Saturday, January 31, 2015

Study group discussion: Diuretics

Which diuretic would you use in a person who has a previous history of skin rashes by the use of sulphonamides?

The only loop diuretic you can use in a patient with sulfa drug allergy is ethacrynic acid.
Also, you have to monitor the levels... Because ethacrynic acid is the most ototoxic.

There is an antibiotic that causes ototoxicity too. Which one?

Aminoglycosides!
Why would a patient on aminoglycosides have muscle weakness?

It causes neuromuscular blockade!
Mechanism?
They block neurotransmitter secretion.

Why are thiazides not used in renal failure? But loop diuretics are?

Loop diuretics have no effect on the GFR, whereas thiazides decrease GFR. 
Cool fact: Metalozone is the only thiazide which can be used in renal failure. 

What causes lithium toxicity? What is the drug of choice for lithium toxicity? Both of the answers are one or the other diuretics. 

Thiazides causes lithium toxicity, which is Nephrogenic diabetes insipidus.
Drug of choice is Amiloride. It blocks the sodium channels..So lithium is not absorbed back again. 

Which is the only diuretic acting from the interstitial side of the tubules?

Spironolactone, eplinerone -The aldosterone antagonist. 
Aldosterone antagonist blocks the aldosterone receptors from the interstitial side..Which decreases sodium chloride channels.

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