Diuretics Flashcards
(71 cards)
1
Q
diuretics acting in the PCT
A
acetazolamide
mannitol
2
Q
diuretics acting in the LOH
A
furosemide
bumetanide
torsemide
3
Q
diuretics acting in the DCT
A
hydrochlorothiazide chlorthalidone metolazone quinothazone indapamide spironolactone eplenerone amiloride triamterene
4
Q
carbonic anhydrase inhibitors (CAIs)
A
acetazolamide
5
Q
osmotic diuretics
A
mannitol
6
Q
loop diuretics
A
furosemide
bumetanide
tosemide
7
Q
benzothiadiazides (thiazide diuretics)
A
hydrochlorothiazide chlorthalidone quinethazone metolazone indapamide
8
Q
class I thiazide diuretics
A
hydrochlorothiazide
chlorthalidone
quinethazone
9
Q
class II thiazide diuretics
A
metolazone
indapamide
10
Q
aldosterone antagonists
A
spironolactone
eplenerone
11
Q
K-sparing diuretics
A
triametrene
amiloride
12
Q
CAI MOA
A
inhibit carbonic anhydrase:
- bicarb not reabsorbed
- H+ not regenerated inside the cells
- Na+/H+ antiporter inhibited
- Na+ reabsorption also inhibited
- increased delivery of NaHCO3, NaCl, & H2O to distal tubule
13
Q
CAI effect on electrolyte excretion
A
increased excretion: -Na & HCO3- (moderate) -H2O (UF) -K+ increased reabsorption: -Cl-
14
Q
CAI clinical uses
A
alkalinize urine (cysteinurea) reduce intraocular pressure seizures (MOA unknown) mountain sickness prophylaxis diuresis (limited)
15
Q
CAI ADEs
A
metabolic acidosis (HCO3- loss in urine) hypokalemia (K+ loss in urine)
16
Q
osmotic diuretics characteristics
A
small molecules are filtered but not reabsorbed
17
Q
osmotic diuretics MOA in PCT
A
osmotically inhibit Na+ & H2O reabsorption
18
Q
osmotic diuretics MOA in peripheral tissues
A
increase osmolarity of plasma extract H2O from peripheral tissues decrease blood viscosity increase RBF decrease RBF tonicity
19
Q
osmotic diuretics MOA in LOH
A
thin descending limb: impair H2O reabsorption
thin ascending limb: impair NaCl & urea reabsorption
thick ascending limb: interfere with transport
20
Q
osmotic diuretics effect on electrolyte excretion
A
increase excretion:
- H2O
- NaCl
- K+
21
Q
acetazolamide ROA
A
oral
22
Q
mannitol ROA
A
injection
23
Q
osmotic diuretics clinical uses
A
dialysis disequilibrium syndrome
reduce intracranial/intraocular pressure
24
Q
osmotic diuretics ADE
A
volume overload
25
osmotic diuretics contraindications
cardiac failure
26
loop diuretics MOA
```
inhibit NK2C
inhibit macula densa NaCl sensation
stimulate prostaglandin biosynthesis
increase RBF
regulate extraction fraction (maintain GFR)
increase renin release
```
27
loop diuretics effect on electrolyte excretion
increased excretion:
- Na+ (potent NaCl loss)
- K+
- H+
- Ca2+
- Mg2+
- H2O
28
loop diuretics effect on RAAS
increase renin release:
- inhibit macula densa
- reflexively activate SNS
- stimulate intrarenal baroreceptors
29
loop diuretics clinical uses
```
edema
pulmonary edema (acute IV)
hypercalcemia
protection against renal failure
washout of toxins
severe HTN (+ other drugs), esp. w/renal insufficiency, cardiac failure, cirrhosis
HTN crisis (IV)
```
30
furosemide ROA
orally
IV
IM
31
furosemide characteristics
loop diuretic
secreted by organic acid transporter: impaired secretion in renal disease
wide margin of safety
32
furosemide pharmacokinetics
```
onset = 30 min
duration = 8hr
half-life = 1.5 hr
extensively protein bound
65% renal excretion
```
33
furosemide ADEs
```
hypokalemia
pH disorders (alkalosis)
high BUN
hyperglycemia
hyperuricemia
ototoxicity
sialadentitis
```
34
da fuk is sialadentitis
inflammation of salivary glands
35
furosemide interactions
```
lithium
indomethacin
probenecid
warfarin
NSAIDS (will cause diuretic resistance)
```
36
bumetanide characteristics
loop diuretic
40x more potent than furosemide
can be used with warfarin
37
bumetanide ROA
oral
38
torsemide characteristics
loop diuretic
vasodilator: also lowers BP
longer half-life than other loop diuretics
39
thiazide diuretic MOA
inhibit Na+Cl-cotransporter (NCCT) in Na+/K+/aldosterone independent segment of distal tubule
40
thiazide diuretics effect on electrolyte excretion
```
increase excretion:
-Na+
-Cl-
-K+
-Mg2+
-titratable acid
decrease excretion:
-Ca2+
```
41
thiazide diuretics clinical uses
```
diuretic
hypercalciurea
antihypertensive (+/- other drugs)
osteoporosis
nephrogenic diabetes insipidus
mild/moderate HTN
"volume dependent" HTN (low renin levels)
HTN w/impaired renal fxn (metolazone&indapamide)
```
42
thiazide characteristics
require secretion into tubular fluid
| ineffective if GFR less than 30 mL/min
43
class I thiazide diuretic clinical uses
GFR >60mL/min
44
class II thiazide diuretic clinical uses
GFR b/t 30-60mL/min
45
hydrochlorothiazide (HCTZ) ROA
oral
| half-life = 2.5h
46
chlorthalidone ROA
oral
| half-life = 47h
47
quinethazone ROA
oral
48
metolazone characteristics
10x more potent than HCTZ
49
indapamide characteristics
20x more potent than HCTZ
50
thiazide diuretics ADEs (overall)
depletion phenomena
retention phenomena
metabolic changes
hypersensitivity&other
51
thiazide diuretics depletion phenomena
hypokalemia
hypochloremic alkalosis
dilutional hyponatremia
hypomagnesemia
52
thiazide diuretics retention phenomena
hyperuricemia
| hypercalcemia
53
thiazide diuretics metabolic changes
hyperglycemia
hyperlipidemia
hyper secretion of renin
hyper secretion of aldosterone
54
thiazide diuretics hypersensitivities&other ADEs
```
fever
rash
pupura
pancreatitis
sialadentitis
withdrawal edema
```
55
aldosterone antagonists MOA
bind to aldosterone receptor in the cytoplasm and prevent its translocation to the nucleus: reduce ENAC channels
56
aldosterone antagonists effect on electrolyte excretion
```
increase excretion:
-Na+
decrease excretion:
-K+ (K sparing)
-H+
```
57
spironolactone characteristics
aldosterone antagonist
pro-drug
extensively metabolized into canrenone (longer half-life)
58
spirinolactone ADEs
hyperkalemia (combo w/thiazide)
gynecomastia
hirsutism
uterine bleeding
59
eplenerone characteristics
aldosterone antagonist
| less ADEs than spironolactone
60
aldosterone antagonists clinical uses
diuretic (combo w/HCTZ)
CHF
cirrhosis
61
K-sparing diuretics MOA
inhibit ENAC in sodium load segment of distal tubule
62
K-sparing diuretics effect on electrolyte excretion
```
increase excretion:
-Na+
decrease excretion
-K+
-H+
```
63
K-sparing diuretics clinical uses
diuretic (combo w/HCTZ)
hyperuricemia
risk of K+ depletion
64
K-sparing diuretics ADEs
hyperkalemia
| megaloblastic anemia in patients w/cirrhosis
65
Tx of cirrhosis
spirinolactone
| add loop diuretic if GFR50mL/min
66
K-sparing diuretics contraindications
significant renal insufficiency
| K+ retaining conditions
67
Tx of chronic renal failure
loop diuretic
68
Tx of nephrotic syndrome
loop diuretic
69
Tx of moderate/severe CHF
loop diuretic
70
Tx of mild CHF w/GFR>50
thiazide
71
Tx of mild CHF w/GFR
loop diuretic
