Diuretics

Question 1

Which diuretics are used in oedema

Answer 1

Thiazide like in HF oedema and Loop in pulmonary oedema
Combination can be used in patients who are resistant to treatment with one diuretic.

Question 2

Thiazide like diuretic examples

Answer 2

Indapamide, bendroflumethazide, Hydrochlorthiazide, chloratlidone

Question 3

Thiazide like action

Answer 3

Inhibit sodium reabsorption at the beginning of the DST.
Act within 1-2hrs and work for 12-24 hrs.

Question 4

When to given thiazide like diuretics

Answer 4

In the morning so it does not interfere with sleep

Question 5

What can high doses of thiazide like diuretics cause

Answer 5

Increase blood glucose
Increased sodium
Increased uric acid
Increased lipids

Question 6

Thiazide like diuretics cautions

Answer 6

Exacerbates diabetes, gout, SLE
Potassium loss

Question 7

Thiazide like diuretics SE

Answer 7

Fatigue
Erectile dysfunction
Nausea
Headache
Electrolyte disturbances

Question 8

Thiazide like diuretics in renal impairment

Answer 8

AVOID if efgf <30ml/min
Metazalone can be used if renal function is <30ml/min but risk of excess diuresis

Question 9

MHRA - HYDROCHLOROTHIAZIDE

Answer 9

Increased risk of non melanoma skin cancer - especially with long term use
Limit exposure to sun and UV and use adequate SPF

Question 10

Loop diuretic examples

Answer 10

Furosemide, Torasemide, Bumetanide

Question 11

Loop diuretic action

Answer 11

Work by inhibiting the loop of henle.
Act within 1 hour
Duration of action is 6 hrs - can be given twice daily

Question 12

Loop diuretic cautions

Answer 12

Exacerbates diabetes- causes less hyperglycaemia compared to thiazide like diuretics.
Gout
Urinary retention can occur if there is an enlarged prostate- check output first

Question 13

Potassium sparing diuretic examples

Answer 13

Triamterene, Amiloride

Question 14

Are potassium sparing diuretics strong ?

Answer 14

No weak- they are given alongside thiazide or a loop diuretic

Question 15

Digoxin and potassium sparing diuretics

Answer 15

Potassium sparing diuretic given alongside digoxin to reduce the risk of digoxin toxicity

Question 16

What colour does triamterene colour urine

Answer 16

Blue

Question 17

Aldosterone antagonists examples

Answer 17

Spironlactone and eplerone

Question 18

Spironolactone indications

Answer 18

Oedema
Ascities caused by cirrhosis of liver

Question 19

SE of aldosterone antagonists

Answer 19

Hyperkalaemia 🧂⬆️
Due to potassium-sparing effect — can be dangerous, especially with ACE inhibitors or renal impairment.
Hyponatraemia 🧂⬇️
Loss of sodium can occur due to its diuretic effect.
GI disturbances 😣
Nausea, vomiting, diarrhoea, or abdominal cramps.
Dizziness & hypotension 😵
Due to volume depletion or blood pressure lowering.

💡 Spironolactone-specific Side Effects (due to hormonal effects):
Gynaecomastia (in males)
Menstrual irregularities (in females)
Impotence / decreased libido
These occur because spironolactone blocks androgen and progesterone receptors.