Diuretics

# Drug Mechanism of Action Actions Therapeutic Uses Adverse Effects

1. ● Thiazides (most ● Inhibit Na/Cl co- ● Unique in that ● Mainstay of ● K depletion –
widely used) transporter in DCT they cause diuresis antihypertensive supplementation
● Chlorothiazide ● Secreted in lumen, with hyperosmolar therapy or spironolactone
● Hydrochlorothiazide so efficacy urine ● Lower peripheral (if due to high
● Chlorthalidone decreases with dec. ● Loss of K due to resistance aldosterone due to
(thiazide-like renal function increased Na without major volume
diuretic, long ● Efficacy reduced delivery to diuretic effect contraction)
duration of action so with NSAIDs due to collecting duct ● Heart failure to ● Hyponatremia –
dosed once daily in reduced RBF ● Loss of Mg augment loops ADH due to vol
HTN) ● Oral (unclear how) ● Idiopathic contraction
● Metolazone (works ● Promote Ca hypercalciuria ● Hyperuricemia –
even in advanced reabsorption at ● Nephrogenic competes for
renal failure) distal tubule diabetes secretion
● Indapamide ● Reduce peripheral insipidus due to ● Orthostatic
(antihypertensive in vascular resistance production of hypotension
low doses, excreted (mechanism of hyperosmolar ● Hypercalcemia
via feces so good for vasodilation urine ● Hyperglycemia –
renal failure unknown) monitor diabetics
patients)

2. Loop diuretics ● Inhibit Na/K/2Cl in ● Increases urinary ● DOC for acute ● Ototoxicity –
ascending limb – Ca content pulm. edema increased with
Furosemide (most
greatest diuretic without causing ● DOC for aminoglycosides
commonly used in this
effect of all diuretics hypocalcemia as acute/chronic (ethacrynic most
class), torsemide,
● Oral/IV calcium gets peripheral common)
ethacrynic acid
absorbed in DCT edema from ● Hyperuricemia –
● NSAIDs reduce heart failure or furosemide and
action renal impairment ethacrynic acid
● Hypercalcemia ● Acute
● Hyperkalemia hypovolemia
● Potassium
depletion –
supplementation
● Hypokalemic
alkalosis as K
exchanged for H
by cells
● Hypo-magnesia in
chronic use –
supplementation
Diuretics
 Diuretics

# Drug Mechanism of Action Actions Therapeutic Uses Adverse Effects

3. Potassium-sparing diuretics

3A. Aldosterone ● Inhibit Na reabsorption ● Effect may be ● Given with loops ● Spironolactone –
antagonists and K secretion at diminished with or thiazides to resembles sex
collecting tubule NSAIDs prevent K steroids,
(spironolactone
● Antagonize depletion gynecomastia in
and eplerenone)
aldosterone ● Spironolactone – males and
intracellularly because DOC in cirrhosis menstrual
they are steroids because edema irregularities in
● Oral due to high females
● Spironolactone – aldosterone ● Hyperkalemia – use
potent inhibitor of P- ● Nephrotic carefully with other
glycoprotein syndrome – high K increasing drugs
● Eplerenone – met. by ald. levels
CYT P450 ● Reduce mortality
in HF
● Resistant HTN
often responds to
these
● Ascites
● PCOS – off-label,
block androgen
receptors

3B. Triamterene and ● Block Na transport ● Ability to block Na/K ● Commonly used ● Triamterene –
amiloride channels, reducing Na- exchange doesn’t with other increased uric acid,
K exchange depend on the diuretics renal stones, and K
● Actually block ENaC in presence of retention
collecting ductule aldosterone

4. Carbonic ● Inhibits CA in PCT ● Increase phosphate ● Open-angle ● Metabolic acidosis

anhydrase ● Less exchange of H for excretion via glaucoma – ● K depletion
inhibitor – Na by the cells unknown reduce aqueous ● Renal stone
acetazolamide ● HCO3 is not mechanism humor formation
reabsorbed – production ● Paresthesia
hyperchloremic (non- (topical drugs like
AG) metabolic acidosis dorzolamide and
● IV/oral brinzolamide
have less
systemic effects)
● Prophylaxis of
mountain
 Diuretics

sickness

# Drug Mechanism of Action Actions Therapeutic Uses Adverse Effects

5. Osmotic diuretics ● increase urine ● maintain urine ● extracellular water
(mannitol and osmolarity to pull out flow following expansion and
urea) water ingestion of hyponatremia
● not useful for toxins that could ● can also cause
conditions in which Na lead to ARF hypernatremia
retention occurs ● mainstay of
● Mannitol should be treatment for
given IV – not raised ICP
absorbed orally

● Most diuretics are secreted into the urine via the organic acid secretory system located in
the middle-third of the PCT.
Diuretics