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Clinical Pharmacology and Therapeutics > Diuretics > Flashcards

Diuretics Flashcards

1
Q

What are the functions of the kidney?

A

Regulatory
Excretory
Endocrine
Metabolism

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2
Q

What drugs act on the renal tubules?

A 
Carbonic anhydrase inhibitors
Osmotic diuretics
Loop diuretics
Thiazides
K+ sparing diuretics
Aldosterone antagonists
ADH antagonists
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3
Q

Where do carbonic anhydrase inhibitors work?

A

PCT

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4
Q

How do carbonic anhydrase inhibitors work?

A

Prevent reuptake of sodium bicarb and water

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5
Q

What are carbonic anhydrase inhibitors generally used to treat?

A

Glaucoma

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6
Q

What are the carbonic anhydrase inhibitors?

A

Acetazolamide and dorzolamide

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7
Q

What are the ADRs associated with carbonic anhydrase inhibitors?

A

Metabolic acidosis and hypokalaemia

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8
Q

Name an osmotic diuretic.

A

Mannitol

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9
Q

Where do osmotic diuretics work?

A

The PCT and descending loop of Henle

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10
Q

What are the ADRs associated with osmotic diuretics?

A

Excessive water loss and hypernatraemia

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11
Q

Where do loop diuretics work?

A

Thick ascending loop of Henle

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12
Q

Name some loop diuretics.

A

Furosemide

Bumetamide

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13
Q

How do loop diuretics work?

A

Inhibit NaCl reabsorption - very potent as major site of water reabsorption

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14
Q

What are the ADRs associated with loop diuretics?

A

Hypokalaemia

Concurrent Ca2+ and Mg2+ excretion

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15
Q

What are examples of thiazide diuretics?

A

Metolazone
Indapamide
Others ending in -thiazide

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16
Q

Where do thiazide diuretics work?

A

DCT

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17
Q

How do thiazide diuretics work?

A

Inhibit NaCl reabsorption and promotes Ca2+ reabsorption

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18
Q

What are the ADRs associated with thiazide diuretics?

A

Hypokalaemia
Hyperuricaemia
Hypercalcaemia

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19
Q

Where do aldosterone antagonists work?

A

Collecting ducts

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20
Q

Name the aldosterone antagonists.

A

Spironalactone

Eplerenone

21
Q

What is good about aldosterone antagonists?

A

There are K+ sparing

22
Q

How do ADH antagonists work?

A

(Aside from the obvious) Reduce the ability of the collecting ducts to concentrate urine.

23
Q

Name some ADH antagonists.

A

Lithium

Demeclocycline

24
Q

Name 2 other drugs with diuretic activity.

A

Digoxin

Amiloride

25
Q

How is digoxin diuretic in nature?

A

Inhibits tubular Na+K+ ATPase

26
Q

How is amiloride diuretic in nature?

A

Inhibits Na+ channels in DCT and CD. K+ sparing, so good adjunct

27
Q

What general ADRs should we be aware of for diuretics?

A 
Anaphylaxis/rash (rare)
Hypovolaemia and hypotension
Acute renal failure (due to above)
Electrolyte disturbance
Metabolic disturbance
28
Q

What are the common ADRs specific to thiazides?

A

Gout

Erectile dysfunction

29
Q

What are the ADRs specific to furosemide?

A

Ototoxicity (rare)

30
Q

What is the ADR specific to bumetanide?

A

Myalgia

31
Q

What are the common ADRs specific to spironolactone?

A

Hyperkalaemia

Painful gynaecomastia

32
Q

Which diuretics interact with ACE inhibitors, and how?

A

K+ sparing diuretics to cause hyperkalaemia -> cardiac problems

33
Q

Which diuretics interact with aminoglycosides (e.g. gentamicin), and how?

A

Loop diuretics to cause ototoxicity and nephrotoxicity

34
Q

Can digoxin be added onto a thiazide and a loop diuretic?

A

No as Loop + thiazide can cause hypokalaemia which can precipitate digoxin toxicity

35
Q

What group of drug increases the risk of hypokalaemia when taken alongside thiazides or loop diuretics?

A

Steroids

36
Q

What happens if i mix a beta blocker and a thiazide?

A

Hyperglycaemia
Hyperlipidaemia
Gout (via hyperuricaemia)

37
Q

Thiazide + what = increased risk of hyponatraemia?

A

Carbamazepine

38
Q

Can diuretic resistance occur?

A

Yes

39
Q

How can diuretic resistance occur iatrogenically?

A

Incomplete treatment of the primary disorder
NSAIDs
Volume depletion

40
Q

How can diuretic resistance occur due to patient factors?

A

Continued high dietary Na+ intake
Poor compliance
Volume depletion

41
Q

What are the 3 major indications for diuretic use?

A

Heart Failure
Hypertension
Decompensated Liver Disease

42
Q

Which diuretics do we use for heart failure?

A

Loop and thiazides

Spironalactone (not for diuretic effect)

43
Q

Which diuretics do we use for hypertension?

A

Thiazides
Spironalactone
Loop

44
Q

Which diuretics do we use for decompensated liver disease?

A

Spironolactone for managing oedema

Loop diuretics

45
Q

How do we prescribe in renal failure?

A

Avoid nephrotoxins as much as possible.

Decrease dosage in line with eGFR if metabolised by or excreted via the kidneys.

46
Q

What is more likely to occur in renal failure?

A

Hyperkalaemia

47
Q

Describe the identification and management of hyperkalaemia.

A

Bloods and ECG to diagnose
Treat with calcium gluconate, insulin (+dextrose), calcium resonium, sodium bicarb, and salbutamol.
Identify the cause and treat

48
Q

How does hyperkalaemia show on an ECG?

A

Tall tented T waves (V4-V6)
Fewer P waves
Widened QRS complexes

Clinical Pharmacology and Therapeutics (26 decks)

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