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38 Cards in this Set
- Front
- Back
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what clinical conditions require diuresis
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edema
hypertension acute renal failure maintainence of adequate urine flow |
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what factors determine the volume and composition of urine
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glomerular filtration
tubular reabsorption tubular secretion |
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what is the mechanism of action for carbonic anhydrase inhibitors
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inhibits carbonic anhydrase -> inhibits reabsorption of bicarbonate in proximal tubule -> sodium bicarb diuresis ->urine becomes alkaline
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true or false carbonic anhydrase inhibitors are very poor diuretics
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true
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what are carbonic anhydrase inhibitors used for
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glaucoma (most common use)
reduction of total bicarb stores -> useful for metabolic alkalosis urinary alkalization -> for excretion of weak acids |
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what are adverse effects of carbonic anhydrase inhibitors
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hperchloremic metabolic acidosis
renal stones renal potassium wasting CNS toxicity (large doses) teratogenichypersensitivity (rare) |
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what is a contraindication of carbonic anhydrase inhibitors
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hepatic cirrhosis -> alkalization of urine decreases urinary trapping of NH4 and may contribute to hepatic encephalopathy
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what is the mechanism of action for osmotic diuretics
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freely filtered through glomerulus - > disrupts the osmotic gradient generated by the absorption of sodium -> limits water resorption from proximal tubule, descending loop of henle, and collecting tubule
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what is the major osmotic diuretic
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mannitol
in diabetes glucose acts as an osmotic diuretic |
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what are clinical indications of osmotic diuretics
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prophylaxis or treatment of acute renal failure
reduction in CSF and intraocular pressure |
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true or false with osmotic diuretics efficiency is maintained during decreased glomerular filtration
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true
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true or false mannitiol is the treatment of choice for oliguric renal failure
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false
furosemide and dopemine is preferable |
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what are contrindications for osmotic diuretics
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not for edema
not when there are nephrotoxic agents or severe renal ischemia damaging tubular epithelium not for anuric renal disease not for marked dehydration not if intracranial hemorrhage |
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what are high ceiling diuretics
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loop diuretics
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what is the mechanism of action of loop diruetics
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they inhibitelectrolyte reabsorption in ascending loop of henle -> decreased reaqbsorption of Na/Cl
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what is the major loop diuretic
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furosemide
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what is the duration of furosemide
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usually 2-3- hours
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how can furosemide be administered
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oral route
IM IV (rapid diuresis) |
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what are the clinical indication of loop diuretics
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edema
heat failure acutre renal failure hypercalcemia udder edema epistaxix prevention (horses) |
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how does furosemide work for hypercalcemia
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lowers plasma concentration by increasing urinary excretion
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what toxicities are associated with loop diuretics
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hypokalemic metabolic alkalosis
ototoxicity dont use with liver failure -> hepatic coma |
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what is the duration of furosemide
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usually 2-3- hours
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how can furosemide be administered
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oral route
IM IV (rapid diuresis) |
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what are the clinical indication of loop diuretics
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edema
heat failure acutre renal failure hypercalcemia udder edema epistaxix prevention (horses) |
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how does furosemide work for hypercalcemia
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lowers plasma concentration by increasing urinary excretion
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what toxicities are associated with loop diuretics
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hypokalemic metabolic alkalosis
ototoxicity dont use with liver failure -> hepatic coma |
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what is the mechamism of action for thiazide and related diuretics
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inhibit NaCl cotransporter in distal convuluted tubule -> increased water excretion
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what are the thazide and related diuretics
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Chlorothiazide
hydrochlorothiazide trichlormethazide |
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what are the clinical indications of thiazide and related diuretics
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edema (when not responsive to furosemide) rarely
udder edema nephrogenic diabetes insipidous calcium oxalates??? no longer done hypertension |
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what are the adverse effects of thiazide or related diuretics
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weakness, fatigue, paresthesia
K depletion hyperglycemia |
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what are the k sparing diuretics
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spironolactone
amiloride rarely used triamterene rarely used |
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what is the mechanism of action for the aldosterone antagonist diuretics
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antagonist against aldosterone which normally enhances Na reabsorption an K secretion
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true or false spironolactone is not used as a sole diuretic agent
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true
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why is spironolactone useful for treating ascites due to liver failure
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usefoul for acites due to liver failure because of the high levels of endogenous aldosterone associated with this condition
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what are the clinical indications for using spironolactone
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refactory edema
ascites due to liver failure |
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what toxicities are associated with spironolactone
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hyperkalemia and hyperchloremic metabolic acidosis
DO NOT use with chronic renal failure |
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what is the primary goal of diuretic therapy
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to reduce the circulating blood or plasma volume
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what is a potential clinical problem of chronic use of diuretics
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renal potassium wasting causing hypokalemia
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