more an 99% of water, electrolytes, and nutrients, that are filtered at the glomerulus undergo
reabsorption.
most diuretics block active reabsorption of _______ and ________ , and thereby prevent passive reabsorption of _________
sodium, chloride, water
the amount of diuresis produced is directly related to
the amount of sodium and chloride reabsorption blocked.
drugs that act ______ in the nephron are in a position to block the greatest amount of solute reabsorption, and hence produce the greatest diuresis
early
______ _____________ block sodium and chloride reabsorption in the loop of Henle
loop diuretics
________ ___________ produce the greatest diuresis
loop diuretics
in contrast to thiazide diuretics, loop diuretics are effective even when the _________ ___________ _________ is low.
glomerular filtration rate
loop diuretics can cause dehydration through __________ _________ ___________
excessive fluid loss
loop diuretics can cause hypotension by decreasing _______ _________ and relaxing _______ _________ ____________.
blood volume, venous smooth muscle
loop diuretics can cause _________ __________ which, fortunately, is usually reversible.
hearing loss
hypokalemia caused by loop diuretics is a special problems for patients taking _________
digoxin
thiazide diuretics block ______ and _____ reabsorption in the early ___________ _____________ ______________.
sodium, water, distal convoluted tubule.
what causes less diuresis? Loop or Thiazide diuretics
Thiazide
thiazide diuretics are ineffective when
glomerular filtration rate is low.
what is an example of a prototype drug that is a loop diuretic?
furosemide (lasix)
what is an example of a prototype drug that is thiazide diuretic?
hydrochlorothiazide
what is an example of a prototype drug that is a potassium sparing diuretic?
spironolactone and triamterene
the use of furosemide can produce ________ __________ and ________. severe dehydration can result and this can promotes ________
excessive loss of sodium, chloride, and water,
promotes hypotension, thrombosis, and embolism.
like the loop diuretics, thiazide diuretics can cause ______________ and ______________. however, thiazides do not cause hearing loss.
dehydration and hypokalemia
thiazide-induced _____________ is a special problem for patients taking digoxin
hypokalemia
potassium-sparing diuretics act by directly or indirectly blocking __________-__________ "____________" in the distal convoluted tubule
sodium-potassium "exchange
potassium-sparing diuretics cause only __________ diuresis
modest
potassium-sparing diuretics are used primarily to counteract _________ _______ in patients taking loop diuretics or thiazides
potassium loss
the principal adverse effect of potassium-sparing diuretics is ____________
hyperkalemia
because of the risk of hyperkalemia, use caution when combining potassium-sparing diuretics with
taking another K+ sparing diuretic, with potassium supplements, and in patients taking ACE inhibitors, angiotensin receptor blockers, or direct renin inhibitors.
loop diuretics and thiazides are used to treat hypertension and edema associated with
(1)_______ ________,
(2)______________,
and
(3) ________ __________
Heart failure, cirrhosis, and kidney disease
what ways are loop diuretics given?
PO,IV, IM
What are the loop diuretics adverse effects
Dehydration: due to excess fluid loss (can lead to thrombosis and embolism)
Electrolyte loss: hypoatremia, and hypokalemia
Orthostatic hypotension
Hyperglycemia
Ototoxicity
Hypokalemia
what are the thiazides adverse effects?
Electrolyte loss: too low Na+ and K+
Orthostatic hypotension
Hyperglycemia
what are the K+ sparing aldosterone antagonists adverse effects?
hyperkalemia
fatal heart dysrythmias
endocrine effects (menstrual irregularities, deeper voice, hirsutism, gynecomastia)
what are K+ sparing nonaldosterone antagonist adverse effects?
Hyperkalemia
Diuretic + digoxin
often lead to hypokalemia
diuretic + lithium
often lead to hypoatremia
Diuretic + blood pressure
often lead to hypotension
Furosemide+ another ototoxic drug
can lead to worse hearing loss
NSAIDS+ diuretics
can decrease the effects of diuretics