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Pharmacology 2 > Diuretics > Flashcards

Diuretics Flashcards

0
Q

What is a diuretic?

A

Increase rate of urine flow and also increase rate of sodium excretion.

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1
Q

What are the 5 types of diuretics?

A 
Osmotic
Loop or high ceiling
Thiazide
Potassium sparing
Carbonic anhydrase inhibitors
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2
Q

T/F: a diuretic causes urination.

A

False. Diuretics do not cause urination.

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3
Q

What are the 7 classifications of diuretics?

A 
Cardiovascular
Osmotic
Physiologic
Loop
Thiazide
Potassium sparing
Carbonic anhydrase inhibitor
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4
Q

What are the two types of cardiovascular diuretics?

A

Digitalis (digoxin)

Phosphodiesterase inhibitors

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5
Q

What are phosphodiesterase inhibitors and provide 3 examples.

A

A cardiovascular diuretic.
Aminophylline
Inamrinone
Milrinone

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6
Q

What are cardiovascular diuretics used for?

A

Treatment of edema due to congestive heart failure.

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7
Q

What two substances are physiologic diuretics?

A

Water

Sodium chloride

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8
Q

When is water used as a physiologic diuretic?

A

In compensated chronic interstitial nephritis of dogs.

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9
Q

When is sodium chloride used as a physiologic diuretic?

A

Used in urolithiasis in sheep, calves and cats.

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10
Q

What are 4 osmotic diuretics?

A

Mannitol
Urea
Glycerin
Isosorbide

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11
Q

Which osmotic diuretic is the most important?

A

Mannitol

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12
Q

What is important to note with mannitol use?

A

It is a full penetrator of membranes. If needed systemically, will be given IV, but can be given orally if needed as a laxative (can’t cross membranes in the gut lumen).

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13
Q

Where do osmotic diuretics work?

A

Loop of Henle and the proximal tubule.

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14
Q

What gives osmotic diuretics relatively safe?

A

Causes insignificant electrolyte loss.

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15
Q

Why is mannitol so widely used?

A

Doesn’t creat too much of an electrolyte imbalance, doesn’t cause much dehydration or hypovolemia, and increases renal perfusion.

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16
Q

How else does an osmotic diuretic work?

A

Has an osmotic effect in the tubule.

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17
Q

Why are osmotic diuretics good to help treat cases of poisoning?

A

Less potent and causes less of an electrolyte imbalance. Important because animal will likely be V&D. Also, causes less dehydration and helps increase renal perfusion

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18
Q

What are 5 therapeutic uses of osmotic diuretics?

A 
Cerebral edema
Glaucoma
Acute renal failure
Mobilization of edema fluids
Drug overdoses
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19
Q

When is the use of osmotic diuretics contraindicated?

A

In cases of generalized edema because fluid is in the interstitial space. That is where mannitol goes, so it will be counter-productive.

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20
Q

How are mannitol and urea given?

A

By IV

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21
Q

How are glycerin and isosorbide given?

A

Orally.

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22
Q

How is mannitol metabolized?

A

It’s not, because it’s not lipid soluble. Instead it is eliminated rapidly by the kidneys.

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23
Q

What are the three loop, or high ceiling diuretics?

A

Furosemide
Bumetanide
Ethacrynic acid

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24
Q

What must you be careful of with loop diuretics?

A

Allergies!!! If allergic to one, may be allergic to others, and also to sulfonamides.

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25
Q

What is the mechanism of action for loop diuretics?

A

Inhibit the Na/K/2Cl symporter in the thick ascending loop of henle. This also inhibits the paracellular reabsorption of Na, Ca and Mg.

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26
Q

What is the most efficacious diruetic?

A

Loop diuretics, because ~25% of filtered Na is reabsorbed in the thick ascending loop.

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27
Q

Why are loop diuretics the most efficacious?

A

Because ~25% of the filtered Na is reabsorbed in the thick ascending loop.

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28
Q

What must ALWAYS be considered and monitored when using a loop diuretic?

A

Increasing Na in the ascending loop increases depolarization of the lumenal membrane facilitating K excretion which results in hypokalemia (BAD) and systemic alkalosis.

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29
Q

What else do loop diuretics stimulate?

A

The RAAS system which also contributes to hypokalemia and systemic alkalosis.

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30
Q

T/F: Loop diuretics also increase renal blood flow.

A

True.

32
Q

How do loop diuretics cause a decrease in blood pressure?

A

They increase systemic venous capacitance via vasodilation.

33
Q

What are two major therapeutic uses of loop diuretics?

A

Tx acute pulmonary edema and pulmonary congestion.

Tx of generalized edema associated with CHF, chronic renal failure and liver cirrhosis

34
Q

What is furosemide (loop) used to treat in horses?

A

Exercise-induced pulmonary hemorrhage.

35
Q

Why are loop diuretics useful in patients with acute renal failure?

A

Increases renal perfusion.

36
Q

When using loop diuretics to help flush toxins out of a poisoning case, what must you be careful of?

A

Be careful because will cause dehydration and electrolyte depletion in an animal that is already V&D.

37
Q

How can loop diruetics be used to tx hyponatremia?

A

Combined with hypertonic saline, loops will prevent kidney from producing concentrated urine.

38
Q

What are 10 adverse effect of loop diuretics?

A 
Ototoxicity
Hypokalemia
Hypomagnesemia
Acute hypovolemia
Hypotension
Arrhythmias
Hyperglycemia
Hyperuricemia
Systemic alkalosis
Hypersensitivity in some patients
39
Q

How are loop diuretics given?

A

Orally and IV

40
Q

What are the pharmacokinetics of loop diuretics?

A

Rapid onset, short duration

Partially metabolized

41
Q

Name 2 thiazide diuretics.

A

Hydrochlorothiazide

Chlorothiazide

42
Q

How do thiazides work?

A

Inhibit Na/Cl symporter in DCT, resulting in inhibition of reabsorption of Na, Cl and duresis.

43
Q

What is the efficacy of thiazide diuretics?

A

Moderate (5% Na reabsorbed in DCT

44
Q

On top of inhibiting Na and Cl reabsorption, what else do thiazide diuretics do?

A

Inhibit K and Mg reabsorption and increase Ca reabsorption.

45
Q

T/F: Thiazide diuretics don’t cause hypokalemia and systemic alkalosis.

A

True.

46
Q

What are the 3 main therapeutic uses of thiazide diuretics?

A

Tx of edema d/t CHF, liver, cirrhosis, nephrotic syndrome, and acute glomerular nephritis.
Tx of hypertension (alone or with other meds)
Tx of nephrogenic DI and useful in central DI

47
Q

T/F: Thiazide diuretics can help treat calcium nephrolithiasis.

A

True.

48
Q

T/F: Thiazide diuretics can be used to treat udder edema in cows.

A

True

49
Q

What are the 4 adverse effects of thiazide diuretics?

A

Electrolyte imbalances
Hyperglycemia
Hypersensitivity (if allergic to sulfonamides as well)
Hyperlipidemia (TGs increase hypertension)

50
Q

How are thiazide diuretics given?

A

Orally

51
Q

How fast are thiazide diuretics absorbed?

A

Slowly, incomplete.

52
Q

Do thiazide diuretics bind to plasma proteins?

A

Yes.

53
Q

How are thiazide diuretics excreted?

A

Mainly by kidneys in the urine.

54
Q

What are the 3 potassium-sparing diuretics?

A

Spironolactone**, Triamterene, Amiloride

55
Q

How and where do potassium-sparing diuretics act?

A

Block aldosterone from binding to receptor in late DCT and collecting duct, causing excretion of NaCl and diuresis PLUS retention of K and H.

56
Q

What is the efficacy of potassium-sparing diuretics (Spironolactone)?

A

Mild, only 2% of Na reabsorbed in DCT and collecting duct.

57
Q

What are the two therapeutic uses of potassium-sparing diuretics (Spironolactone)?

A

Diuretic

Treatment of primary or secondary hyperaldosteronism

58
Q

What are the 3 adverse effects of potassium-sparing diuretics (Spironolactone)?

A

Hyperkalemia
Systemic acidosis
Adverse effects of reproduction (acts of progesterone and androgen receptors)

59
Q

How are potassium-sparing diuretics (Spironolactone) given?

A

Orally

60
Q

T/F: potassium-sparing diuretics (Spironolactone) are readily aborbed, but poorly protein bound.

A

False, potassium-sparing diuretics (Spironolactone) are readily absorbed and HIGHLY bound to plasma protein.

61
Q

Where are potassium-sparing diuretics (Spironolactone) metabolized?

A

The liver.

62
Q

What are the onset and duration of action?

A

Slow onset, long duration.

63
Q

How do potassium-sparing diuretics, Triamterene and Amiloride work?

A

Block Na channels in luminal membrane resulting in excretion of Na and retention of K and H.

64
Q

What are the 2 therapeutic uses for Triamterene and Amiloride (potassium-sparing)?

A

Tx hypokalemia and hypomagnesemia

Ocassinoally in edematous disorders and hypertension

65
Q

What are the 2 adverse effects of Triamterene and Amiloride (potassium-sparing)?

A

Hyperkalemia

Systemic acidosis

66
Q

How are Triamterene and Amiloride (potassium-sparing) given?

A

Orally

67
Q

How is Amiloride (potassium-sparing) excreted?

A

By the kidneys.

68
Q

How is Triameterene (potassium-sparing) excreted?

A

Converted to active metabolite in the liver which is actively secreted in urine.

69
Q

What are 4 carbonic anhydrase inhibitors?

A

Acetazolamide
Methazolamide
Dorzolamide and Brinzolamide (opthalmic)

70
Q

How do carbonic anhydrase inhibitors work?

A

Reversible inhibition of carbonic anhydrase preventing exchange of H for Na in PCT (#1) and collecting duct (#2).

71
Q

How do carbonic anhydrase inhibitors work in treating glaucoma?

A

Lowe IOP by inhibiting carbonic anhydrase in the eye which decreases formation of aqueous humor.

72
Q

What are 2 therapeutic uses for carbonic anhydrase inhibitors?

A 
Tx of open-angle glaucoma
Udder edema (Acetazolamide)
73
Q

What are 6 adverse effects of carbonic anhydrase inhibitors?

A 
Mild systemic acidosis
Hypokalemia
Hyperglycemia
PU/PD
Behavioural changes
Pruritis of paws
74
Q

How is Acetazolamide (carbonic anhydrase inhibitor) given?

A

Orally

75
Q

How is Acetazolamide (carbonic anhydrase inhibitor) excreted?

A

Actively secreted by kidneys into the urine.

76
Q

How are Dorzolamide and Brinzolamide (carbonic anhydrase inhibitors) given?

A

Topically into the eye.

77
Q

What is the onset and duration of carbonic anhydrase inhibitors?

A

Fast onset (~30 min) and moderate duration (4-6hrs)

Pharmacology 2 (9 decks)

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