pharm diuretics review

situations you can use diuretics (all w/ HTN)

high coronary disease risk

DM

recurrent stroke

heart failure

initial monotherapy for HTN

non-black and black can use diuretics

blacks w/ DM + HTN

THZD (diuretics)

non-black would be ACEi/ARB

thiazide diuretic name (ALL)

chlorothiazide

Chlorthalidone

HCTZ

Indapamide

Metolazone

loop diuretics name

Bumetanide

Ethacrynic acid

Furosemide

Torsemide

potassium-sparing diuretics name

Emiloride

Eplerenone

Spironolactone

triamterene

eplerenone and spironolactone

aldosterone antagonists

good for treating resistant HTN

osmotic diuretics

mannitol

urea

thiazide diuretic

HCTZ

thiazide-like diuretics

Indapamide

Metolazone

Chlorthalidone

most widely used diuretic for HTN

thiazide-like diuretics

thiazide-like diuretics has a _ derivative

sulfonamide derivative → issue with crystalluria

Thiazide diuretics MOA

increases sodium and water excretion by inhibiting sodium and chloride reabsorption in nephron’s distal tubule

renally dosed!

thiazide diuretics SE

hyperuricemia

volume depletion

orthostatic Hypotension

thiazide diuretics interactions

antiDM

antiHTN

opioids

lithium

nsaids

BAS

Thiazide-like diuretics (chlorthalidone MOA

inhibits distal convoluted tubule sodium and chloride reabsorption

Has a longer duration of action than HCTZ

caution with thiazide diuretics if

pt is using insulin

monitor every 6 mos!

Loop diuretics MOA

inhibits NA/K/CL cotransport in the ascending Loop of Henle

Loop diuretics SE

hypocalcemia

hypokalemia

hyperglycemia

hyperuricemia

ototoxicity

Loop diuretics allergy

sulfa

potency of bumetanide, torsemide, furosemide

Bumetanide and torsemide more potent than furosemide

Loop diuretics onset of action

Rapid acting -> can be used in emergency situations

Lasix (loop diuretic) SE

tinnitus

photosensitivity

only loop diuretic without sulfa moiety

ethacrynic acid

potassium-sparing diuretics SE

hyperkalemia

hyponatremia

metabolic acidosis

triamterene SE

blue colored urine

potassium-sparing diuretics interactions

ACE/ARB → hyperkalemia

NA Channel blockers

triamterene and amiloride

drugs that cause crystal nephropathy

acyclovir

MTX

rescue for MTX-induced nephropathy

leukovorin

darbo vs. epo alfa, which one does dialysis pts get

epo alfa

how to take biphosphonates

30 mins before meal

sit up after

components of CrCl

Serum creatinine (SCr)

Urine creatinine concentration (UCr)

Urine volume (V)

Time (t)

CrCl = (UCr × V) / (SCr × t)

Body factors affecting CrCl

Age

Sex

Body weight

Muscle mass

ferrous sulfate vs. gluconate

Ferrous sulfate (most common, cheapest)

Ferrous gluconate (less elemental iron, better tolerated)

iron absorption

Best on empty stomach

↑ absorption with vitamin C

Avoid with calcium, PPIs, antacids

biggest iron SE

GI upset*

dark stools

diarrhea

When to Use Ferrous Gluconate (instead of sulfate)

Patient can’t tolerate ferrous sulfate (GI side effects)

Need gentler option (less elemental iron per tablet)

Better for sensitive stomachs / adherence issues

timing after giving iron in anemic pt

Reticulocyte response: ~1 week

Hemoglobin improves: ~2–4 weeks

Continue iron ~3 months after Hgb normalizes (replenish stores)

best indicator for iron stores

ferritin