Podcast
Questions and Answers
What is the primary goal of diuretic drugs?
What is the primary goal of diuretic drugs?
Diuretic drugs aim to remove excess fluid and minerals from the body through urine.
Which of the following are clinical indications for diuretics? (Select all that apply)
Which of the following are clinical indications for diuretics? (Select all that apply)
What is the mechanism of action of carbonic anhydrase inhibitors?
What is the mechanism of action of carbonic anhydrase inhibitors?
Carbonic anhydrase inhibitors block the enzyme carbonic anhydrase, which is involved in the production of hydrogen ions (H+) and bicarbonate in the kidneys.
What is a common side effect of carbonic anhydrase inhibitors?
What is a common side effect of carbonic anhydrase inhibitors?
Signup and view all the answers
Which of the following diuretics is classified as an osmotic diuretic?
Which of the following diuretics is classified as an osmotic diuretic?
Signup and view all the answers
Osmotic diuretics are commonly used to treat heart failure.
Osmotic diuretics are commonly used to treat heart failure.
Signup and view all the answers
What is the primary mechanism of action of loop diuretics?
What is the primary mechanism of action of loop diuretics?
Signup and view all the answers
Which of the following diuretics is NOT a sulfa drug?
Which of the following diuretics is NOT a sulfa drug?
Signup and view all the answers
What is the most common side effect of loop diuretics?
What is the most common side effect of loop diuretics?
Signup and view all the answers
How do thiazide diuretics work?
How do thiazide diuretics work?
Signup and view all the answers
Thiazide diuretics are not recommended for patients with chronic kidney disease.
Thiazide diuretics are not recommended for patients with chronic kidney disease.
Signup and view all the answers
Which of the following diuretics is commonly used to prevent kidney stones?
Which of the following diuretics is commonly used to prevent kidney stones?
Signup and view all the answers
K+ sparing diuretics are less effective than spironolactone.
K+ sparing diuretics are less effective than spironolactone.
Signup and view all the answers
What is the mechanism of action of K+ sparing diuretics?
What is the mechanism of action of K+ sparing diuretics?
Signup and view all the answers
What is the primary indication for SGLT2 inhibitors?
What is the primary indication for SGLT2 inhibitors?
Signup and view all the answers
Which of the following diuretics are commonly prescribed during pregnancy? (Select all that apply)
Which of the following diuretics are commonly prescribed during pregnancy? (Select all that apply)
Signup and view all the answers
What is the primary mechanism by which SGLT2 inhibitors exert their diuretic effect?
What is the primary mechanism by which SGLT2 inhibitors exert their diuretic effect?
Signup and view all the answers
Study Notes
Pharmacology of Diuretics
- Diuretics are used to remove extra fluid and minerals through urine.
- Goals include reducing edema, treating hypertension, managing vascular congestion in heart failure, and increasing urination.
- Diuretics should be taken in the morning to avoid nocturia (frequent urination at night).
- Sequential nephron blockade is a potent combination for refractory congestion.
- This combination is effective but increases the risk of renal dysfunction.
Learning Objectives
- List major diuretics and their clinical indications.
- Explain the mechanism of action of major diuretics.
- Discuss pharmacokinetics and major drug interactions of diuretics.
- Describe common and severe adverse effects of commonly used diuretics.
- Summarize patient management with edema.
Goal of Diuretic Drugs
- Remove extra fluid and minerals through urine
- Reduce edema
- Treat hypertension
- Manage vascular congestion in all forms of heart failure
- Increase urination
- Take diuretics in the morning to avoid nocturia (minimize nighttime urination).
Indications
- Heart failure, renal disease, cirrhosis
- Edema, hypertension, ascites diuresis, fluid overload
Classes of Diuretics
- Carbonic anhydrase inhibitors (e.g., Acetazolamide)
- Osmotic diuretics (e.g., Mannitol)
- Loop diuretics (e.g., Furosemide, Ethacrynic acid)
- Thiazide diuretics (e.g., Hydrochlorothiazide, Chlorthalidone)
- Potassium-sparing diuretics (e.g., Spironolactone, Triamterene)
Acetazolamide
- Carbonic anhydrase inhibitor
- Weaker diuretic, acting on the eye, brain, and kidneys
- Indications include glaucoma, high-altitude pulmonary edema, and metabolic alkalosis
- Prophylaxis of acute mountain sickness
Osmotic Diuretics (Mannitol)
- Pharmacologically and metabolically inert substances
- Filtered in the glomerulus, not reabsorbed
- Massive diuresis
- Best drug to reduce intracranial pressure (cerebral edema) and intraocular pressure (glaucoma)
- Creates a powerful osmotic gradient in the kidneys
- Draws water out of brain parenchyma to intravascular space and excreted
- Useful in reducing vitreous humor
- Rapidly excreted via kidneys (IV administration)
Loop Diuretics
- Powerful, rapid onset diuretics
- Act on the ascending limb of the loop of Henle
- Inhibit Na-K-2Cl cotransporter, reducing sodium reabsorption
- Potent for chronic kidney disease and heart failure
- Types: sulfa drugs (furosemide, torsemide, bumetanide) and non-sulfa drugs (ethacrynic acid)
- Common adverse effects: sulfa allergies, hypokalemia, metabolic alkalosis, increased Li clearance, aminoglycoside enhanced toxicity, and reduced efficacy with NSAIDs.
Furosemide (Loop Diuretic)
- Very effective, commonly used loop diuretic
- First-line therapy for heart failure
- Blocks Na-K-2Cl cotransporter, inhibiting NaCl reabsorption, increasing water and electrolyte excretion
- Causes loss of calcium and magnesium
- Bioavailability is variable; better absorbed when taken before meals
- Excreted through kidneys as unchanged compound or glucuronide.
- Short half-life (1.5 hours)
Torsemide (Loop Diuretic)
- More potent than furosemide
- Advantage: mitigation of cardiac fibrosis
- Higher bioavailability, greater absorption regardless of edema
- Eliminated via hepatic pathway
- Longer half-life (4 hours) compared to furosemide
Bumetanide (Loop Diuretic)
- High bioavailability
- Extremely well absorbed, undergoes substantial hepatic elimination
- Similar efficacy to Furosemide and Torsemide
Ethacrynic Acid (Loop Diuretic)
- Non-sulfa loop diuretic
- Suitable for patients with sulfa allergies
- Adverse effect: ototoxicity (damage to inner ear hair cells)
Thiazide Diuretics
- Reliable class of antihypertensive diuretics
- Best for essential hypertension and renal stones
- Enhance calcium reabsorption, reducing calcium excretion
- Common: Hydrochlorothiazide, Chlorthalidone
- Risk of hyperglycemia, gout
- AE: electrolyte derangement, hyperglycemia, decreased K+
Chlorthalidone (Thiazide Diuretic)
- More potent than Hydrochlorothiazide, long half-life
Potassium-Sparing Diuretics
- Include both steroid and non-steriod drugs
- Examples: Spironolactone and Amiloride.
- Effective regardless of aldosterone status
- Spironolactone- also blocks Na channels on cells that reabsorb Na+
- Helps prevent potassium loss, useful in cases of hyperkalemia
- AE: Gynecomastia, hyperkalemia
Eplerenone (Potassium-Sparing)
- Mineralocorticoid receptor blocker
- Higher selectivity for mineralocorticoid receptors than spironolactone
- Used to treat LV systolic dysfunction, congestive heart failure, and hypertension after acute MI.
SGLT2 Inhibitors
- Used as diuretics in Type 2 diabetes and cardiovascular diseases.
- Prevent adverse cardiorenal events in diabetic patients.
- Keep you from reabsorbing glucose, which leads to water and sodium elimination. They inhibit SGLT-2
- Examples include Canagliflozin, Dapagliflozin
Diuresis and Pregnancy
- Diuretics can sometimes be used safely during pregnancy to treat severe illnesses and life-threatening conditions, or to replace a drug with noted fetal effects.
Summary of Diuretic Action
- A detailed diagram of the nephron and the location of various diuretic actions.
Additional Considerations
- The presentation discusses specific diuretics more thoroughly
- Including their mechanisms of action, side effects, and specific indications for specific medical conditions.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Related Documents
Description
This quiz covers the pharmacology of diuretics, including their mechanisms of action, clinical indications, and pharmacokinetics. Explore how diuretics help manage conditions like hypertension and heart failure, as well as their potential adverse effects. Test your knowledge on patient management related to edema and fluid balance.
