Diuretics

Question 1

Acetazolamide

Methazolamide, Dorazolamide, Brinzolamide, Dichlorphenamide

Amide

Answer 1

Carbonic Anhydrase Inhibitors(CAIs)

Indication: Tx edema w/ pt’s who have metabolic alkalosis… could be due to Hypocapnia(increased CO2 offload) CO2 is ACID

CHF

MOA: Works at the ProxCT and prevents the synth of H2CO2 from CO2.. DecreaseH2CO2(Bicarb) to help reduced the alkalinity and increase co2 conc. CO2 is ACID!!

Effects:

Adverse:: could lead to metabolic acidosis.Hyperammonemia

w/ glaucoma could decrease aq humor and decreased IOP as topical

Acute mountain sickness: due to increase alt so O2 low leas to hyper vent which blows off Co2 and leads to respiratory alkalosis

Acteazolamide is a sulfa drug

Question 2

Side effects of CAI

Answer 2

Bitter taste in mouth, sluggishness, tingling in hands and feet(Parathesias), decreased appetite and weight loss, skin rxn

Increased urinary excretion

Question 3

Mannitol and Glycerol

Answer 3

IV OSMOTIC DRUGS

Indication: Not used for edema because could lead to vol expansion could lead to edema… so headinjury to decrease ICP. and Glaucoma for IOP.

MOA: Water follows solutes

Adverse: Not used for diuretic properties and more to draw out fluid.

SZ, thrombphlebitis, HA, CP, Tachycardia, blurred vision, chills, and fever.

Contraindications: Intracranial bleed, HF, Pulmonary edema and Hypovolemia

Question 4

Furosemide, Ethacrynic Acid, Torsemide, and Butamide

Answer 4

Loop Diuretics(Better than Thiazides)

Indication: Edematous, due to HF.. IV DRUG can also be used for Acute HyperCa and HyperK

MOA: Inhibition of the Na/Cl/K channel in the thick ascending LOH Na/K+ ATPase effected to disrupt transport. Ca2+ also leaves

Effects: Increased Na/Cl/K are excreted.. Leads to K+ wasting

Adverse: HypoK and metabolic Alkalosis(hyperK) and increased HCO3, Decreased BV

Sulfa Drug interaction expect ethacryinc acid

Can be used w/ HTN crisis

Question 5

Cholothiazides, Hydrocholorthiazides, and Tricholormethiazide

Answer 5

Thiazide Diuretics(sulfonamide)

Indication: HTN, HF, Kidneystones(Increased Ca2+ reabsorb so don’t collect in kidneys), Insipidus DM

MOA: Inhibit reabsorb NaCl in DCT. Lowers Na+ in the cells which leaves to decreased ca. Na is excreted. K+ is also excreted

Effects: Lead to Na+ excretion… Cals cause smooth muscle dilation

Adverse: can lead to HypoK and Metabolic Alkalosis.. HypoNa, Hyperlipidemia

Can dilate arterioles by reducing pressure

USE WITH METALAZONE FOR SYNERGIST EFFECT

Cholorthiazide IV ONLY

Question 6

Amiloride and Triamterene

Answer 6

K+ sparring Diuretics

Indications: Hypokalemia from Thiazides or Loops, Drug Resistant HTN

MOA: Directly inhibit ENaCs in the late DT and CD, reducing Na and thus water reabsorption. Interfere w/ Na/K+ exchanger

Effects: reducing Na and thus water reabsorption.

Adverse: Metabolic alkalosis (same mech as loop diuretics), hypokalemia, hyperuricemia (= gout), hyperglycemia (diabetes mellitus aggravation), hyperlipidemia, hypercalcemia, impaired carb tolerance, hyponatremia, weakness, fatigue, parasthesia, hypotension, arrhythmias.

Question 7

Spironolactone and Eplerenone

Answer 7

K+ sparring Diuretics

Indication:Aldosteronism from any cause, hypokalemia from diuretics post MI, Drug resistant HTN

MOA: interfere w/ aldosterone receptor

Effect: reducing Na and thus water reabsorption.

Adverse: Hyperkalemia (offset by combining with thiazides), hyperchloremic metabolic acidosis. Spironolactone only: gynecomastia, impotence, and BPH in males, secondary amenorrhea (irregular menses) and postmenopausal bleeding in females.

Eperlonoe: no side effects

Question 8

Conivaptan and Tolvaptan

Answer 8

Antidiuretic hormone antagonist. (ADH ANTAGONIST)=diuretic

Indication: SIADH(Syndrome of inappropriate ADH), CA of Lung,

MOA: Tolvaptan for V2 ADH
Conivaptan at V14 and V2

Effects: Diuretic

Adverse: Thirsty, dry mouth, asthenia, constipation and hyperglycemia

Conivaptan IV ONLY
Tolvaptan: Oral