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cardio:diuretics:start [2026/02/13 00:53] – created andrew2393cnscardio:diuretics:start [2026/02/15 03:28] (current) – andrew2393cns
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 Diuretics alter renal sodium handling to reduce extracellular volume. Diuretics alter renal sodium handling to reduce extracellular volume.
  
-Because water follows sodium, altering sodium reabsorption alters:+Because water follows sodium, altering sodium reabsorption changes:
  
   * Blood volume   * Blood volume
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   * [[cardio:hypertension:start|Hypertension]]   * [[cardio:hypertension:start|Hypertension]]
   * [[cardio:heart_failure:start|Heart Failure]]   * [[cardio:heart_failure:start|Heart Failure]]
-  * Edema states+  * Volume overload states
  
 -------------------------------------------------------------------- --------------------------------------------------------------------
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 ===== Nephron-Based Physiology ===== ===== Nephron-Based Physiology =====
  
-Understanding diuretics requires understanding where sodium is reabsorbed.+Sodium reabsorption by segment:
  
 Proximal Tubule: Proximal Tubule:
-  * ~65% Na⁺ reabsorption+  * ~65%
  
 Thick Ascending Limb: Thick Ascending Limb:
-  * ~25% Na⁺ reabsorption+  * ~25%
  
 Distal Convoluted Tubule: Distal Convoluted Tubule:
-  * ~5% Na⁺ reabsorption+  * ~5%
  
 Collecting Duct: Collecting Duct:
-  * ~3% Na⁺ reabsorption (aldosterone-sensitive)+  * ~3% (aldosterone-sensitive)
  
 Each diuretic class blocks a specific transporter. Each diuretic class blocks a specific transporter.
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 -------------------------------------------------------------------- --------------------------------------------------------------------
  
-===== Loop Diuretics =====+[[cardio:diuretics:carbonic_anhydrase:start|Carbonic Anhydrase Inhibitors]]
  
-Site: Thick Ascending Limb   +Weak Diuretic Effect
-Target: NKCC2 transporter  +
  
-Block:+Agents: 
 +  * [[cardio:diuretics:acetazolamide|Acetazolamide]] 
 +  * Methazolamide 
 +  * Dichlorphenamide
  
-  * Na⁺ +Effect: 
-  * K⁺ +  * ↓ HCO₃⁻ reabsorption 
-  * 2Cl⁻ reabsorption+  * Mild natriuresis 
 +  * Metabolic acidosis 
 + 
 +Clinical Use: 
 +  * Glaucoma 
 +  * Altitude sickness 
 +  * Metabolic alkalosis 
 +  * Periodic paralysis 
 + 
 +-------------------------------------------------------------------- 
 + 
 +[[cardio:diuretics:loop:start|Loop Diuretics]] 
 + 
 +Very Strong Diuresis
  
 Agents: Agents:
- 
   * [[cardio:diuretics:furosemide|Furosemide]]   * [[cardio:diuretics:furosemide|Furosemide]]
   * [[cardio:diuretics:torsemide|Torsemide]]   * [[cardio:diuretics:torsemide|Torsemide]]
   * [[cardio:diuretics:bumetanide|Bumetanide]]   * [[cardio:diuretics:bumetanide|Bumetanide]]
  
-Clinical use: +Clinical Role:
   * Acute pulmonary edema   * Acute pulmonary edema
-  * Volume overload +  * Decompensated [[cardio:heart_failure:start|Heart Failure]]
-  * HFrEF+
   * Advanced CKD   * Advanced CKD
- +  * Severe volume overload
-Strongest natriuresis.+
  
 -------------------------------------------------------------------- --------------------------------------------------------------------
  
-===== Thiazide & Thiazide-Like Diuretics =====+[[cardio:diuretics:thiazide:start|Thiazide & Thiazide-Like Diuretics]]
  
-Site: Distal Convoluted Tubule   +Long-term vascular remodeling benefits.
-Target: NCC transporter   +
- +
-Block: +
- +
-  * Na⁺/Cl⁻ reabsorption+
  
 Agents: Agents:
- 
   * [[cardio:diuretics:hydrochlorothiazide|Hydrochlorothiazide]]   * [[cardio:diuretics:hydrochlorothiazide|Hydrochlorothiazide]]
   * [[cardio:diuretics:chlorthalidone|Chlorthalidone]]   * [[cardio:diuretics:chlorthalidone|Chlorthalidone]]
   * [[cardio:diuretics:indapamide|Indapamide]]   * [[cardio:diuretics:indapamide|Indapamide]]
  
-Primary use: +Clinical Role: 
- +  * First-line therapy for [[cardio:hypertension:start|Hypertension]] 
-  * First-line [[cardio:hypertension:start|Hypertension]] +  * Mild edema
- +
-Moderate natriuresis. +
-Long-term vascular remodeling effects.+
  
 -------------------------------------------------------------------- --------------------------------------------------------------------
  
-===== Potassium-Sparing Diuretics =====+[[cardio:diuretics:mra|Potassium-Sparing Diuretics]]
  
-Site: Collecting Duct +---- Mineralocorticoid Receptor Antagonists (MRAs)
- +
-Two mechanisms: +
- +
-Mineralocorticoid Receptor Antagonists (MRAs):+
  
   * [[cardio:hf:spironolactone|Spironolactone]]   * [[cardio:hf:spironolactone|Spironolactone]]
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 Block aldosterone receptor. Block aldosterone receptor.
  
-Direct ENaC Blockers:+Used in: 
 +  * HFrEF (mortality benefit) 
 +  * Resistant [[cardio:hypertension:start|Hypertension]] 
 + 
 +---- Direct ENaC Blockers
  
-  * Amiloride +  * [[cardio:diuretics:amiloride|Amiloride]] 
-  * Triamterene+  * [[cardio:diuretics:triamterene|Triamterene]]
  
 Block epithelial sodium channel. Block epithelial sodium channel.
  
-Clinical use: +Electrolytes: 
- +  * ↑ K⁺ (risk of hyperkalemia)
-  * Resistant hypertension +
-  * Heart failure (mortality benefit for MRAs) +
-  * Prevent hypokalemia+
  
 -------------------------------------------------------------------- --------------------------------------------------------------------
  
-===== Carbonic Anhydrase Inhibitors ===== +[[cardio:diuretics:osmotic:start|Osmotic Diuretics]]
- +
-Site: Proximal Tubule   +
- +
-Target: +
- +
-  * Carbonic anhydrase+
  
 Agent: Agent:
- +  * [[cardio:diuretics:mannitol|Mannitol]]
-  * Acetazolamide +
- +
-Cause: +
- +
-  * Bicarbonate loss +
-  * Mild natriuresis +
-  * Metabolic acidosis +
- +
-Clinical use: +
- +
-  * Glaucoma +
-  * Altitude sickness +
-  * Metabolic alkalosis +
- +
-Weak diuretic effect. +
- +
--------------------------------------------------------------------- +
- +
-===== Osmotic Diuretics ===== +
- +
-Site: Proximal Tubule & Loop   +
- +
-Agent: +
- +
-  * Mannitol+
  
 Mechanism: Mechanism:
- 
   * Increases tubular osmotic pressure   * Increases tubular osmotic pressure
-  * Pulls water into tubular lumen +  * Pulls water into lumen
- +
-Use:+
  
 +Clinical Use:
   * Cerebral edema   * Cerebral edema
   * Increased intracranial pressure   * Increased intracranial pressure
 +
 +Not used for chronic hypertension.
  
 -------------------------------------------------------------------- --------------------------------------------------------------------
  
-===== Diuretics & Electrolytes ===== +===== Electrolyte Comparison =====
- +
-Loops:+
  
 +Loop Diuretics:
   * ↓ K⁺   * ↓ K⁺
   * ↓ Mg²⁺   * ↓ Mg²⁺
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 Thiazides: Thiazides:
- 
   * ↓ K⁺   * ↓ K⁺
   * ↑ Ca²⁺   * ↑ Ca²⁺
  
 MRAs: MRAs:
- 
   * ↑ K⁺   * ↑ K⁺
  
 Carbonic Anhydrase Inhibitors: Carbonic Anhydrase Inhibitors:
- 
   * ↓ HCO₃⁻   * ↓ HCO₃⁻
  
-Electrolyte monitoring is essential.+Monitoring electrolytes is essential.
  
 -------------------------------------------------------------------- --------------------------------------------------------------------
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 Hypertension: Hypertension:
- +  * [[cardio:diuretics:chlorthalidone|Chlorthalidone]] preferred over [[cardio:diuretics:hydrochlorothiazide|HCTZ]]
-  * [[cardio:diuretics:chlorthalidone|Chlorthalidone]] preferred+
  
 Heart Failure: Heart Failure:
- +  * [[cardio:diuretics:loop:start|Loop Diuretics]] for congestion 
-  * [[cardio:diuretics:furosemide|Loop Diuretics]] for congestion +  * [[cardio:hf:spironolactone|Spironolactone]] for mortality reduction
-  * [[cardio:hf:spironolactone|Spironolactone]] for mortality benefit+
  
 Resistant Hypertension: Resistant Hypertension:
- 
   * Add [[cardio:hf:spironolactone|Spironolactone]]   * Add [[cardio:hf:spironolactone|Spironolactone]]
  
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   * Sodium drives water   * Sodium drives water
-  * Loops are strongest +  * Loops are most potent 
-  * Thiazides best for chronic HTN+  * Thiazides are best chronic BP agents
   * MRAs reduce mortality in HFrEF   * MRAs reduce mortality in HFrEF
-  * Always monitor potassium +  * Hyperkalemia risk with MRAs and ENaC blockers 
-  * Electrolyte shifts define each class+  * Electrolyte patterns define each class
  
 -------------------------------------------------------------------- --------------------------------------------------------------------
cardio/diuretics/start.1770944033.txt.gz · Last modified: by andrew2393cns