Pharm - Diuretics

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MOA/site of osmotic diuretic

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increases osmolarity of tubular fluid to inhibit water/solute reabsorption in proximal tubule

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MOA/site of loop diuretic

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inhibit Na/K/Cl co transport in thick ascending loop

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MOA/site of thiazide diuretic

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inhibit Na/Cl cotransport in early distal tubule

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MOA/site of carbonic anhydrase inhibitors

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inhibits H secretion and bicarb reabsorption to reduce Na reabsorption in proximal tubule

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MOA/site of aldosterone antagonists

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inhibits action of aldosterone which decreases Na reabsorption and K secretion in collecting tubule

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MOA/site of Na channel blockers

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decreases Na reabsorption and K secretion in collecting tubules

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examples of osmotic diuretic

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mannitol

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examples of loop diuretics

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furosemide, bumetanide, ethacrynic acid

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examples of thiazides

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HCTZ and chlorthalidone

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example of carbonic anhydrase inhibitor

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acetazolamide

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examples of aldosterone antagonists

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spironolactone, eplerenone

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examples of Na channel blockers

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triamterene, amiloride

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Diuretic used for mountain sickness and glaucoma

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Acetazolamide

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SE of acetazolamide

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Paresthesias, alkalization of the urine (which may ppt. Ca salts), hypokalemia, acidosis, and encephalopathy in patients with hepatic impairment

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SE of loop (furosemide) diuretics

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Hyperuricemia, hypokalemia and ototoxicity

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Aminoglycosides used with loop diuretics potentiate adverse effect

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Ototoxicity

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Loops lose and thiazide diuretics retain

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Calcium

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Class of drugs that may cause cross-sensitivity with thiazide diuretics

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Sulfonamides

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SE of thiazide (HCTZ) diuretics

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Hyperuricemia, hypokalemia and hyperglycemia

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Diuretic used to treat primary aldosteronism

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Spironolactone

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SE of spironolactone

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Gynecomastia hyperkalemia, and impotence

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this part of the nephron is responsible for 60-70% of Na reabsorption (NaCl and Na bicarb)

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proximal convoluted tubule

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how is bicarb reabsorbed?

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conversion into CO2 and H2O via carbonic anhydrase; it regenerates within tubule cell

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in the prox tubule, what is Na exchanged for?

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H+

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MOA of carbonic anhydrase inhibitors

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prevents the conversion of bicarb to CO2 and H2O which prevents it from forming H+ in the cell, which prevents exchange of H+ with Na

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where are WAs and WBs reabsorbed mainly?

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proximal tubule

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where are Ca and Mg largely reabsorbed?

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TAL of Henle

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what drives the reabsorption of Ca and Mg in the TAL of Henle?

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K makes a net positive charge inside the cells because it is reabsorbed from the lumen and also from the blood

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Ca is reabsorbed in the distal convoluted tubule under the control of ____

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PTH

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Na reabsorption in the cortical collecting tubule is paired with ___

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loss of K or H+

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acetazolamide is a ___

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carbonic anhydrase inhibitor

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MOA of carbonic anhydrase inhibitor

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inhibits carbonic anhydrase in the brush border and inside cells of the proximal convoluted tubule

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primary effect of carbonic anhydrase inhibitor

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diuresis of Na bicarb

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secondary effects of carbonic anhydrase inhibitor

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metabolic acidosis, K wasting (excess Na is reabsorbed later in the tubules)

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this is used to decrease IOP of the eye

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acetazolamide (CAI)

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this is used to treat altitude sickness by increasing acidity of CSF

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acetazolamide (CAI)

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SE of CAIs

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drowsiness, paresthesia, cross allergenicity with sulfonamides, renal stones, K wasting, hepatic encephalopathy

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furosemide, bumetanide, torsemide, ethacrynic acid are

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loop diuretics

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MOA of loop diuretics

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inhibit cotransport of Na/K/Cl across TAL of Henle

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what part of the nephron has the greatest diluting ability

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TAL of Henle

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what changes in electrolyte excretion occur with loop diuretics?

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positive charge inside cell is decreased so Ca, K, H+ are excreted more

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what drug class inhibits the action of loop diuretics due to its effect on GFR?

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NSAIDs, decreases prostaglandins

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you can use loop diuretics to tx:

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edema, pulm edema, hypercalcemia (with added volume support)

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SE of loop diuretics

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hypokalemic metabolic alkalosis, K wasting, ototoxicity

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HCTZ is

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thiazide

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thiazides are ___ which is similar to loop diuretics

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sulfonamides

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thiazides are longer/shorter acting than loop diuretics

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longer acting

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MOA of thiazides

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inhibit NaCl transport in early distal tubule

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SE of thiazides

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hypokalemic metabolic alkalosis, increased Ca reabsorption, dilutional hyponatremia (decreases excretion of water b/c they act in diluting portion), K wasting, uremia

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thiazides are used to tx:

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HTN, chronic edema, renal stones (reduces urine Ca concentration)

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spironolactone and eplerenone are

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K sparing diuretics

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MOA of K sparring diuretics

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antagonize aldosterone to reduce Na reabsorption

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effect of K sparing diuretics

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increase Na CL, decrease K and H+ excretion

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SE of K sparing diuretics

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hyperkalemic metabolic acidosis, gynecomastia and antiandrogenic effects (spironolactone)

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use K sparing diuretics to tx:

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K wasting, aldosteronism

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what type of diuretic should be used with digoxin to prevent toxicity?

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K sparing ones to avoid hypokalemia that causes toxicity

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mannitol, glycerin, isosorbide and urea are what types of diuretics?

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osmotic

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MOA of osmotic diuretics

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the substance are freely filtered but not reabsorbed so they remain in the urine and "holds" water due to the osmotic effect; in proximal convoluted tubule

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effects of osmotic diuretics

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increased urine volume, greater excretion of filtered solutes (Na), reduce brain/eye volumes and intracranial pressure

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clinical uses of osmotic diuretics

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maintain high urine flow (decreased renal blood flow), glaucoma, increased intracranial pressure

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SE of osmotic diuretics

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hyponatremia and pulm edema, hypernatremia as water is excreted, HA, vomiting/nausea

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ADH and desmopressin are what type of diuretic?

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ADH agonists

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how must ADH agonist be given?

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parenterally

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demeclocycline and conivapten are what type of diuretic?

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ADA antagonists

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MOA of ADH is water reabsorption

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activates V2 receptors to stimulate adenylyl cyclase; increases cAMP and increases # of water channels

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use of ADH agonists

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pituitary DI

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syndrome of inappropriate ADH secretion (from tumors) can be treated with:

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demeclocycline and conivaptan (ADH antagonists)

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SE of demeclocycline in kids

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bone and teetch abnormalities

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paresthesias, GI distress and metabolic acidosis are SE of

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acetazolamide

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hyperammonemia (hepatic encephalopathy) is a SE of

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carbnoic anhydrase inhibitors because they cause urinary alkalosis which allows the excreted ammonium ion to be converted to ammonia gas which is reabsorbed

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this type of diuretic is used in altitude sickness and glaucoma

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carbonic anhydrase inhibitors