Cv Drugs - Diuretics & Antidiuretics

Front 1

Acetazolamide
Dorzolamide

Back 1

Diuretic
CA Inhibitor (everywhere)
- Decrease bicarbonate reabsorption
- Less Na+ recovery (diuresis)
- Produce alkaline urine
- Produce acidotic blood

Front 2

1) What are the CA Inhibitor diuretics?

2) Where do they work?

3) What are they indicated for?

4) What are adverse effects?

Back 2

1) Acetazolamide and Dorzolamide

2) PT

3) Glaucoma, urine alkalization for elimination of toxic/lipid soluble weak acids

4) Metabolic acidosis, elevated renal pH, renal stones

Also used for Altitude sickness (stimulates hyperventilation from metabolic acidosis)

Front 3

Furosemide (Lasix)

Back 3

Diuretic
Loop Diuretic
- Sulfonamide

- Used when rapid volume depletion needed (e.g. acute pulmonary edema)

- Major side effects (e.g. Hypo- magnesium, calcium, kalemia, chloride)

Front 4

Bumetanide

Back 4

Diuretic
Loop Diuretic
- Sulfonamide

Front 5

Torsemide

Back 5

Diuretic
Loop Diuretic
- Sulfonamide

Front 6

Ethacrynic Acid

Back 6

Diuretic
Loop Diuretic
- NOT Sulfonamide

Front 7

1) What is the MOA of Loop Diuretics?

2) Where specifically do they work?

3) What are Loop Diuretics indicated in?

4) What are the side effects of Loop Diuretics?

Back 7

1) Inhibit Na,K,Cl cotransporter (this site is responsible for recovering 30% of filtered Na+)
Also lose Ca, Mg, HOH

2) TAL - thick ascending limb

3) Acute pulmonary edema, CHF, HTN, refractory edemas, Hypercalcemia <---**

4) Hypokalemia (Alkalosis)
Hypovolumia-->thirst-->hyponatremia
HYPERuricemia
HYPERglycemia
Ototoxicity (Ethacrynic acid)
Sulfa Sensitivity (Other 3)

High-Ceiling Diuretics (POWERFUL)

Front 8

Chlorothiazide (Diuril)

Back 8

Diuretic
Thiazide

Front 9

Hydrochlorothiazide (HCTZ)

Back 9

Diuretic
Thiazide

Front 10

Polythiazide

Back 10

Diuretic
Thiazide (DCT)

Front 11

Indapamide

Back 11

Diuretic
Thiazide
PLUS vasodilator
(HCTZ is not also vasodilator)

Front 12

Chlorthalidone

Back 12

Diuretic
Thiazide

Front 13

Metolazone

Back 13

Diuretic
Thiazide

Front 14

Spironolactone

Back 14

Diuretic
Potassium-Sparing
- Also aldosterone ANT

Front 15

Eplerenone

Back 15

Diuretic
Potassium-Sparing

Front 16

Triamterene

Back 16

Diuretic
Potassium-Sparing

Front 17

Amiloride

Back 17

Diuretic
Potassium-Sparing

Front 18

Mannitol

Back 18

Diuretic
Osmotic

Front 19

Vasopressin (ADH)

Back 19

Diuretic
ADH Agonist
V1 and V2

Front 20

Desmopressin

Back 20

Diuretic
ADH Agonist
V2 only

Front 21

Lithium Ion

Back 21

Anti-Diuretic
ADH Inhibitors
- Blocks V2 mechanism
- Li-induced DB insipidus is treated w/ desmopression

Front 22

1) What drug class / loop diuretic combination can enhance ototoxicity?

2) What drug can enhance hypokalemia if taken w/ Loop Diuretics?

Back 22

1) Aminoglycosides and the non-sulfa loop diuretic, ethacrynic acid

2) Digoxin - hypokalemia

Front 23

1) What are the sulfonamides?

2) What Sulfa antibiotics can these drugs cross-react with?

3) What class of diuretic can cross react with the sulfonamide drugs?

Back 23

1) Furosemide, bumetanide, torsemide (loop diuretics)

2) Sulfamethoxazole

3) Thiazides (DCT): HCTZ, Indapamide

Front 24

1) What are symptoms of sulfonamide hypersensitivity?

Back 24

1) Skin Reactions: hive, photo sensitivity, Stevens-Johnson syndrome (painful rash on mucuous membranes and all over body)

- Hepatitis, kidney failure

- Reduced WBC, RBC, Platelets

Front 25

1) What are the thiazides?

2) What is the MOA?

3) What is retained (vs. other diuretics)?

Back 25

1) Thiazides: HCTZ, Indapamide, others

2) They work on the DCT.
- Inhibit the Na+Cl- cotransporter

3) Ca2+ is retained

Front 26

1) What are thiazides indicated in?

2) What are side effects of thiazides?

Back 26

1) CHF, HTN, Nephrogenic DB insipidus (direct stimulus of ADH site)
- Reduces Ca2+ stone formation

2) Hypokalemia / Alkalosis
Hyperuricemia
Hypercalcemia (<-- ONLY DIFF IN SIDE EFFECTS FROM LOOPS)
Hyperglycemia
Sulfa Sensitivity

Front 27

1) What drug is used when RAA is high? What class of diuretic is it?

2) What are other classes of K+ sparring diuretics?

Back 27

1) Spironolactone: CT, K+ sparing (is an aldosterone ANT)

2) Amiloride and Triamterene

Front 28

1) Describe why loop and thiazide (DCT) may result in hyperuricemia?

2) Describe why some loop diuretics result in hyperglycemia?

3) How does the hypovolemia and hyponatremia occur?

Back 28

1) Loop Diuretics / Thiazides are weak acids --> compete for oraganic acid excretion sites in PT --> uric acid buildup

(uric has to compete w/ diuretics, lactate, etc)

2) Hypokalemia -->less K+ for beta cell K+ current -->steeper gradient (faster current)-->less insulin release

3) During Na+ and water loss, compensatory mechanisms kick in (ADH, etc); pt wants water-->unrestricted water intake leads to acute dilutional hyponatremia (CNS, ventricular arrhythmias, convulsions)

Front 29

1) Which K+ sparring diuretic is used specifically against high aldosterone?

2) How does it do this?

3) What are some possible side effects?

Back 29

1) Spironolactone

2) Aldosterone receptor competitive ANT (Anti-HTN, Anti-CHF)

3) Hyperkalemia, acidosis (DIFFERENT FROM OTHERS)

Front 30

1) What K+ sparring diuretics are Na+ transport blockers?

Back 30

1) Amiloride, Tramterene

Usually combined w/ thiazides or loops to neutralize K+ loss

Front 31

1) What is the major osmotic diuretic?

2) How does it work?

3) What is it indicated in?

Back 31

1) Mannitol

2) filtered, not reabsorbed

3) edema, glaucoma, to make nephrotoxic drugs readily excretable

Front 32

1) Why is desmopressin and not vasopressin indicated in neurogenic diabetes insipidus?

Back 32

1) Vasopressin acts at V1 AND V2 receptors, producing vasoconstriction and increased BP (V1) and water retention (V2); Desmopressin only works at V2