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23 Cards in this Set
- Front
- Back
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Diuretic MOA
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Lower blood pressure by:
• Blocking uptake of Na+ into renal epithelial cell → Na+ stays in lumen → H20 leaves cell → Preload↓ → Stroke volume↓ → BP↓ |
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Types of Diuretics
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Carbonic Anhydrase inhibitors
Loop Diuretics Thiazide Diuretics Antikaliuretic (K+ sparing) |
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Loop Diuretics
Included Drugs |
End in "mide" or "nide":
Furosemide Bumetanide Torsemide |
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Loop Diuretic
MOA - basic/location |
Blocks Na+/K+/Cl- symporter
(thick ascending limb) |
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Loop Diuretic
ADME |
• Absorption: Oral, IV (multiple doses/day)
• Distribution: • Metabolism: • Elimination: Renal |
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Loop Diuretic
Clinical Use |
• Edema:
- Chronic heart failure (acute pulmonary edema) - Chronic renal insufficiency • Acute hypercalcemia |
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Loop Diuretic
Adverse Effects |
Common:
• Hypokalemia • Metabolic alkalosis Severe: • Ototoxicity (w/ aminoglycoside Ab) |
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Loop Diuretic
Contraindications and Interactions |
Contraindications:
• Hepatic cirrhosis • Renal failure • Heart failure • NSAIDs Interactions: • Aminoglycoside Ab • NSAIDs |
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Thiazide Diuretics
Included Drugs |
End in "azide":
- Bendroflumethiazide - Chlothalidone* - Chlorothiazide - Hydrochlorothiazide - Indapamide - Polythiazide - Trichloromethiazide |
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Thiazide Diuretics
MOA basic/location |
Blocks Na+/Cl- symporter
(distal tubule) |
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Thiazide Diuretics
ADME |
• Absorption: Oral administration (1 dose/day)
• Distribution: Bound to plasma protein • Metabolism: Long acting; wide range of half-lives • Elimination: Renal |
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Thiazide Diuretics
Clinical Use |
First line of therapy in uncomplicated patient
- Hypertension - Heart Failure - Nephrolithiasis - Nephrogenic Diabetes Insipidus |
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Thiazide Diuretics
Adverse Effects |
Common:
• Hypokalemia • Metabolic alkalosis • Hypercalcemia Life threatening: • Hyponatremia • Prolonged QT → Torsades |
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Thiazide Diuretics
Contraindications and Interactions |
Contraindications:
- Hepatic Cirrhosis - Renal Failure - Heart Failure - NSAIDs Interactions: - Extensively bound to plasma proteins - NSAIDs |
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Antikaliuretic Diuretics (K+ Sparing)
Included Drugs |
End in "ene" or "one"
- Amiloride* - Triamterene - Spirolactone - Epelerenone |
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Antikaliuretic Diuretics (K+ Sparing)
MOA basic/location |
1. Block Na+ channels
Epithelial channels on principal cells 2. Competitive antagonist of aldosterone - Alter activity and transcription of Na+ epithelial channels (early and late respectively) |
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Antikaliuretic Diuretics (K+ Sparing)
Drugs That Block Na+ Channels |
- Amiloride
- Triamterene |
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Antikaliuretic Diuretics (K+ Sparing)
Competitive Antagonists of Aldosterone |
- Spirolactone
- Eplerenone |
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Antikaliuretic Diuretics (K+ Sparing)
ADME |
• Absorption:
• Distribution: Lipid soluble • Metabolism: • Elimination: |
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Antikaliuretic Diuretics (K+ Sparing)
Clinical Use |
- Mineralocorticoid excess
- Hyperaldosteronism - Need to increase K+ - Heart failure |
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Antikaliuretic Diuretics (K+ Sparing)
Adverse Effects |
Common:
• Hyperkalemia Life threatening: • Acute renal failure |
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Antikaliuretic Diuretics (K+ Sparing)
Adverse Effects (Spirolactone) |
Affinity for steroid and androgen receptors
• Progesterone and anti-adrenergic side effects - Gynecomastia - Impotence - Menstrual problems |
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Antikaliuretic Diuretics (K+ Sparing)
Contraindications and Interactions |
Contraindications:
- Oral K+ administration - Chronic renal insufficiency - Agents that blunt renin-angiotension system |
