Diuretics

Diuretics

DIURETICS

INDUCE DIURESIS -- > INCREASE URINE VOLUME

Classification

1. Acetic anhydride inhibitor 
2. Osmotic Diuretics
3. Potassium sparing diuretics
4. Loop diuretics 
5. Thiazides

DRUGS CLASSIFICATION 

1. Acetic Anhydrase Inhibitor (AAI)
eg. ACETAZOLAMIDE

- weak diuretics.
- Act on PCT (proximal convoluted tubule).
- it increases NAHCO3 excretion, making your urine alkaline & salty.
- INCREASE NA/H20 EXCRETION.

“ACID”azolamide causes ACIDosis.

USES

Mnemonics ''GUMA''

• Glaucoma 
• Urinary alkalizer 
• Metabolic alkalosis 
• Prophylaxis of mountain sickness 

A/E
Mnemonics ''ACID MANS''
- hypercholemia metabolic acidosis
- neuropathy (due to increase seizure threshold)
- ammonia toxicity (ammonia reabsorption -->hepatic encephalopathy)
- sulfa allergy (renal damage, crystalluria, rash, blood dysrasia)


But if you’re allergic to sulfur, then you better adjust your doses. Don’t take too much since it could cause hyperchloremic metabolic acidosis.


2. OSMOTIC DIURETICS:
it targets your PCT, makes you pee, and increases fluid osmolarity.

Mnemonic ''GUM''

• Glycerol
• Urea
• Mannitol

MANNITOL

Uses: '' BCGS''
B- Barturate Poisoning
C- Cerebral Edema
G- Glaucoma
S- Stroke /Shock

C/I : ''CAP'

• If cerebral hemorrphage --> C/I ( as Mannitol can escape from hemorrphagic vessels & cause dehydration of brain cells via osmotic action) 
• Pulmonary edema 
• anuria ??? 
• CHF (it causes tachycardia) 

*** If you have CHF or Anuria, DON’T take mannitol if you know whats good for ya!


3. THIAZIDE DIURETICS
Hydrochlorothiazides
Chlorothiazides

THIAZIDE - 1ST DOC for HYPERTENSION.

• MoA - Act on DCT (distal convoluted tubules).
• Increase Na, K, Cl, H20 excretion.
• Increase Calcium reabsorption. 

Thiazide diuretics use (4) MNEMONIC ''HE IS DOCTOR'' - DOC FIRST IN HTN^^

• HTN
• CHF
• idiopathic hypercalcuria
• nephrogenic diabetes insipidus
• Generalised Edema 

SE of thiazide diuretics (4)
HyperGLUC

• glycemia
• lipidemia
• uricemia
• calcemia

C/I THIAZIDES = diabetes, dyslipidemia, gout, young patients




4. LOOP DIURETICS

• ethacrynic acid
• furosemide
• bumetanide
• torsemide

(most effective diuretics)

What is different about ethcyrnic acid compared to the other loop diuretics ???(important)

it is not a sulfonamide thus it can be used when a pt has a sulfa allergy
If you are allergic to sulfur yet edematous & want to live, take ethacrynic acid instead cause its a phenoxyacetic acid derivative.

Loop diuretics use (3)

• Edema (CHF, cirrhosis, nephrotic syndrome)
• HTN
• hypercalcemia

Loop diuretics SE (6)(mnemonic) OH DANG
O -ototoxicity
H- hypokalemia
D- dehydration
A - sulfa allergy
N -nephritis (interstitial)
G- gout


D/I
Mnemonics ''L and D''
L = Lithium - decreased clearance

A = Aminoglycosides ( due to ototoxicity)

D = Digitalis (due to hypokalemia)


5. POTASSIUM SPARING DIURETICS

increase excretion of Na, Cl, H20 but RETAIN POTASSIUM K. 

(mnemonic) K+ STAys
Spironolactone
triamterene
amiloride

2 different MoA (depends on locations)
- Disted Convoluted Tubule (DCT) --> Triamterene, Amiloride . 

-Collecting Tubule(CT) --> spironolactone

Treatment

• - hypertension often combination with thiazide diuretics or loop diuretics. 
• - hypoaldosteronism. 

SE (2)

• hyperaldosteronism
• hyperkalemia 
• gynecomastia (via an antiandrogen effect)