inhibit Na/Cl cotransport on distal convoluted tubule
thiazide (low ceiling)
Chlorothiazide (Diuril)
thiazide
Hydrochlorothiazide (Esidrix)
thiazide
Bendroflumethiazide (Naturetin)
thiazide
Indapamide (Lozol)
thiazide
Chlorthalidone (Hygroton, Thalinone)
thiazide
Metolazone (Mykrox, Zaroxolyn)
thiazide
Block carbonic anhydrase (CA) in the proximal convoluted tubule and prevent reabsorption of bicarbonate
Carbonic anhydrase inhibitors
Weak diuretics used clinically to correct acid-base disturbances (alkalosis)
Carbonic anhydrase inhibitors
used locally to tx glaucoma
Dorzolamide (Truopt)
May cause [at the exception of dorzalamide]: metabolic acidosis; increased serum levels of weak bases; hypokalemia; hyperuricemia; hyperammonemia
Carbonic anhydrase inhibitors
Acetazolamide (Diamox, sequel)
Carbonic anhydrase inhibitors
Dichlorphenamide (Daranide)
Carbonic anhydrase inhibitors
Methazolamide (Neptazane)
Carbonic anhydrase inhibitors
Dorzolamide (Trusopt)
Carbonic anhydrase inhibitors
Weak diuretic, used clinically to reduce blood glucose levels in type 2 diabetes
Sodium/glucose cotransporter inhibitors
Canagliflozin (Invokana)
Sodium/glucose cotransporter inhibitors
Dapagliflozin (Farxiga)
Sodium/glucose cotransporter inhibitors
Ampagliflozin (Jardiance)
Sodium/glucose cotransporter inhibitors
Block glucose and sodium cotransport (SGLT2) on proximal convoluted tubule
Sodium/glucose cotransporter inhibitors
May cause hypoglycemia and increase the risk of urinary track infections
Sodium/glucose cotransporter inhibitors
Very efficient diuretics used for the Prophylaxis of renal failure
Osmotic agents
Used to reduce intracranial pressure in cerebral edema
Osmotic agents
Easily filtered by glomerulus but not reabsorbed results in large water loss.
Osmotic agents
contraindicated in established renal failure
Osmotic agents
Will transiently increase extracellular volume leading to worsening, then will get better.
Osmotic agents
In the presence of kidney failure can cause serious edema and heart failure
Osmotic agents
Mannitol (Osmitrol)
Osmotic agents
Glycerol (Osmoglyn)
Osmotic agents
treatment of choice for edema due to cirrhosis or heart failure.
Loop diuretics (high ceiling)
Treatment of choice for all type of edematous states in patient with creatine clearance below 30 mL/min.
Loop diuretics (high ceiling)
Used for pulmonary edema.
Loop diuretics (high ceiling)
Used for acute hypercalcemia
Loop diuretics (high ceiling)
Act by inhibiting the Na+/K+/2Cl- cotransporter (NKCC2) in the thick ascending limb of the loop of Henle
Loop diuretics (high ceiling)
May cause hypokalaemia (potassium wasting)
Loop diuretics (high ceiling)
may increase blood glucose.
Loop diuretics (high ceiling)
May cause; hypokalaemia (potassium wasting) and metabolic alkalosis; hypomagnesaemia; hyperuricemia; may also increase blood glucose.
Loop diuretics (high ceiling)
Bumetanide (Bumex)
Loop diuretics (high ceiling)
Ethacrynic acid (Edecrin)
Loop diuretics (high ceiling)
Furosemide (Lasix)
Loop diuretics (high ceiling)
Torsemide (Demadex)
Loop diuretics (high ceiling)
Used in primary hyperaldosteronism
Aldosterone antagonists (potassium sparing)
To counteract potassium loss caused by more powerful diuretics
Aldosterone antagonists (potassium sparing)
reduces the expression of sodium channel and Na+K+ATPase in distal end of distal convoluted tubules, which results in decreased Na+ reabsorption and K+ excretion in the urine.
Aldosterone antagonism
Antiendrogenic effect can lead to impotence and gynecomastia [less with Eplerenone]
Aldosterone antagonists (potassium sparing)
Spironolactone (Aldactone)
Aldosterone antagonists (potassium sparing)
Eplerenone (Inspra)
Aldosterone antagonists (potassium sparing)
Triamterene (Dyrenium)
Used to counteract potassium loss caused by more powerful diuretics
Amiloride (Midamor)
Used to counteract potassium loss caused by more powerful diuretics
May cause hyperkalemia
Other potassium sparing agents
Disrupt sodium-potassium exchange in the distal nephron indirectly by inhibiting epithelial sodium channels (ENaC)
Other potassium sparing agents
Used in syndrome of inappropriate ADH secretion including heart failure
Vasopressin antagonists
induces translocation of aquaporin (AQP2) to the membrane of collecting ducts
Vasopression (ADH)
V1a and V2 receptor antagonist
Conivaptan (Vaprisol)
V2 receptor antagonist
Tolvaptan
Infusion site reactions are common
Vasopressin antagonists
Conivaptan (Vaprisol)
Vasopressin antagonists
Tolvaptan (Samaca)
Vasopressin antagonists
K+ and Na+ strongly excreted
loop diuretics
K+ and Na+ moderately excreted
thiazides
Na+ strongly excreted, K+ weakly excreted
Osmotic diuretics
used to treat congestive heart failure
loop diuretics
used to treat cirrhosis
loop diuretics
used to treat pulmonary edema
loop diuretics
used to treat nephrotic syndrome
loop diuretics
used to tx renal impariment
loop diuretics
used to treat glaucoma
carbonic anhydrase inhibitors
used to tx high-altitude sickness
carbonic anhydrase inhibitors
used to tx nephrolithiasis
thiazides
used to tx htn
thiazides
used to tx diabetic insipidus
thiazides
used to tx hyercalcemia
loop diuretics
used to tx hyperaldosteronism
K+ sparing diuretics
used to tx hypokalemia
K+ sparing duretics