Renal Diuretics Notes PDF

RENAL Last edited: 12/3/2024 1 4. DIURETICS I. PHYSIOLOGY OF DIURETICS II. CARBONIC ANHYDRASE INHIBITORS VI. BIOAVAILABILITY AND DOSING OF LOOP DIURETICS A. CARBONIC...

RENAL Last edited: 12/3/2024 1 4. DIURETICS I. PHYSIOLOGY OF DIURETICS II. CARBONIC ANHYDRASE INHIBITORS VI. BIOAVAILABILITY AND DOSING OF LOOP DIURETICS A. CARBONIC ANHYDRASE INHIBITORS III. LOOP DIURETICS VII. APPROACH TO DIURESIS IN HYPERVOLEMIA B. LOOP DIURETICS IV. THIAZIDE DIURETICS A. IDENTIFY THE VOLUME STATUS OF PATIENTS C. THIAZIDE DIURETICS V. POTASSIUM SPARING DIURETICS B. MONITOR FOR COMPLICATIONS D. POTASSIUM SPARING DIURETICS 00:07 I. Physiology of Diuretics A. Carbonic Anhydrase Inhibitors 01:08 1. Location of Effect 2. Mechanism Diuretics RENAL : Note #14 1 of 7  B. Loop Diuretics 07:55 1. Location of Effect 2. Mechanism C. Thiazide Diuretics 15:35 1. Location of Effect 2. Mechanism D. Potassium Sparing Diuretics 24:30 1. Location of Effect 2. Mechanism 2 of 7 RENAL : Note #14 Diuretics  31:30 II. Carbonic Anhydrase Inhibitors 38:53 III. Loop Diuretics Diuretics RENAL : Note #14 3 of 7  50:17 IV. Thiazide Diuretics 1:00:14 V. Potassium Sparing Diuretics 4 of 7 RENAL : Note #14 Diuretics  1:10:30 VI. Bioavailability and Dosing of Loop Diuretics Diuretics RENAL : Note #14 5 of 7  1:13:51 VII. Approach to Diuresis in Hypervolemia A. Identify The Volume Status of Patients 1. Obtain a Thorough History and Physical Examination Indications: o Assess volume status for IV fluid administration Abnormal Findings: i) Hypovolemic ii) Hypervolemic o History of fluid loss: o History of fluid retention:  Renal loss: Diuretics and cerebral salt wasting  CHF, Cirrhosis, CKD, iatrogenic fluid resuscitation  Extrarenal Na+ loss: Vomiting and diarrhea o Physical Exam: o Physical exam:  Normal skin turgor, moist membranes  ↓Skin turgor, dry membranes  ↑JVP and ↑CVP  ↓JVP and ↓CVP  Oliguria (↑venous congestion)  Oliguria (↓perfusion)  ↑BP  ↓BP, ↑HR  Pulmonary edema/effusions  Peripheral edema  Ascites  Weight gain 6 of 7 RENAL : Note #14 Diuretics 2. Begin a Diuretic Regimen if Hypervolemic Indications: o Evidence of Hypervolemia (seen in CHF, cirrhosis, CKD/AKI) The First Agent of Choice: o Begin Loop Diuretics  Large Volume Removal for the following: Pulmonary edema Peripheral edema Ascites Weight gain B. Monitor for complications 1. Determine the Diuretic to Add to Augment Complications (e.g. Sequential Nephron Blockade) Indications: o Hypervolemia + one of the following:  Hypernatremia  Hypokalemia  Metabolic alkalosis Next Step in Diuresis: o Add Thiazide Diuretics  Volume removal PLUS Hypernatremia o Add Potassium-Sparing Diuretics  Volume removal PLUS Hypokalemia o Add Carbonic Anhydrase Inhibitors  Volume removal PLUS Metabolic alkalosis 2. Monitor for Volume and Electrolyte Derangements Indications o Aggressive Diuresis Abnormal Findings: o Hypovolemia-related issues (e.g. Hypotension, AKI): → Discontinue Loop and Thiazide Diuretics o Hyperkalemia → Discontinue K+ Sparing Diuretics o Hyponatremia → Discontinue Thiazide Diuretics Diuretics RENAL : Note #14 7 of 7