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2012-09-19 23:50:13
diuretics loop

Chapter 41
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  1. High-ceiling (loop) diruetics: Prototype and other:
    P: Furosemide (Lasix)

    O: Ethacrynic acid (Edecrin), Burnetanide, Torsemide (Demadex)
  2. High-ceiling (loop) diruetics: Mechanism of Action
    Promotes urination by blocking reabsorption of Na and Cl in descending limb of Henle's loop, produces profound diuresis
  3. High-ceiling (loop) diruetics: Uses
    Rapid mobilization of fluid, pulmonary edema associated with hf, renal, or liver disease, HTN that cannot be controlled with other diuretics, renal insufficiency
  4. High-ceiling (loop) diruetics: Adverse Effects
    hyponatremia, hypochloremia, dehydration, hypotension, hypokalemia, ototoxicity, hyperglycemia, hyperuricemia, magnesium deficiency, fetal harm, raises LDL and lowers HDL (little), may cause dysrhythmias when used with digoxin ( reduces K), can elevate lithium levels, NSAIDs can blunt effects of loop diuretics
  5. Thiazide diuretics: Prototype and other
    P: Hydrochlorothiazide (HCTZ)

    O: Chlorothiazide (Diuril), Methyclothiazide (Enduron), Chlorthalidone (Hygroton, Thalitone), Metolazone (Zaroxolyn)
  6. Thiazide diuretics: Mechanism of Action
    Promotes urination by blocking reabsoprtion of Na and Cl in early segment of distal convoluting tubule
  7. Thiazide diuretics: Uses
    treat HTN, mobilize edema w/ mild HF, hepatic or renal disease, protect against postmenopausal osteoporosis by promoting reabsoption of Ca, ineffective when glomerular filtration rate (GFR) is low ( <15-20 mL/min), diabetes insipidus-paradoxical effect
  8. Thiazide diuretics: Adverse Effects
    hyponatremia, hypochloremia, hypercalcemia, dehydration, hypokalemia, magnesium deficiency, hypotension, hypergylcemia, hyperuricemia, increase LDL and triglycerides, cause dysrhythmias when used with digoxin (reduced K), can elevate lithium levels, NSAIDs blunt effects, fetal harm
  9. Potassium-Sparing Diuretics: Prototype and other
    P: Spironolactone (Aldactone)

    • O: Triamtrene (Dyrenium), Amiloride (Midamor)
    • Other Aldosterone Blocker: Eplerenone (Inspra): Not considered diuretic, used for HF
  10. Potassium-Sparing Diuretics: Mechanism of Action
    Blocks actions of aldosterone in distal nephron, produces minimal diuresis, causes retention of K and increased excretion of Na
  11. Potassium-Sparing Diuretics: Uses
    HTN and edema, used in combo with other diuretics to counterbalance K loss, HF (blocks negative effects of aldosteron on heart and bld vessels), Primary hyperaldosteronism, premenstrual syndrom, PCOS, acne
  12. Potassium-Sparing Diuretics: Adverse Effects
    hyperkalemia, dysrhythmias, endocrine effects (gynecomastia, menstrual irregularities, impotence, hirsutism, deep voice)
  13. Osmotic Diuretics: Prototype
    Mannitol (Osmitrol)
  14. Osmotic Diuretics: Mechanism of Action
    Creates an osmotice force in the lumen of the nephron, promotes diuresis by inhibiting passive reabsoprtion of water
  15. Osmotic Diuretics: Uses
    porphylaxis of renal failure, reduces intracranial and intraocular pressure
  16. Osmotic Diuretics: Adverse Effects
    Edema, CHF and pulmonary edema