diuretics and such

Furosemide brand

Lasix

are osmotic diuretics used long term

NO

are CAIs usually used for kidney issues more or glaucoma more

GLAUCOMA— otherwise like “swimming up the river”

why are diuretics actually class D for preg most the time

decrease placental perfusion

why are thiazides better in osteoporosis

bc loop diuretics potassium wasting

hzt brand

Microzide

Spironolactone brand

Aldactone

Triamterne +HZT brands

Dyazide, Maxzide

Bumetanide brand

Bumex

Metolazone brand

Zaroxolyn

Torsemide brand

Demadex

Chlortalidone brand

Hygroton

Eplerenone brand

Inspra

Triamterene brand

Dyrenium

Natriuretics agents def

drugs that ↑renal Na+ excretion. Almost always cause ↑ water excretion

• nat are always diuretics bc increase urine outflow

Loop diuretics

Furosemide, bumetanide, torsemide, ethacrynic acid

Thiazides

HCTZ, metolazone, chlorothiazide, chlorthalidone, indapamide

K+- sparing diuretics

spironolactone, eplerenone, amiloride, triamterene

CAI (list em)

acetazolamide

what does diuertic mean

increases urine volume

another word for additive effects

synergistics

• one drug increases effect of other disproportionately

reasons for edema?

• excessive Na intake — take in more water

• liver cirrhosis— scarring in liver causes HTN in liver veins

• heart failure— not strong enough to pump forcefully through periphery (left side) or not letting enough blood in (right side failure)

main ions affected by diuertics

na, k, cl, water

diuretics other ions transported

H, hco3, ca, mg, organic ions

goal of diuretics

increase excretion of salt and water

what is diuretic resistance

• causes: renal failure, cirrhosis, heart fail, drug induced (NSAIDs— decreasing blood flow), high intake of Na

• from PATHOLOGIES

• think less blood flow means the drug can’t get around the body to do its job

what prevents diuretic resistance

cont IV of loop diuretic

Hypertrophy def

organ gets bigger bc its cells swell up

cause of diuretic braking

overuse of diuretic

• you get rid of sodium SO FAST it upreg Na transporters/hanging on to Na unnecessarily/diminishing diuretic effects

diuretic resistance causes

• excess Na

• nsaids

• emboli (kidney/renal block)

diuretic resistance net effect

reduced diuretic absorption bc of decreased renal perfusion

is cai recommended as diuretic

nahhhh fam

Vasopressin— list drugs

desmopressin, vasopressin

Vasopressin antagonists

conivaptan

Osmotic diuretics:

mannitol, glycerol

what is most effective diuretic?

loop diuretic

where is acetazolamide working

1

where do osmostic agents work

2

which is seocnd most effective diuretic

thiazide

where do loop diuretics work

3

where do thiazides work

4

where do aldosterone antagonists work

5

where do ADH antagonists work

6

what is potassium sparing diuretics

aldosterone antagonists

when water permeability is high, do diuretics work better or worse and WHY

WORSE

• diuretics do better when the salt is trapped into the tubule to be excreted, meaning water is forced to stay in the tubule with it. if water could just diffuse into the tubule, then there would be less Na excretion

why take ACEIs and ARBs with diuretics?

• synergistic effect

• diuretics start the RAAS system which can then re-increase the blood pressure which defeats the purpose! so aceis and arbs block the raas from kicking in as well

loop diuretic channel involved

na/k/2cl symport

site of loop diuretic

thick ascending loop of henle

what other synthesis does loop diuretic cause and what is result

• pge2 synth to increase renal blood flow

loop diuretic what should you not take with it

don’t take nsaids

(bc causes pge2 synthesis)

loop diuretic effects

• loss of na, k, cl, ca, mg

• reabsop uric acid— lots of urination

• decrease vascular resistance

• decrease pressure in pulmonary

loop diuretics black box warning

profound diuresis leading to electrolyte abnormalities

Furosemide, Bumetanide preg class

c

Torsemide, Ethacrynic acid preg class

b— but according to experts its D

what preg drugs ok?

bc, D and X are no buenoooo

loop diuretic ADR

• hypokalemia

• hypocalcemia

• hyperglycemia

• photosensitivity

• ototox

• alkalosis (with K deficient comes H+ def)

• increase LDL, decrease HDL (the good cholesterol)

why does hypokalemia cause hyperglycemia

what does hypokalemia cause

cardiac arrhythmia

hyperkalemia affects

muscle twitching, cramps

digoxin toxic up or down with diuretics

up bc hypokalemia lets moer dioxgoin bind to na/atpase

• usally blocks channel to let more Na in cell, causing more Ca in to increase heart contractions

• bad if heart not lit in heart failure

what heart condition do loop diuertics increase risk of

qt prolongation

what happens with lithium and loop diuretics

increaes lithium reabsorption in place of sodium— can create toxicity

what do corticosteriods do with loop diuertics

increase hypokalemia (think mineralocorticoid/aldosterone like effects— K wasting)

anticoag effect with loop diuertics

increase bleed risk bc

why do loop diuretics increase ototox with aminoglycosides

compounded effect

food, sucralfate, Cholestyramine, Colestipol— increase or decrease levels of loop diuertics?

decrease bc bind drug in the GI

rel pot of furosemide

1

bumetanide rel pot

40

which loop diuretic mostly hepatic (liver) excreted

torsemide

torsemide rel pot, and one other special fact! Ooo!

3

• also longest acting

ethacrynic acid rel pot

0.7 (least potent or effective)

thiazide diuretic moa

distal convulated tubule— inhibit SYMPORT of na/cl

• BY decreasing Na in at this point, more prox tubule absorption of water and Na

• so you ABSORB a bit more water BEFORE the collecting duct — cauase mild dehydration so you absorb water earlierrrr in the kidney

what does thiazide diuertics do

decrease Na, Cl reabsorption— water follows

• decreases blood volume, arteriolar resistance

what does thiazide do to Ca levels and WHY

hypercalecemia— DECREASE excretion

• bc cells are “sodium hungry” bc its all getting execreted— activate Na/Ca antiporter to get sodium in, pumping Ca back into blood

• is acting LIKE parathyroid hormone

thiazide ADRS

hypokalemia, hyponatremia, hypercalcemia, hyperglycemia,

allergy reactions to sulfonamide, hyperuricemia, photosensitivity,

up LDL, up TG, ↓HDL, rash

thiazide ind

dema due to HF, hepatic cirrhosis, chronic renal disease

• Also osteoporosis, nephrogenic diabetic insipidus

def diabetic insipidus

excessive thirst bc of ADH trouble

thiazide preg class

b

most potent thiazide

metolazone (APPARENTLY?)

renally (kidney) excreted thiazides

chlorothiazide, HCTZ, Trichlormethiazide

• majority of Hydroflumethizide, Metolazone, Chlorthalidone

hepatic (liver) excreted thiazide

Indapamide

what could thiazides OR loop be used for

• HTN

• heart failure

• renal failure (have to use both)

• hyperkalemia

what is unique ind for thiazides

• Nephrogenic diabetes insipidus

• Osteoporosis (↓ Ca2+ excretion)

unique ind for loop

Acute pulmonary edema

Nephrotic syndrome (proteins allowed through glom capillary)

Hypercalcemia (↑ Ca2+excretion)

what is another name for aldosterone antagonists

K+ sparing diuretics

what do the Na channel inhibitor subtype of K sparing diuretics do

stop Na from entering principal cells of collecting duct from urine

• K flows out of principal cells in opp direction so when that’s stopped K is s p a r e d

Na channel inhibitor subtype of K sparing diuretics names

• triamterene

• amiloride (Midamor)

Na channel inhibitor subtype of K sparing diuretics when to adjust dose

anuria (no urine output), pregnancy

Na channel inhibitor subtype of K sparing diuretics AMILORIDE when to adjust dose

chronic renal failure

Na channel inhibitor subtype of K sparing diuretics TRIAMTERENE when to adjust dose

hepatic and renal disease

Na channel inhibitor subtype of K sparing diuretics ADR

• hyperkal

• metabolic acidosis— moves in same direction into cell as H+

potential hyperkalemic specific ddi with Na channel inhibitor subtype of K sparing diuretics

acei, arb, K supplements or NSAIDs

Na channel inhibitor subtype of K sparing diuretics which more potent

triamterene (0.1); amiloride is literally 1 so tenfold less potent

Na channel inhibitor subtype of K sparing diuretics when renally elminated (kidney)

amiloride

Mineral corticoid receptor antagonist (MRA) subtype of K+ sparing diuretics names

• spironolactone

• eplerenone

what do the Mineral corticoid receptor antagonist (MRA) subtype of K+ sparing diuretics do

prevent aldosterone from hitting its receptors, which prevents upreg of ENaC channels (so less Na reabsorbed/more lost in urine), results in water loss (diuresis)

what does aldosterone do

• increase ENaC channels

• increase Na/K atpase activity

• increase K/H secretion

think water and Na SAVING

Mineral corticoid receptor antagonist (MRA) subtype of K+ sparing diuretics which more selective

eplerenone compared to spironolactone

spironolactone brand

aldactone

eplerenone brand

inspra