14. Diuretics - Pharm

• Carbonic anhydrase inhibitor (CAIs) ends in?

  -amide
• Diuretics causes hypokalemia and alkalosis due to loss of K and H+
• CAI - urine is rich in?

  alkaline - increase Na, K and HCO3
• Prolong use of CAI can cause?

  hyperchloremic metabolic acidosis
• CAI extrarenal action

  • reduce aqueous humor - treat glaucoma
  • reduce CSF
  • raise CO2 level in brain --> decrease pH + increase seizure threshold
• CAI uses

  • acute mountain sickness
  • decrease CSF formation --> decrease pH of the CSF and brain
  • cause bicarbonaturia and metabolic acidosis
• CAI ADE

  • hypokalemia
  • hyperchloremic metabolic acidosis
  • type 2 tubular acidosis
  • renal stones
• CAI C/I

  • liver disease
  • hyperammonemia or hepatic encephalopathy
  • COPD
• CAI other uses

  • retinal artery occlusion
  • metabolic alkalosis
• Loop diuretic MOA

  • inhibit NKCC2 transport system in thick ascending limb
  • reduce reabsorption of NKCC2 in apical membrane
• Loop diuretic uses

  • manage acute pulmonary edema
  • hypertension - thiazide preferred
• Loop diuretic - other uses

  • acute hypercalcemia
  • hyperkalemia
• Loop diuretic ADE

  • hypokalemia
  • alkalosis
  • hypocalcemia
  • hyperuricemia - gout
  • ototoxicity
• Loop diuretic - drug interaction

  • ototoxicity - if use with aminoglycoside or vanco
  • hypokalemia - if use with corticosteroid
  • digoxin toxicity
• Loop diuretic

  • decrease lithium clearance --> cause lithium toxicity
• What drug can reduce activity of loop diuretic if use together?

  NSAID
• Which loop diuretic is used if the pt has sulfa allergy?

  ethacrynic acid
• thiazide MOA

  • inhibit Na/Cl symporter in early DCT
• Thiazide effect

  • increase Na excretion
  • decrease Ca excretion --> can lead to hypercalcemia
  • vasodilation
  • decrease insulin release --> cause hyperglycemia
• Thiazide - uses

  • hypertension with osteoporosis
  • powerful vasodilator
  • diuretic effect
• Thiazide other uses

  • CHF
  • Nephrogenic diabetic insipidus
  • idiopathic hypercalciuria
  • calcium stones
• Thiazide ADE

  • sulfonamide allergy
  • hypokalemia
  • alkalosis
  • hyperuricemia - gout
  • hypercalcemia --> leads to decrease PTH level
• Thiazide drug interaction

  • use with digoxin - cause hypokalemia
  • reduce clearance of lithium --> lithium toxicity
• Thiazide vs. Loop diuretics

  • thiazide
  • develop hyponatremia + hypercalcemia
  • Loop
  • develop hypocalcemia + volume contraction
• K+ sparing diuretics

  • administer with thiazide + loop diuretic during antihypertensive + HF to prevent K+ loss
• K+ sparing diuretic - MOA

  • mineralocorticoid receptor antagonist
  • ENaC inhibitor
• ENac inhibitor (K+ sparing diuretic) - name

  • triam
  • amilo
• ENac inhibitor MOA

  • increase Na+ and decrease K+ loss
• ENaC inhibitor uses

  • with diuretic to correct hypokalemia
  • treatment for lithium induced diabetics insipidus --> block Li+ entry into collecting ducts cells
• ENaC inhibitor - Amilo uses

  • cystic fibrosis
  • Liddle's syndrome
  • genetically - low level of aldosterone + renin