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Pharmacology > Unit 4- Diuretics > Flashcards

Unit 4- Diuretics Flashcards

1
Q

Acetazolamide

Drug class

A

Carbonic anhydrase inhibitors

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2
Q

Acetazolamide

Mechanism

A

Inhibits luminal carbonic anhydrase at proximal tubule –> less activity of Na/H antiporter, decreased HCO3 and Na+ (and water) reabsorption

FeNa = 5%

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3
Q

Acetazolamide

Uses

A

Decrease intraocular volume/pressure and the prevention and treatment of mountain sickness

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4
Q

Acetazolamide

Side effects

A

Increased K+ excretion and metabolic acidosis

Hepatic encephalopathy, BM depression, skin toxicity, allergic reactions

Contraindicated in cirrhotic patients;

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5
Q

Methazolamide

Drug class

A

Carbonic anhydrase inhibitors

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6
Q

Methazolamide

Mechanism

A

Inhibits luminal carbonic anhydrase at proximal tubule –> less activity of Na/H antiporter, decreased HCO3 and Na+ (and water) reabsorption

FeNa = 5%

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7
Q

Methazolamide

Uses

A

Decrease intraocular volume/pressure and the prevention and treatment of mountain sickness

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8
Q

Methazolamide

Side effects

A

Increased K+ excretion and metabolic acidosis

Hepatic encephalopathy, BM depression, skin toxicity, allergic reactions

Contraindicated in cirrhotic patients;

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9
Q

Dichlorphenamide

Drug class

A

Carbonic anhydrase inhibitors

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10
Q

Dichlorphenamide

Mechanism

A

Inhibits luminal carbonic anhydrase at proximal tubule –> less activity of Na/H antiporter, decreased HCO3 and Na+ (and water) reabsorption

FeNa = 5%

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11
Q

Dichlorphenamide

Uses

A

Decrease intraocular volume/pressure and the prevention and treatment of mountain sickness

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12
Q

Dichlorphenamide

Side effects

A

Increased K+ excretion and metabolic acidosis

Hepatic encephalopathy, BM depression, skin toxicity, allergic reactions

Contraindicated in cirrhotic patients;

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13
Q

Aminophylline

Drug class

A

Bronchodilator (Methylxanthine)

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14
Q

Aminophylline

Mechanism

A

Phosphodiesterase inhibition and enhanced signalling via increased cAMP and cGMP; works at proximal tubule; decreased HCO3 and Na+ (and water) reabsorption

FeNa = 5%; aminophylline = theophylline + ethyelenediamine (solubility agent); metabolized by liver;

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15
Q

Aminophylline

Uses

A

Reduce inflammation and bronchospasm in moderate to severe asthma, night symptoms;

NOT as diuretic

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16
Q

Aminophylline

Side effects

A

Larger doses give nausea, vomiting, CNS stimulation or seizures, tachycardia/arrythmias

cimetidine and quinoline increase blood levels

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17
Q

Mannitol

Drug class

A

Osmotic diuretic

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18
Q

Mannitol

Mechanism

A

Opposes water and sodium reabsorption at proximal tubule –> increased osmolarity of tubular fluid

FeNa = 5%; must give IV; other osmotic diuretics include glucose, urea, isorbide

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19
Q

Mannitol

Uses

A

Increased clearance of drugs, minimize renal failure (shock or surgery), decrease intraocular or intracranial pressures, diagnose oliguria

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20
Q

Mannitol

Side effects

A

Risk of pulmonary edema

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21
Q

Furosemide

Drug class

A

Loop diuretic (- charge)

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22
Q

Furosemide

Mechanism

A
  • Inhibits Cl portion of Na-K-2Cl cotransporter in luminal membrane at medullary and cortical (proximal) talH –> decreased K+, Ca++ and Na+ reabsorption, resultant K+ loss
  • FeNa = 25%; eventually causes increase in PT reabsorption,decreases positive & negative free water clearance; decreases cortex-medulla molarity gradient;
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23
Q

Furosemide

Uses

A
  • Crisis edema (pulmonary, CHF, cirrhosis), hypercalcemia, drug toxicity/OD; severe hypertension in setting of CHF or cirrhosis
  • take before salty meals, reduce salt intake; useful in patients with renal insufficiency (GFR < 30-40)
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24
Q

Furosemide

Side effects

A
  • Hypokalemia/hypocalcemia/hypomagnesemia (–> arrhythmia), contraction alkalosis, increased BUN & creatinine, ototoxicity (esp. w/aminoglycoside)
  • Hyper -glycemia, -lipidemia, -uricemia; hypo -magnesia, -natremia; gout, photosensitivity, nephrocalcinosis, drug interactions; erectile dysfunction
  • Avoid NSAIDs
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25
Bumetanide Drug class
Loop diuretic (- charge)
26
Bumetanide Mechanism
* Inhibits Cl portion of Na-K-2Cl cotransporter in luminal membrane at medullary and cortical (proximal) talH --\> decreased K+, Ca++ and Na+ reabsorption, resultant K+ loss * FeNa = 25%; eventually causes increase in PT reabsorption,decreases positive & negative free water clearance; decreases cortex-medulla molarity gradient;
27
Bumetanide Uses
* Crisis edema (pulmonary, CHF, cirrhosis), hypercalcemia, drug toxicity/OD; severe hypertension in setting of CHF or cirrhosis * take before salty meals, reduce salt intake; useful in patients with renal insufficiency (GFR \< 30-40)
28
Bumetanide Side effects
* Hypokalemia/hypocalcemia/hypomagnesemia (--\> arrhythmia), contraction alkalosis, increased BUN & creatinine, ototoxicity (esp. w/aminoglycoside) * Hyper -glycemia, -lipidemia, -uricemia; hypo -magnesia, -natremia; gout, photosensitivity, nephrocalcinosis, drug interactions; erectile dysfunction * Avoid NSAIDs
29
Ethacrynic acid Drug class
Loop diuretic (- charge)
30
Ethacrynic acid Mechanism
* Inhibits Cl portion of Na-K-2Cl cotransporter in luminal membrane at medullary and cortical (proximal) talH --\> decreased K+, Ca++ and Na+ reabsorption, resultant K+ loss * FeNa = 25%; eventually causes increase in PT reabsorption,decreases positive & negative free water clearance; decreases cortex-medulla molarity gradient;
31
Ethacrynic acid Uses
* Crisis edema (pulmonary, CHF, cirrhosis), hypercalcemia, drug toxicity/OD; severe hypertension in setting of CHF or cirrhosis; sulfa-free * useful in patients with renal insufficiency (GFR \< 30-40)
32
Ethacrynic acid Side effects
* Hypokalemia/hypocalcemia/hypomagnesemia (--\> arrhythmia), contraction alkalosis, increased BUN & creatinine, ototoxicity (esp. w/aminoglycoside) * Hyper -glycemia, -lipidemia, -uricemia; hypo -magnesia, -natremia; gout, photosensitivity, nephrocalcinosis, drug interactions; erectile dysfunction * Avoid NSAIDs
33
Chlorthiazide Drug class
Thiazide diuretic (- charge)
34
Chlorthiazide Mechanism
Inhibits the Cl portion of the Na-Cl cotransporter in the luminal membrane at the early distal tubule --\> decreased Na+ (and water) reabsorption, increased Ca++ reabsorption, resultant K+ loss
35
Chlorthiazide Uses
HTN (intravascular contraction), chronic edema (cardiac insufficiency), idiopathic hypercalciuria (stones), nephrogenic diabetes insipidus
36
Chlorthiazide Side effects
Hypokalemia/hypercalcemia, contraction alkalosis, increased BUN & creatinine Hyper -glycemia, -lipidemia, -uricemia, -calcemia; hypo -magnesia, -natremia; gout, photosensitivity, impotence, drug interactions FeNa = 8%; lethal interaction w/quinidine (v. tach --\> fib, may be due to hyperkalemia); avoid NSAIDs, bile sequestrants; increased risk of hypokalemia w/anti-inflammatory steroids or Amphotericin B; decreases positive free water clearance
37
Hydrochlorothiazide Drug class
Thiazide diuretic (- charge)
38
Hydrochlorothiazide Mechanism
Inhibits the Cl portion of the Na-Cl cotransporter in the luminal membrane at the early distal tubule --\> decreased Na+ (and water) reabsorption, increased Ca++ reabsorption, resultant K+ loss
39
Hydrochlorothiazide Uses
HTN (intravascular contraction), chronic edema (cardiac insufficiency), idiopathic hypercalciuria (stones), nephrogenic diabetes insipidus
40
Hydrochlorothiazide Side effects
Hypokalemia/hypercalcemia, contraction alkalosis, increased BUN & creatinine Hyper -glycemia, -lipidemia, -uricemia, -calcemia; hypo -magnesia, -natremia; gout, photosensitivity, impotence, drug interactions FeNa = 8%; lethal interaction w/quinidine (v. tach --\> fib, may be due to hyperkalemia); avoid NSAIDs, bile sequestrants; increased risk of hypokalemia w/anti-inflammatory steroids or Amphotericin B; decreases positive free water clearance
41
Chlorthalidone Drug class
Thiazide-like diuretic
42
Chlorthalidone Mechanism
Inhibits the Cl portion of the Na-Cl cotransporter in the luminal membrane at the early distal tubule --\> decreased Na+ (and water) reabsorption, increased Ca++ reabsorption, resultant K+ loss
43
Chlorthalidone Uses
Reduce stroke risk, CHF events; HTN (intravascular contraction), chronic edema (cardiac insufficiency), idiopathic hypercalciuria (stones), nephrogenic diabetes insipidus
44
Chlorthalidone Side effects
Hypokalemia/hypercalcemia, contraction alkalosis, increased BUN & creatinine Hyper -glycemia, -lipidemia, -uricemia, -calcemia; hypo -magnesia, -natremia; gout, photosensitivity, impotence, drug interactions FeNa = 8%; lethal interaction w/quinidine (v. tach --\> fib, may be due to hyperkalemia); avoid NSAIDs, bile sequestrants; increased risk of hypokalemia w/anti-inflammatory steroids or Amphotericin B; decreases positive free water clearance
45
Quinethazone Drug class
Thiazide-like diuretic
46
Quinethazone Mechanism
Inhibits the Cl portion of the Na-Cl cotransporter in the luminal membrane at the early distal tubule --\> decreased Na+ (and water) reabsorption, increased Ca++ reabsorption, resultant K+ loss
47
Quinethazone Uses
HTN (intravascular contraction), chronic edema (cardiac insufficiency), idiopathic hypercalciuria (stones), nephrogenic diabetes insipidus
48
Quinethazone Side effects
Hypokalemia/hypercalcemia, contraction alkalosis, increased BUN & creatinine Hyper -glycemia, -lipidemia, -uricemia, -calcemia; hypo -magnesia, -natremia; gout, photosensitivity, impotence, drug interactions FeNa = 8%; lethal interaction w/quinidine (v. tach --\> fib, may be due to hyperkalemia); avoid NSAIDs, bile sequestrants; increased risk of hypokalemia w/anti-inflammatory steroids or Amphotericin B; decreases positive free water clearance
49
Metolazone Drug class
Thiazide-like diuretic
50
Metolazone Mechanism
Inhibits the Cl portion of the Na-Cl cotransporter in the luminal membrane at the early distal tubule --\> decreased Na+ (and water) reabsorption, increased Ca++ reabsorption, resultant K+ loss
51
Metolazone Uses
HTN (intravascular contraction), chronic edema (cardiac insufficiency), idiopathic hypercalciuria (stones), nephrogenic diabetes insipidus
52
Metolazone Side effects
Hypokalemia/hypercalcemia, contraction alkalosis, increased BUN & creatinine Hyper -glycemia, -lipidemia, -uricemia, -calcemia; hypo -magnesia, -natremia; gout, photosensitivity, impotence, drug interactions FeNa = 8%; lethal interaction w/quinidine (v. tach --\> fib, may be due to hyperkalemia); avoid NSAIDs, bile sequestrants; increased risk of hypokalemia w/anti-inflammatory steroids or Amphotericin B; decreases positive free water clearance
53
Indapamide Drug class
Thiazide-like diuretic
54
Indapamide Mechanism
Inhibits the Cl portion of the Na-Cl cotransporter in the luminal membrane at the early distal tubule --\> decreased Na+ (and water) reabsorption, increased Ca++ reabsorption, resultant K+ loss
55
Indapamide Uses
HTN (intravascular contraction), chronic edema (cardiac insufficiency), idiopathic hypercalciuria (stones), nephrogenic diabetes insipidus
56
Indapamide Side effects
Hypokalemia/hypercalcemia, contraction alkalosis, increased BUN & creatinine Hyper -glycemia, -lipidemia, -uricemia, -calcemia; hypo -magnesia, -natremia; gout, photosensitivity, impotence, drug interactions FeNa = 8%; lethal interaction w/quinidine (v. tach --\> fib, may be due to hyperkalemia); avoid NSAIDs, bile sequestrants; increased risk of hypokalemia w/anti-inflammatory steroids or Amphotericin B; decreases positive free water clearance
57
Amiloride Drug class
K+-sparing diuretic; renal ENaC inhibitor (+ charge)
58
Amiloride Mechanism
Blocks Na channel and Na/H antiporter in lumenal membrane at the late distal tubule and collecting duct --\> decreased K+ secretion and distal tubule acid secretion, increased Ca++ absorption
59
Amiloride Uses
Combination with other diuretics to prevent hypokalemia; edema, idiopathic hypercalciuria (stones); lithium-induced polyuria & toxicity, Liddle syndrome, mucocilliary clearance
60
Amiloride Side effects
Hyperkalemia in patients with renal failure or on ACE inhibitors Contraindicated in patients with renal failure (hyperkalemia), ACEi/ARB use; FeNa = 2%
61
Torsemide Drug class
Loop diuretic (- charge)
62
Torsemide Mechanism
Inhibits Cl portion of Na-K-2Cl cotransporter in luminal membrane at medullary and cortical (proximal) talH --\> decreased K+, Ca++ and Na+ reabsorption, resultant K+ loss
63
Torsemide Uses
Crisis edema (pulmonary, CHF, cirrhosis), hypercalcemia, drug toxicity/OD; severe hypertension in setting of CHF or cirrhosis
64
Torsemide Side effects
Hypokalemia/hypocalcemia/hypomagnesemia (--\> arrhythmia), contraction alkalosis, increased BUN & creatinine, ototoxicity (esp. w/aminoglycoside) Hyper -glycemia, -lipidemia, -uricemia; hypo -magnesia, -natremia; gout, photosensitivity, nephrocalcinosis, drug interactions; erectile dysfunction FeNa = 25%; eventually causes increase in PT reabsorption,decreases positive & negative free water clearance; decreases cortex-medulla molarity gradient; avoid NSAIDs, take before salty meals, reduce salt intake; useful in patients with renal insufficiency (GFR \< 30-40)
65
Triamterene Drug class
K+-sparing diuretic; renal ENaC inhibitor (+ charge)
66
Triamterene Mechanism
Blocks Na channel and Na/H antiporter in lumenal membrane at the late distal tubule and collecting duct --\> decreased K+ secretion and distal tubule acid secretion, increased Ca++ absorption
67
Triamterene Uses
Combination with other diuretics to prevent hypokalemia; edema
68
Triamterene Side effects
Hyperkalemia in patients with renal failure or on ACE inhibitors Megaloblastic anemia in patients with liver cirrhosis Contraindicated in patients with renal failure (hyperkalemia); FeNa = 2%
69
Spironolactone Drug class
K+-sparing diuretic; aldosterone receptor antagonist
70
Spironolactone Mechanism
Competes for aldosterone receptor, inhibiting mRNA transcription and translation --\> decreased Na and K channels, decreased number and activity of Na-K-ATPase pumps in the late distal tubule and collecting duct --\> decreased K+ secretion, distal tubule acid secretion
71
Spironolactone Uses
Reduction in CHF mortality (30% in NYHA class III and IV); combination with other diuretics to prevent hypokalemia; edema; primary and secondary aldosteronism; hypertension; anti-testosterone agent
72
Spironolactone Side effects
Hyperkalemia in patients with renal failure or on ACE inhibitors; male patients may have gynecomastia, erectile dysfunction, and loss of libido; female patients may have amenorrhea, breast soreness, and oligomenorrhea Contraindicated in patients with renal failure (hyperkalemia); FeNa = 2%; requires a salt-restricted diet; only drug not requiring tubular lumen access
73
Conivaptan Drug class
Aquaretic
74
Conivaptan Mechanism
Vasopressin (ADH) receptor antagonist working at collecting duct --\> increased free water excretion
75
Conivaptan Uses
Hyponatremia (SIADH, CHF) New drug class with unproven clinical benefit
76
Tolvaptan Drug class
Aquaretic
77
Tolvaptan Mechanism
Vasopressin (ADH) receptor antagonist working at collecting duct --\> increased free water excretion
78
Tolvaptan Uses
Hyponatremia (SIADH, CHF) New drug class with unproven clinical benefit

Pharmacology (26 decks)

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