Anesthesia Pharmacology: Renal Pharmacology
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Primary site of action of loop diuretics:
- distal tubule
- collecting duct
- thin descending limb of the loop of Henle
- thick ascending limb of the loop of Henle
- at the site of glomerular filtration
Examples of loop diuretics in clinical use:
- torsemide (Demadex)
- bumetanide (Bumex)
- ethacrynic acid (Edecrin)
- A & B
- A, B & C
Loop diuretics: Pharmacokinetics
- rapidly absorbed
- eliminated by renal secretion only
- eliminated by glomerular filtration only
- loop diuretics act on the interstitial side of the principal cell
- indomethacin (Indocin) increases loop diuretic clearance
Loop diuretics: Effects on magnesium and calcium excretion
- increase in magnesium secretion
- increase in calcium secretion
- hypomagnesemia in patients (prolonged loop diuretic use)
- No hypocalcemia in patients (prolonged loop diuretic use)
- all of the above
clincial uses of loop diuretics:
- acute hypercalcemia
- pulmonary edema
- hyperkalemia
- bromide overdosage
- all of the above
Most efficacious diuretic in management of acute pulmonary edema secondary to congestive heart failure.
- chlorothiazide (Diuril)
- mannitol (Osmitrol)
- bumetanide (Bumex)
- carbonic anhydrase inhibitor
- spironolactone (Aldactone)
Diuretic most likely to cause alkalinization of the urine:
- torsemide (Demadex)
- acetazolamide (Diamox)
- ethacrynic acid (Edecrin)
- chlorothiazide (Diuril)
- none of the above
Furosemide (Lasix) toxicity:
- ototoxicity
- hypouricemia
- hypermagnesemia
- severe fluid overload
- hypernatremia