Diuretics

Question 1

Six classes of diuretics classified by ?

Answer 1

site of action in the nephron

Question 2

Six classes of diuretics?

Answer 2

Thiazide

Thiazide-like

Loop

Potassium sparing

Osmotic

Carbonic anhydrase inhibitors

Question 3

Inhibit NA/Cl transporter in the distal convoluted tubule

is the MOA of ?

Answer 3

Thiazide Diuretics (HCTZ)

Question 4

Thiazide Diuretics (HCTZ) clinical uses?

Answer 4

Mild to moderate HTN, CHF, cirrhosis, renal insufficiency, nephrotic syndrome

Question 5

Thiazide Diuretics (HCTZ) pharmacokinetics?

Answer 5

Rapid absorption after oral administration

Well distributed into extracellular space ( throughout the body )

Excreted unchanged by the kidneys

Question 6

Hydrochlorothiazide (HCTZ)

use caution in?

Answer 6

renal impairment

gout

elderly

Question 7

Hydrochlorothiazide (HCTZ)

causes?

Answer 7

hypokalemia

electrolyte imbalance

Question 8

Hydrochlorothiazide (HCTZ)

pregnancy cat.?

Answer 8

B

Question 9

Thiazide Diuretics: Adverse 
Reactions?

Answer 9

CV: hypotension
GU: erectile dysfunction (men)
META: metabolic alkalosis
it will change electrolytes and anion gap

Endo: hyperglycemia

GI: anorexia, nausea, cramping, vomiting

HEME: blood dyscrasias

MS: muscle cramps
remember we are reducing water weight

Neuro: dizziness, drowsiness, lethargy, weakness

Renal: azotemia

**warn them about orthostatic change initially **

Question 10

Thiazide Diuretics could potentiate _______ toxicity

Answer 10

digoxin

• *watch with incremental increases with Thiazide cause you can cause dig toxicity
• *

Question 11

________ reduce diuretic effect

Answer 11

NSAIDS

Question 12

______ ____ potentiate hyperglycemia, hyperlipidemia

Answer 12

Beta blockers

Question 13

______________ enhance hypokalemia

Answer 13

Corticosteroids

raises level of HCTZ

Question 14

Get synergistic effect if used concurrent with loop diuretics?

Answer 14

Thiazide Diuretics

Question 15

Bile acid resins bind and reduce _________ effect by 85%

Answer 15

Thiazide

Question 16

Thiazide Diuretics may reduce effectiveness of?

Answer 16

lithium

warfarin

vitamin D

• *so watch coumadin levels
• *

Question 17

Thiazide Diuretics: Conscientious Considerations?

Answer 17

Use with care if using insulin

Always review for possible drug interactions

Watch for drugs that alkalinize urine

Diuresis may be limited by dehydration

Perform initial determination of serum electrolytes, BUN uric acid, and glucose to monitor for electrolyte imbalances

Question 18

Loop Diuretics

Answer 18

These are big!!!

Torsemide (Demadex)

Furosemide (Lasix)
works within 10 min

Bumetanide (Bumex)
doesn’t effect electrolytes like most of these do

Question 19

Torsemide is?

Answer 19

Demadex

Question 20

Furosemide is ?

Answer 20

Lasix

Question 21

Bumetanide is?

Answer 21

Bumex

Question 22

Loop Diuretics MOA?

Answer 22

Inhibit the Na/K/Cl cotransporter on the thick ascending Loop of Henle

Primary effect on prostaglandin synthesis

Question 23

Loop Diuretic also can cause?

Answer 23

Vascular and bronchial dilation

Auto-regulation of renal blood flow
people with RAS, or bad kidney function then this works very well

Question 24

Loop Diuretics patients have a risk of ?

Answer 24

hypocalcemia

hypokalemia

hyperglycemia

hyperuricemia

**this one drops both Na and K (not just K like thiazide) **

Question 25

Loop Diuretics produces?

Answer 25

transient diuresis not limited by dehydration

Question 26

Loop Diuretics may cause ?

Answer 26

Ototoxicity May be enhanced by aminoglycoside use synergistic effects

Question 27

Potassium-Sparing Diuretics example?

Answer 27

Sprinolactone - Aldactone Triamterene

Question 28

Potassium-Sparing Diuretics MOA?

Answer 28

Inhibit Na reabsorption; dependent on K and H+ exchange Block aldosterone receptor

Question 29

Potassium-Sparing Diuretics patients have a risk of ?

Answer 29

hyperkalemia hyponatremia metabolic acidosis * *drive K up and Na down * *

Question 30

Potassium-Sparing Diuretic is a ____ _______, usually used in combination with other diuretic classes

Answer 30

Weak diuretic

Question 31

___________ causes blue-colored urine

Answer 31

Triamterene

Question 32

_________ potentiate hyperkalemia

Answer 32

ACEIs

Question 33

Osmotic Diuretics examples?

Answer 33

Mannitol (Osmitrol)

Question 34

What diuretic adds solutes already present in renal tubular fluid?

Answer 34

Osmotic Diuretics

Question 35

How does Mannitol work ?

Answer 35

Water is pulled from the tubular fluid, resulting in less sodium and water to be reabsorbed

Question 36

Osmotic Diuretics are used in treatment of ?

Answer 36

Acute renal failure Glaucoma Cerebral edema

Question 37

Osmotic Diuretics pharmacokinetics?

Answer 37

mannitol is a sugar not well absorbed in the nephron ---- osmotic pull of water------ diuresis

Question 38

Carbonic Anhydrase Inhibitors example?

Answer 38

Acetazolamide

Question 39

Acetazolamide is also used in?

Answer 39

Used for glaucoma epilepsy (rarely) idiopathic intracranial hypertension altitude sickness

Question 40

Carbonic anhydrase inhibition results in?

Answer 40

results in increased excretion of Na, K, and sodium bicarbonate

Question 41

CAI are the ________ of all diuretics

Answer 41

weakest

Question 42

CAI are mainly used in the tx of?

Answer 42

open-angle glaucoma

Question 43

CAI has a risk of what ?

Answer 43

Risk of Stevens-Johnson syndrome erythema multiforme toxic epidermal necrolysis bone marrow suppression

Question 44

CAI: caution is advised with ?

Answer 44

high-dose ASA

Question 45

CAI cannot be used in patients with a _______.

Answer 45

sulfa allergy

Question 46

profofol _____ has sulfa in it but generic does not have sulfa in it ( so watch for surfer allergies)

Answer 46

trade

Question 47

Aldosterone Antagonist example?

Answer 47

Spironolactone (Aldactone)

Question 48

Spironolactone (Aldactone) | class?

Answer 48

Potassium-sparing

Question 49

Spironolactone (Aldactone) | MOA?

Answer 49

antagonizes aldosterone-specific mineralocorticoid receptors primarily in the distal convoluted tubule Decreasing Na and water reabsorption and increasing K retention

Question 50

Spironolactone (Aldactone) | monitoring parameters?

Answer 50

Cr, electrolytes at baseline then periodically If severe heart failure, Cr, K 1wk after tx start or dose incr., then qmo x3mo, then q3mo x1y, then q6mo **watch for peaked T’s **