Diuretics

Question 1

Carbonic Anhydrase Inhibitors-acetazolamide, methazolamide, dichlorphenamide

Answer 1

-MOAIncreased bicarbonate excretion, urinary alkalinization, Triggers tubuloglomerular feedback (TGF)
leading to decrease in RBF and GFR
-Therapeutic uses - - glaucoma, urinary alkalinization, aid to dissolve renal stones that form in acidic conditions, metabolic alkalosis
-Toxicity - - metabolic acidosis, some renal stone formation (alkaline conditions), hypokalemia, allergic sulfur reactions

Question 2

Osmotic Diuretics-Mannitol, isosorbide, glycerin, urea

Answer 2

• MOA-Limit Na+ and water reabsorption, expand extracellular fluid volume leading to decrease in renin release and increase in RBF
• Increase urinary excretion of nearly all electrolytes including Na+, K+, Ca+2, Mg+2, Cl-, phosphate
• Therapeutic uses - -treatment of acute renal failure, reduction of intracranial and intraocular pressure, treatment of dialysis disequilibrium syndrome
• Toxicity - - expansion of extracellular volume problem with congestive heart failure, pulmonary edema, electrolyte loss

Question 3

Loop Diuretics-Furosemide, bumentanide, ethacrynic acid, torsemide

Answer 3

• MOA-Increase urinary excretion of Na+, Cl-, Ca+2, Mg+2, K+, Block macula densa sensing mechamism and thus block TGF and do not decrease GFR
• Theraputic uses - - pulmonary edema and other edematous states, acute renal failure, hypertension
• Toxicity - - electrolyte loss, ototoxicity, metabolic alkalosis, allergic sulfur reaction (not with ethacrynic acid)

Question 4

Thiazide Diuretics-hydrochlorthiazide, polythiazide, trichlormethiazide, indapamide, chlorthalidone, quinethazone, metolazone, chlorthiazide, methylclothiazide, bendroflumethiazide, hydroflumethiazide

Answer 4

-MOA-Increase urinary excretion of Na+, Cl-, K+
Decrease urinary excretion of Ca+2, No effects on TGF or RBF
-Therapeutic uses - - hypertension, edema, calcium nephrolithiasis
-Toxicity - - hyponatremia, hypokalemia, metabolic alkalosis, hypercalcemia, allergic sulfur reaction

Question 5

K+ Sparing Diuretics-triamterene, amiloride, spironolactone, eplerenone

Answer 5

-MOA-Increase urinary excretion of Na+, Decrease urinary excretion of K+, H+, Do not effect TGF or RBF
-Triamterene and amiloride are ENaC inhibitors
-Eplerenone and spironolactone are aldosterone antagonists
-Therapeutic uses - - in combination with other diuretics to treat: hypertension, edema
-for spironolactone and eplerenone-hyperaldosteronism, endocrine diseases
Toxicity - - hyperkalemia, metabolic acidosis, gynecomastia, impotence (spironolactone)

Question 6

Neseritide

Answer 6

• Brain natriuretic peptide
• MOA-binds to specific receptors and via c-GMP signaling inhibits Na+ reabsorption in the inner medullary collecting duct and thus increase Na+ excretion, also inhibits renin-Ang II-aldosterone pathway
• given IV
• currently limited therapeutic use acutely decompensated CHF

Question 7

What are the Carbonic anhydrase inhibitors (3)

Answer 7

acetazolamide, methazolamide, dichlorphenamide

Question 8

What are the osmotic diuretics (4)

Answer 8

Mannitol, isosorbide, glycerin, urea

Question 9

What are the loop diuretics (4)

Answer 9

Furosemide, bumentanide, ethacrynic acid, torsemide

Question 10

What are the thiazide diuretics (11)

Answer 10

hydrochlorthiazide, polythiazide, trichlormethiazide, indapamide, chlorthalidone, quinethazone, metolazone, chlorthiazide, methylclothiazide, bendroflumethiazide, hydroflumethiazide

Question 11

What are the K+ sparring diuretics (4)

Answer 11

triamterene, amiloride, spironolactone, eplerenone