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Flashcards in Diuretics Deck (43):
1

Carbonic Anhydrase Inhibitors MOA

Inhibits carbonic anhydrase in the proximal tubule to block H2CO3 production which decreases the amount of H ion available for exchange with sodium, resulting in increased sodium and water loss. Not used for diuresis because effect wears off due to up regulation of mitochondria H ion production. Oral or topical (optical).

2

Acetazolamide (Diamox)

Carbonic Anhydrase Inhibitor that alkalinizes the urine (increased HCO3) to increase the excretion of weak acids. Treats metabolic acidosis and acute mountain sickness (respiratory alkalosis).

3

Dorzolamide (trusopt)

Carbonic Anhydrase inhibitor. Used topically for closed angle glaucoma. Inhibits bicarb transport in the eye and choroid plexus to decrease aqueous humor and CSF.

4

Brinzolaminde (Azopt)

Carbonic Anhydrase inhibitor. Used topically for closed angle glaucoma. Inhibits bicarb transport in the eye and choroid plexus to decrease aqueous humor and CSF.

5

Carbonic Anhydrase Inhibitor Side Effects

Hyperchloremic Metabolic acidosis and Hyperuricemia

6

Carbonic Anhydrase Inhibitor Contraindications

sulfa hypersensitivity.

7

Loop Diuretic MOA

Blocks the Na/K/2Cl cotransporter in the thick ascending limb. Reduces the medullary concentration gradient. Induce prostaglandins to decrease salt transport and cause vasodilation. Oral or parenteral.

8

Loop Diuretic Indications

CHF, Pulmonary edema (due to vasodilatory effect not diuresis), Severe peripheral edema, Hypercalcemia (decreased calcium and mg reabsorption due to reduced K gradient).

9

Furosemide (Lasix)

Loop diuretic

10

Bumetanide

Loop Diuretic

11

Toresmide

Loop Diuretic

12

Ethacrynic Acid

Loop Diuretic. Safe with Sulfa allergies but causes severe ototoxicity.

13

Loop Diuretic Side Effects

Hypokalemic metabolic alkalosis (induced K/H loss at distal exchange site for sodium). Hyperuricemia. Irreversible ototoxicity (especially ethacrynic acid).

14

Loop Diuretic Contraindications

Sulfa hypersensitivity (except ethacrynic acid).

15

Thiazide Diuretics MOA

Inhibits sodium reabsorption at the distal convoluted tubule by inhibiting the Na/Cl cotransporter. Dependent on prostaglandin synthesis (salt transport). Increases ATP dependent K channel opening to hyperpolarize the membrane leading to vasodilation (reduces insulin secretion). Oral. Decreases calcium excretion.

16

Hypertension DOC

Thiazide Diuretics

17

Thiazide Diuretics Indications

HTN, nephrolithiasis (decreases calcium in the urine due to increased membrane potential from luminal Na).

18

Hydrochlorothiazide

Thiazide Diuretic

19

Chlorothiazide

Thiazide Diuretic

20

Chlorthalidone

Thiazide Diuretic.

21

Metolazone

Thiazide Diuretic. Able to produce diuresis even in patients with a reduced GFR

22

Quinethazone

Thiazide Diuretic

23

Indapamide

Thiazide Diuretic. Has pronounced vasodilatory effects, acts as a CCB. Doesn't increase lipid levels. Excreted by the biliary system (used in renal insufficiency).

24

Thiazide Diuretics Side Effects

Hyperuricemia (except indapamide). Hyperglycemia (decreased insulin secretion). Hyperlipidemia (except indapamide).

25

Thiazide Diuretic Contraindictions

Sulfa allergy, Diabetes.

26

Spironolactone (Aldactone)

Potassium sparing aldosterone antagonist.

27

Spironolactone (Aldactone) Indications

Used in combination (with thiazides or loops) to treat edema associated with CHF. High doses will treat hirsutism by inhibiting sex hormone receptors.

28

Spironolactone (Aldactone) Side Effects

Hyperkalemia (caution with ACEI/ARB), Gynecomastia.

29

Eplerenone (Inspra)

Potassium sparing aldosterone antagonist

30

Eplerenone (Inspra) Side Effects

Drug interactions. Metabolized by CYP3A4.

31

Direct Inhibitors of Sodium Influx MOA

Inhibit Na/K exchanger independent of aldosterone. Directly inhibit aldosterone-sensitive sodium channels so less potassium is excreted.

32

Amiloride

Potassium sparing direct inhibitor of sodium influx.

33

Triamterene

Potassium sparing direct inhibitor of sodium influx.

34

Lithium induced Diabetes insipidus DOC

Amiloride

35

Direct Inhibitors of Sodium Influx MOA

Inhibit the Na/K exchanger independently of aldosterone.

36

Mannitol

Osmotic Diuretic

37

Isosorbide

Osmotic Diuretic

38

Glycerin

Osmotic Diuretic

39

Urea

Osmotic Diuretic

40

Osmotic Diuretics MOA

Filtered but not reabsorbed. Osmotically keeps the water in the tubule. IV only.

41

Osmotic Diuretics Indications

Prophylaxis for AKI (protection from nephrotoxins), decreases intraocular pressure, decreases intracranial pressure.

42

Osmotic Diuretic Contraindications

CHF. Causes extracellular fluid expansion (dehydrates cells) and can cause pulmonary edema.

43

Desmopressin

ADH Agonist