Pharm 20 - Diuretics Flashcards Preview

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Flashcards in Pharm 20 - Diuretics Deck (56)
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Mannitol clinical applications

Cerebral edema, increased intraocular pressure, prophylaxis of oliguria in acute renal failure


Mannitol adverse effects

Thrombophlebitis, acidosis, seizure, urinary retention, pulmonary edema; also hypotension, palpitations, fluid/electrolyte imbalance, N, D, rhinitis


Mannitol contraindications

Anuria, severe dehydration, After administration of mannitol: heart failure, pulmonary congestion, renal dysfunction


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


Loop Diuretics MOA

Reversibly/competitively inhibits NKCC2 (Na/K/Cl co-transported) in luminal thick ascending limb; reduces lumen-positive transepithelial potential difference


Loop Diuretics Names (4)

Furosemide, Bumetanide, Torsemide, Ethacrynic acid


Loop Diuretics clinical applications

HTN; acute pulmonary edema; edema due to heart failure, cirrhosis, or renal dysfunction; hypercalcemia; hyperkalemia


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


Loop Diuretics contraindications

Hypersensitivity to sulfonamides (but can still use Ethacrynic acid); Anuria


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


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


Thiazide Diuretics names (7)

HydrochloroTHIAZIDE, BendroflumeTHIAZIDE, HydrolumeTHIAZIDE, PolyTHIAZIDE, Chlorthalidone, Metolazone, Indapamide


Thiazide clinical applications

HTN, edema associated w/ heart failure, cirrhosis, renal dysfunction, corticosteroid Tx, and estrogen Tx


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


Thiazide contraindications

Anuria, hypersensitivity to sulfonamides, co-administration with drugs that prolong QT interval (quinidine, stall) b/c it predisposes to torsades de pointes


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


Spironolactone & Eplerenone Class & MOA

Potassium-Sparing Diuretics: Binds to, and prevents, nuclear translocation of the mineralocorticoid receptor -> inhibits aldosterone action


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


Spironolactone & Eplerenone adverse effects

Hyperkalemic metabolic acidosis, GI hemorrhage, agranulocytosis, SLE; also gynecomastia, dyspepsia, lethargy, abnormal menstruation, impotence, rash


Potassium-Sparing Diuretics contraindications

Anuria, Hyperkalemia, Acute renal insufficiency


Amiloride & Triamterene Class & MOA

Potassium-Sparing Diuretics: competitive inhibitor of principal cell apical membrane ENaC sodium channel


Amiloride & Triamterene clinical applications

HTN, Liddle's syndrome


Amiloride & Triamterene adverse effects

Hematopoietic diseases, nephrotoxicity (triamterene), hyperkalemic metabolic acidosis; also orthostatic hypotension, hyperkalemia, dyspepsia, HA


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


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


[-PRIL] Types

1) Captopril: active when administered, processed to active metabolite
2) Enalapril, Ramipril: ester prodrug converted in plasma to active metabolite (Enalaprilat, Ramiprilat)
3) Lisinopril: active when administered, excreted unchanged