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28 Cards in this Set

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