Acetazolamide

Tx: short-term diuresis, glaucoma (↓eye fluid), altitude sickness (metab. acidosis→  ↑resp. drive), unrinary alkalinization, epilepsy

Ax: Carbonic Anhydrase Inhibitor - acts at PCT,

inhibits CA (inhibits NaHCO3 reabsorb.),

↑HCO3 secretion, ↓Na+ reabsorb., ↓H+ secretion

SE: metabolic acidosis, kidney stones, renal wasting of K+

Ms: oral (F = 100%), short-term use (ineffective after several days of use)

Ethacrynic Acid

Furosemide

Bumetanide

Torsemide

Tx: Pulmonary edema, CHF, HTN, nephrotic/liver edema, hyperclacemia

Ax: Loop Diuretics - acts on thick ascending limb, inhibits Na+/K+/2Cl- cotransporter,

↑Na+?Cl-/Ca2+/Mg2+/K+/H+ secretion (FeNa=25-30%)

SE: fluid electrolyte imbalance - hypokalemia & hypochloric, Metabolic acidosis - hyperuricemia & hypomagnesemia, ototoxicity (reversable), allergic rxn (sulfa drugs)

Chlorothiazide

Hydrochlorothiazide

Chlorthalidone

Tx: edema, CHF, liver & renal dysfunction, HTN, hypocalcemia, kidney stones (from hypercalciuria), nephrogenic diabetes insipidus

Ax: Thiazide Diuretics - act at DCT,

 inhibit Na+/Cl- symporter,

↑Na+/Cl-/K+/H+ secretion (FeNa=5-7%)

SE: fluid electrolye imbalance - hypokalemia & hypochloric, Metabolic acidosis - hyponatremia & hyperuricemia, ↑cholesterol/LDL (5-15%), Allergic rxn (sulfa drugs)

Amiloride

Triamterene (A+T)

Spironolactone

Eplerenone (S+E)

Tx: combo tx with loop + thiazide diuretic (↓ K+ loss), sprironolactone/eplerenone: primary + secondary hyperaldosteronism

Ax: K+-sparing diuretics - act on collecting duct, A+T - block Na+ channels (lumen less neg: ↓K+/H+/Ca/Mg secrertion), S+E - competative aldosterone blockers (no

↑Na+ pumps, so no K+/H+ secretion)

SE: Hyperkalemia (must monitor K+), metabolic acidosis (no H+ when retain K+)

Ms: S+E slow onset (2days) due to change in gene expression

Mannitol

Tx: Acute renal failure, glaucoma, ophthalmic/neurosurg (dry eye, ↓brain mass)

Ax: Osmotic diuretic - ↑Posm→ ↑renal bloodlfow,

flitered into lumen → ↓salt + water reabsorb. (PCT)→ ↓medulla toxicity, hi-volume dilute urine

SE: short use, i.e. less than 1 day (not typically a diuretic)

Ms: Only IV, Does not ↑GFR, 80% renal elim., t½=15min-1.5hrs (kidney failure 6-36hrs)