Drugs For Cardiovascular Disorders I

Front 1

What are the classes of diuretics?

Back 1

• Group of compounds used to mobilize fluid

• Several classes of diuretics:
• Loop – action at ascending loop of Henle (e.g., furosemide);also known as high ceiling diuretics, b/c a higher dose = higher response w/o a ceiling
• Thiazides – action at distal tubule (e.g., hydrochlorothiazide)
• Potassium-sparing – action at distal nephron (e.g., spironolactone)
• Osmotic – inhibits passive water reabsorption (e.g., mannitol)

Front 2

note: many cardiovascular drugs are used for multiple indications

Back 2

note

Front 3

Loop diuretic

Back 3

Works on na, K, 2Cl transporter
- blocks their reabsorption from the lumen
- Na increases in urine, H2O increases in urine
- but drug has to get into lumen to work
side effects: hypokalemia, hypocalcemia, poss hypomagnisemia, huponatremia, but less

Front 4

Furosemide (Lasix®, others)

Back 4

Indication – volume overload, edema
Mechanism – blocks Na & Cl reabsorption at TAL(thick ascending limb of LOH)
Dose – 20-80 mg (max 300 mg bid)
Onset/Duration – 30-60 min / 6-8 h
Elimination – some hepatic metabolism, renal excretion
Adverse effects – volume depletion, hypotension, hypokalemia, hypomagnesemia, hypocalcemia, hyperglycemia, ototoxicity; caution in pregnancy; interactions with antihypertensives, digoxin, NSAIDs, lithium, aminoglycoside antibiotics

Front 5

Hydrochlorothiazide (HydroDiuril®, others)

Back 5

Indication – hypertension, mild edema
Mechanism – blocks Na/Cl reabsorption at distal tubule
Dose – 12.5-25 mg daily (available in combo products)
Onset/Duration – 1-2 h / 6-12 h
Adverse effects – volume depletion, hypotension, hypokalemia, hypomagnesemia, hypercalcemia, hyperglycemia, hyperlipemia, hyperuricemia; caution in pregnancy/lactation; interactions with antihypertensives, digoxin, NSAIDs(cause sodium reabsorption so work against loop diuretics), lithium (similar to Na so when low on Na, the body takes up Li, can cause inc. Li), dec BP b/c of volume depletion and arterial smooth muscl relaxation in tissue

Front 6

Hydrochlorothiazide (HydroDiuril®, others)

Back 6

Indication – hypertension, mild edema
Mechanism – blocks Na/Cl reabsorption at distal tubule
Dose – 12.5-25 mg daily (available in combo products)
Onset/Duration – 1-2 h / 6-12 h
Adverse effects – volume depletion, hypotension, hypokalemia, hypomagnesemia, hypercalcemia, hyperglycemia, hyperlipemia, hyperuricemia (bad for ppl. w/gout b/c inc uric acid levels which is true whenever you loose a lot of fluid b/d it's reabsorbed... so doesn't work well if creat clearance <25 ml/min; caution in pregnancy/lactation; interactions with antihypertensives, digoxin, NSAIDs, lithium
works @ beg of DCT; blocks Na, CL symport out of lumen into cell
- a thiazide diuretic