Diuretics

Front 1

Mannitol

Back 1

Osmotic Diuretic;

IFU: rapid reduction of intracranial pressure in emergency situations - not used chronically for HTN;

MOA: filtered via glomerulus but doesn't undergo any reabsorption --> provides osmotic force to limit water resorption and increases flow rate which limits sodium resorption time -> Natriuresis/Diuresis

CI/SE: excessive use leads to fluid loss but sodium resorption->hypernatremia+excess H2O loss

Front 2

Acetazolamide

Back 2

Carbonic Anhydrase Inhibitor (CA IV/II);

IFU: mountain sickness, glaucoma, gout;

MOA: indirectly inhibiting Na+ resorption by preventing shuttling of HCO3- by cells of PCT. Also prevents Na+ resorption (NHE3) b/c the H+ made by CAII inside is no longer created

: inhibition of NHE3 leads to increase NaCl absorption in other region-->decrease diuresis later

CI/SE: significant HCO3- loss and hyperchloremic metabolic acidosis (with alkalinized urine--NOT used for HTN

Front 3

Furosemide/Bumetanide/Torsemide

Back 3

Loop diuretic;

IFU: CHF (relieves edema), HTN at low doses, Hypercalcemia due to hyperparathyroidism, hyperkalemia;

MOA: inhibit NKCC2 in TAL --> directly inhibiting NaCl resorption and reducing transepithelial potential that causes paracellular Na/Mg/Ca entry --> diuresis; IV for acute, ORAL for maintenance; most potent and used diuretics - high ceiling

CI/SE: hypokalemia, metabolic acidosis, ototoxicity (reversible), hyperuricemia, hyperglycemia, hypomagnesia, hypocalcemia, allergy to Sulfa drugs

Front 4

Ethacrynic Acid

Back 4

Loop diuretic

IFU: CHF, HTN at low doses, hypercalcemia due to hyperparathyroidism, drug induced hyperkalemia;

MOA: inhibit NKCC2 in TAL reducing transepthelial potential and inhibiting NaCl resorption; IV for acute;

ORAL for maintenance; NO SULFA ALLERGY, so used in those with allergy;

CI/SE: hypokalemia, metabolic alkalosis, ototoxicity (reversible), hyperuricemia, hyperglycemia, hypomagnesia, hypocalcemia

Front 5

Loop Diuretic Drugs

Back 5

Furosemide, Bumetanide, Torsemide, Ethacrynic Acid

Front 6

Sulfa Drugs

Back 6

Diuretics: Furosemide, Bumetanide, Torsemide, acetazolamide, hydrochlorothiazide

Antibacterial: sulfonamides (short, intermediate, long acting)

Anti-diabetics: Sulfonylureas

Front 7

Hydrochlorthiazide/Chlorthalidone

Back 7

Thiazide diuretics;

IFU: FIRST line treatment for HTN; CHF with mild edema, osteoporosis (only if hypercalcuria occurs)

MOA: inhibit NaCl resorption by DCT by inhibiting NCC co-transporter leading to diuresis

CI/SE: hypokalemia (lead to V arrhythmia), hypomagnesia, hypercalcemia, hyperuricemia, hyperglycemia and glucose intolerance

: less potent diuretic

Front 8

Amiloride/Triamterene

Back 8

K+ sparing diuretics;

IFU: HTN and CHF;

MOA: direct inhibition of ENaC channel reduces Na+ resorption and K+ secretion (K+ sparing)

CI/SE: hyperkalemia (increased risk with renal disease, diabetes, ACEi/ARB use), metabolic acidosis

Extra: reduces risk of V-arrhythmia, hyperglycemia, and gout when used with loop and thiazide diuretic

Front 9

Spirinolactone/Eplerenone

Back 9

K+ sparing diuretic;

IFU: HTN and CHF; reduce mortality associated with CHF due to aldosterone antagonist activity;

MOA: mineralocorticoid receptor antagonist which prevent aldosterone induced ENaC expression

CI/SE: hyperkalemia (more risk with renal disease, diabetes, ACEi/ARB), metabolic acidosis AND spironolactone can cause impotence and gynecomastia due to androgen receptor antagonist activity