Diuretics

Diuretics

Increases urination by decreasing reabsorption of ions like sodium
1. Water is pulled by the ions via passive transport
Used to treat edema, HTN, and glaucoma
Thiazide Diuretics
1. Most common of all diuretics
2. Most common: HCTZ
  1. Others: metolazone; chlorthalidone; indapamide
3. Affects the distal tubule
4. Inhibits the Na/Cl co-transporter
  1. Increases excretion of Na, Cl, K, and Mg
  2. Less Ca excretion
  3. Reduced peripheral vascular resistance
5. Used to treat HTN, diabetes insipidus, hypercalciuria, and heart failure
6. Taken orally for 1-3 wks to decrease BP
7. Secreted by the kidneys
8. Side effects: hyperuremia (and gout), hyponatremia; hypokalemia; volume depletion; hyperglycemia; hyperlipidemia
Osmotic Diuretics
1. Carry water as they are filtered through the glomerulus
2. Mannitol is the most common
3. Increases water excretion, but not sodium excretion
4. Prevents acute renal failure and increased intracranial pressure
Potassium-Sparing Diuretics
1. Acts on collecting tubule
2. Inhibits Na reabsorption and K excretion
  1. Caution in renal disease patients: increased risk for hyperkalemia
3. Used to treat HTN, but with a thiazide
4. Aldosterone Antagonists
  1. Prevent proteins from stimulating Na/K exchange sites
    1. Blocking aldosterone should relieve edema
  2. Spironolactone and eplerenone
  3. Used as a diuretic and in heart failure
  4. Highly bound to plasma proteins
  5. Side effects: GI upsets; mimicry of sex hormones
5. Sodium Channel Blockers
  1. Triamterene and amiloride
  2. Blocks sodium transport channels, decreasing Na/K exchange
  3. Side effects: K retention; renal stones, increased uric acid
Loop Diuretics
1. Causes the most diuresis
  1. Useful in emergency situations
2. Acts on ascending loop of Henle
3. Most common is furosemide; others are bumetanide and torsemide
4. Inhibits Na/K/2Cl cotransport, reducing reabsorption
  1. Increases excretion of Na, K, and Ca
  2. Decreases renal vascular resistance
    1. Increases renal blood flow
  3. Increases prostaglandin synthesis - may increase renal blood flow
5. Used in treating acute pulmonary edema in heart failure
6. Used to treat hyperkalemia nd hypercalcemia
7. Side effects: ototoxicity; hypermagnesemia; hyperurecemia; potassium depletion
Carbonic Anhydrase Inhibitors
1. Acetazolamide and methazolamide
2. Weak diuretic
3. Works on proximal tubule
4. Decreases ability to exchange Na for H for bicarbonate
5. Used to treat glaucoma
  1. Acetazolamide (Diamox) 2 250mg tablets
  2. Dorzolamide and brinzolamide are used topically
6. Also treats pseudotumor cerebri and mountain sickness
7. Side effects: metabolic acidosis, K depletion, renal stones, drowsiness, paresthesia
8. Avoid in patients with cirrhosis

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	Created by Curtis Burnley over 6 years ago