Pharm - Renal - Diuretics

Front 1

High ceiling (Loop) diuretics
Site 2
Furosemide (Lasix)
Mech

Back 1

inhib Na K 2Cl pump
only on tubular side of cell

Front 2

High ceiling (Loop) diuretics
Site 2
Furosemide (Lasix)
Other renal effects

Back 2

inc renal blood flow
GFR same
high does site 1 Na reab

Front 3

High ceiling (Loop) diuretics
Site 2
Furosemide (Lasix)
Pharmaco

Back 3

50 min half life
secreted into prox tubule
95% bound in plasma

Front 4

High ceiling (Loop) diuretics
Site 2
Furosemide (Lasix)
Effects: inc secretion

Back 4

inc uriniary excretion: Na,K (hypo if taking digoxin or ascities), H (site 4), Cl & Mg(more than Na), Ca

Front 5

High ceiling (Loop) diuretics
Site 2
Furosemide (Lasix)
Effects: dec secretion

Back 5

urate (gout), Li (competes with Na at site 1 for reab, as Na leaves more Li)

Front 6

High ceiling (Loop) diuretics
Site 2
Furosemide (Lasix)
Hemodynamic effects

Back 6

vasodilators - very rapid, acute HF treatment
dec lef vent filling pressure
reduce pulmonary congestin

Front 7

High ceiling (Loop) diuretics
Site 2
Furosemide (Lasix)
Chronic use

Back 7

reduce TPR

Front 8

High ceiling (Loop) diuretics
Site 2
Furosemide (Lasix)
Other toxicities

Back 8

ototoxicity (rare, reversible)
hyperglycemia/triglycemia
GI disturbances

Front 9

High ceiling (Loop) diuretics
Site 2
Bumetanide
Uses

Back 9

used if allergy to furosemide (still has sulfur group)
diabetes

Front 10

High ceiling (Loop) diuretics
Site 2
Bumetanide
Benefits

Back 10

Less hyperglycemia, used in diabetics

Front 11

High ceiling (Loop) diuretics
Site 2
Ethacrynic acid
Uses

Back 11

if have allergy to sulfonamide

Front 12

High ceiling (Loop) diuretics
Site 2
Ethacrynic acid
Side E

Back 12

more GI
lower hyperglycemia

Front 13

High ceiling (Loop) diuretics
Site 2
Tosemide
Uses

Back 13

greater bioavailability
longer half life; once day dosing

Front 14

Site 3 Diuretics
Thiazide Diuretics
4

Back 14

chlorothiazide
benzthiazide
indapamide
metolazone

Front 15

Site 3 Diuretics
Thiazide Diuretics
Amt. Na Absorbed

Back 15

15%

Front 16

Site 3 Diuretics
Thiazide Diuretics
Mech

Back 16

inhib NaCl reabsorption at distal convouted tubule (NCC)

Front 17

Site 3 Diuretics
Thiazide Diuretics
Effects

Back 17

do not lead to countercurrent washout
dec renal blood flow

Front 18

Site 3 Diuretics
Thiazide Diuretics
Pharmaco

Back 18

same efficacy
varying half lives
chlorothiazide (short)
chlorthalidone (long)

Front 19

Site 3 Diuretics
Thiazide Diuretics
Effects - Inc urinary excretion

Back 19

Na - ineffective when GFR less than 30 ml/min (metolazone and indapamide at high doses can work, elderly effected)
K (site 4 cause hypokalemia; reduce NaCl diet)
H (site 4, may lead to alkylosis)

Front 20

Site 3 Diuretics
Thiazide Diuretics
Effects - Dec urinary excretion of

Back 20

Ca (opposite site 2)
urate (same mech for furosemide)
Li

Front 21

Site 3 Diuretics
Thiazide Diuretics
Toxicities

Back 21

hyperglycemia, insulin is reduced, less sensitive
inc cholesterol and triglycerides
hypersensitive rxn

Front 22

Site 3 Diuretics
Thiazide Diuretics
Drug interactions

Back 22

K sparing, site 2 + 4
Li problem with loop
inc toxicity of digitalis

probenicid

Front 23

Site 3 Diuretics
Thiazide Diuretics
Major Use

Back 23

essential hypertension
congestive HF; mild edema
hypocalcemia
hypercalcinuria (reduce renal stone formation)

Front 24

Site 4 Diuretics
K sparing
Spironolactone
Mech

Back 24

receptor bindign competitive antagonist of ald
not specific for mineralocorditocoid receptor

Front 25

Site 4 Diuretics
K sparing
Spironolactone
Pharmaco

Back 25

slow onset
half life 10-35h
orally with food
steroid

Front 26

Site 4 Diuretics
K sparing
Spironolactone
Effects

Back 26

inc Na excretion
inhibit K loss (hyperkalemia)

Front 27

Site 4 Diuretics
K sparing
Spironolactone
Uses

Back 27

HF; liver failure
anti-androgenic effects (hynomastia, impotence)
NOT in DIABETICS or impaired renal fxn b.c of hyperkalemia

Front 28

Site 4 Diuretics
K sparing
Eplerenone

Back 28

Antag. to only mineralcorticoid receptor (not androgen)
anti-hypertensive and post MI

Front 29

Site 4 Diuretics
K sparing
Eplerenone
Side E

Back 29

hyperkalemia

Front 30

Site 4 Diuretics
K sparing
phys antag
Amiloride and Triamterene
Mech

Back 30

faster acting
Inhib Na influx through channel
less Na for Na/K ATPase
dissipates gradient, removes drive to transport K

Front 31

Site 4 Diuretics
K sparing
phys antag
Amiloride
pharmaco

Back 31

half life 6-9 hrs; excreted by kidney

Front 32

Site 4 Diuretics
K sparing
phys antag
Amiloride
Effects

Back 32

slight inc in Na and H20 excretion; dec K excretion (hyperkalemia, worse than spirlolactone b.c not compensatory mech)
inc Li reab
elevate urate

Front 33

Site 4 Diuretics
K sparing
phys antag
Triamterene
characteritics

Back 33

oral, shorter half life
some metab
some nephrotoxicity

Front 34

Site 1 Diuretics
Carbonic anhydrase inhib
acetazolamide
use

Back 34

for glaucoma, epilepsy
not for diuretic
prevent some bicarb and Na reab

Front 35

Dopamine
Renal blood flow

Back 35

b1 agonist, inc GFR, post MI

Front 36

Osmotic Diuretics
Mannitol and Isosorbide
Mech

Back 36

inert, filtered by not reab, NOT metab
osmotically prevent water reab
countercurrent washout via inc renal blood flow
reduce intracranial and intraocular pressure

Front 37

Osmotic Diuretics
Mannitol and Isosorbide
Uses

Back 37

reduction in intracraninal or intraocular P before surgery
prophylaxis of acute renal failure

Front 38

Osmotic Diuretics
Mannitol and Isosorbide
Side E

Back 38

diffuse slowly in and out of CSF; could inc vol in CSF if removed from periph
headache, nausea, vomiting b.c of inc CSF osmolarity

Front 39

Osmotic Diuretics
Mannitol and Isosorbide
Contraindications

Back 39

anuria (could not remove agent)
peripheral edema
HF (inc circulating load)

Front 40

Osmotic Diuretics
Mannitol and Isosorbide
other drug

Back 40

glycerol

Front 41

Osmotic Diuretics
Isosorbide
specific Use

Back 41

greater effects on eye, prior to surgery