Flashcards in Pharm 20 - Diuretics Deck (56)
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31
Mannitol clinical applications
Cerebral edema, increased intraocular pressure, prophylaxis of oliguria in acute renal failure
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Mannitol adverse effects
Thrombophlebitis, acidosis, seizure, urinary retention, pulmonary edema; also hypotension, palpitations, fluid/electrolyte imbalance, N, D, rhinitis
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Mannitol contraindications
Anuria, severe dehydration, After administration of mannitol: heart failure, pulmonary congestion, renal dysfunction
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Mannitol therapeutic considerations
Promotes vigorous natriuresis so monitor pt's volume status; if water loss exceeds sodium excretion -> causes hyponatremia; used mostly for emergent reduction of ICP in head trauma, brain hemorrhage, etc; sometimes used to Tx compartment syndrome
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Loop Diuretics MOA
Reversibly/competitively inhibits NKCC2 (Na/K/Cl co-transported) in luminal thick ascending limb; reduces lumen-positive transepithelial potential difference
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Loop Diuretics Names (4)
Furosemide, Bumetanide, Torsemide, Ethacrynic acid
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Loop Diuretics clinical applications
HTN; acute pulmonary edema; edema due to heart failure, cirrhosis, or renal dysfunction; hypercalcemia; hyperkalemia
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Loop Diuretics adverse effects
Hypotension, erythema multiforme, Stevens-Johnson syndrome, pancreatitis, aplastic/hemolytic anemia, leukemia, thrombocytopenia; also volume contraction alkalosis, dose-related OTOTOXICITY, hypokalemia, hypomagnesemia, hyperglycemia, rash, cramps, spasticity, HA, blurred vision, dyspepsia, glycosuria
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Loop Diuretics contraindications
Hypersensitivity to sulfonamides (but can still use Ethacrynic acid); Anuria
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Loop Diuretics therapeutic considerations
Bumetanide is most potent; co-administration with aminoglycosides increases ototoxicity and nephrotoxicity; edema due to hypoalbuminemia can be Tx w/ low dose loop diuretics
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Thiazide Diuretics MOA
Acts as competitive antagonist at NCC Na/Cl co-transporter in luminal membrane of distal convoluted tubule -> inhibits NaCl resporption; promotes increased transcellular calcium resorption in distal convoluted tubule
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Thiazide Diuretics names (7)
HydrochloroTHIAZIDE, BendroflumeTHIAZIDE, HydrolumeTHIAZIDE, PolyTHIAZIDE, Chlorthalidone, Metolazone, Indapamide
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Thiazide clinical applications
HTN, edema associated w/ heart failure, cirrhosis, renal dysfunction, corticosteroid Tx, and estrogen Tx
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Thiazide adverse effects
Cardiac arrhythmia, Stevens-Johnson syndrome, toxic epidermal necrolysis, pancreatitis, hepatotoxicity, SLE; also hypotension, vasculitis, photosensitivity, electrolyte abnormalities, hypokalemic metabolic alkalosis, hyperglycemia, hyperuricemia, dyspepsia, HA, blurred vision, impotence, restlessness
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Thiazide contraindications
Anuria, hypersensitivity to sulfonamides, co-administration with drugs that prolong QT interval (quinidine, stall) b/c it predisposes to torsades de pointes
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Thiazide therapeutic considerations
Can used to diminish hypercalciuria for pts at risk for nephrolithiasis and osteoporosis; HYDROCHLOROTHIAZIDE DECREASES GLUCOSE TOLERANCE (may unmask diabetes); in pts w/nephrogenic diabetes insipidus, may DECREASE urine flow
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Spironolactone & Eplerenone Class & MOA
Potassium-Sparing Diuretics: Binds to, and prevents, nuclear translocation of the mineralocorticoid receptor -> inhibits aldosterone action
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Spironolactone & Eplerenone clinical applications
HTN (especially obesity-related HTN); Edema b/c of heart failure, cirrhosis, or nephrotic syndrome; Hypokalemia; Primary aldosteronism; Spironolactone only: acne, female hirsutism
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Spironolactone & Eplerenone adverse effects
Hyperkalemic metabolic acidosis, GI hemorrhage, agranulocytosis, SLE; also gynecomastia, dyspepsia, lethargy, abnormal menstruation, impotence, rash
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Potassium-Sparing Diuretics contraindications
Anuria, Hyperkalemia, Acute renal insufficiency
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Amiloride & Triamterene Class & MOA
Potassium-Sparing Diuretics: competitive inhibitor of principal cell apical membrane ENaC sodium channel
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Amiloride & Triamterene clinical applications
HTN, Liddle's syndrome
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Amiloride & Triamterene adverse effects
Hematopoietic diseases, nephrotoxicity (triamterene), hyperkalemic metabolic acidosis; also orthostatic hypotension, hyperkalemia, dyspepsia, HA
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Spironolactone & Eplerenone therapeutic considerations
Mild diuretics when used in isolation (but potentiates loop diuretics); can be used in combination with thiazides to reduce potassium-wasting; can reduce mortality in heart failure from inhibition of cardiac fibrosis resulting from a paracrine aldosterone-signaling pathway
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Amiloride & Triamterene therapeutic considerations
Drug of choice for Liddle's syndrome (genetic HTN from gain-of-function mutations in beta/gamma subunits of ENaC sodium channel
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