • Tolvaptan, conivaptan, mozavaptan: hypernatremia, thirst, dry mouth, hypotension, dizziness
42
Q

ACE inhibitors interact with which diuretics? What can occur as a result?

A

K+-sparing diuretics

Increaed hyperkalemia and resultant cardiac arrhythmias

43
Q

Aminoglycosides interact with which diuretics? What can occur as a result?

A

Loop diuretics

Ototoxicity and nephrotoxicity

44
Q

Anticoagulants interact with which diuretics? What can occur as a result?

A

Thiazide and Loop diuretics

Increased anti-coagulant activity with loop

Decreased anti-coagulant activity with thiazide

45
Q

B-blockers interact with which diuretics? What can occur as a result?

A

Thiazide and Loop Diuretics

Hyper- glycemia, lipidemia, uricemia

Increased plasma levels of propanolol

46
Q

Carbamazepine/ chloropropamide interact with which diuretics? What can occur as a result?

A

Thiazide diuretics

Increased risk of hyponatremia

47
Q

Digoxin interacts with which diuretics? What can occur as a result?

A

Thiazide and Loop diuretics

Hyopokalemia and increaed digoxin binding/toxicity

48
Q

NSAIDs interact with which diuretics? What can occur as a result?

A

Thiazide and Loop Diuretics/ K+ sparing diuretics

Reduced diuretic effect. Increaed risk of salicylate toxicity with high doses of salicylates (thiazide/ loop d.)

Increased risk of hyperkalemia (K+ sparing d.)

49
Q

Quinidine interacts with which diuretics? What can occur as a result?

A

Loop and thiazide d.

Polymorphic V. Tach (torsade de pointes)

50
Q

Sulfonylureas interact with which diuretics? What can occur as a result?

A

Loop diuretics

Hyperglycemia

51
Q

Steroids interact with which diuretics? What can occur as a result?

A

Thiazide and Loop d.

Increased risk of hypokalemia

52
Q

Contraindication for acetazolamide

A

Cirrhosis (increased urine pH reduces NH3 secretion and thereby increases serum NH3)

53
Q

What are the difference in the (4) CA Inhibitors

A
  • Dichlorphenamide: about 30x more potent than acetazolamide
  • Methazolamide: about 5x more potent than acetazolamide
  • Dorzolamide: topical preparation for ocular use (no systemic effects)
54
Q

Mannitol route

A

IV

55
Q

Contraindications for Mannitol

A
  1. CHF
  2. Renal failure
  3. Pulmonary edema
56
Q

How does K+ in the lumen of the nephron affect diffusion of other positvely charged ions?

A

The positive charge repels the Ca2+ and Mg2+, increasing their paracellular diffusion and reabsorption.

57
Q

What is the most efficacious diuretic class?

A

Loop diuretics

They can cause excretion of up to 20% of the filitered Na+

58
Q

Which diuretics are the only ones which cause vasodilation?

A

Loop diuretics

59
Q

Which diuretic is the only one to cause otoxicity?

A

Loop diuretics

(furosemide)

60
Q

Key points about Bumetanide

A

Loop diuretic

–About 40X more potent than furosemide

–Shorter half-life than furosemide: ~ 1 hr

–50% metabolized by the liver

61
Q

Key points about torsemide

A

Loop diuretic

–Longer half-life than furosemide: ~ 3 hrs

–Longer duration of action, too: ~ 5-6 hrs

–Better oral absorption than furosemide

–80% metabolized by the liver

62
Q

Key points about ethacrynic acid

A

Loop Diuretic

–Last resort; used only when others exhibit hypersensitivity

–No CA inhibition

–Nephrotoxic and ototoxic

63
Q

What AE are unique to thiazides?

A

Hyperglycemia and hyperlipidemia

64
Q

How do thiazides prevent kidney stones?

A

By reducing ca2+ excretion

65
Q

What is the most efficacious thiazide? It is the only one used if pt has ________ _________

A

Metolazone. Only one used if pt has renal insufficiency.

66
Q

How is Amiloride secreted into the nephron?

A

Via the organic base transporter

67
Q

Difference between amiloride and triamterene

A

Triamterene is 10x less potent than amiloride and has a shorter half-life

68
Q

Which ADH antagonists affect which vasopressin receptors?

A

V2 receptor antagonists: tolvaptan, mozavaptan, and lixivaptan

V1a and V2 receptor antagonist: conivaptan

69
Q

Combination of what (2) diuretics will cause a powerful urination of Na+ (and as such can be a powerful diuresis)?

A

Loop and thiazides

70
Q

Edema associated with hepatic cirrhosis is resistant to what type of diuretics? Which are effective?

A

Resistant to loop

Spironolactone is effective

71
Q

Why is spironolactone abetter option for CHF than thiazide or loop diuretics?

A

You risk hypokalemia with these, but do not have that with spironolactone.

72
Q

What diuretics are indicated in right heart failure (chronic)?

A

Oral loop diuretics

73
Q

What diuretics are indicated in left heart failure (acute)?

A

This is a life-threatening situation and IV loop diuretics are indicated

74
Q

Which ADH inhibitor has signficant efficacy in acute heart failure symptoms?

A

Tolvaptan

75
Q

Why is Tolvaptan particularly useful for issues of hyponaturemia, in comparison to furosemide?

A

It is tremendously sodium sparing

76
Q

For pts with signficant hypertension who are prescribed multiple drugs, which diuretic will almost always be one of them?

A

Thiazide diuretic

77
Q

In what ay are thiazides useful for patients with calcium oxalate stones (kidney stones)?

A

Thiazide diuretics can decrease calcium concentrations in the urine by promiting calcium reabsorption in the distal convoluted tubule.

78
Q

Which diuretic can be used in cases of hypercalcemia? Which should be avoided?

A

Loop diuretics may be used with hydration to increase calcium excretion.

Thiazides ought to be avoided, as they increae clacium reabsorption

79
Q

What are some causes for Diuretic resistance?

A
  1. NSAID co-administration
  2. CHF
  3. Nephrotic syndrome
  4. Hepatic cirrhosis/ renal failure
  5. Therapeutic sta
80
Q

For what patients do you use combined Loop + Thiazide Diuretics? What issues can you run into with this combination?

A

Only in patients refractory to one or the other. May be to robust and lead to K+ wasting.

81
Q

What is the benefit of combined K+ sparing + loop or thiazide diuretics? (2)

A

Prevents hypokalemia

Allows you to avoid renal insufficiency

MHD1/Pharm1 Exam 4 (26 decks)

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