24 Questions
What is the effect of Loop Diuretics on calcium levels?
They induce hypocalcemia
What is the mechanism of action of Triamterene and Amiloride?
They block Na+ channels directly
What is the indication for Spironolactone in CHF?
It is used to reduce mortality by 30%
What is the adverse effect of Loop Diuretics on glucose levels?
They cause hyperglycemia
What is the effect of Thiazide Diuretics on calcium levels?
They induce hypercalcemia
What is the mechanism of action of Spironolactone?
It antagonizes aldosterone receptors
What is the main difference between Triamterene and Amiloride compared to Spironolactone?
Triamterene and Amiloride act directly on Na+ channels, while Spironolactone antagonizes aldosterone receptors
What is the consequence of using Loop Diuretics with Nephrotoxic drugs?
It increases the risk of nephrotoxicity
What is the advantage of triamterene and amiloride over spironolactone?
They are more rapid and shorter acting, allowing for daily dosage adjustment.
What is the mechanism of action of carbonic anhydrase inhibitors?
Inhibition of carbonic anhydrase enzyme.
What is the indication for mannitol in cerebral edema?
Rapid reduction of ICP.
What is a common adverse effect of spironolactone?
Gynecomastia.
What is the contraindication for mannitol in acute renal failure?
Impaired renal function.
What is the indication for acetazolamide in emphysema?
Correction of alkalosis.
Why is spironolactone preferred in liver cirrhosis?
It does not cause hypokalemia or alkalosis.
What is the combination of diuretics that potentiates their diuretic effect and antagonizes hypokalemic effect?
Triamterene and amiloride.
What is the mechanism by which Na+ lost by loop diuretic is reabsorbed in distal tubules?
In exchange with K+ under the effect of aldosterone
What is the therapeutic use of Thiazide Diuretics in treating CHF?
To overcome refractoriness to loop diuretics
What is the effect of chronic therapy with Thiazide Diuretics on urine output in nephrogenic diabetes insipidus?
Decreases urine output
Which of the following is a side effect of Thiazide Diuretics?
Hyperuricemia
What is the mechanism of action of Spironolactone?
Inhibits the action of aldosterone
Which of the following diuretics is preferred in elderly patients to decrease the risk of osteoporosis?
Thiazide Diuretics
What is the effect of chronic therapy with Thiazide Diuretics on Ca2+ excretion?
Decreases Ca2+ excretion
What is the treatment for Na+ lost by loop diuretic?
Add the aldosterone antagonist (spironolactone)
Study Notes
Diuretics
Loop Diuretics
- May lead to hypotension, hemoconcentration, thrombosis, ototoxicity, and nephrotoxicity
- Can cause refractoriness, hyperglycemia, and hyperlipidemia
- Can induce hypocalcemia and are used in the treatment of hypercalcemia
- Used with caution with nephrotoxic drugs (e.g., cephalosporins, aminoglycosides) and ototoxic drugs (e.g., aminoglycosides)
- Can cause liver failure, hypokalemia, and alkalosis, which may precipitate hepatic encephalopathy
Thiazide Diuretics
- Inhibit active electroneutral NaCl reabsorption in the early part of the distal tubule (diluting segment)
- Cause excretion of 5-10% of filtered Na+
- Have vasodilator action, which is the basis for their antihypertensive effect
- Available in different preparations, including hydrochlorthiazide, chlorthalidone, indapamide, and metolazone
- Used to treat hypertension, CHF, nephrogenic diabetes insipidus, and idiopathic hypercalciuria and Ca2+ stones
Adverse Effects of Thiazide Diuretics
- Can cause hypokalemia, hypomagnesemia, alkalosis, and hyperuricemia
- May cause hypersensitivity reactions in patients sensitive to sulfonamides
- Can cause edema and liver cirrhosis, where spironolactone is the preferred treatment
Potassium Retaining Diuretics
- Mineralocorticosteroid antagonists (MRAs) and direct inhibitors of Na+ channels
- Triamterene and amiloride are direct inhibitors, while spironolactone and eplerenone are MRAs
- Used to treat CHF, hypertension, and nephrogenic diabetes insipidus
- Can cause hyperkalemia and metabolic acidosis as adverse effects
- Gynecomastia can occur as an adverse effect of spironolactone, but not eplerenone
Osmotic Diuretics
- Mannitol is an osmotic diuretic used to rapidly reduce ICP in cerebral edema and IOP in acute congestive glaucoma
- Used in prophylaxis against acute renal failure in patients with oliguria
- Can cause adverse effects such as heart failure and dilutional hyponatremia, and is contraindicated in acute renal failure and congestive heart failure
Carbonic Anhydrase Inhibitors (CAIS)
- Include acetazolamide, brinzolamide, and dorzolamide
- Mechanism of action involves diuresis with alkaline urine and decreased blood bicarbonate with metabolic acidosis
- Used to treat emphysema and high altitude sickness, as well as epilepsy as an adjuvant
This quiz covers the adverse effects of loop diuretics and thiazide diuretics, including hypovolemia, hyponatremia, and their impact on calcium levels. It also explores their uses in treating hypercalcemia and hypercalcuria.
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