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osmotic diuretics
mannitol
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carbonic anhydrase inhibitors
acetazolamide
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loop diuretics
furosemide
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thiazide diuretics
hydrochlorothiazide
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potassium sparing diuretics
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Use, admin, toxicity of osmotic diuretics
- used for: oligurai acute renal failures, reduction of intraocular pressure, cerebral edema
- can give IV, observe for crystals in vial
- toxicity: electrolyte imblaland (serum dilution of K and Na), fluid overload, dehydration
- pt related variables: HF, renal function resistant to diuretic
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acetazolamide
- carbonic anhydrase inhibitor
- blocks reabsorption of Na and bicarbonate
- results in mild metabolic acidosis
- used for diuresis, glaucoma, seizures (acidosis increases threshold), altitude sickness, met alkylosis
- toxicity: GI distress, anorexia, met acidosis
- pt related variable: sulfonamide sensitivity
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furosemide
- loop diuretic
- blocks reabsorption of NaCl
- increases loss of Na, K, Mg, Cl and water, as well as Ca
- used for HTN, edema, hypercalcemia, hyponatremia (with NaCl infusion)
- toxicity: hypokalemia, hyperuricemia, hyperglycemia (hypoK antagonizes insulin effect), ototoxicity, hypovolemia, hypomagnesemia
- pt related variables: gout, DM, allergy to sulfa/diuretics, liver dz
- interacts with DIGOXIN
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hydrochlorothiazide
- thiazide diuretic
- blocks Na reabsorption
- increases loss of Na, K, Mg, Cl and water (not Ca)
- may not be effective in pts with renal probs (except metolazone and indapamide)
- used for HTN, edema, hyPOcalcemia
- toxicity: hypoK, hypouricemia, hypoglycemia, dehydration, hypoNa, hypoMg, hyperCa, increased LDL and total cholesterol, constipation
- pt related variables: gout, DM, allergy to diuretics, renal probs
- interacts with DIGOXIN, LITHIUM (increases levels)
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Spironolactone
- k-sparing diuretic (and Mg sparing diuretic)
- antagonizes aldosterone
- used to block the k-wasting of other diuretics, improve CHF
- toxicity: hyperkalemia, gynecomastia
- pt related variables: interactions with potassium supplement or ACEI to increase serum K, renal failure
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