by aplaca


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Acetazolamide
Block Na+/H+ antiporter; inhibits HCO3- reabsorption & carbonic  anhydrase
↓ CSF & intraocular volume
Glaucoma, epilepsy, acute mountain sickness
Site 1
Complications:
Alkalinized urine - hyperchloremic metabolic acidosis
Furosemide
Loop, Site 2
Block Na+/K+/2Cl- (NKCC2); acts on tubular side of cell; effective natriuretic; ↑ RBF
Use: vasodilator, diuresis
Edema (acute and/or pulmonary), ↑ Ca2+; HTN in pts w ↓ RBF

Complications:
↓K+ Mg2+,ototoxicity, hyperglycemia, hypertriglyceridemia, GI problems, hypochloremic metabolic alkalosis, hypotension
Secreted into proximal tubule, Counter-current wash out
Bumetanide
Loop, Site 2
NKCC2 blocker; 4x as potent as furosemide
Use: diuresis, vasodilator
Diabetic pts or pts allergic to furosemide
Complications:
ototoxicity, hypokalemia, dehydration, allergy (sulfa), nephritis, gout


Ethacrynic acid
Loop, Site 2
NKCC2 blocker w/o sulfonamide group
Pts w/ sulfa allergy
Complications:
More GI problems, less hyperglycemia

Torsemide
Loop, Site 2
NKCC2 blocker w/ 2x greater bioavailability
Note: Long half-life (QD dose)
Chlorothiazide
Thiazide, Site 3
Block Na+/Cl- cotransport; produce hyperosmolar urine
Use: long-term therapy
HTN management, CHF, hypercalciuria, mild edema, diabetes insipidus
Long half-life
Complications:
↓ K+; ↓ Na+; hyperuricemia; orthostatic hypotension, ↑ Ca2+, ↑ glucose, hyperlipidemia; hypersensitivity; impaired Li+ excretion; metabolic alkalosis; toxic with digitalis; decrease RBF
Hydrochlorothiazide
Thiazide, Site 3
NCC blocker, more potent than CTZ
Chlorthalidone
Quinethazone
Indapamide
Thiazide, Site 3
Metolazone
Thiazide, Site 3
AND PCT
Complications:
(+) phosphaturia
Spironolactone
K+-sparing, Site 4
Aldosterone receptor antagonist (competitive); blocks aldosterone Na+/K+ exchange; inhibits K+ loss
Use:Slight Na+ excretion & diuresis
K+ protection from diuretics; strong action in CHF or liver cirrhosis, hyperaldosteronism
Complications:
Hyperkalemia (bad in DM or ↓ GFR); gynecomastia, impotence, menstrual irregularities
Eplerenone
K+-sparing, Site 4
Specific mineralocorticoid receptor antagonist
Use:Combo w/ site 3 diuretics
HTN, post-MI, K+ protection
Complications: Hyperkalemia
Triamterene
K+-sparing, Site 4
Physiologic antagonist of aldosterone (electrogenic, fast-acting); inhibits Na+ channel influx, dissipates transepithelial potential
Use:Combo w/ site 3 diuretics
HTN, post-MI, K+ protection
Complications: Rare nephrotoxicity w/ indomethacin
Amiloride
K+-sparing, Site 4
Physiologic antagonist of aldosterone (electrogenic, fast-acting); inhibits Na+ channel influx, dissipates transepithelial potential
Use:Combo w/ site 3 diuretics
HTN, post-MI, K+ protection
Complications:hyperkalemia, increased Li reabsorption, elevate urate
Dopamine
Hemodynamic
a1, b1, DA receptor agonist
↑ blood flow & GFR, ↓ counter-current exchange
Use: Renal vasodilator
w/ dobutamine post-MI
Caffeine
Hemodynamic
Vasa recta
Mannitol
Osmotic, plasma compartment
Countercurrent washout, 4 attributes: inert, osmotically active, filtered not reabsorbed, not metabolized; prevent reabsorption of water
Cerebral edema, glaucoma, prophylaxis of acute renal failure

Complications: Excess CSF vol if removed rapidly: HA, nausea, vomiting; contraindicated in anuria, peripheral edema, CHF, & dehydration
Isosorbide
Osmotic, plasma compartment Countercurrent washout, 4 attributes: inert, osmotically active, filtered not reabsorbed, not metabolized; prevent reabsorption of water 
Cerebral edema, glaucoma, prophylaxis of acute renal failure
Use: eye surgery
Complications: Excess CSF vol if removed rapidly: HA, nausea, vomiting; contraindicated in anuria, peripheral edema, CHF, & dehydration
Glycerol
Osmotic, plasma compartment Countercurrent washout, 4 attributes: inert, osmotically active, filtered not reabsorbed, not metabolized; prevent reabsorption of water 
Cerebral edema, glaucoma, prophylaxis of acute renal failure
Complications: Excess CSF vol if removed rapidly: HA, nausea, vomiting; contraindicated in anuria, peripheral edema, CHF, & dehydration
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