Loop Diuretics

Front 1

chlorthalidone

Back 1

thiazide like

Front 2

metolazone

Back 2

thiazide like

Front 3

indapamide

Back 3

thiazide like

Front 4

acetazolamide

Back 4

CA inhibitor

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dorzolamide

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CA inhibitor

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brinzolamide

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CA inhibitor

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CA inhibitor inhibit....and enhance.....

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bicarb and Na reabsorption, enhance phosphate excretion

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what to use for glaucoma

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dorzolamide of brinzolamide

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drug for mountain sickness

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CA inhibitor

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drug for metabolic alkalosis

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CA inhibitor

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furosemide

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loop diuretic

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bumetanide

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loop diuretic

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torsemide

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loop diuretic

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ethacrynic acid

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loop diuretic

Front 15

MOA of loop diuretic

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inhibits NKCC2

Front 16

which loop diuretic possess CA inhibition activity

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furosemide

Front 17

triamterene

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K sparing inhibitor of ENaC

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amiloride

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K sparing inhibitor of ENaC

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spironolactone

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K sparing aldosterone antagonist

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eplerenone

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K sparing aldosterone antagonist

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Nesiritide

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Natriuretic Peptide (human recombinant BNP)

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Carperitidie

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human recombinant ANP

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mannitol

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aquaretic-osmotic diuretic

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urea

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aquaretic osmotic diuretic

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glycerin

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aquaretic osmotic diuretic

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isosorbide

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aquaretic osmotic diuretic

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conivaptan

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aquaretic vasopressin antagonist

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tolvaptan

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aquaretic vasopressin antagonist

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lithium

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aquaretic vasopressin antagonist

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demeclocycline

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aquaretic vasopressin antagonist

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where do thiazides work

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DCT

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3 things Thiazides do

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inhibit NCC (NaCl) reabsorption
enhances Ca reabsorption d/t low Na in cell that activates Na/Ca exchange on basolateral side
enhanced prostaglandin production

Front 33

tx of CHF

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thiazide

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tx of hypercalciuria

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thiazide

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tx of nephrogenic diabetes insipidus

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thiazide

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tx of nephrogenic diabetes insipidus

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thiazides

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adverse effects of thiazides

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hypokalemic metabolic acidosis
hyponatremia
hyperglycemia, hyperlipidemia hyper urecemia, hypercacemia, (hyperGLUC) sulfa sensitivity

hyper

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secondary effect of K sparing ENaC inhibitors

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decreased excretion of K and H due to hyperpolarization of cell

Front 39

drugs that increase prostaglandin production

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loop diuretics, thiazides, K sparing

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indication for k sparing diuretic ENaC inhibitor

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tx of htn with other drugs

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liddle syndrome and tx for it

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autosomal dominant form of low-renin htn due ot mutations in ENaC; tx is k sparing diuretic

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adverse effects of k sparing ENaC inhibitors

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hyperkalemia (K not excreted b/c Na isn't reabsorbed) (esp inpts taking meds that reduce RAS activity)
metabolic acidosis (H not excreted)
*triamterene can cause megaloblastic anemia, interstitial nephritis, kidney stones

Front 43

site of action of k sparing

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Collecting Duct

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MOA of aldosterone antagonists

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competitive antagonist of aldosterone receptor in collecting duct; inhibits H and K secretion

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indications for K sparing aldosterone antagonist

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hyperaldosteronism, K depletion, CHF

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eplerenone is tx for what?

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HTN only

Front 47

adverse effects of aldosterone antagonists

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hyperkalemia
metabolic acidosis
endocrine effects w/ spirnolactone

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common adverse effects for all k sparing

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hyperkalemia and metabolic acidosis

Front 49

gynecosmastia in males or deepening of voice in females is adverse effect of which drug

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spironolactone

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MOA of natriuretic peptides

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binds to receptors in Collecting duct that stimulate cGMP
cGMP inhibits the non selective cation channel CNGC

PKG is also stimulated which inhibits Na pump activity os Na is not reabsorbed

Front 51

what else do natriuretic peptides do

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inhibit renin release,
inhibit endothelin secretion
vasodilate
decreases systemic sympathetic activity

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indicated for pts with acute decompensated heart failure

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nesiritide

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reduces preload (venular dilation)
reduces afterload (arteriolar dilation)
increases natriuresis

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both nesiritide and carperitide

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MOA of osmotic diuretics

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draw water into lumen with it

Front 55

where are osmotic diuretics working

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PCT and descending limb

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osmotic diuretics used for

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drug detox, elevated intracranial/intraocular pressure, prophylaxis for acute renal failure

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adverse effects of osmotic diuretics

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pulm edema
dehydration
contraindicated in CHF pts

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vasopressin antagonists of V1a and V2 receptors

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conivaptan

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oral form vasopressin antagonist

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tolvaptan

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antagonst at v2 receptor only

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tolvaptan

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action of v1a V1b receptors

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contraction of vascular smooth muscle and contraction of myometrium

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action of V2 receptors

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bring aquaporin 2 channels to luminal membrane

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action of lithium and demeclocycline

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decrease formation of or interfere with action of cAMP

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use of vasopressin antagonists

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CHF, SIADH

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adverse effect of megaloblastic anemia or interstitial nephritis

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triamterene

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clinical indications for thiazides

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hypercalciuria, CHF, hypertension, nephrogenic diabetes insipidius

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drugs that cause alkalemia

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loop and thiazides

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drugs that cause acidemia

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CA inhibitors, K sparing

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increases Ca in urine

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loop diuretics

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decreases Ca in urine

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thiazides

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loop adverse effects

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OHDANG
ototoxicity, hypokalemia, dehydration, allergy, nephritis (interstitial), gout