Diuretics-Dr. Bateson

Front 1

Acetazolamide
class?
MOA?
oral bioavailability?
uses?

Back 1

-Carbonic anhydrase inhibitor
-abolishes NaHCO2 reabsorption in proximal tubule
-~100%
-Acute mountain sickness, edema from heart failure, epilepsy, familial periodic paralysis, alkalosis (from thiazides or loop diuretics)

Front 2

Dorzolamide
class?
MOA?
Pk?
uses?

Back 2

-Carbonic anhydrase inhibitor
-inhibits NaHCO2 reabsorption, binds to CA on RBC with chronic use
-topical (eye drops)
-open angle glaucoma

Front 3

Furosamide
-class?
-MOA?
-Pk?
-uses?

Back 3

-Loop diuretic
-Na K Cl symporter inhibitor
-IM, PO, IV, (oral=~60%)
-acute pulm edema, heart failure, edema, ascites, HTN, hyperCa

Front 4

Ethacrynic acid
-class?
-MOA?
-Contra?

Back 4

-Loop diuretic "high ceiling"
-Na K Cl symporter inhibitor
-serious hypovolemic/hypoNa states, anuria unresponsive to drugs (suggests kidney failure)

Front 5

Hydrochlorothiazide
-class?
-MOA?
-uses?

Back 5

-thiazide
-Na Cl symporter inhibitor in early distal convoluted tubule
-HTN (1st choice), MOST edemas, ascites, Ca nephrolithiasis, meniere's dz, nephrogenic diabetes insipidus

Front 6

Indapamide
-class?
-MOA?
-Contra?

Back 6

-Thiazide congener (similar)
-Na Cl symporter inhibitor at the early distal convoluted tubule
-thiazide/sulfa hypersensitivity, anuria, renal decompensation, pregnancy

Front 7

Triamterene
class?
MOA?
uses?
Contra?

Back 7

-Potassium sparing diuretic
-acts on ENaC in late distal convoluted tubule and cortical collecting duct
-treat and prevent hypokalemia
-chronic renal insufficiency, hyperK states, severe hepatic dz, pts with RAS blunting drugs, high doses of NSAIDs

Front 8

Amiloride
class?
MOA?
uses?

Back 8

-Potassium sparing diuretic
-ENaC inhibitor so that Na entry can't depolarize cell forcing K to exit
-lithium induced nephrogenic diabetes insipidus (blocks Li uptake)

Front 9

Spironolactone
class?
MOA?
adverse effects?

Back 9

-Potassium sparing diuretics
-steroid that is an aldosterone receptor antagonist (reduces ENac and Na-K-ATPase expression)
-sexual dysfunction ~40%, gynecomastia, hirsutism, prostate hypertrophy, menstrual irregularities

Front 10

Conivaptan
class?
MOA?
pk?
uses?

Back 10

-vassopressin/ADH antagonist (competitive)
-acts on V2 AND V1b(affects renal blood flow) and inhibits aquaporin distribution to the apical membrane
-IV adminis, strong inhibitor of CYP3A4
-SIADH, Chronic euvolemic hyponatremia

Front 11

Tolvaptan
class?
MOA?
Adverse?
Contra?

Back 11

-Vassopressin/ADH competitive antagonist
-(only acts on V2 receptor), given PO, inhibits V2 receptor regulation of aquaporins on the medullary collecting duct
-GI, nephrogenic diabetes insipidus, postural hypotension, hypoK
-hypovolemic hypoN, concurrent use with CYP3A4 inhibitors