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26 Cards in this Set
- Front
- Back
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Where do loop diuretics primarily work?
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The TAL
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What diuretics act on the collecting tubule?
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K+ sparing diuretics, osmotic diuretics, and ADH antagonists
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What is a drug example of a proximal tubule diuretic?
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The CA inhibitor Acetazolamide
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What are the three K+ sparring diuretics?
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Amiloride, spironolactone, and triamterene
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What is one osmotic diuretic? What are some ADH antagonists?
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Mannitol
Vaptans and demeclocycline |
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What is the net effect of CA inhibitors? Why are they used?
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They inhibit NaCl reabsorption and bicarbonate reabsorption in the proximal tubule--ACUTE INCREASE IN URINE pH
USED TO TREAT GLAUCOME and ALKALINIZE THE URINE and ACUTE MT. SICKNESS |
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What are some toxicities of carbonic anhydrase?
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hyperchloremic metabolic acidosis, CaPO4 stones, NH3 intoxication, and renal K+ wasting
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What do the loop diuretics accomplish by blocking the Na/K/Cl transporter?
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They reduce the positive potential in the TAL to ZERO--this increases the urinary NaCl and K+, Mg++, and Ca++ excretion
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What are some toxicities of loop diuretics?
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Hypercalciuria, K+ and Mg++ wasting, metabolic alkalosis(increases distal sodium delivery to the collecting duct), ototoxicity
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If someone has hypercalcemia how should you treat it?
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Loop diuretics and normal saline
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True/False: Thiazides increase K+ and Ca++ excretion.
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FALSE--they increase urinary NaCL and K+ excretion BUT NOT CALCIUM EXCRETION
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What is a side effect of thiazide diuretics?
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Hypercalcemia
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What are thiazides mainly used for?
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First line antihypertensive agent
Used in CHF and hypercalciuria(like with loop diuretics) |
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What are some toxicities of thiazides?
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Hyperlipidemia, elevated uric acid, calcium, and glucose, renal K+ wasting, and metabolic alkalosis
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When would someone need both a loop AND a thiazide diuretic?
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Refractory edema with a low GFR and severe hyperkalemia
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What can exacerbate diuretic induced renal K+ (or H+) wasting?
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High levels of aldosterone and renin
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How do potassium sparing agents mainly work?
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INHIBIT luminal ENaC activity(amiloride or triamterene) to reduce the negative transport potential to reduce potassium secretion and hydrogen secretion
SPIRONOLACTONE IS A COMPETITIVE INHIBITOR AT THE GLUCOCORTICOID RECEPTOR FOR ALDOSTERONE |
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Why are K+ sparing agents used?
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Hypokalemic patients who are currently on other diuretics
OR Primary and secondary aldosteronism |
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What is the effect of aldosterone in the collecting tubule?
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They interact with a glucocorticoid receptor to UPREGULATE ENaC channels
SPIRONOLACTONE IS A COMPETITIVE INHIBITOR AT THE GLUCOCORTICOID RECEPTOR FOR |
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What are the toxicities of K+ sparing diuretics?
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HYPERKALEMIA(especially with renal disease), metabolic acidosis, BPH/gynecomastia(spironolactone)
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How do osmotic diuretics work?
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Osmotic water flow is driven by medullary hypertonicities and osmotic diuretics obligate free water excretion
They have a major effect in water permeable segment |
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What are some indication for osmotic diuretics?
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Mannitol is indicated in cases of need for reduction of intracellular volume(like cerebral edema)
Intratubular obstruction(cast nephropathy, rhabdomyolysis) |
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What are some toxicities of mannitol?
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Hypernatremia(from hyperglycemia), volume depletion, and acute kidney injury
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What are some ADH antagonists? What is a toxicity?
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Tolvaptan--hypernatremia
Can be used against acute and chronic hypernatremia, SIADH, Heart failure, and ADPolycystic Kidney Disease |
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How do loop diuretics cause hypocalcemia?
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They inhibit the triple transporter and this eliminates the strong positive transepithelial voltage used to move calcium and other divalents across the paracellular pathway
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What drug is given for hypercalciuria?
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THIAZIDES--reduces the calcium in the urine
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