U of U PA School Nephrology Pharmacology Diuretics

What drugs are freely filtered at the glomerulus? What arent?

Freely - ionized/non ionized

Not - drugs bound to protein

What does tubular reabsorption do to drugs?

Increase the half life

What factors affect the renal excretion of drugs? (4)

Concentration of drugs in plasma

Renal blood flow

Disease states

Urine pH

What drugs contribute to CKD? (5)

Long term NSAID use

Combined analgesics - NSAIDs + acetaminophen

Calcineurin Inhibitors

Lithium

PPI

What can diuretics predispose a patient to?

Dehydration

Contraction alkalosis

What should be monitored for diuretics? (4)

Volume status

Electrolytes

BP

Lipids - thiazides/loop

Where do osmotic diuretics work?

PCT and descending loop of Henle

Where do loop diuretics work?

Ascending loop of Henle

Where do thiazide diuretics work?

DCT

Where do potassium sparing diuretics work?

CD and DCT

What diuretics have a synergist effect when used together?

Loop + thiazides

What is the most potent diuretic?

Loop diuretics

What is the MOA of loop diuretics?

Blocks the reabsorption of Na and Cl via NKCC2

What is the contraindication of loop diuretics?

Anuria

What are the ADRs of loop diuretics? (4)

AKI

Hypovolemia

Electrolyte disturbances

Ototoxicity

What are the uses of loop diuretics?

Edema

Fluid overload

Hyperkalemia

What are the thiazide diuretics?

Hydrochlorothiazide

Chlorothiazide IV

Chlorthalidone (thiazide like)

What is the MOA of thiazide diuretics?

Inhibit the sodium/chloride co-transporter

What are the contraindications of thiazide diuretics?

Sulfonamide allergy

Anuria

What are the advantages of thiazide diuretics?

Gentler than loops

Longer acting

First line in hypertension

What are the aldosterone antagonists?

Spironolactone

Eplerenone

What is the MOA of aldosterone antagonists?

Blocks aldosterone increasing NaCl and water excretion

Conserves potassium and hydrogen

What are the contraindications of aldosterone antagonists?

Hyperkalemia

Addisons

What are the ADRs of aldosterone antagonists?

Spironolactone - gynecomastia

Hyperkalemia

What are the uses of aldosterone antagonists? (4)

Hypertension

Acne

HF

Primary aldosteronism

What is the carbonic anhydrase inhibitor?

Acetazolamide

What is the MOA of carbonic anhydrase inhibitors?

Inhibit carbonic anhydrase causing NaCl/NaHCO3 loss

Modest diuretic action

What are the contraindications of carbonic anhydrase inhibitors?

Severe renal and hepatic impairment

Decreased sodium and potassium

Adrenocortical insufficiency