#5 Komiskey Diuretics 1 Flashcards

1
Q

You have a patient with altitude sickness and you would like to prescribe a medication that works in the proximal tubule by blocking sodium bicarbonate reabsorption. What would you choose and what could be a possible side effect?

A

CAAP (Carbonic Anhydrase inhibitors like Acetazolamide work in the Proximal tubule)
Acetazolamide
SE: metabolic acidosis
Can also be used to treat glaucoma

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2
Q

You are in the hospital and the resident asks you what osmotic diuretic would you use to decrease intracranial pressure. You answer?

A

Mannitol

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3
Q

You just prescribed Furosemide for your patient and you give them a list of possible side effects. This list would include what items?

A
OH DANG!             (Loops loose of K+, Ca2+, Mg)
Ototoxicity
Hyperkalemia
Dehydration
Allergy (to sulfa)
Nephritis
Gout
Ethacrynic Acid --> high ototoxicity
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4
Q

You would like to prescribe a loop diuretic because you remember Dr. Komiskey saying they would not develop acidosis but you can’t remember how they work or which ones they are. You ask a friend and she says:

A
The LOOP of FURy ascends up Mt. Saint Henle
Loop diuretics
Furosemide, Bumetanide, Torsemide
Ascending loop of Henle
Blocks Na+/K+/2Cl- cotransporter
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5
Q

A patient comes into your office with gout. He mentioned that he was on a diuretic. Based on the gout which two would you suspect?

A

Loop or Thiazide

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6
Q

Your patient has had a long history of calcium oxalate stones and you are considering putting them on a medication in this diuretic class to decrease the excretion of calcium.

A

Thiazide

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7
Q

What is the mechanism of action for Hydrochlorothiazide?

A

(If you don’t want your THIghs to look like DISTAL TUBULES you should not keep Na+/Cl- around)
MOA: Inhibits Na+/Cl- transport in the distal convoluted tubule

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8
Q

Your patient is diabetic. Why might you avoid thiazides?

A

SE: Hyperlipidemia
HCTZ: Hyperglycemia
Other HCTZ SE: (Hypercalcemia, hypokalemia, hypomagnesemia, Hyperuricemia, Pancreatitis, metabolic alkalosis, **Stevens-Johnson rash*)

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9
Q

What medication might cause Stevens-Johnson syndrome?

A

Hydrochlorothiazide
Stevens-Johnson Syndrome – rare, serious disorder of your skin and mucous membranes. It’s usually a reaction to a medication or an infection. Often, Stevens-Johnson syndrome begins with flu-like symptoms, followed by a painful red or purplish rash that spreads and blisters. Then the top layer of the affected skin dies and sheds.

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10
Q

Your patient is on a loop diuretic but is losing too much K+. What diuretic would you combine with the Furosemide that the patient is currently on?

A

Spironalactone
COLLECT Potato SPears to block ALDO
Spironolactone blocks the effects of Aldosterone in the late distal tubules and COLLECTing ducts.

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11
Q

You need a medication to treat Liddle’s Syndrome. Which Na+ inhibiting K+ sparing diuretic could you use?

A
Triamterene (shorter half life)
or Amiloride (also used to treat HTN, CHF, Li induced diabetes insipidus)

Liddle’s syndrome: gain of function - abnormality of ENa Channel
Results in Na retention and low levels of aldosterone

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