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Thiazide - MoA
- inhibit Na/Cl channel in distal tubule
- leads to increase distal delivery of Na+
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Thiazide - special action
- promotes Ca2+ reabsorption
- good for osteoporosis & Ca2+ kidney stones
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Thiazide - Use
- first line therapy => mild diureticssevere edema
- osteoporosisManage Ca2+ kidney stones
- Nephrogenic Diabetes Insipidus
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What is Nephrogenic Diabetes Insipidus
- when kidney does not respond to ADH
- Thiazide can cause decrease volume leading to increase proximal water reabsorption (in theory)
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Thiazide - Adverse Effects
- Electrolyte imbalance (inc. Ca; dec. Na & K)
- Hyperuricemia (dec. excretion of uric acid; Gout)
- Hyperglycemia, Hyperlipidemia (all about concentration)
- Impotence
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Thiazide - Contraindications
- Sulfonamide toxicity (antibiotic)
- K-depletion drugs (Digoxin & Quinidine)
- NSAIDs
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Loop Diuretics - MoA
- inhibits NKCC channels in ascending loop
- increase distal delivery of Na
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Loop Diuretics - Use
- acute pulmonary edema
- CHF
- Nephrotic syndrome, cirrhosis
- acute renal failure
- HTN
- hyperkalemia, hypercalcemia
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Loop Diuretics - Adverse Effects
- Electrolyte imbalance (dec. Na, K, Ca, Mg)
- Hyperuricemia (exacerbates Gout)
- Metabolic Alkalosis
- Hyperglycemia & Hyperlipidemia
- Ototoxicity
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Loop Diuretics - contraindications
- K-depletion drugs (digoxin & quinidine)
- Ototoxicity causing drugs (Aminoglycoside)
- NSAIDs
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What happens when you increase distal delivery of Na?
- increase K excretion => hypokalemia
- increase H+ excretion => alkalosis
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What is the difference between Thiazide & Loop Diuretics effect on Calcium?
- Thiazide - increase Ca2+ reabsorption
- Loop Diuretic - decrease Ca2+ reabsorption
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How are Loop Diuretic different from Thiazide in potency?
- Loop Diuretics are stronger diuretics
- shorter duration & looses effectiveness over time
- good for emergency short term, fast action use!
- for long term therapy, use Thiazide
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Spironolactone
Aldosterone antagonist
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Eplerenone
Aldosterone antagonist
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Aldosterone antagonist - MoA
- block aldosterone effect on Na channels in distal tubules
- K sparing diuretic
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Aldosterone antagonist - Use
use in conjunction with other diuretics for K sparing action
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Aldosterone antagonist - Adverse Effects
- Hyperkalemia
- Renal insufficiency (controls blood vessels)
- Metabolic acidosis (inc K => K/H exchange)
- Gynecomastia, Impotence, Hirsutism
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Amiloride
Na channel blocker
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Triamterene
Na Channel blocker
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Na channel blockers - MoA
- blocks Na channels in distal tubule
- K-sparing diuretics
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Na channel blockers - Use
weak diuretic used in combination with other diuretics for K sparing effect
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Na channel blocker - Adverse Effects
- Hyperkalemia
- Renal insufficiency
- Metabolic acidosis
- Kidney stones (basic urine)
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Carbonic Anhydrase Inhibitor
- inhibits Carbonic Anhydrase in proximal tubuleincrease distal delivery of Na
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