Thiazide and Related Diuretics

Question 1

MOA of Thiazide and related diuretics

Answer 1

Inhibit sodium reabsorption at the beginning of the distal convulated tubule

Question 2

Duration and onset of action of Thiazide and related diuretics

Answer 2

Acts within 1-2 hours of oral administration and effect last for 12-24hrs

Question 3

Suitable time to administer Thiazide and Thiazide like diuretics

Answer 3

Give in the morning to avoid diuresis at night which can interfere with sleep

Question 4

Indication of Thiazide Like Diuretics

Answer 4

Lower doses reduce BP
Higher doses are used for oedema due to CHF
More effects on biochemical balance [ K, Na+, uric acid, glucose and lipids ) with little advantage on BP

Question 5

Examples of Thiazide and related Diuretics

Answer 5

Bendroflumethiazide
Chlortalidone- long duration of action and may be given on alternate days.
Indapamide-

Question 6

Indication of bendroflumethiazide

Answer 6

Use for mild or moderate HF or hypertension

Question 7

Indication of Indapamide

Answer 7

Lowers BP with less effect on electrolyte balance and less aggravation of diabetes

Question 8

Contraindications of Thiazide and related Diuretics

Answer 8

Avoid in hypokalaemia, hyponatraemia, Hypercalcaemia and Addison’s disease( low levels of sodium and high levels of potassium)

Question 9

Caution with Thiazide and related diuretics

Answer 9

Hypokalaemia can occur with loop and Thiazide diuretics
Risk of Hypokalaemia greater with Thiazide than loop diuretics
Hypokalaemia dangerous with patient with severe CV disease CV disease or patient on cardiac glycoside
In hepatic failure, Hypokalaemia can lead to encephalopathy particularly in alcohol cirrhosis

Question 10

Side effects of Thiazide and related diuretics

Answer 10

Constipation, electrolyte imbalance, headache, postural hypertension and skin reactions

Question 10

Thiazide and Thiazide like diuretics can exacerbate symptoms of…

Answer 10

Gout and diabetes ( hyperglycaemia or Hyperuricaemia)

Question 11

Pregnancy and Thiazide and related Diuretics

Answer 11

Should not be used to treat gestational HTN
They cause neonatal thrombocytopenia, bone marrow suppression, jaundice, electrolyte imbalance)

Question 12

List examples of loop diuretics

Answer 12

Furosemide and bumetanide

Question 12

Thiazide and related Diuretics

Answer 12

Use with caution and avoid in severe liver disease
Thiazide and related diuretics are ineffective if eGFR <30 and should be avoided

Question 13

Mechanism of action of Loop Diuretics

Answer 13

Inhibit reabsorption from the ascending loop of henle

Question 14

Indication of loop diuretics

Answer 14

Used in pulmonary oedema due to left ventricular failure and in CHF
Stronger diuretics than Thiazide and can be used for resistant oedema

Question 15

Loop diuretics can exacerbate diabetes but hyperglycaemia is less likely than Thiazide. T/F

Answer 15

True

Question 16

Facts about bumetanide and Furosemide

Answer 16

Acts within I hr of oral administration and similar in activity
Diuresis is complete within 6hours so can be given twice a day without interfering with sleep

Question 17

Contraindication of loop diuretics

Answer 17

Renal failure
Severe hypokalaemia
Severe Hyponatraemia
Liver cirrhosis

Question 18

Loop diuretics in renal impairment

Answer 18

High doses or rapid IV admin of loop diuretics may cause tinnitus and deafness

Question 19

Which diuretics Coadministratered with Triamterene colour bodily fluid Blue

Answer 19

Furosemide + Triamterene