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Flashcards in Diuretics Deck (38):
1

What are the main physiological roles of kidneys

Regulation: Fluid, electrolytes, acid base
Excretion: metabolites, Drugs
Endocrine: renin, Erythropoietin
Metabolism: Vitamin D, insulin, PTH

2

What are the types of commonly used diuretics

Loop
Thiazide
K sparing diuretics
Aldosterone antagonists

3

What are types of rarely used diuretics

Carbonic anhydrase inhibitors
Osmotic diuretics
ADH antagonists

4

What are Drugs that have diuretic-like effects

Digoxin
Amiloride

5

What is mechanism of action of carbonic anhydrase inhibitors

Inhibit carbonic anhydrase at PCT
Inhibit Na reabsorption

6

What are side effects of carbonic anhydrase inhibitors

Metabolic acidosis (bicarb loss)
Hypokalaemia

7

What is Carbonic anhydrase inhibitors indicated

Glaucoma

8

What is mechanism of action of osmotic diuretics

Freely filtered and poorly reabsorbed
Increases filtrate osmolality
Draws water into filtrate down osmotic gradient

9

When is osmotic diuretics indicated

Cerebral oedema
Pulmonary oedema

10

What are side effects of osmotic diuretics

Hypovolaemia
Hypernatraemia

11

What is mechanism of action of ADH Antagonists

Inhibit ADH receptors at DCT and CD
Inhibit water reabsorption

12

What are types of ADH antagonists

Lithium
Demeclocycline

13

What is mechanism of action of digoxin

Inhibit Na/K+ ATPase

14

When is digoxin indicated

Atrial fibrillation
Has a mild diuretic effect

15

Give examples of loop diuretics

Furosemide
Bumetanide

16

What is mechanism of action of Loop diuretics

Inhibit NKCC2 co transporter at thick ascending limb
Inhibit Na reabsorption (25%)
Inhibit K reabsorption

17

When is loop diuretics indicated

Heart failure
Liver failure

18

What are side effects of loop diuretics

Hypokalaemia
Hypokalaemic metabolic alkalosis
Ototoxicity

19

What are drug interactions with loop diuretics

Aminoglycosides: ototoxicity, nephrotoxicity
Steroids: hypokalaemia
Digoxin: hypokalaemia, digoxin toxicity

20

Give examples of thiazide diuretic s

Bendroflumethiazide
Thiazide-like diuretics: chlortalidone, metolazone

21

What is mechanism of action of thiazide diuretics

Inhibit NaCl co transporter at DCT
Inhibit Na reabsoprtion

Decreased Ca excretion
Decreased Uric acid excretion

22

What are indications of thiazide diuretics

Hypertension
Heart failure
Kidney stones

23

What are side effects of thiazide diuretics

Hypokalaemia
Hyponatraemia
Hypercalcaemia
Hyperuricaemia
Gout
Erectile dysfunction

24

What are drug interactions of thiazide diuretics

Steroids
Digoxin
Beta blockers - hyperglycaemia, hyperlipidaemia
Carbemazepine - hyponatraemia

25

What are types of K sparing diuretics

Amiloride
Aldosterone antagonists

26

What is mechanism of action of amiloride

Inhibit ENaC at DCT + CD
Inhibit Na reabsorption (2%)

Inhibit ROMK activity
Reduce K excretion

27

When is amiloride indicated

Add-on therapy to K-losing diuretics

28

What are drug interactions with amiloride

Ace-inhibitors: Hyperkalaemia

29

Give examples of aldosterone antagonists

Spironolactone
Eplerenone

30

What is mechanism of action of spironolactone

Inhibit aldosterone binding to Mineralocorticoid receptors at DCT + CD
Inhibit Na/K ATPase and ENaC synthesis
Inhibit Na reabsorption
Reduce K excretion

31

When is spironolactone indicated

Hypertension
Heart failure
Liver failure
Hyperaldosteronism

32

What are side effects of spironolactone

Gynaecomastia
Hyperkalaemia

33

What are the general side effects of diuretics

Hypersensitivity - Anaphylaxis, rash
Hypovolaemia, postural hypotension
Electrolyte imbalance
Metabolic disturbance

34

What are causes of diuretic resistance

Patient in compliance
High Na intake
Volume depletion
NSAID
Incomplete treatment of primary disorder

35

What are issues of prescribing drugs in renal disease

Drug Nephrotoxicity
Accumulation of drugs to toxic levels

36

What are prescribing rules in renal disease

Avoid nephrotoxins
Monitor U+Es and renal function
Use lower dose according to GFR

37

Give examples of nephrotoxic drugs

Ace inhibitors
NSAIDs
Aminoglycosides
Penicillin
Metformin

38

What are prescribing rules in the elderly with renal disease

Renal function overestimated
Start at low dose, titrate slowly

Polypharmacy is common
Cautious of DDIs