ascites

Question 1

name some aldosterone antagonists

Answer 1

spironoloactone

eplerenone

Question 2

indications for aldosterone antagonists

Answer 2

1. ascites and oedema due to liver cirrhosis
   - spiro = 1st line
2. chronic HF - at least moderate or in 1 month of MI - with BB and ACE-I/ARB
3. primary hyperaldosteronism - those not wanting surgery or awaiting surgery

Question 3

moa aldosterone antagonists

Answer 3

• competitively bind to aldosterone receptor. = increases na and h20 excretion and k+ retention.

Question 4

SE aldosterone anatagonists

Answer 4

• Hyperk+
• gynaecomastia

eplerenone less likely endo SE

• aldosterone antagonists = liver impairment and jaindice and cause of SJS

Question 5

do not give aldosterone anatagonists to what patient

Answer 5

• hyperkalaemia
• severe renal impairment
• addisons disease;already aldosterone deficient
• avoid or prescribe with caution in pregnant or lactating

Question 6

which aldosterone antagonists is licensed for HF only

Answer 6

• eplerenone

Question 7

what dose do you give spironolactone in ascites, and HF

Answer 7

Ascites; 100mg

HF - 25mg

Question 8

when should patients take spironolactone

Answer 8

with food

Question 9

indications for loop diuretics

Answer 9

1. releif from SOB in acute pulmonary oedema with o2 and nitrates
2. for symptomatic rx of fluid overload in CHF
3. trat oedema.

Question 10

MOA loop diuretics

Answer 10

• on ascending limb of LOH: inhibit 2cl/na/k transporter

- direcet effect on blood vessels = dilatation of capacitance veins

Question 11

SE loop diuretics

Answer 11

• dehydration
• hypotension
• increased loss of electrolytes + indirect loss of mg, ca, h+
• hearing loss and tinnitus at high doses - as same transporter in endolymphatic system

Question 12

CI of loop diuretics

Answer 12

• hypovolaemia

- dehydration

Question 13

loops should be used cautiously in which patients

Answer 13

• hepatic encephalopathy
• severe hypokalaemia
• severe hypona
• chronic use - worsen gout as inhibit uricc acid excretion

Question 14

interactions with loop diuretics

Answer 14

• potential to affect drugs excreted by kidneys
• lithium - reduced
• digoxin toxicity high risk
• worsen SE aminoglycosides

Question 15

name loops

Answer 15

furosemide, bumetanide

Question 16

in acute pulmonary oedema what dose of loops would you give once only

Answer 16

40mg IV - do not administer at rate > 4mg/min

Question 17

when should patients take oral maitnenance doses of loops

Answer 17

• morning and second dose in early afternoon to avoid nocturia

Question 18

name some colloids

Answer 18

gelatins, albumin

Question 19

colloid indications

Answer 19

• exapnd circuating volume in shock and impaired tissue perfusion. (but not 1st choice)
• cirhotic liver disease - albumin to prevent hypovolaemia in large volume paracentesis

Question 20

MOA colloids

Answer 20

• large osmotically active molecules - so cannot corss semipermeable membrane and remain in plasma

Question 21

SE colloids

Answer 21

• contain sodium so diffusion can promote oedema if enter interstitim. -
• high plasma volume = CO issues and pulmonary oedema
• gelatin = Hypersensitivity reactions

Question 22

who should you give colloids to carefully

Answer 22

• HF

- renal impairment