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D&T3 Cardiology > Diuretics > Flashcards

Diuretics Flashcards

1
Q

What are the uses of diuretics?

A
  1. Mobilize fluid
  2. Excrete fluid (edema)
  3. Excrete electrolytes
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2
Q

What are the six classes of diuretics?

A
  1. Carbonic Anhydrase Inhibitors
  2. Thiazides and related drugs
  3. Loop Diuretics
  4. K+ Sparing Diuretics
  5. Osmotic Diuretics
  6. Miscellaneous
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3
Q

What is Acetazolamide?

A

A Carbonic Anhydrase Inhibitor

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4
Q

Where is the site of action for carbonic anhydrase inhibitors?

A

Proximal Tubule

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5
Q

What are the effects of inhibiting the intracellular Carbonic Anhydrase enzymes?

A

Results in: Decreased H+ and HCO3- in cell –> Decreased Na+/H+ luminal exchange–> Decreased Na+/HCO3- basolateral cotransport –> DECREASED Na+ REABSORPTION

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6
Q

What is the result of inhibiting the luminal carbonic anhydrase enzyme?

A

Increased Luminal HCO3-

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7
Q

What are the effects of CA inhibitor use?

A
  1. Weakly diuretic (only 5% increase in Na+ excretion)
  2. Large increase in HCO3- excretion (problem for metabolic acidosis)
  3. Increased K+ excretion
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8
Q

What are the therapeutic uses of CA Inhibitors?

A
  1. Decreasing IOP for Glaucoma- OA
  2. Urinary Alkalinization
  3. Mountain Sickness
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9
Q

What are the adverse effects of CA Inhibitors?

A
  1. Metabolic Acidosis
  2. Hypokalemia
  3. Drowsiness
  4. Hypersensitivity
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10
Q

What are the Thiazide Drugs?

A
  1. Hydrochlorothiazide
  2. Chlorothiazide
  3. Polythiazide
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11
Q

What are the Thiazide Related Drugs?

A
  1. Chlorthalidone
  2. Indapamide
  3. Metolazone
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12
Q

Where is the site of action of Thiazides and Related Drugs?

A

Distal Convoluted Tubule

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13
Q

What is the MOA of Thiazides?

A

Inhibition of luminal Na/Cl Cotransport –> Decreased Na+ Reabsorption

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14
Q

How do Thiazides inhibit sodium reabsorption?

A

By binding to the Cl- site of the luminal Na/Cl cotransporters, thus preventing symport of Na+

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15
Q

Describe the effect Thiazides have on urine composition

A
  1. Increased Na+, H20, K+, Cl- and HCO3-

2. Decreased Ca++ and Uric Acid

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16
Q

Which drugs are bad for patients with gout?

A

Thiazides and related drugs

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17
Q

What are the therapeutic uses of Thiazides?

A
  1. HTN
  2. CHF or Edema
  3. Hypercalciuric Renal Stones
  4. Nephrogenic DI
  5. Nephrotic Syndrome (+SP)
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18
Q

What condition causes Thiazides to become ineffective?

A

A GFR

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19
Q

Which Thiazides/Related drugs are effective at GFRs less than 40mL/min?

A

Metolazone and Indapamide

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20
Q

What are adverse effects of Thiazides?

A
  1. Decreased K+ (potential Digitalis Interaction –> MI)
  2. Elevated Uric Acid, Glucose, Calcium and Lipids
  3. Hypovolemia
  4. Hypersensitivity to other Sulfonamide drugs
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21
Q

What are the Loop Diuretic Drugs?

A
  1. Furosemide
  2. Bumetanide
  3. Torsemide
  4. Ethacrynic Acid*
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22
Q

Which loop diuretic is not a Sulfa drug?

A

Ethacrynic Acid

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23
Q

What are the most efficacious diuretics?

A

Loop Diuretics

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24
Q

What is the MOA of Loop Diuretics?

A

Inhibit Na+-K+-2Cl- cotransport in the ascending limb of the loop of Henle; resulting in a decrease in Na+ reabsorption

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25
At what site does the loop diuretic bind to the symporter?
At the Cl binding site
26
Why would a person develop muscle cramps when using a loop diuretic?
Hypokalemia (may need to give a supplement)
27
By what percent do loop diuretics increase Na and H2O excretion?
25%
28
What is the net effect of loop diuretics?
Increased Excretion of- Na, H2O, K, Cl and Ca
29
What are the therapeutic uses of Loop Diuretics?
1. Acute Pulmonary Edema 2. CHF, Renal or Hepatic Edema 3. HTN (with a low GFR) 4. Hypercalcemia
30
Which class of diuretics would be bad for patients with osteoporosis?
Loop Diuretics
31
What are potential side effects of loop diuretics?
1. Ototoxicity (worsens that caused by amino glycosides) 2. Hyperuricemia 3. Hyperglycemia 4. Hypersensitivity 5. Hyperlipidemia
32
What are the 4 Potassium Sparing Diuretics?
1. Triamterene 2. Amiloride 3. Spironolactone 4. Eplerenone
33
Which Potassium Sparing Diuretics are sodium channel inhibitors?
1. Triamterene | 2. Amiloride
34
What Potassium Sparing Diuretics are Aldosterone Receptor Antagonists?
1. Spironolactone | 2. Eplerenone
35
Describe the MOA and effect of Spironolactone and Eplerenone
MOA- competitive antagonists at renal Aldosterone Receptors --> decreased Na and K exchange in distal tubule **Ineffective in absence of Aldosterone
36
What are the effects of Aldosterone?
1. Activates and increases synth of Na channels and moves them to the luminal membrane 2. Activates and increases synth of Na/K ATPases and moves them to membranes 3. Alters permeability of Tight JXNs 4. Increases ATP synthesis
37
How does Aldosterone effect urine composition?
1. Increases Na, Cl and H2O excretion | 2. Decreases K+ and H+ excretion
38
What is the therapeutic use of Eplerenone?
HTN, CHF and post-MI
39
What is the therapeutic use of Spironolactone?
1. Primary Hyperaldosteronism 2. Prevention of hypokalemia 3. **Edema from hepatic cirrhosis and nephrotic syndrome 4. CHF
40
What are the side effects of the Aldosterone Receptor Antagonists (Eplerenone and Spironolactone)?
1. Hyperkalemia | 2. Gynecomastia and menstrual irregularities
41
How can hyperkalemia effect the heart?
If levels of K+ get too high, they can affect the contractility of the heart and cause an MI
42
What is the MOA of Triamterene and Amiloride?
MOA- Block Na channels and decrease Na+/K+ exchange in the distal tubule and collecting duct
43
Why could Triamterene and Amiloride cause an increase in urine pH?
Because they inhibit Na from coming into the cell, so there is not as much excretion of H+ into the lumen to maintain electroneutrality
44
What are the net effects of Triamterene and Amiloride?
1. Decreased K+ and H+ Secretion | 2. Increased NaCl excretion by 2-3%
45
What are the therapeutic uses of Triamterene and Amiloride?
1. Secondary Hyperaldosteronism | 2. Prevent Hypokalemia
46
What are osmotic Diuretics?
Freely filtered substances that are not reabsorbed and work by increasing osmotic pressure in the lumen and causing passive decreases in H2O and Na+ reabsorption
47
What are the osmotic diuretic drugs?
1. Mannitol 2. Glycerol 3. Isosorbide 4. Urea
48
What are the effects of Osmotic Diuretics?
1. Increased urinary flow 2. Slight increase in Na+ excretion 3. Decreased urine osmolarity
49
How are osmotic diuretics given?
IV
50
What are therapeutic uses of Osmotic Diuretics?
1. Maintain urine flow rate 2. Acute Renal Failure 3. Reduced intracranial pressure 4. Glaucoma (decreased IOC)
51
What are side effects of osmotic diuretics?
1. Increased ECF volume (problem in patients with CHF) | 2. Altered Na+, K+ blood levels
52
Which diuretics increase urine volume the most?
Loop Diuretics **CA, Thiazides and K-Spar also increase
53
Which diuretic increases Na+ Excretion the most?
Loop Diuretics **CA, Thiazides and K-Spar also increase
54
Which diuretic decreases K+ excretion?
K-Sparing
55
Which diuretics increase K+ excretion?
CA, Thiazides and Loops
56
Which diuretics decrease Ca++ excretion?
Thiazides
57
Which diuretics increase Ca++ excretion?
CA, Loops and K-Spar
58
Which diuretic has a risk for hypovolemia?
Loops
59
Which diuretics could cause hyperkalemia?
K-Sparing
60
Which diuretics cause hyperuricemia?
CA, Thiazides and Loops
61
Which diuretics cause hyperglycemia?
Thiazides
62
Which diuretics cause Hyperglycemia?
Thiazides
63
Which diuretics cause hypercalcemia?
Thiazides
64
Which diuretics cause ototoxicity?
Loops
65
Which diuretics cause Hypersensitivity?
CA, Thiazides and Loops
66
Which diuretics are teratogens?
CA and Loops
67
Which diuretics can treat Pulmonary Edema?
Loops
68
Which diuretics can treat acute renal failure?
Osmotics and Loops
69
Which diuretics can treat hypercalcemia?
Loops
70
Which diuretics are used to treat cerebral edema?
Osmotic DIuretics

D&T3 Cardiology (7 decks)

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