Diuretics 2
Terms
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- Major site of bicarbonate reabsorption
- Promixmal convoluted tubule
- Segment with Na, K, 2Cl cotransporter
- Thick ascending limb
- In the TAL potassium is pumped via cotransporter into the cell and diffuse back into the lumen withou an anion. What is this necessary for?
- Creates positive potential to drive Ca and Mg reabsporption.
- PTH controlls the Ca reabsorption in what segment?
- Distal convoluted tubule
- This diuretic is an exception in that it enters cell from the basolateral side instead of being filter or secreted
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Spironolactone
binds to the aldosterone receptor and antagonizes its effects - Site of action for acetazolamide
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Proximal tubule
a brush border and intracellular carbonic anhydrase inhibitor - Acetazolamides effects on sodium and potassium
- CA produces less H to countertransport with Na, so Na excretion goes up and thusly, so does K when it reaces the CCT
- Its action limits Na reabsoprtion in the proximal tubule leading to downstream potassium wasting
- acetazolamide
- Systemic effects of acetoazolamide
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Eye: Decrease HCO3 and lower aqueuous humor production
CSF: acidify CSF to cause hyperventilation and prevent high altitude sickness - Use for glaucoma
- acetazolamide
- Four toxicities of acetazolamide
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Drowsiness and paresthesias
basic urine leads to renal stones
Potassium wasting
hepatic encephalopathy - Four loop diuretics
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Furosemide
Bumetanide
torsemide
Ethacrynic acid - Site of action for loop diurectics and duration of action
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TAL
Short (4 hours) - Effect of loop diuretics on Na, potassium, calcium and H
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Increased Na delivery to the CCT increases K wasting and H secretion...hypokalemic alkalosis
In TAL, inhibition leads to lower K diffuse back to the lumen, and no potential to drive Ca, so Ca excretion goes up - Major use of loop diuretics
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Edema in
CHF
Ascites
Acute pulmonary edema - Best diuretic for acute pulmonary edema
- Loop diuretics
- Treatment of hypercalcemia from malignancy
- Loop diuretics
- Toxicities of loop diuretics
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hypokalemic alkalosis
Severe K wasting (affects heart)
Ototoxicity from reduced excretion of aminoglycosides - Ethacrynic acid differs from other loops in what regards?
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It is urocosuric
It also inhibits the basal K-Cl transporter
It is not a sulfanamide derivative - Torsemide vs Furosemide and bumetanide
- T acts for 4-6 hours vs 2-3 for F and B
- Short actiing thiazide diuretics
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Hydrochlorothiazide
Metalozone
2-3 hours - Long acting thiazide diuretics
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Chlorthalidone
Indapamide
24-72 hours - Site of action for thiazide diuretics
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DCT
Na-Cl transporter - Toxicity of thiazides
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hypokalemia
hyperglycemia
hyperuricemia
hyperlipidemia - Increases calcium reabsorption
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thiazide diuretics
Hydrocholorthiazide
Metalozone
Indapamide
Chlorthalidone - Uses for thiazides
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Hypertension
Chronic edema (eg CHF)
Renal stones from high Ca - Four K sparing diuretics
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Amiloride
Triamterene
Spironolactone
Eplerenone - Differences between K sparing diuretics
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Amiloride and Triamterene block ENaC
Spironolactone and Eplerenone block aldosterone receptor - Duration of action for Amiloride and triamterence vs. Spironolactone
- 12-24 vs 27-72
- Toxicity of K sparing diuretics
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hyperkalemia (don't give w/ K supplement)
gynecomastia
antiandrogenic effects - Side effect of triamterene
- poorly soluble and may cause kidney stones
- Mannitol
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osmotic diuertic
given IV - uses for mannitol
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to maintain high urine flow
reduce intraocular pressure
reduce intracranial pressure