2nd mid term Flashcards
Location of action: Acetazolamide
PCT
Actions: Acetazolamide
Loss of NaHCO3 -> Diureses
Metabolic acidosis
K+ wasting
Why will we see K+ wasting with Acetazolamide?
Excess Na+ is reabsorbed in the collecting duct in exchange for K+
When will we give Acetazolamide in case of diuresis?
Only if edema comes together with metabolic alkalosis
Location of action: Mannitol
PCT
Side effects: Mannitol
Pulmonary edema
HF exacerbation
Na+ inbalanace
Location of action: Loop diuretucs
Thick ascending limb
MOA: Acetazolamide
Inhibition of CA
MOA: Loop diuretucs
Inhibition of Na+/K+/2Cl- at the luminal side
Which drugs interact with Loop diuretics?
NSAID’s
Aminoglycosides
Lithium
Digoxin
Actions: Loop diuretucs
Natriuresis
Loss of lumen + potential -> Loss of Mg+ and Ca+ reab.
K+ and H+ wasting
Hypokalemic metabolic acidosis
COX-2 activation -> Increased GFT and systemic vasodilation
When will we give: Loop diuretucs
HF
Pukmonary edema
HTN
Acute renal failure
Side effects: Loop diuretucs
Sulfonamide Hypovolemia Ototoxicity Hypocalcemia Hypomagnesemia Hypokalemic metabolic acidosis
Names: Loop diuretucs
Furosemide
Ethacrynic acid
What is special about Ethacrynic acid
Not a Sulfa drug
Location of action: Thiazides
Distal convoluted tubule
MOA: Thiazides
Inhibition of Na+/Cl- transporter
Names: Thiazides
Hydrochlorothiazide
Indapamide
Drug interaction: Hydrochlorothiazide
Digoxin
DM patients
When to give: Hydrochlorothiazide
HTN CHF Nephrolithiasis Nephrogenic DI Osteoporosis
Actions: Thiazides
Natriuresis
Hypercalcemia
K+ wasting
Which diretics causes hypocalcemia?
Loop diuretics
Which diretics causes hypercalcemia?
Thiazides
MOA: K+ sparing diuretics (2)
Aldosteron receptor inhibitors
ENaC inhibitors
Names: Aldosteron receptor inhibitors
Spironolactone
Eplerenone
Duration of action: Spironolactone
24-48 h
Indications: Aldosteron receptor inhibitors
Hyperaldestronism
Hypokalemia
CHF
Antiadrogenic
Names: ENaC inhibitors
Amiloride
Indications: ENaC inhibitors
Hypokalemia caused by other drugs
Nephrogenic DI
Liddle’s syndrome
Names: SGLT2 antagonists
Canaglifozin
Dapaglifozin
ADH agonists
Desmopressin
MOA: Desmopressin
Synth. analoge of ADH
V2 selective agonist
CAn be given in many ways
Indications: Desmopressin
Centrala DI
Nocturia
ADH antagonists:
Tolvaptan
Conivaptan
MOA: Tolvaptan
Selective V2 antagonist
Diuretics used in HTN:
Thiazides- Hydrochlorothiazide
Loop diuretics- Furosemide
Which has 2-3 h duration of action?
Hydrochlorothiazide/Furosemide
Furosemide
Which has longer duration of action?
Hydrochlorothiazide/Furosemide
Hydrochlorothiazide: 8-12H
Sympatholytics used in HTN:
Clonidine- a2 agonist Methyldopa- a2 agonist Prazosin- a1 antag Doxazosin- a1 antag Tamsulosin- a1 antag Proprapranol- B non selective Metoprolol- B1 selective Bisoprolol- B1 selective Nevibolol- B1 selective Labetalol- a.B Carvedilol- a,B
Which B non selective can enter thr CNS?
Propranolol
Dihydropyridines, which is long acting?
Amlodipine
Dihydropyridines, which is short acting?
Nifedipine
Dihydropyridines:
Nifedipine
Amlodipine
Nicardipine
Nimodipine
Which Dihydropyridine can help treat subarachnoid hemorrhage?
Nimodipine
Indications: Diltiazem
HTN
Angina pectoris
Which c be given to pregnant women?
Nifedipine
Indications: Verapamil
HTN
Angina pectoris
Migrane prophylaxis
Anti arrhytmic
Which class AA is Verapamil?
Class IV
Which Dihydropyridine can exacerbate Myocardial ischemia?
Nifedipine
CCB contraindications
Conduction abnormalities
CHF patients
HTN ttreatment: NO releasing agents
Hydralazine
Nitroprusside
Which drug induce the release of NO from endothelial cells?
Hydralazine
Adverse effect: Hydralazine
Lupus at high dose
Which NO releasing drug induces arterial and venous dilation?
Nitroprusside
Adverse effect: Nitroprusside
Cyanide toxicity
Nitroprusside is Long/Short acting
Short
K+ channel opening agents
Minoxidil
Diazoxine
Indications: Minoxidil
Severe HTN
Baldness (topical)
Fenoldopam has short/long duration
Short- 10 min
Endothelin antagonist:
Bosentan
ACE inhibitors:
Captopril
Enalapril
Perindopril
Ramipril
Which is not a prodrug?
Captopril
Enalapril
Perindopril
Ramipril
Captopril
כי הוא ילד כאפות
MOA: ACE inhib.
Reduction of AG-II and Aldosterone
Increase in bradykinin- Vasodilator
Adverse effects: ACE inhib.
Dry cough
Teratogen
Hyperkalemia
AKI
ARB’s:
Losartan
Irbesartan
Valsartan
ARB’s adverse effect
Teratogenic
Hyperkalemia
Aliskiren is a
Renin antagonist
Adverse effect: Aliskiren
Teratogenic
Hyperkalemia
Angioedema
Indication of drug therapy for HTN
BP > 140/90 mmHg
Anti hypertensive therapy- How will you start?
ACE inhib. or ARB's + CCB or diuretics if resistance ACE inhib. or ARB's + CCB + diuretics if resistance Add Spironolactone and B blocker
Spironolactone is an example of _____ drug
K+ sparing diuretics- Aldosteron receptor inhibitor
Nitrates
Nitroglycerin
Isosobride dinitrate
Adverse effect: Nitrates
Headaches Flushing Reflex tachycardia Tolerance after 8-10 h Syncope
Contraindications: Nitrates
Systolic BP < 90 mmHg
Right vent. MI
Patient on PDE-5 inhib.
HOCM
Which B non selective antag. can be given in case of Angina?
Propranolol
New drugs for the treatment of Angina
Trimetazidine
Ivabradine
MOA: Trimetazidine
pFOX inhibitor
Druga that improve survival in HF patients
ACE inhib.
ARB’s
Spironolactone
B-Blockers
Diuretics that are given in case of CHF
Hydrochlorothiazide
Furosemida
Spironolactone
Drugs that increase cardiac muscle contractility
Digoxin
B-agonists
PDE-III inhib.
Digoxin is eliminated by
Kidnys
Net effects: Digoxin
Positive ionotropic (Increased I.C Ca2+) Negative chronotropic (Vagus stimulation) Negative dromotropic (AV decreased)
Contraindications: Digoxin
Hypertrophic cardiomyopathy
WPW
AV block
Diastolic HF
Digitoxin is eliminates by the
Liver
B Blockers that are given in the treatment of HF
Metoprolol (B1 selective)
Carvedilol (B,a)
PDE in the treatment of Acute HF
Milrinone
Theophylline
Contraindication agents in CHF
Thiazolinedione
NSAID’s
COX-2 inhib.
CCB
Which drug is completely contraindicated in acute HF?
B-Blockers