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28 Cards in this Set
- Front
- Back
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Where does acetazolamide act?
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proximal convoluted tubule
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Where does mannitol act? (3)
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proximal convoluted tubule, thin descending limb, collecting tubule
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Where does furosemide act?
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thick ascending limb
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Where does hydrochlorothiazide act?
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distal convoluted tubule
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Where do the K+ sparing diuretics act?
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collecting tubule
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Where do the "vaptans" act?
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collecting tubule (ADH antagonists)
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How does mannitol function as a diuretic?
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Osmosis - increase tubular fluid osmolarity therefore draws fluid into blood, increase urine flow
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When is mannitol used? (3)
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1) shock
2) drug overdose 3) decrease intracranial & intraocular pressure |
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When is mannitol contraindicated? (2)
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1) anuria
2) CHF |
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What are adverse side effects of mannitol? (2)
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1) pulmonary edema
2) dehydration |
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What is acetazolamide used for? (4)
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1) glaucoma
2) metabolic alkalosis 3) alkalinizes urine to pee out acidic drug overdoses 4) altitude sickness |
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How does acetazolamide work?
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Inhibits carbonic anhydrase - don't reabsorb bicarbonate from proximal tubule, reduce total body bicarbonate
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What are toxicities of acetazolamide? (4)
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1) sulfa drug allergy!
2) hyperchloremic metabolic acidosis 3) neuropathy 4) NH3 toxicity |
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How does furosemide work?
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inhibits NKCC cotransporter - prevents urine concentration because medulla not hypertonic enough; also increases calcium excretion
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When would you give furosemide?
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1) edematous states like CHF, nephrotic syndrome, pulmonary edema, liver cirrhosis
2) HTN 3) hypercalcemia |
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What are toxicities of furosemide? OH DANG!
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1) ototoxicity with aminoglycosides (contraindicated in pregancy)
2) hypokalemia 3) dehydration 4) allergy - sulfonamide 5) nephritis - interstitial 6) gout - inhibits tubular secretion of uric acid |
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What do you give patients allergic to sulfonamides but in need of diuresis?
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ethacrynic acid (phenoxyacetic acid derivative)
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How do thiazide diuretics work?
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inhibit NaCl reabsorption --> increased urinary flow, increased calcium reabsorption
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When would you give hydrochlorothiazide?
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1) HTN
2) idiopathic hypercalciuria 3) CHF 4) nephrogenic diabetes insidpidus (inc. Na and water absorption somehow) |
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What are toxicities of thiazide diuretics?
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1) hypokalemic metabolic alkalosis
2) hyponatremia 3) sulfa drug allergy 4) hyperglycemia 5) hypercalcemia 6) hyperuricemia 7) hyperlipidemia |
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What are 4 K+ sparing diuretics?
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Spironolactone, triamterene, amiloride, eplereone
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How does spironolactone work?
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aldo receptor antagonist - prevent Na reabsorption, K secretion in collecting tubule
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How do triamterene and amiloride work?
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block Na+ channels in collecting tubule - no Na+ reabsorption, no K+ secretion
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When would you give a K+ sparing diuretic?
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1) hypokalemia
2) hyperaldosteronism 3) CHF |
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What are toxicities of K+ sparing diuretics?
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1) HYPERkalemia
2) spironolactone causes gynectomastia and antiandrogen effects |
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How do ACE inhibitors work?
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inhibit angiotensin converting enzyme --> reduce levels of AII and prevent breakdown of bradykinin (which is vasodilator)
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When would you give an ACE inhibitor?
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1) HTN
2) CHF 3) diabetic renal disease |
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What is Losartan?
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AII receptor blocker
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