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CPT > L4 - Diuretics > Flashcards

L4 - Diuretics Flashcards

1
Q

Diuretic

A

Increased urine production

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2
Q

Natriuretic

A

Loss of sodium in urine

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3
Q

Aquaretic

A

Loss of water without electrolytes

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4
Q

Carbonic anhydrase inhibitor mechanism of action

A 
Inhibit carbonic anhydrase in the PCT 
Inhibits:
- HCO3- reabsorption 
- Na+ reabsorption via sodium/ HCO3- cotransporter in the PCT therefore more delivered to the EnaC channels distally 
- therefore more K+ is secreted
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5
Q

When are carbonic anhydrase inhibitors used

A

In glaucoma and mountain sickness

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6
Q

Side effects on carbonic anhydrase

A

Metabolic acidosis

Hypokalaemia

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7
Q

Name of osmotic agent

A

Mannitol

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8
Q

Osmotic agent mechanism of action

A
  • Osmolarity is more negative in the lumen due to mannitol therefore water is diffused out of the tubule down the osmotic gradient
  • Increased diuresis without electrolyte loss therefore urine is more dilute
  • acts everywhere in the nephron especially the PCT
  • Reduces intracellular pressure
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9
Q

When are osmotic agents used

A

Raised intracranial pressure in ITU - intensive treatment unit

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10
Q

Osmotic agent side effects

A
  • hypernatremia

- dehydration

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11
Q

SGLT 2 inhibitors mechanism of action

A
  • inhibits glucose and Na+ reabsorption in the PCT
  • more Na+ delivered to the ENaC channels distally in the DCT and collecting duct
  • therefore more K+ secreted
  • more Na+ delivered to the macula densa in the DCT therefore RAAS not activated
  • increased uric acid secretion
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12
Q

When are SGLT 2 inhibitors used

A

Diabetes
Hypertension
Hyperuricaemia

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13
Q

SGLT2 inhibitor effects

A 
Decrease plasma glucose 
Decrease body weight 
Decrease blood pressure 
Decrease plasma uric acid 
Decrease glomerular hyperfiltration
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14
Q

Loop diuretic mechanism of action

A
  • Inhibits the NKCC2 channel in the ascending limb of the loop of Henle
  • decreases Na+ and K+ reabsorption
  • decreased ROMK function
  • decrease Mg2+ and Ca2+ reabsorption
  • more Na+ delivered to ENaC therefore more K+ secreted
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15
Q

What percentage of sodium is reabsorbed in ascending limb of the loop of Henle

A

25%

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16
Q

When is furosemide given

A

Heart failure
Hypertension
Hyperkaleamia
Hypercalcaemia

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17
Q

Effects of furosemide

A
  • loss of water and sodium
  • loss of Ca2+
  • hypokalaemic metabolic alkalosis
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18
Q

Thiazides diuretic mechanism of action

A
  • Inhibits Na+ Cl- co transporter in the DCT
  • Facilitates the NCX to reverse therefore Na+ is transported from the blood the the tubule and Ca2+ is reabsorbed into blood
  • increased Ca2+ reabsorption (also stimulated by PTH)
  • more Na+ is delivered to ENaC channels in the collecting duct therefore more K+ is secreted
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19
Q

What percentage of sodium is reabsorbed in the DCT?

A

5%

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20
Q

Effects of thiazides diuretics

A

Loss of water and sodium
Hypokalaemic metabolic alkalosis
Increased calcium reabsorption

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21
Q

Thiazide side effects

A 
Hypokalaemic metabolic alkalosis 
Hyperuricaemia - gout 
Arrhythmia 
Hyponatraemia 
Hyperglycaemia- Increased glucose uptake - with beta blocker 
Increased cholesterol and triglyceride - bad for diabetics 
Erectile dysfunction 
Hypercalcaemia
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22
Q

Amiloride

A

PCT:

  • inhibits NHE
  • abolishes 80% of ang II secreting H+

DCT:

  • inhibits ENaC channels
  • decreased reabsorption of Na+
  • K+ sparring
23
Q

Spironolactone

A

Aldosterone receptor antagonist
- aldosterone normally attaches to intracellular mineralocorticosteroid receptors which would increase ENaC expression and Na/K+ ATPase expression

24
Q

ADH antagonists - Aquaretics mechanism of actions

A
  • reduces expression of aquaporins

- therefore diuretic but not natriuretic - produces dilute urine

25
Q

When are aquaretics used?

A

Hyponatraemia

Prevents cysts enlargement in adult poly cystic kidney disease

26
Q

Name of ADH antagonist

A

Tolvaptan
Lithium
Demeclocycline

27
Q

Lithium

A

Treats bipolar disorder

Side effect - inhibits ADH therefore diuretic and can dehydrate rapidly

28
Q

Acetazolamide

A

Carbonic anhydrase inhibitor
Acts on PCT
Side effect: hypokalaemic metabolic acidosis

29
Q

Furosemide side effects

A 
Hypokalaemia metabolic alkalosis 
Hypomagnesia 
Ototoxicity 
Increased lipids, triglycerides and glucose reabsorption - bad for diabetics 
Gout
30
Q

Examples of thiazides

A

Bendroflumethiazides

Indapamide

31
Q

Aldosterone receptor antagonist examples

A

Spironolactone
Canrenone
Eplerenone

32
Q

Alcohol

A

Inhibits ADH release but DOESN’T block the receptor
Decreases water resorption
Urinate more

33
Q

Caffeine

A

Increased GFR

Decreased tubular sodium reabsorption

34
Q

Generic adverse drug reactions

A

Hypovalaemia and hypotension:

  • activates RAAS
  • can lead to AKI

Electrolyte disturbance
Metabolic abnormalities
Anaphylaxis/ photosensitivity rash

35
Q

Spironolactone side effects

A

Hyperkalaemia - arrhythmia
Impotence
Painful gynaecomastia

36
Q

Bumetanide

A

Loop diuretic

Can cause myalgia

37
Q

Aminoglycoside interactions

A

E.g gentamicin

Ototoxic therefore do not give with loop diuretic like furosemide

38
Q

Digoxin interaction

A

Used in atrial fibrillation
Narrow therapeutic window
Can cause hypokalaemia therefore do not give with thiazides and loop diuretics

Can cause increased digoxin binding and toxicity

39
Q

Beta blockers and thiazides effects

A

Hyperglycaemia
Hyperlipidemia
Hyperuricaemia

40
Q

Steroid interactions

A

Decrease K+ reabsorption

Therefore do not give with thiazides or loop diuretics

41
Q

Lithium interactions

A

Thiazide - increases lithium toxicity

Loop diuretic - reduces lithium level

42
Q

Carbamazepine

A

Anti- epileptic

Used with thiazides and loop diuretics can cause hyponatreamia

43
Q

Hypertension

A

Thiazide - vasodilation and diuretic
Spironolactone
Loop diuretic - body quickly accommodates

Ace inhibitors
ARB
CCB
B blockers

44
Q

Heart failure

A
  • causes secondary hyperaldosteronism due to low BP
  • loop diuretic - can cause hypokalaemia
  • spironolactone as adjunct to decrease hypokalaemia
  • ACEi
  • ARB
  • B blocker
  • SGLT2
  • Tolvaptan
45
Q

Decompensated liver disease

A

Normally causes low K+

Spironolactone - K+ sparing
Loop diuretics

  • Tolvaptan
46
Q

Nephrotic syndrome

A

Large dose of loop diuretic
+/- thiazides
+/- K+ sparing diuretic and K+ supplements

47
Q

Chronic kidney disease

A

Decrease GFR

  • Water and sodium retention
  • acidosis as less H+
  • hyperkaleamia
  • loop diuretic
  • AVOID potassium sparring diuretics
48
Q

Diuretic resistance

A

chronic renal failure :

  • OATs transport things non specifically therefore completes with furosemide
  • reduced nephron number

Nephrotic syndrome

  • gut oedema therefore less absorption of furosemide
  • hypoalbuminaemia therefore less carriers for furosemide

Heart failure
- furosemide transported less due to low circulation

49
Q

Lifestyle advice

A
  • decrease salt intake
  • exercise
  • less fluid intake
50
Q

Refractory oedema

A

In heart failure patients higher concentration of drugs are required and there is less effect

  • check salt intake
  • give furosemide IV if gut oedema
  • minimal effective dose adapted

On day 1 works well but day 3 to 4 more Na+ reabsorbed due to upregulation

51
Q

Bartter’s syndrome

A

Extreme furosemide effect

Hypotension

52
Q

Gitelman’s syndrome

A

Congenital
100% thiazide effect
Hypotension

53
Q

Liddle’s syndrome

A

Increased ENaC activity
Hypertension
More sodium and water reabsorption

CPT (23 decks)

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