Diuretics Blake Briggs, Class of 2017.

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Presentation transcript:

Diuretics Blake Briggs, Class of 2017

Introduction Understanding nephron function is essential in learning diuretics PCT (acetazolamide) DCT (thiazides) CD -K sparing diuretics TAL ((loops)

Mannitol MOA- Osmotic load (increase tubular osmolarity  increase osmosis  increase urine flow) Uses: drug overdoses, lowering ICP/IOP Toxicity: Pulmonary edema, dehydration Contraindications: heart failure, anuria Water extracted from tissue, increase medullary blood flow and thus decrease the tonicity, impairs water absorption in the TDL

Acetazolamide MOA- Carbonic anhydrase inhibitor: prevents reabsorption of Na- HCO3 in the PCT. Uses: lowers IOP (glaucoma), alkalinizes urine (drug OD), altitude sickness, pseudotumor cerebri

Loop diuretics Drugs: Furosemide , Bumetanide, Torsemide (longest half life) MOA: block reabsorption of Na/K/2Cl in Thick Ascending limb; increases RBF. Uses: when a large diuresis is needed: CHF, Pulm Edema, cirrhosis, nephrotic Syndrome Toxicity: OH DANG! Ototoxicity, hypokalemia, dehydration, allergy (sulfas)/alkalosis, nephritis , gout Ethacrynic Acid- more ototoxic, but not a sulfa drug! Unique facts: Loops need to be secreted into the tubule to work. So they work less in renal failure. Abolish hypertonicity of medulla and prevents concentration of urine Stimulates PGE release Can cause Acute Interstitial Nephritis

Thiazides Drugs: HCTZ, Chlorthalidone, Metolazone MOA: block NaCl absorption in DCT decreases diluting capability of nephron Uses: HTN (1st line), idiopathic hypercalciuria, Nephrogenic DI, Osteoporosis Toxicity: HyperGLUC- Glucose, Lipids, Uric acid, Calcium

K+ Sparing Diuretics Drugs: Spironolactone, Eplerenone: MOA: competitive aldosterone receptor antagonists in cortical CD Remember the trio of aldosterone effects: K secretion, Na reabsorption, H secretion. Toxicity: “feminization due to anti-androgen effects (aldosterone has androgenic properties and receptor crossover)”, hyperkalemia Uses: Ascites, hyperaldosteronism, hypokalemia, heart failure, hirsutism Eplerenone has less/no anti-androgen effects

K+ Sparing diuretics Drugs: Triamterene, Amiloride: MOA: block NaCl channels in cortical CD. Toxicity: hyperkalemia. NO anti-androgen effects (does not block aldosterone) Uses: HTN, nephrogenic DI (amiloride)

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