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CVS Pharma papre 1 > مدرات البول > Flashcards

مدرات البول Flashcards

1
Q

بسم الله الرحمن الرحيم وبه نستعين
فارج الهم كاشف الغم مجيب دعوة المضطرين رحمن الدنيا والاخرة ورحيمهما ارحمنا رحمة تغنينا بها عن رحمة من سواك
تغنينا: فعل مضارغ مرفوع وقعت الجملة الفعلية في محل الصفة ل رحمة وليست في محل جواب الطلب ل ارحمنا

ACEI & NSAIDs # in

A

renal hypoperfusion state

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2
Q

Renal hypoperfusion state casues?

A 
Hypovolemia
Extensice dose of loop diretics
Heart failure
Liver cirrhosis
Nephrotic syndrome

ACEI Efferet VC
NSAIDS Afferent VD
Renal Hypoperfusion

Marked decrease in IGP And GFR

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3
Q

Glmerultubular balance?

tubuloglomerulat balance

A

in low GFR there is great reabsoprtion of Na Ca and H2O from tubule decreaisng urine volume

passage of Nacl in high amount to the macula densa decreasing PG synthesis thus decreaing VD of afferents so less GFR

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4
Q

Hypercalcemia and dehydration

A

Casuing vomiting and polyureae and dehydfration decreasing GFR and so increasing Reabsorption of Ca maitain the hypercalacemic state

IV saline to resolve the dehydration decreasing ca reabosortion
Loop direutic preventing reabsotption of Ca from Loop of Henle

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5
Q

CLASSIFICATION OF DIURTEIC ACCORDING TO K?

A 
LOSING?
Loop
thiazide
CAEI
OSMOTIC

SPARING?>
Spironolactone , eplrenone
Amiloride , Triametrene

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6
Q

related to its natruretic effect

A

❖ High ceiling: Loop
❖ Moderate: Thiazides
❖ Low: K+ spairing & CAIs

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7
Q

All diureitcs except ? have to reach to the lumen of nephron to act → any defect in the delivery of diuretics to
lumen → ↓ responsee

A

spironolactone

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8
Q

Mannitol (osmotic diuretic): enters through GF. So Mannitol is # in ???because it can’t access to nephron → remain in blood → ?????? (Dilutional hyponatremia, Acute HF,…)

A

acute renal failure

circulatory overload

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9
Q

Loop & Thiazides: enter lumen through ??? → compete with→??

contraindicated in?

A

organic acid secreory system
uric acid secretion

Hyperuricemia and Gout

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10
Q

Amiloride & triamterene: → can be used in Gout??? why

A

enter through organic base secretory system

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11
Q

Loop diuretics: Their access to the lumen in renal failure is decreased due to accumulation of acid waste products in
blood → ↓ diuretic effect (Refractoriness: ↓ effect due to chronic use). Treatment:

A

↑ the dose of loop diuretics قرص ك

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12
Q

Spironolactone: enters to cells of DCT from ??????? to compete with aldosterone on its receptors

A

peritubular capillaries

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13
Q

thiazides + loop diuretic

A

In case of : Hyperplasia in early part of DCT due to chronic use of loop diuretics
to avoid refractoriness

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14
Q

Spironolactone + K losing diuretics

A

To avoid hypokalemia

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15
Q

Loop, thiazides, CAEI acidic drug ?

A

secteted by acid secretory sytem > hyperurecmeia # Gout

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16
Q

Amiloride trimatrine ?

A

secreted by oraginc base secretory system > used in Gout

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17
Q

Thiazides Less effective in RF (↓ GFR & Moderate ceiling). ???????????can be used in renal failure

A

Metolazone

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18
Q

Loop Dose should be increased in case of

A

Renal Failure

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19
Q

Mannitol # in Acute renal failure: can not reach to the lumen →

A

circulatory overload → # in acute renal faliure

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20
Q

. Hypokalemia ليه؟
+: قبل الخط Diuretics❖
decreaing Na reabsorption → ↑ Na+ delivry to the late part of DCT → ↑ Alodosterone → ↑ Na+ exchange with K+ and H+ → hypokalemia and alkalosis.
❖ Thiazides > loop: Part of delivered Na+ by loop diuretic is reabsorbed by early part of DCT before reaching macula densa
❖ Treatment: add

A

spironolactone

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21
Q

Diuretics inhibiting Na+

reabsorption → interfere with reabsorption of electrolytes related to Na+ at the site of action.

A

loop diureitcs ↓ Calcium (→Hypocalcemia) and Magnesium (→hypomagnesemia) reabsorption at ascending limb of
loop of Henle

هيبربوتاسيوم = هيبر ماجنسيوم والعكس صحيح reabsoprtion Magnesium ↑ spairing K

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21
Q

Loop dirutics work on ?

Thiazides?

A

Ascending loop of henle

Early part of DCT

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22
Q

lOOP examples?

A

frusemide : renal elmination with variable absorption
bumetanide hepatic elmination
toresmide

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23
Q

ThiaZides Examples/

A

Hydrocholrthalidone short acting
Chlotalidone long acting
Indapampide in HTN
Metolazone in Renal failure

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24
Mechanism of loop
decerasing reabsorption of Na / k / 2cl and this leads to loss of Na20 and water loss of meullary hypertonicity and loss absoprtion of water by medulla loss of H20 > Na PG production oVD of afferent and increasing GFR decreasing the reabsorption of Na from the asecnding loop #NSAIDS
25
Thiazaid mechnisms of action ?
Decreasing Reabsoption of Na at the early part of DCT and this exretion of Na and H20 > intial hypovolemia> movment of Na from the walls of blood vessels to blood casuing VD
26
wHY LOOPS ARE USED IN ACUTE PULMONARY EDEMA/
DUE TO VENODILATOR EFFECT
27
whY USED LOOP IN ACUTE RENAL FAILURE ?
INCRSAING RENAL BLOOD FLOW
28
Thiazid are used in HTN ?
due to vasodilator effect
29
HTN and diretics?
loop diretics in hypertienon enephalipoathy Thiaziade in HTN due to ? 1-intial diretic hypovolemic effect 2-2ry VD effect due to escape of Na from the wall of blood vessels into the blood
30
Indications of Loop diretics/
EEE Emergency? 1-Acute pulmnary edema due to venodilator effect 2-Hypertensive enchepphalophaty ``` Edema referactory to other diuretics? Heart failure renal insufficincy liver ciirhosis ARF due to increased RBF ``` Electrolytes DISTURBACNES: Hypercalacemia : after saline increase gfr decrasing the ca reabsoptiom Hyperkalemia : decreasing K reabsorption at the loop the na reaching macula densa and aldosterone exhanging the K with NA causing K excretion Hypervolemic dilutional hyponaterima : H20>>Na Distal renal tubular acidosis exchnge of H with Na excerting The H+
31
Hypercalacemia : | and loop
after saline increase gfr decrasing the ca reabsoptiom
32
Hyperkalemia and loop
33
Hyperkalemia and loop
decreasing K reabsorption at the loop | the na reaching macula densa and aldosterone exhanging the K with NA causing K excretion
34
Hypervolemic dilutional hyponaterima :
H20>>Na
35
Distal renal tubular acidosis
exchnge of H with Na excerting The H+
35
Distal renal tubular acidosis
exchnge of H with Na excerting The H+
36
Hert failrure and dirtucs?
Loop in acute heart failure | Thiazid in loop refecatriness in congestive heart failure
37
Adverse effects of loops
``` Hypovolenmia L hyptension collapse also thizia Hypokalemia < thiazide Hypomagneisuma also thi Hypocalacemia Hyperurecemia also thi Organs: ototoxicity 8th cranial nerve Git upset intersitial nephritis Myalgia Hypersenesitvity reactions Refractoriness ```
38
Thiazaid indication
cvs and renal CVS Hyper tension due to intial dirtic + 2ry VD effect Congetice heart failure in loop refreactoriness Renal : nephrogein diabitus inspidus by decrasing PGs decasring GFR decreasing urine output Idipathic calcuiria and ca stones : decreasing the GFR increasing the ca reabosortion
39
Mention adverse effects of the Thiazides?
Hypokalemia and alkalosis HypoMangsisumia Hyponatreima due to decrease exchangre at early part of distal convoluted tubule Hyperureicemia due to acid competition Hypersensitvity Glucose intolerance potassium out of beta cells decrasing insulin release Hyperlipidemia Hepatic encephaloiphathy: NH4TO NH3 CROSSING BBB impOtenece
40
Mention SPECIAL adverse effects of the Thiazides?
Glucose intolerance potassium out of beta cells decrasing insulin release Hepatic encephaloiphathy: NH4TO NH3 DUE TO ALKALOSIS CROSSING BBB
41
Contraindications of Thiazides?
In edema of liver cirrhosis to avoid hepatic encephalopathy | In edema of renal failure cuz it is ineffective in low GFR
42
ethacrynic acid)
GIT upset
43
bumetanide)
Myalgia (
44
Kinetic refratoriness of the Loops?
1- Decrease in intestinal absorption due to decompenstaed heart failure what solve? IV injection 2-Decreasing plasma protein binding due to nephrophaty or liver cirrhosis? Mixing the drug with albumin in vitro 3-decerases excretion of diuretic by the acid secretory system due to renal failure due to accumulation of acid metabolites : increases the dose of Frusemide 5 folds
45
Dynamic refratrincess of loop diuretics?
1-Hypertrophy of early part of DCT increasing Na reabosrption > Thiazide 2-Hyperalodsterniusm increasing na exchange with K in distal DCT > Spironolactone aldosterone antagonist
46
1K sparing dirtics 2osmotic 3carobonic anydrase site of action ?
1-DCT 2-PCT and descending limb of loop of henele and Collecting tubule 3-PCT
47
indirect K sparings?
Spironloactone and Eplernone Inhibits aldosternoe preventions of mediator protein synthesis no synthesis of Na channels of luminal DCT Used in CHF + LOOP + ACEI Used in Hyperaldosteronism Edema Delayed onset (3days) Long acting
48
Direct K sparing?
Amiloride trimaterene Short onset Short acting Hypokalemia HypoMagnusmia Combined with K losing diuretics
49
Adverse effects of Potassium sparing diuretics ?
Hyperkalemia Metabolica acidosis INDirect spironlocatone Gyncomastia : due to anatgonizing androgen receptors
50
IVI Mannitol Mechanism of Action | ?
filtration not rabsorped increasing osmolarity of the urine keepin h20 in tubules Pereserve Na and kick out h20
51
Mannitol not deffective in Heart failure?
due to Na over load edema and mannitol is preserving agent of Na decreasing reapsotoptrion of Na < < decreasing reabsorption of H2o meaining it presreves Na and get rid of H2o
52
Osmotic diretics indications
IVI Mannitol is used in Dehydrating agent for ? Cerebral edema and icp Acute glucoma IOP Prophylaxis in ?- ARF pateint with oliguria caused by trauma or hemolytic reaction
53
Adverse effects of mannitol
``` only if in ARF? Cirulatory overload Acute heart failure Dilutional hyponatremia Acute pulmonary edema ```
54
Carbonic anhydrase inhibitors (CAIs)
``` Weak diuretic (most of Na+ lost is reabsorbed again in distal nephron) ```
55
Examples of CAEI | ?
Acetazolamide Methozolamid Brizolamide Dorzolamide
56
Mech of CAEI?
Easy!? Decresing CAE Activity of production of H+ - Decreasing NaHCO3 reabsorption and it is excreted in urine Alkaline urine Acidic Blood
57
Methazolamide is preferred
Glaucoma: act & chronic. ↓ | aqueous humor formation
58
Carbonic anydrase inhibitors indications ?
3E A Emphysema and high altitude sickness Excretion of acidic drugs as aspirin and barbituates toxicity Epilipsy Acute and chronic gluocoma methozolamide
59
Adverse effects of the CAEI ?
``` MRCH Metabolic acidosis and CNS depression Refractoriness Ca Po4 Stones (alkaline urine) Hypersensitvity ```
60
Amilordie ant triametrene pereferd than Spironloactone in hyokalmeia/
due to ability of daily adjustment of doseage dut to short action and rapid action
61
K-sparing diuretics are combined with K+ losing diuretics (thiazides& loop)
To potentiate their diuretic effect & to antagonize their hypokalemic effect (more effective than exogenous K+ & Mg ++ supplement)
62
Spirnolactone preferd in liver cirrhosise ?
In liver cirrhosis there is hyperaldosternoism and Spirnolactone and aldostenoe antagonist Thiazide has minmal effect beacus lost na is reabsorped at the late part of DCT Spironloactone not casuing Hypokalemia or alkalosis avoding hepatic encephalophathy
63
Loop diuretics can be used in refractory edema of liver cirrhosis only after ?
full dose of spironolactone why??? to avoid development | of hypokalemia and alkalosis that may lead to hepatic encephalopathy
64
Carbonic Anhydrase Inhibitors are weak diuretics:
because most of the fluids & Na+ | lost are reabsorbed again at more distal sites
65
Loop & thiazides diuretics induce hypokalemia:
They ↑ Na+ delivered to late part of DCT → excretion of K+ & H+ in exchange with Na+ reabsorption by aldosterone (avoided by adding spironolactone)
66
Vasopressin receptors • V1A: Vascular → ? • V2: ? • V1A & V1B :?
Vasoconstriction → control blood pressure Renal → H20 reabsorption from collecting ducts CNS receptors
67
(Vaptans) :Vasopressin Receptors Antagonists indications
Evlumic hyponateremia L SIADH High aldosterone | Hypervolemic Hyponatremia : Congestive heart failure
68
ACEI & NSAIDS are contraindicated in any cause of ??? to avoid development of acute renal failure
renal | hypoperfusion
69
Lithium (antidepressant) toxicity is enhanced with
diuretics (Thiazides & loop)
70
NSAIDs inhibit Prostaglandin (PG) synthesis
VC Of aFFRENTS decrasing GFR
71
SIADH:
Syndrome of Inappropriate anti-diuretic hormone secretion
72
Hypercalcemia | Hypercalcuria
loop | thiazide
73
Hypokalemia
amiolride | triametrene
74
Hyperkalemia
Loop
75
Hypervolemic Dilutional Hyponatremia
Loop
76
Renal tubular Acidosis
Loop
77
Alkalosis due to sick sinus syndrome and | emphysema
CAEI
78
الحمدلله الذي أنزل علي عبده الكتاب ولم يجعل له عوجا

CVS Pharma papre 1 (4 decks)

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