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Exam 3

main purpose of diuretics

increase urine output
eliminate excess fluid from the body
lowers blood pressure

kidneys

at level of umbilicus
22% of cardiac output
active organ
decreased blood flow to it can cause renal damage or failure

nephron

functional unit of the kidney

glomerular filtration

20% of total blood flow thru nephron
99% reabsorbed in tubules
1% excreted as urine
adult output = 30 to 60 ml/hour

aldosterone

is a mineralocorticoide secreted by the adrenal cortex
increases NA & H2O reabsorption in distal tubule

acid base balance

Na reabsorption
with Cl to preserve neutrality
exchange of Na for H or K

5 major diuretic groups

carbonic anhydrase
osmotic diuretics
loop diuretics
thiazide diuretics
potassium sparing

carbonic anhydrase inhibitors

increase diuresis of sodium bicarbonate
poor diuretic b/c ends up being reabsorbed in the loop of Henle
inhibitors block Na & HCO3 in PCT

Loop diuretics KNOW

inhibit the reabsorption of Na, Cl
the most potent diuretics
use for pulmonary edema, renal failure, CHF, heart failure, edema
act principally at the thick ascending limb of the loop of Henle

most common diuretics used KNOW

Forosemide (Lasix)
Bunetanide (Bumex)

thiazide diuretics

block Na & Cl reabsorption in the distal tubule
less potent than loop
indications: mild edema, HTN

osmotic diuretics

block reabsorption of NaCl in the proximal tubule & descending limb of the loop of Henle
up to 20% of filtered load NaCl & water to be excreted in the urine

Mannitol KNOW

selected agent
lower toxicity
short half life
rapid onset
maintained continued diuretic action
continuous infusion
used with head injury

potassium sparing

block reabsorption of Na in the distal tubule
in the distal tubule:
Na is exchanged for potassium & hydrogen
blocking this exchange makes these agents potassium sparing diuretics

diuretic complications

volume depletion & electrolyte imbalance - most common
hypokalemia thru volume loss & electrolyte shifts-loops especially
acid base imbalance
hyperglycemia
tinnitus & hearing loss

classification of Lasix & Bumex

loop diuretics

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