Diuretics Flashcards
(27 cards)
Thiazide Diuretics Meds
- hydrochlorothiazide
- chlorthalidone
- metalozone
- indapamide
Thiazide Diuretics MOA
decreases sodium and chloride reabsorption in distal convoluted (more Na+ and Cl- excreted)
Thiazide Diuretics AEs
- hypokalemia
- hypomagnesmia
- hyperuricemia
- hyperglycemia
- hyperlipidemia
- diuresis
Thiazide Diuretics Caution
- when renal function declines with age
- if risk for metabolic effects (increased uric acid, insulin resistance)
Thiazide Diuretics Interactions
- steroids cause salt retention-> decreasing effect of thiazide
- NSAIDs blunt thiazide response
- Class IA or III antiarrhythmics prolongs QT interval which may cause torsades with diuretic-induced hypokalemia
- probenacid and lithium block thiazide effects by disrupting its excretion
- thiazides decrease lithium clearance and may cause toxicity
- hypokalemia with digoxin may increase risk of toxicity
Thiazide Diuretics Special Notes
- BEST DIURETIC FOR HTN
- chlorthalidone is 1.5-2x more effective than HCTZ
- HCTZ is just as effective at 12.5 mg than 25 or 50 mg doses
- dose in the morning
- not effective when GFR <30
Loop Diuretics Meds
- furosemide
- torsemide
- bumetanide
- ethacrynic acid
Loop Diuretics MOA
- blocks Na+ and Cl- reabsorption at the ascending loop of Henle
- decreases renal vascular resistance and increased renal blood flow
Loop Diuretics Dosing
- start low and titrate
- taper slowly
- in morning to prevent nocturia
- there is a ceiling dose but you can increase frequency, do a continuous infusion, or combine with a thiazide
Loop Diuretics AEs
- hypokalemia
- hypomagnesmia
- hypocalcemia
- excessive diuresis
- reflex activation of RAAS
- hypouricemia
Loop Diuretics Monitoring
- electrolytes
- renal functioning (CrCl, GFR)
Loop Diuretics Interactions
- aminoglycosides can cause ototoxicity when combined
- NSAIDs block diuretic response
- Class IA or III antiarrhythmics prolong QT and with diuretic-induced hypokalemia may cause torsades
- probenacid blocks loop diuretics by stopping excretion
Loop Diuretics Caution
- any drug that can aggravate hyperglycemia, dyslipidemias, hyperuricemia
- kidney functioning with ACE I or ARBs
Potassium Sparing Diuretics Meds
- amiloride
- triamterene
Potassium Sparing Diuretics MOA
inhibits sodium transport at late distal and collecting ducts
Potassium Sparing Diuretics AEs
- hyperkalemia
Potassium Sparing Diuretics Monitoring
renal functioning
K+
Potassium Sparing Diuretics Interactions
- ACE Is may increase risk of hyperkalemia
- indomethacin decreases renal functioning when combined with triamterene
- cimetidine increases bioavailability and decreases clearance of triamterene
Potassium Sparing Diuretics Special Notes
- used in combination with loops or thiazides to reduce K+ loss
Aldosterone Antagonists Meds
- spironolactone
- eplerenone
Aldosterone Antagonists MOA
- increases NaCl excretion, decreases K+ excretion
- modulates vascular tone
Aldosterone Antagonists AEs
- hyperkalemia
- dyncomastia/breast tenderness (spironolactone)
- menstrual irregularities
- Hirsutism
Aldosterone Antagonists Cautions
- elderly
- diabetic patients
- these groups have increased risk of hyperkalemia
Aldosterone Antagonists Interactions
- ACE Is/ARBs/NSAIDs increase hyperkalemia
- Digoxin with spironolactone causes increased plasma concentration
- K+ supplements increase risk of hyperkalemia
