Diuretics Flashcards Preview

Pharmacology > Diuretics > Flashcards

Flashcards in Diuretics Deck (42):
0

Furosemide Indications

Loop
NKCC2
DOC for acute pulmonary edema with heart failure
Hypercalcemia
Hyperkalemia
Ethacrynic acid is non-sulfa but more ototoxic

1

Furosemide Adverse Effects

Loop, NKCC2
**Ototoxicity**
Hyperuricemia
Acute Hypovolemia
**Hypokalemia**
Hypomagnesemia
Allergies (Sulfa)

2

Torsemide indications

Loop, NKCC2
DOC for acute pulmonary edema with heart failure
Hypercalcemia
Hyperkalemia

3

Torsemide adverse effects

Loop, NKCC2
**Ototoxicity**
Hyperuricemia
Acute hypovolemia
**Hypokalemia**
Hypomagnesemia
Allergies (sulfa)

4

Loop Diuretics Mechanism

NKCC2
Site-ascending LOH
Blocks Na/Cl/K co transporter
**Increased prostaglandin synthesis (COX2)**
Ethacrynic acid is non sulfa but more ototoxic, furosemide and torsemide are sulfa

5

Loop Diuretic Urine Composition

Increased calcium, sodium, potassium, magnesium
Increased volume

6

Thiazides Mechanism

NCCT
Site - DCT
Block Na/Cl co transporter
ceiling-saturates at low dose

7

Loop Effects

NKCC2
Ascending LOH Na/Cl/K cotransporter
Most effective **DOC for acute pulmonary edema with heart failure**
Produces a lot of urine
Increases renal blood flow via decreased resistance

8

Thiazide Effects

NKCC2
Site - DCT
Decreases PVR and BP even after volume recovery

9

Thiazide Indication

HTN
Mild heart failure
Hypercalciuria
**Diabetes Insipidus**

10

Thiazide Urine composition

Increased sodium, potassium, Chloride, Magnesium
Decreased Calcium
Increased volume

11

Thiazide Adverse effects

Give oral only
NKCC2
Hypokalemia
Hyponatremia
Hyperuricemia
Volume depletion
**Hyperglycemia**
**Hyperlipidemia**

Takes 1-3 week to obtain stable effects

12

Thiazides

Chlorthalidone
Hydrchlorothiazide
Metolazone
(Sulfa derivatives)

13

Loops

Furosemide
Torsemide
Ethacrynic Acid

14

Aldosterone Agonists

Spironolactone
Eplerenone

15

Aldosterone Agonist Mechanism

Antagonizes aldosterone at cytoplasmic receptors (preventing translocation)
Acts at collecting duct
Used in combination with other diuretics

16

Aldosterone Antagonist Indication

Primary hyperaldosteronism
Edema

17

Aldosterone Antagonist PK

Oral and strongly protein bound
**Induces CYP450**

18

Aldosterone Antagonist Adverse Effects

GI upset and peptic ulcers
**Endocrine->irregular menstrual cycles, gynecomastia, impotence**
Hyperkalemia
Nausea, Lethargy
Mental Confusion

19

ENaC K sparing Drugs

Amiloride
Triamterene

20

ENaC K Sparing Mechanism

Blocks Na transport channels
Decreases sodium/potassium exchange
Acts at collecting duct

21

ENaC K sparing indications

Primary hyperaldosteronism
Heart failure
Hypokalemia

22

ENaC K sparing Adverse effects

Same as spironolactone -GI upset and peptic ulcers, Endocrine issues (gynecomastia, impotence, irregular menstrual), Hyperkalemia, nausea, lethargy, mental confusion
Plus leg cramps**
Increased BUN, uric acid

23

CAH inhibitor Drug

Acetazolamide

24

CAH inhibitor Mechanism

Acts mainly in the PT
Prevents formation of H+ needed for Na+ reabsorption in the PT

25

CAH inhibitor Indication

Glaucoma (decreases production of aqueous humor)
Treat metabolic alkalosis
Mountain sickness prophylaxis
Epilepsy

26

CAH inhibitor Adverse effects

**Metabolic acidosis**
K depletion (rare)
Renal stones
**Contraindicated in hepatic cirrhosis due to decreased NH4+ excretion**

27

Osmotic Drug

Mannitol

28

Osmotic Effect

Does not affect sodium excretion

29

Osmotic drug mechanism

Filtered into glomerulus, draws H2O into tubular fluid

30

Osmotic drug indications

Increased ICP
Acute renal failure (shock)
Drug toxicity
Trauma (maintain urine)

31

Osmotic PK

IV only

32

Osmotic Adverse

Extracellular H2O expansion ->Dehydration
Hypo or hypernatremia
Oral->osmotic diarrhea

33

ADH antagonist

Conivaptan

34

Conivaptan

Inhibits CYP3A4

35

ADH antagonist Effect

Renders CT impermeable to H2O

36

ADH antagonist mechanism

Inhibit ADH
Decrease aquaporins in the collecting duct

37

ADH antagonist indication

SIADH
Hyponatremia

38

ADH antagonist Urine composition

Increased plasma Na
Decreased H2O reabsorption ->dilute urine

39

ADH antagonist PK

IV only

40

ADH antagonist adverse

Nephrogenic diabetes insipidus
Renal failure

41

Diuretic main uses

Management of edema and hypertension