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Flashcards in Kidney-Diuretics Deck (26):
1

Which drugs target the PCT? Which are sulfa drugs?

Acetazolamide-carbonic anhydrase inhibitor
**sulfa drug

Mannitol-osmotic diuretic

2

What does acetazolamide do to the blood chem?

Increases Urinary K+ excretion
metabolic acidosis
DOES NOT cause increase in NaCl excretion
**hyperchloremic metabolic acidosis

3

What does mannitol do to blood chem?

Increases NaCl urinary excretion
increases urinary K+ excretion

4

What are the indications for acetazolamide?

glaucoma
urinary alkalinization
metabolic alkalosis
altitude sickness (resp alkalosis)
pseudotumor cerebri

5

What are the side effects of acetazolamide?

hyperchloremic metabolic acidosis
paresthesias
NH3 toxicity
sulfa allergy

6

What is the MOA of mannitol?

osmotic diuretic
inhibits H2O reabsorption
causes excretion of H2O
increases serum osmolarity
increases serum Na+

7

What is the indication for mannitol?

drug OD
elevated intracranial or intraocular pressure
acute closed angle glaucoma

8

What are the SE of mannitol?

contraindicated in anuria, CHF
can cause pulmonary edema, dehydration

9

What are the loop diuretics? Which are sulfa drugs?

furosemide
torsemide
bumetanide
ethacrynic acid (only non-sulfa)

10

What is the MOA of the loop diuretics?

inhibit Na+/2Cl-/K+ cotransport
cause dilute urine b/c they abolish the hypertonicity of the medulla
also stimulate PGE release and dilate the afferent arteriole
cause Ca++ excrétion. Loops lose Ca++.

11

What is the clinical use for loop diuretics?

Edema (CHF, cirrhosis, nephrotic syndrome, pulmonary edema).
Less often HTN
Hypercalcemia

12

What are the SE of loop diuretics?

OH DANG
Ototoxicity
Hypokalemia
Dehydration
Allergy (sulfa)
Nephritis
Gout (inhibits uric acid excretion)

13

Which drugs make you worried about ototoxicity?

aminoglycosides
vancomycin
loop diuretics

14

What are the thiazide diuretics? Where do they act? MOA?

chlorthalidone
HCTZ
metalozone
DCT, inhibit NaCl reabsorption
Decrease Ca++ excretion. Thiazides retain calcium.

15

What are the indications for thiazide diuretics?

HTN
CHF (usu loop first)
idiopathic hypercalciuria (but not w/ hypercalcemia)
nephrogenic Diabetes Insipidius
Osteoporosis (b/c retain Ca++)

16

What are the SE of thiazide diuretics?

HyperGLUC
hypokalemic metabolic alkalosis w/ hyponatremia
hyperglycemia
hyperlipidemia
hyperuricemia
hypercalcemia
**think about sulfa allergy

17

What do loop and thiazide diuretics do to the blood chem?

Loop: increase urinary NaCl and K+
Metabolic alkalosis (via hypochloremia)

Thiazide: increase urinary NaCl & K+ metabolic alkalosis via hypochloremia. Also get hyponatremia.

18

What are the SE of K+ sparing diuretics?

hyperkalemia (can lead to arrhythmias)
Spironolactone only-endocrine effects--gynecomastia, anti androgen, anti-progesterone-menstrual irregularity

19

Why does eplerenone not have the anti-androgen effects?

b/c it mainly just binds to mineral corticoid receptors

20

Which indications for spironolactone take advantage of its anti-androgen effects?

PCOS
acne

21

Which diuretics do you use in the case of CHF?

if volume overload. Strong effect: loop. Less effect: thiazide.
+ K-sparing to prevent hypokalemia

22

Which drugs are used in CHF patients to decrease mortality?

beta blocker
ACE inhibitor or ARB
aldosterone antagonists
strong diuretic if a lot of fluid retention

23

What do K+-sparing diuretics do to blood chem?

increase in NaCl in urine
do NOT increase K+ in urine
cause metabolic acidosis

24

Which diuretic do you use w/ acute pulmonary edema?

loop

25

Which diuretic do you use w/ glaucoma?

acetazolamide, mannitol

26

Which diuretic do you use w/ edema associated w/ nephrotic syndrome?

loop