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38 Cards in this Set
- Front
- Back
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Thiazide Mechanism |
Inhibit passive Na & Cl reabsorption by symporter in distal tubule |
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Thiazide Electrolyte Excretion |
↑ Na, K, Cl, Mg excretion ↑ H₂O excretion ↓ Ca excretion |
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Thiazide max urine production rate |
3ml/min |
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Thiazide Disadvantages |
-Hypokalemia (K-wasting) -Hypokalemic metabolic alkalosis -Reduced uric acid secretion (factor for gout) -Reduced insulin sensitivity due to alkalosis (results in hyperglycemia) |
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Thiazide Uses |
-Management of hypertension -Management of edema in mild/moderate congestive heart failure -Management of edema in chronic renal or hepatic disease |
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High Ceiling/Loop Mechanism |
Inhibit passive K, Na and Cl in ascending (thick) Loop of Henle |
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High Ceiling/Loop Electrolyte Excretion Pattern |
↑ Na, K, Cl, Mg, Ca excretion ↑H₂O excretion |
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High Ceiling/Loop max urine production rate |
∼10ml/min |
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High Ceiling/Loop Advantages |
-High efficacy (urine volume increase) -Rapid onset, short duration (administration usually via injection) |
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High Ceiling/Loop Disadvantages |
-Hypokalemia (K-wasting) -Ototoxicity (deafness and balance problems) -Dehydration -Electrolyte imbalance -Blockade of uric acid secretion (hyperuremia, gout) -Reduced insulin secretion -Hypocalcemia |
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High Ceiling/Loop Uses |
-Primarily used when desired diuretic effect is greater than can be achieved by other diuretics
-Edema -Congestive heart failure -Hypervolemia based hypertension -Hepatic Cirrhosis |
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MR Receptor Antagonist Mechanism |
Competitive Pharmacological antagonist of aldosterone at MR receptors in cells of the collecting duct -MR activation results in Na-K pores in walls of tubule -MR antagonists reduce presence of pores |
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MR Receptor Antagonist Electrolyte excretion pattern |
↑ Na excretion ↑ H₂O excretion ↓K, Ca, Mg excretion |
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MR Receptor Antagonist max urine production rate |
~3ml/min |
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MR Receptor Antagonist Advantages |
No hypokalemia or K-wasting |
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MR Receptor Antagonist Disadvantages |
-Hyperkalemia (excessive plasma K concentration) -Slow onset, sustained effect -Weak progesterone mimic (Sprironolactone only) - causes breast growth in men |
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MR Receptor Antagonist Uses |
-Aldosterone dependent hypertension -Renin dependent hypertension -Refractory edema -Hypokalemia -Hepatic cirrhosis -Congestive heart failure |
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Na-K Pore Blockers Mechanism |
-Block Na & K (MR-dependant) conducting pores of cells of collecting duct -Unrelated to aldosterone concentration in blood or aldosterone function on pore formation -Relatively rapid response b/c no change of membrane pore is necessary for effect |
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Na-K Pore Blockers Electrolyte excretion |
↑ Na excretion ↑ H₂O excretion ↓ K, Ca excretion |
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Na-K Pore Blockers max urine production rate |
~3ml/min |
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Na-K Pore Blockers Advantages |
No hypokalemia or K wasting |
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Na-K Pore Blockers Disadvantages |
Hyperkalemia |
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Na-K Pore Blockers Uses |
-Primary aldosteronism (excessive aldosterone secretion from adrenal gland) -Refractory edema
-Often combined w/ K-wasting diuretics to prevent excessive K excretion
-Hypokalemia -Hepatic cirrhosis -Congestive heart failure -Renin dependent hypertension |
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Carbonic Anhydrase Inhibitor Mechanism |
-Inhibits renal carbonic anhydrase -Inhibits normal HCO₃⁻ reabsorption -Increases HCO₃⁻ and Na excretion & decreases H⁺ excretion -Urine becomes more basic than normal -Acidic drugs are excreted more rapidly -Basic drugs are excreted more slowly -Blood plasma becomes more acidic than normal
-pH dependent action: not effective when plasma pH is low |
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Carbonic Anhydrase Inhibitor Electrolyte excretion |
↑ Na, HCO₃⁻, K, PO₄ excretion ↑ H₂O excretion ↓ H⁺ excretion
↓↓ Plasma pH ↑↑ Urine pH |
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Carbonic Anhydrase Inhibitor mac urine production rate |
~3ml/min |
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Carbonic Anhydrase Inhibitor Advantages |
-Alkaline urine → ↑ excretion of acidic drugs (useful in overdose situation) |
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Carbonic Anhydrase Inhibitor Disadvantages |
-Ineffective as diuretic in metabolic acidosis -Efficacy limited due to bicarbonate wasting -Alkaline urine → ↑ excretion of acidic drugs (harmful for therapeutic drug use) |
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Carbonic Anhydrase Inhibitor Uses |
-Rarely used as a diuretic (not very effective and may create an acid-base imbalance) -Usually used to adjust acid-base balance (treating chronic metabolic alkalosis)
Non-Renal Actions: -Epilepsy (CAI's raise seizure threashold) -Glaucoma (CAI effect in eye) |
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Osmotic Diuretics Mechanism |
-injected, distributes though body to extracellular fluid which becomes hypertonic -Osmotic removal of intracellular water to extracellular space and then to blood vessels -increases blood volume (hypervolemia) -triggeres physiological response to hypervolemia → increased urine production
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Osmotic Diuretics Electrolyte Excretion |
↑ H₂O excretion ↑ Na, K, Cl excretion |
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Osmotic Diuretics max urine production rate |
~3ml/min |
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Osmotic Diuretics Advantages |
-Maintains urine output even when renal blood flow is decreased |
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Osmotic Diuretics Disadvantages |
-Hyponatremia -Hypokalemia -Expansion of extracellular fluid and blood volumes, can be problematic for individuals with compromised cardiac function -Not used in individuals w/ congestive heart failure -Dehydration -Must be injected -Bad for people w/ pulmonary edema |
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Osmotic Diuretics Uses |
-Maintenance of urine production in situations where it may stop (anuria) -Reduce intracraineal pressure caused by edema (common use of Mannitol) -Prophylaxis of acute renal failure -Introduction of polyuria to eliminate toxicants and poisons |
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ACE Inhibitors Mechanism |
-reduce all plasma production -consequently reduces aldosterone secretion -subsequent reduction of renal Na and H₂O reabsorption |
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ACE Inhibitors Uses |
-Treat essential hypertension -Treat congestive heart failure |
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ACE Inhibitors Side Effects |
-Hyperkalemia (K sparing) -Proteinuria -Forbidden in pregnant women: (teratogenic effects) |
