Review 2.2

• which diuretic is the most effective? and why?

  loop diuretics

  produce more fluid loss even when renal blood flow and GFR are low
• where are the loop diuretics site of action?

  ascending loop of henle
• loop diuretics uses

  pulmonary edema, CHF,

  edema: cardiac, hepatic, and renal origin

  HTN that cannot be controlled by other diuretics
• which diuretic is good for renal impairment pts?

  severe renal impairment patients
• side effects of loop diuretics

  ototoxic

  hyponatremia, hypochloremia, hypokalemia

  hyperuricemai

  hyperglycemia
• what meds should not be given with loop diuretics?


  digoxin due to potassium loss

  other ototoxic drugs

  lithium

  NSAIDs decrease effectiveness of Furosemide
• what are the loop diuretics?

  Furosemide

  ethacrynic acid

  torsemide

  bumetanide
• what two loop diuretics are approved for HTN?

  Torsemide and furosemide
• how do thiazide diuretics and loop diuretics differ?

  loop diuretics can produce max diuresis even when urine flow is low

  thiazide cannot produce max diuresis when urine flow is low
• hydorchlorothiazide MOA where

  early segment of the distal convoluted tube
• thiazides are not ototoxic
• which diuretic is first line choice for HTN?

  Thiazides
• which BP med would you start a pt on for HTN?

  ACE or ARB
• what is increased excretion in thiazides?

  potassium, sodium, chloride, water,
• which thaizide has shown more effective than HCTZ but causes more hypok and hyponat?

  Chlorthalidone
• Hydrochlorothiazide therapeutic uses

  Essential HTN

  Edema

  DM insipidus
• Hydrochlorothiazide side effects

  same as loop diuretics

  impact on lipids, calcium, and magnesium
• what is an osmotic diuretic and its use?

  Mannitol

  use: reduces ICP - given IV
• what are the potassium-sparing diuretics (aldosterone antagonist)

  Spironolactone and Esplerenone
• potassium-sparing diuretics are rarely used alone
• Spironolactone BBW

  tumorgenic in rats
• Spironolactone off brand uses

  hirsutism, acne vulgaris, PCOS, female pattern hair loss, reducing male-pattern hair growth
• spironolactone blocks what hormone?

  Aldosterone
• Spironolactone side effects

  hyperk, gynecomastia, menstrual irregularities, impotence, and deepening of the voice
• Spironolactone is approved for which classes of CHF?

  classes III-IV
• what is a nonsterodial MRA?

  Finerenone
• what two diuretics are selective to MRAs 3 and 4?

  Eplerenone and Finerenone
• Finerenone should a reduced morbidity and mortality to which pts?

  CKD and DMT2
• what are two diuretic non-aldosterone antagonist?

  Triamterene and Amiloride
• what are two aldosterone antagonist?

  spironolactone and Esplerenone
• Amiloride and Triamteren MOA

  disrupts k+ and na exchange in the distal nephron by reducing ion transport indirectly blocking aldosterone
• Amiloride must be watched closely when on these drugs

  ACE, ARB, or direct renin inhibitor
• ACEi end with what?

  -prils
• ACE uses 


  HTN, CHF, MI, diabetic and nondiabetic neuropathy,

  prevention: MI, stroke, death with high CV risk
• main side effects of ACEs


  cough, fetal injury, hyperkalemia, first dose hypotension, angioedema, neutropenia, renal failure
• how do ACEi create cough as a side effect?

  increases levels of bradykinin in the lungs causing vasodilation (increased production of prostaglandins and nitric oxide)
• what drug may intensify first dose hypotension with ACEs?

  diuretics
• ACEi drug interactions

  cause lithium to accumlate to toxic doses

  NSAIDs decrease antiHTN effects
• what route is ACE excreted by?

  kidneys
• what ACE can only be given IV?

  Enalapril