Cardio Pharm- Diuretics (Thiazides, loops, K+ sparing diuretics)

thiazides and thiazide like diuretics inhibit __________ cotransporter in distal convoluted tubule

Na+/Cl-, meaning LESS Na+ and Cl- reabsorption

T/F: thiazides are good to use in edema

T, thats one of their main uses- makes sense, if someone has edema, theyre in fluid overload we want to get rid of that excess fluid, aka use a diuretic, and thiazides are diuretics

_______ can be used in nephrogenic diabetes insipidus

thiazides/thiazide like diuretics

loop diuretics

K+ sparing diuretics

ACE inhibitors

thiazides/thiazide like diuretics!!

note that this seems counterinuituive bc thiazides increase glucose levels, but diabetes insipidus doesnt work the same as diabetes mellitus

thats also why ACE inhibitors although they are great for ppl w diabetes mellitus, they are NOT used for nephrogenic diabetes inspidus

Ca2+, uric acid, glucose, and serum LDL are increased in which diuretic

thiazides/thiazide like diuretics

loop diuretics

K+ sparing diuretics

THIAZIDES/THIAZIDE LIKE DIURETCS

cram the pance mneumonic

GLUCOSE is OH SO ELEVATED with THIAZIDES

G- glucose increases, THIS IS WHY THIAZIDES ARE CONTRAINDICATED IN DIABETES MELLITUS

L- lipids (increased LDL)

U- uric acid levels increase (this is why thiazides are contraindicated in gout)

C- serum Ca2+ increases (this seems like a bad thing and it can be, BUT, for people with kidney stones who therefore have too much Ca2+ in the urine, this is a GOOD thing bc we're decreasing Ca2+ excretion in urine by keeping it in the blood)

O- Oh

S- So

E- Elevated

T/F: thiazides, especially hydrochlorothiazide, INCREASE risk for SCC

T!!!!!

working at a derm office I remember seeing a bunch of old men on hydrochlorothiazide who always were having SCCs removed

why are thiazides contraindicated with digoxin

Thiazides can cause hypokalemia, which in turn increases the sensitivity of the heart to digoxin's effects. This can result in serious or even fatal heart rhythm problems

how do we know thiazides cause hypokalemia? bc the 4 things that go up (GLUCOSE mneumonic)- K+ wasnt in that mneumonic, so we know serum levels DECREASE

chlorthalidone and indapamide are __________

thiazides

loop diuretics

thiazide like diuretics

calcium channel blockers

thiazide like diuretics

the thiazides themselves end in thiazide, and the thiazideLIKE DIURETICS dont, but chlorTHalidone atleast has a TH in it

indapamide just remember its a thiazide like diuretic

which class of HTN meds are good for renal stone prophylaxis?

which class of HTN meds are contraindicated in renal stones?

good for renal stones- thiazides/thiazide like diuretics bc they increase serum Ca2+ so Ca2+ in urine decreases

bad for renal stones- loop diuretics; makes sense, with loops, we PEE OUT LIKE ALL OUR ELECTROLYTES, so ca2+ is peed out- so we have more Ca2+ in urine, bADDDD if ur prone to renal stones

T/F: thiazide diuretics have a boxed warning for water and electrolyte depletion

false- thats LOOP DIURETICS, remember, these act at the loop of henle and are way more intense; loops include furosemide aka lasix which is super intense

so we pee out all of our electrolytes in an attempt to pee out the water too that follows those electrolyes, so we lose a bunch of fluid which is great for severe edema, but defo increased risk for dehydration

Ethacrynic acid is what type of diuretic

loop

which loop diuretic can be used if pt has a sensitivity to sulfa drugs

Ethacrynic acid

T/F: spironolactone and Eplerenone are aldosterone receptor blockers and K+ sparing diuretics

T

are Amiloride and Triamterene diuretics?

yes!! they are K+ sparing diuretics; note that they work differently than the other K+ sparing diuretics (spironolactone and eplerenone)

Amiloride and Triamterene are Na+ channel blockers

megaloblastic anemia is an AE for:

Amiloride

Spironolactone

Eplerenone

Triamterene

loop diuretics

thiazides

ACEs

Triamterene

why? bc triamterene messes w folic acid pathway

think TRIamterene is TRIng sooo hard to mess w folic acid pathway, thus causing megaloblastic anemia