C- Diuretics & RAAS Antagonists

Question 1

CO=

Answer 1

HR*SV

Question 2

Increase Cardiac Output by increasing

Answer 2

Intropy
Heart Rate
Preload

Question 3

Decrease CO by

Answer 3

Inc. Afterload

Question 4

Specific Goals of Heart Failure Management with Pharmacotherapy

Answer 4

Reduction of congestion
Modulate neurohormonal activation
Improve flow

Question 5

Used first as needed to reduce congestion
Reverse Na+ and fluid retention
Relieve volume overload: dyspnea peripheral edema
Lowers preload (LVEDP)

Answer 5

Diuretics

Question 6

resulting in long-term stabilization, positive remodeling, and increased survival with RAAS antagonists and β-blockers

Answer 6

Modulate neurohormonal activation

Question 7

Loop diuretics preferred because of ______- can augment with a thiazide diuretic

Answer 7

efficacy

Question 8

may be difficult to accomplish pharmacotherapeutically with vasodilators and requires mechanical devices or transplantation

Answer 8

improve flow

Question 9

ALDO–> Na+ sparing is the _______ but can cause K+ wasting

Answer 9

Major action

Question 10

ALDO antagonists are ____ sparing

Answer 10

K+ sparing

Question 11

fluid optimization with diuretics is a major part of heart failure therapy

Answer 11

Reduction of congestion

Question 12

ALDO–> Na+ sparing is the major action but can cause ______

Answer 12

K+ wasting

Question 13

ACE-ARB are ____ sparing

Answer 13

K+ sparing

Question 14

Furosemide ______diructic

Answer 14

most common

Question 15

Loop and thiazide are both ____ wasting

Answer 15

K+

Question 16

#11: Hydrochlorothiazide 
#14: Furosemide (Lasix®) 
#42: HCTZ-Triamterene (Dyazide) 
#70: Spironolactone (Aldactone®)

Answer 16

Important diuretics

Question 17

most common diuretic

Answer 17

Furosemide

Question 18

Interactions with membrane transport proteins
• Interactions with enzymes (acetazolamide) or hormone receptors (spironolactone)
• Osmotic effects preventing water reabsorption (mannitol)

Answer 18

Mechanisms of diuretics

Question 19

Important diructics from top 200 list

Answer 19

#11: Hydrochlorothiazide 
#14: Furosemide (Lasix®) 
#42: HCTZ-Triamterene (Dyazide) 
#70: Spironolactone (Aldactone®)

Question 20

Most diuretics exert effects at __________ surface of renal tubule cells

Answer 20

luminal (urine)

Question 21

Inhibit NaCl transport (Na+-K+-2Cl–transporter) in TAL - greatest efficacy due to large capacity of this segmen

Associated with increase in Mg++, Ca++ excretion (diminish lumen-positive potential)

Answer 21

Loop Diuretics

Question 22

_________ diuretics act via inhibition of Na+-K+-ATPase

Answer 22

No, None, Nada

Question 23

Diuretic agents decrease _________ at various sites in the nephron

Answer 23

Na+ reabsorption

Question 24

In loop diuretics:
Handled by glomerular filtration and renal secretion (same organic acid transporter as uric acid)
Is the mechanism for?

Answer 24

Mechanism for hyperuricemia

Question 25

Loop Diuretics | Use in Heart Failure

Answer 25

Used in HF patients with volume overload Efficacy is enhanced with salt restriction Furosemide most commonly used

Question 26

Loop diuretics most _________ in HF

Answer 26

efficacious

Question 27

Loop Diuretics | Adverse Reactions

Answer 27

Hypokalemic metabolic alkalosis | Hyperuricemia

Question 28

Inhibit the Na+/Cl- cotransporter --> increased urinary excretion of NaCl Modest diuretic effect since only 5-10% of filtered Na+ is reabsorbed here

Answer 28

Thiazide Diuretics

Question 29

Thiazides ________ of Ca++ ( NOTE: loop diuretics decrease serum Ca++ levels)

Answer 29

increase reabsorption

Question 30

Competitive antagonist at aldosterone receptor

Answer 30

Spironolactone

Question 31

Vasodilation Salt / Water Excretion

Answer 31

ACE INHIBITORS / ANGIOTENSIN RECEPTOR BLOCKER Adrenergic and RAAS blockers- REDUCE MORBIDITY AND IMPROVE SURVIVAL

Question 32

Decreased Contractility | May worsen symptoms

Answer 32

BETA BLOCKERS Adrenergic and RAAS blockers- REDUCE MORBIDITY AND IMPROVE SURVIVAL

Question 33

Thiazides increase reabsorption of Ca++ ( NOTE: loop diuretics _________ Ca++ levels)

Answer 33

decrease serum

Question 34

Salt / Water Excretion Potassium retention

Answer 34

ALDOSTERONE RECEPTOR BLOCKADE Adrenergic and RAAS blockers- REDUCE MORBIDITY AND IMPROVE SURVIVAL