Cardiac Flashcards
1
Q
What is Preload?
A
Amount of pressure in heart at the end of diastole
or amount of blood distending the ventricles prior to the next contraction
2
Q
What is Afterload?
A
Amount of pressure produced by the heart after contraction
or resistance to the outflow of blood-what the heart has to pump against
3
Q
What does Inotropic affect?
A
Myocardial contractility
4
Q
What does Chronotropic affect?
A
Heart rate (chrono=time)
5
Q
What does Lusitropic affect?
A
Relaxation
6
Q
What does a vasopressor affect?
A
Causes vasoconstriction–>Increase b/p
7
Q
What does a vasodilator affect?
A
Causes vessels to dilate–>decreases SVR & lowers B/P
8
Q
The autonomic nervous system has 2 parts, name them.
A
SNS-sympathetic
PNS-parasympathetic
9
Q
Name the neurotransmitters in the SNS
A
Norepinephrine
Epinephrine
Dopamine
10
Q
The sympathetic NS stimulates different ________ receptors depending on sructure
A
Adrenergic
11
Q
Activation of the SNS produces _____ or _____ response
A
Fight or Flight
12
Q
Alpha 1 receptors are present in?
A
Vascular beds
13
Q
When activated, Alpha 1 receptors cause?
A
Vasoconstriction of arteries and veins (increased b/p)
14
Q
Alpha 2 receptors are present on?
A
presynaptic nerve endings
15
Q
What do Alpha 2 receptors do? (2 things)
A
- Inhibit presynaptic release of norepinephrine through feedback mechanism
- Decreases sympathetic outflow
- –it regulates fight/flight response
16
Q
Name the 7 types of Adrenergic receptors
A
- Alpha 1
- Alpha 2
- Beta 1
- Beta 2
- Dopaminergic
- Vasopressin 1
- Vasopressin 2
17
Q
Where are Beta 1 receptors located?
A
Cardiac muscle
18
Q
What do Beta 1 receptors do?
A
Increase Heart Rate Increase Contractility (inotropic effect)
19
Q
Where are Beta 2 receptors located?
A
Bronchial muscle
Peripheral vasculature
Liver
20
Q
What do Beta 2 receptors do?
A
Bronchodilate lungs
Vasodilate peripheral vasculature-(sometimes see this as s/e)
Increase glucose release from Liver
21
Q
Where are Dopaminergic receptors located?
A
Kidneys & viscera
22
Q
What do Dopaminergic receptors do?
A
Dilate arterioles in Renal and Splanchnic (mesenteric/splenic/hepatic beds) circulation.
23
Q
Where are Vasopressin 1 receptors located?
A
Smooth muscle
Liver
Tissues
24
Q
What do Vasopressin 1 recpetors do?
A
Cause vasoconstriction–> Increase b/p
25
Where are Vasopressin 2 receptors located?
Kidneys
26
What do Vasopressin 2 receptors do?
Increase water permeability and reabosption in the collecting tubules--> Increase b/p
27
True/False: Some medications actually have to touch the receptor to work (actual physical contact).
True
28
Name 2 Inotropes
1. Dobutamine (Beta 1 activity)
| 2. Isoproterenol
29
Name 2 types of vasopressors/inotropes with mixed effects that act directly on the receptor.
1. Dopamine
| 2. Epinephrine
30
True/False: the infant heart differs in how it responds to meds to tx CHF vs older child/adult
True
31
Why is an infant's response to CHF meds different than child/adult? (2 things)
Limited response to Inotropes &
| Electrolyte and metabolic reaction differences in their heart.
32
Why do infants have limited response to inotropes? (6 things)
1. Immature heart
2. Restricted functional reserve
3. Lower ratio of active myofilaments to noncontractile elements
4. Greater stiffness of ventricle
5. Underdeveloped sympathetic nerves
6. Higher CO per unit Surface Area
33
Name the Pure Inotropes used in NICU
Digoxin
Dobutamine
Milrinone
Isoproterenol
34
True/False: Digoxin has a very narrow therapeutic range
True
35
What are the MOA's of Digoxin? (5 things)
1. By inhibiting Na+/K+ ATPase pump
2. Slows conduction through SA & AV nodes
3. Decreases HR by increasing Vagal activity
4. Decreases Cardiac filling pressures and capillary pressures
5. Has anti-arrhythmic properties
36
When the Na+/K ATPase pump is inhibited, what does this cause?
Increased intracellular Na+ & Ca++
| Increased Contractility
37
Why is there increased contractility with Digoxin?
The heart likes Ca++ to pump and there is increased intracellular Ca++
38
Digoxin is used to tx?
L-sided heart failure
| Atrial fibrillation/flutter
39
Is Digoxin used to tx R-sided heart failure?
No
40
Are loading doses of Digoxin typically used?
No-d/t risk of toxicity
41
When might a loading dose of Digoxin be used?
What must be done with a Dig load?
Arrhythmias
Acute heart failure
Dose must be split
42
Are IV and PO Digoxin doses equivalent?
NO
43
With IV Digoxin, it's given slowly over 5-10 min. What should the order include? Why?
HR cut off for holding dose.
| Can be a tip off for toxicity.
44
Where is Digoxin absorbed?
GI
45
GI absorption of Digoxin is affected by?
Immature gut flora affected by:
- Age
- Feeding type
- Drug therapy (i.e. acid suppression)
46
True/False: Because of immature gut flora in infants, there can be a reduction in the metabolism of Digoxin
True
| Only 10% of Dig is metabolized by gut flora in adults
47
The distribution of Digoxin is Larger/Smaller in infants vs. adults?
Larger
48
Digoxin is Eliminated how?
Urine (active tubular secretion) via Renal P-glycoprotein
| -monitor closely w/renal dysfunction
49
What does Renal P-glycoprotein do?
It's a transporter involved in tubular secretion of drugs
***Drug-drug interactions possible: inhibitors & inducers---i.e. Dig (substrate) + Erythromycin (inhibitor)=increased Dig levels
50
When should Dig levels be checked? (5 things)
1. Toxicity
2. Accidental ingestions
3. Renal Failure
4. Compliance
5. Absoprtion issues
51
What is the best time for Dig level?
Trough-right before next due dose.
52
What are EDLS?
Endogenous Digoxin-like substances. Sometimes found in infants.
53
What do EDLS do?
Interfere w/interpretation of serum concentrations
54
True/False: EDLS decrease with increasing GA?
True
55
What consideration to EDLS might you want to take?
Draw blood level before starting Dig therapy. Will tell you if EDLS present. If not, serum testing may be a useful guide.
56
What are the adverse effects of Dig?
Bradycardia, Ventricular arrhythmias, SA/AV block
Feeding intolerance
Hypokalemia potentiates Dig toxicity
Hyperkalemia w/Acute Dig toxicity
57
Besides K+, what other electrolytes can predispose infant to Dig toxcity?
Hypomagnesemia
| Hypercalcemia
58
What drugs decrease the absorption of Dig?
Antiacids, Metoclopramide, Sucralfate
59
What drugs increase concentration of Dig?
Erythromycin, azithromycin, Amiodarone, Verapamil, Nifedepine, Spironolactone, Carvedilol
60
What drug causes decreased clearance of Dig?
Indomethacin (decreased GFR)
61
Dobutamine is a synthetic __________
| So it does not what?
Catecholamine
| Depend on release of endogenous catecholamines for it's activity
62
Dobutamine primarily stimulates what receptors?
Beta 1
63
The Beta 1 action of Dobutamine causes what effects?
-Increases contractility and therefore CO
(positive inotrope)
-Little effect on HR (mild chronotropic effect)
-Increased Stroke Vol.
-Mild increase in myocardial O2 consumption
64
With Dobutamine, besides Beta 1 receptor action, what other receptors may have mild activity?
So what might you see?
```
Beta 2 (vasodilation of periphery)
Alpha 1
```
Could see a little: hypertension, Increased SVR, b/c can have an opposite effect from Beta 1 with Alpha 1
65
Does Dobutamine cause increased U.O.? Why
Yes
| Increased CO
66
Does Dobutamine increase SVR?
No, mild at high doses.
67
What situations is Dobutamine used for?
Shock, hypotension, congestive heart failure
68
What are the adverse effects of Dobutamine?
- Tachycardia (monitor HR, B/P, C.O.)--use caution in pts w/A fib. (can see increased conduction)--
- IV extravasation (not as severe since no Alpha effects)
69
Milrinone is a _________ inhibitor.
Phosphodiesterase (Ino-dilator)
70
Milrinone causes increased Ca++ entry into myocardial cells which causes increased ____________.
Contractility
71
Milrinone causes relaxation of ________ _____ & ___________ which reduces both preload and afterload (lusitropic effect)
Vascular muscle & Vasodilation
72
In what situations is Milrinone used?
- Septic shock
- Short-term for acute decompensated heart-failure
- Low CO after surgery
- Pulmonary Hypertension
73
Is a loading dose of Milrinone used?
No, d/t resulting increased b/p
74
Milrinone is ___________ eliminated.
Renally, so need to adjust the dose with dysfunction
75
What are the side effects of Milrinone?
Hypotension & Arrhythmias
Thrombocytopenia & Hepatotoxicity
Hypokalemia
76
What is an advantage of Milrinone?
- Longer half-life than Dopa, Dobuta, etc
| - Can just stop the drip (no wean usually needed)
77
Isoproterenol like Dobutamine is...?
Synthetic
78
Isoproterenol stimulates what receptors?
Beta 1 & Beta 2
79
Does Isoproterenol stimulate Alpha receptors?
No
80
The Beta 1 action of Isoproterenol causes an increase in? (3 things)
Rate of contraction (HR)
Force of contraction (Contractility)
Cardiac output
81
The stimulation of Beta 1 by Isoproterenol results in ____________ by Beta 2, causing what effects?
```
Bronchodilation
Increased SBP
Increased CO
Decreaesed MAP
Decreased DBP
Increased myocardial consumption (increased HR)
```
82
In what situations might Isoproterenol be used?
Cardiac Shock
Post-heart transplant to increase CO
Emergency situations to stimulate heart
83
What are the adverse effects of Isoproterenol?
- Tachycardia
- Ventricular Arrhythmias
- Systemic vasodilation-->decreased afterload & b/p, flushing
- Hypoglycemia d/t blunting the B2 receptor
84
Name the 2 drugs that are both vasopressors and inotropes.
Dopamine
| Epinephrine
85
Dopamine directly stimulates what receptors?
Dopaminergic
Beta
Alpha 1
86
Dopamine is a metabolic precursor which indirectly causes the release of ________ _________
Endogenous Norepinephrine
87
True/False: Dopamine has dose-dependent effects
True
88
Low dose Dopamine 2-5 mcg has what effect?
| So what might you see?
Dopaminergic (D1 & D2 receptors)
| see increased renal perfusion; vasodilation of vascular beds: renal, mesenteric, coronary
89
The Beta 1 effects of Dopamine do what at what dosing?
Increase contractility & HR
| At moderate dosing 5-10 mcg/kg/min
90
The Alpha 1 effects of Dopamine do what at what dosing?
Vasoconstriction-->increased SVR & b/p
| >10mcg/kg/min
91
Clearance of Dopamine is prolonged in what 2 situations?
Renal and Hepatic dysfunction
92
What is the first-line agent for shock, hypoperfusion & hypotension?
Why?
Dopamine
Increases CO, B/P, peripheral perfusion, possibly U.O.
93
What are some infant-specific issues r/t Dopamine?
- May be less effective as Inotorope <6 mos
- Vasoconstriction may occur at lower doses
- Primary vasoconstriction vs effect on contractility (may have decreased perfusion to some organs)
94
True/false: with Dopamine use it's possible to get more Alpha effect when you thought you were getting more Beta effect.
True:
| May see better b/p's at a cost to other organs
95
What are the adverse effects of Dopamine?
Tachycardia, hypertension, arrhythmias
Decreased peripheral perfusion w/high doses
IV infiltration: vasoconstriction, ischemia, necrosis, tissue shoughing
96
With Dopamine infiltration what med is used to prevent further damage and block further Alpha effects?
How must it be given?
Phentolamine
Central line (no UAC)
97
Epinephrine stimulates what receptors?
Alpha 1, Beta 1, Beta 2
| receptor-mediated
98
At low doses of Epinephrine, what receptors are effected?
| So what is seen?
Beta 1 & 2
Increased HR & Contractility;
Decreased SVR, Bronchodilation
99
At high doses of Epinephrine, what receptors are affected?
| So what is seen?
Alpha 1
| Increased SVR, MAP & myocardial oxygen demand
100
Epinephrine is used for what 3 things?
Cardiac arrest
Bradycardia
Hypotension
101
What are the adverse effects of Epinephrine?
Arrhythmias & Hypertension
Decreased peripheral, renal and gut perfusion
Hyperglycemia
IV infiltration: vasoconstriction, ischemia, necrosis, tissue sloughing
102
If you have an IV infiltrate of Epinephrine, what medication is used?
How must it be given?
Phentolamine
| Given via central line (not UAC)
103
What is important to know about Epinephrine's sensitivity and it's expiration?
It is photosensitive (light sensitive)
| Cover & expires in 3 days
104
What is the T2 of Epinephrine?
Just a few minutes
105
Epinehprine for cardiac resuscitation can be given in what 3 ways?
IV, IO, ETT
106
Milrinone is an inotrope and also a __________. It can be used in 2 different ways "ino-dilator"
Vasodilator
So- if using for inotropic effects, don't forget at high doses-->see decreased b/p in periphery
107
How does Milrinone cause vasodilation?
Causes Ca++influx into the cells--> Vasodilation in the lungs (helps w/PPHN)
108
What is the mechanism of action of Nitroprusside?
It is converted to Nitric Oxide
109
Name the Vasodilator meds. (7 of them)
```
Milrinone
Nitroprusside
Nitroglycerine
iNO
ACE Inhibitors
Angiotensin II blockers (ARB's)
Hydralazine
```
110
Nitroprusside is a mixed ______-_______ vasodilator.
| It has the following functions (4).
Mixed aterial-venous
1. Decreased vascular resistance
2. Increases CO
3. Decreases preload and afterload
4. Dilates coronary vasculature
111
When is Nitroprusside used?
Hypertensive crisis
Afterload reduction in refractory CHF
ECMO
112
What kind of toxicity can you have with Nitroprusside?
| When might you suspect this?
Cyanide toxicity
Sudden tachyphylaxis and the drug is NOT working (increased SVO2 sats, metabolic acidosis--cyanide increases Lactate production)
113
What are the adverse effects of Nitroprusside?
Profound hypotension
| Thyroid suppression
114
Does Nitroprusside work fast?
Yes, very fast & short duration of action
115
When might you have increased risk of cyanide toxicity?
Renal or Hepatic dysfunction of if the infusion is used a long time (should only be temporarily used)
116
What is the antedote for Cyanide posioning?
Sodium Thio-Sulfate--produces the metabolite cyanite (less toxic and able to be eliminated by the kidneys)
117
How does Nitroglycerin work
Nitrate-->NO-->vascular smooth muschle relaxation
118
What is the hemodynamic effect of Nitroglycerin?
1. Dilate large veins-->pooling of blood/decreased preload
2. Dilate coronary vasculature
3. Decreased myocardial O2 consumption
119
True/False: Nitroglycerin can be used topically to increase perfusion to ischemic tissue
True
120
When is Nitroglycerin infusion used?
Low CO syndrome after cardiac surgery
121
Does Nitroglycerin have more effect on veins or arteries?
VEINS
122
What are the adverse reactions/side effects of Nitroglycerin?
Hypotension and reflux Tachycardia
Headache/flushing
Unwanted hypotension when used topically
123
What should the RN/NNP do if applying topical Nitroglycerine to a pt?
Wear gloves! It can affect the person applying it too.
124
iNO is a ________ ____________ drug used in what condition?
Pulmonary vasodilator
| PPHN
125
What is the MOA of ACE inhibitors?
Blocks the conversion of Angiotensin I to Angiogensin II (blocks systemic vasoconstriction)
126
What are the hemodynamic effects of ACE inhibitors?
Decreases preload and afterload
| Increases CO
127
In what situations might an ACE inhibitor be used?
Hypertension
Afterload reduction in CHF
Neonatal renovascular HTN
Valvular Regurgitation
128
If Angiotension II is produced, what is the result?
Increased Afterload and Aldosterone Secretion-->Increased Na+ & H2O retention-->Increased preload
129
Name the ACE inhibitors mentioned in lecture (1 is PO, 1 IV)
Enalapril (PO)--prodrug hydrolyzes to active
enalaprilat
Enalaprilat (IV)
130
With Enalapril and Enalaprilat is the dosing equivalent when switching modes?
NO
Watch mcg/mg!!!
It is a compound suspension
131
Is captopril used frequently in NICU?
Does it have a shorter or longer T2 than enalapril? So,what might be seen?
Is it compounded?
NO
Shorter
Might see more b/p swings
Yes
132
What are the adverse effects of ACE inhibitors? (6)
1. Dry cough
2. Maculopapular rash
3. Hypotension
4. Hyperkalemia
5. Renal complications in pts w/renal aftery stenosis
6. Teratogenic
133
How so Angio II receptor blockers (ARB's) work?
| Are they used frequently in NICU?
Blockade of Angiotension I receptors
No
134
Hydralazine is a direct ___________
| It primarily affects ________
Vasodilator
| Arteries
135
When is Hydralazine used in NICU?
Can it be used PRN?
Is it available IV & PO?
Initially for HTN control
Yes--not long-term, will change to another drug
Yes
136
Name the Anti-Arrhythmics. (3)
Beta-Blockers
Na+ Blockers
Other (Adenosine)
137
What is the MOA of beta-blockers?
Blocks Epinephrine and Norepinephrine at Beta receptors-->Decreased: HR, CO, Contractility
138
What are the adverse effects of Beta-blockers?
Bronchospasm (Beta 2 blockade)
Bradycardia (Beta 1 blockade)
Hypoglycemia (Beta 2 blockade)
139
True/False: there are Selective Beta blockers and non-selective Beta blockers?
True
Beta 1 selective (cardio-selective)** with max doses can see B2 effects**
Non-selective (broad spectrum B1 & B2)
140
Beta blockers have Intrinsic ____________ activity
sympathomimetic (ISA for short)
141
What is ISA activity?
- Small but significant Beta agonist effect (so get B blocker but also a little B agonist effect).
- Good Antihypertension effects
- Reduced side-effects (bradycardia)
142
True/False: Some Beta-blockers have Alpha adrenergic blocking activity
True
143
Name the Beta-blockers used in NICU
Propranalol
| Esmolol
144
Propranalol is a selective/non-selective beta blocker?
Non-selective (B1 & B2)
145
What effects does Propranalol cause?
- Decreased HR, myocardial contractility, B/P, & myocardial O2 demand
- Negative Inotrope and Chronotrope
146
What is Propranalol used for? (7 things)
1. Hypertension
2. A fib
3. SVT
4. V tachycardia
5. TOF cyanotic spells
6. Neonatal thryotoxicosis
7. Hemangiomas
147
What are the adverse effects of propranalol? (3)
1. Hypoglycemia (usually seen 1st dose)
2. Hypotension and Bradycardia
3. Bronchospasm (non-specific B activity)
148
Can you suddenly stop Propranalol?
No, gradual taper needed
149
Esmolol is given via ___________ _____.
Continuous Drip
150
Esmolol is used in what pts (though infrequently in NICU)
Post-op Cardiac Pts
151
Name the 3 Na+ channel blockers in NICU
Procainamide
Propafenone
Flecainide
152
Procainamide works by?
Depressing myocardial contractility by increasing electrical stimulation threashold of the ventricle (making the heart less excitable).
153
Procainamide what type of drug?
Class 1A Antiarrhythmic w/Anticholinergic and local anesthetic effects
154
When would you use reduced dosing?
Renal & Hepatic impairment
155
When is Procainamide used?
Ventricular arrhythmias
A Fib
SVT
156
What are s/e's of Procainamide?
- Prolonged Q-T, A-V block, hypotension
| - Agranulocytosis, hemolytic anemia, neutropenia, thrombocytompenia
157
What is important to monitor for when giving Procainamide?
Drug interactions (additive Q-T prolongation)
158
How is Procainamide metabolized?
By acetylation in the liver-->N-acetyl procainamide (NAPA, an active metabolite)
159
The half-life of Procainamide is dependent on?
Liver acetylator hpenotype, cardiac fxn, renal fxn (NAPA)
160
How is Procainamide excreted?
Urine
161
How is Procainamide monitored?
Procainamide levels in the blood
| N-Acetyl procainamide (NAPA) levels
162
Propafernone is a class _____ antiarrhythmic agent
1C
163
How does Propafenone work?
1. Blocks the fast inward Na+ current
2. Slows the rate of increase of action potential
3. Prolongs conduction and refractoriness
164
When might Propafenone be used?
PO option for paroxysmal SVT
165
How is the dosing of Propafeneone different from typical meds?
Dosed in meters squared, so must calculate it.
166
Is propafenone compounded?
yes
167
What are the s/e's of Propafenone?
Prolonged QT interval (proarrhythmic)
| Bradycardia, Hypotension
168
What is important to monitor when giving Propafenone?
Drug interactions (cummulative QT prolongation)
169
What type of pharmacokinetics is a/w Propafenone?
Nonlinear (d/t saturable kinetics profile)
| -so might bump up dose a little and get 10-fold effect
170
Is Flecainide the 1st line drug for SVT's?
No, but has been used when other meds failed
171
Flecainide is metabolized by?
Excreted unchanged in?
Can you measure serum levels?
Liver
Urine
Yes
172
True/False: there are reports of decreased absorption of Flecainide w/dairy milk/infant formula feeds.
True
173
Must Flecainide be compounded?
| Is there an IV form?
yes
| Not availble in U.S.
174
What is the s/e of Flecainide?
proarrhythmic
175
Adenosine works on what receptor?
| Which is linked to what channels via the G-protein system?
A1 (Adenosine receptor)
| linked to K+ channels
176
What does Adenosine do?
- Slows conduction time/re-entry pathwyas through A-V node
| - Restores normal rhythm
177
In what situations is Adenosine used?
Sustained paroxysmal SVT after no self-resolution & vagal maneuvers have been tried
178
What is the T2 of Adenosine?
| So give slow/fast?
1-5 seconds (<10 for sure)
| Fast 1-2 seconds in line closest to heart, immediately flush with NS
179
When monitoring baby getting Adenosine, what might bee seen briefly?
"flat line" when heart re-sets
180
Name the Ca+ channel blocker meds used or hypertension. (2)
1. Amlodipine
| 2. Nicardipine
181
True/False: Amlodipine is compounded?
True
182
Amlodipine is dosed either _____ or ___ x's / day
1 or 2
183
Is Amlodipine used often?
No, mainly in Renal pts.
184
Nicardipine inhibits entry of Ca++ into the cardiac and smooth muscle causing:
Relaxation of coronary and vascular smooth muscle
| Vasodilitation of coronary arteries (increases myocardial O2 delivery)
185
When is Nicardipine used?
Hypertension
| Arrhythmias
186
What are the s/e's of Nicardipine?
Flushing, Vasodilation, Palpitations, Hypotension, Headache
187
Nicardipine is incompatibile w/what typical NICU meds?
Ampicillin
Cefepime
Furosemide
188
Are drug interactions typical w/Nicardipine?
Yes, so check
189
Like Propafenone, Nicardipine has what type of pharmacokinetics?
Saturable, (non-linear metabolism) so the longer the pt is on it, the longer the effect
190
Name the Alpha 2 receptor Agonist
Clonidine
191
Clonidine stimulates what receptors?
Central Alpha 2 receptors (feedback mechanism receptor)
192
Clonidine is used for?
Centrally mediated HTN
| Adjunct in NAS (can also help w/increased b/p in these pts)
193
Can you abruptly stop Clonidine?
No, taper slowly to avoid rebound HTN
194
Diuretics are used frequently in post-op period in what pts?
Why?
CHF
Decrease pulmonary edema
Maintain euvolemic state
Anti-hypertensive
195
What are the 4 main classes of diuretics?
Loop (most common)
Thiazide
K+ sparing
Carbonic anhydrase inhibitors
196
Thiazides and K+ -sparing diuretics act mainly where in the kidney?
Cortex of the kidney
197
Loop diuretics act mainly where in the kidney?
Medulla
198
Thiazides work by?
Inhibiting active exchange of Cl- & Na+ in cortical dilating segment of the ascending loop of Henle
199
K+ sparing work by?
Inhibiting reabsorption of Na in the distal convoluted tubule and collecting duct
200
Loop diuretics work by?
Inhibiting exchange of Cl-/Na+/K+ in the thick segment of the ascending loop of Henle
201
Name the 2 most common Loop diuretics
Furosemide (lasix)
| Bumetanide (Bumex)
202
How much Na is reabsorbed int he ascending limb of the loop of henle w/Loop diuretics?
25-35%
203
IV furosemide is ___ x's as potent as IV dose
2 x's
204
Adverse effects of Loop diuretics?
#1: Hypokalemia
- Hypomagnesemia
- Hypocalcemia (bad for bones)
- Hyperuricemia
- Nephrocalcinosis
- Ototoxicity
- Long-term: Osteopenia
205
Name 2 Thiazide diuretics
1. Hydrochlorothiazide
| 2. Chlorothiazide
206
Thiazides act in the distal tubule to decrease reabsorption of?
Na+
207
Thiazides have loose efficacy in what pts?
Renal dysfunction
208
Thiazides might be used with what other type to obtain synergisitc diuretic effect?
Loop Diuretics
209
Thiazides are typically used in neonates to decrease the risk of?
Nephrocalcinosis and Osteopenia seen w/Loop Diuretics
210
What are the adverse effects of Thiazides?
```
Hypokalemia
Hypomagnesemia
Hypercalcemia
Hyperglycemia
-Reduced vascular resistance due to both blood volume reduction & relaxation of smooth muscle arterioles
```
211
Which Thiazide is expensive?
Chlorothiazide
212
Name a K+ sparing Diuretic
Spironolactone
213
How does Spironolactone work?
- Aldosterone antagonist
- Competes w/receptor sites in distal renal tubules
- Increasing Na+ & H2O excretion while preserving K+
214
Are K+ sparing diuretics potent?
| What might they be used with?
No
| Might be used w/other diuretics to prevent excretion of K+
215
What are the adverse effects of K+ sparing diuretics?
GI upset/nausea
Hyperkalemia
Lethargy
216
Are K+ sparing diuretics compounded? Name?
Yes, Aldactazide
| is Aldactone & Hydrochlorothiazide in equal amounts
