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Pharmacy Pre-Reg 2020/2021 > Cardiovascular - Diuretics > Flashcards

Cardiovascular - Diuretics Flashcards

1
Q

What are examples of loop diuretics and when are they used?

A

E.g. furosemide, bumetanide,

Acts on ascending limb of loop of henle

Used is HF - IV in acute, when there is odema or breathlessness in chronic

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2
Q

Give examples of thiazide and related diuretics, and when are they used?

A

Thiazide
Bendroflumethiazide
Cyclopenthiazide

Thiazide related
Indapamide 
Metolazone
Chlortalidone 
Xipamide

Act on the DCT
Used in hypertension and heart failure

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3
Q

Give an example of a potassium sparing diuretics and where does it act?

A

Amiloride

Acts on the collecting duct

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4
Q

Give examples of aldosterone antagonists and when are they used?

A

Spironolactone - adjunct in heart failure

Eplerenone - used in HF after MI, and in men who are experiencing oestrogen like side effects

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5
Q

Give an example of an osmotic diuretic and when is this used?

A

Mannitol

Used in cerebral odema

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6
Q

Give an example of a carbonic anhydrase inhibitor and when is this used?

A

Acetazolamide

Used in glaucoma and altitude sickness (unlicensed)

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7
Q

How do diuretics work?

A

Inhibit NaCl reasorption in the nephron, thereby inhibiting water reabsorption, so there is an increase in urine volume

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8
Q

What should a patient do if they are taking a diuretic and are experiencing diarrhoea or vomiting? Why?

A

Stop taking the diuretic for 1-2 days and increase fluid intake

To prevent dehydration, AKI, hypotension and worsening heart failure

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9
Q

What monitoring needs to be done for patients on diuretics?

A

Measure BP, electrolytes and renal function:
1-2 weeks after any change
Once treatment is stable, monitor every 6 months

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10
Q

What are more potent, loop or thiazide diuretics?

A

Loop

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11
Q

What has a longer duration of action, loop or thiazide diuretics?

A

Thiazide

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12
Q

What electrolyte and metabolic disturbances are associated with thiazides?

A 
Hypokalaemia 
Hyponatraemia
Hyperuricaemia
Hypercalcaemia 
Increased glucose levels
Lipids
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13
Q

Which thiazides are preferred in

a) hypertension
b) heart failure
c) diabetes

A

a) indapamide
b) bendroflumethiazide
c) indapamide

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14
Q

Which thiazide has the smallest effect on glucose levels?

A

Indapamide

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15
Q

What conditions can thiazide and loops exacerbate?

A

Diabetes

Gout

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16
Q

Some diuretics can cause hypokalaemia. When is this especially dangerous?

A

When patients are also taking a cardiac glycoside e.g. digoxin
Patients who have severe CHD

Potassium sparing diuretics e.g. amiloride can be used

17
Q

Why can chlortalidone be given on alternate days to control odema?

A

It had a longer duration of action

18
Q

What diuretic is used in acute heart failure?

A

IV furosemide

19
Q

Why should diuretics be given in the morning (or before 4pm)?

A

To prevent them from interfering with sleep due to diuresis

20
Q

Can you give potassium sparing diuretics with potassium supplements?

A

No

21
Q

Can potassium sparing diuretics be given alongside ACE Inhibitors?

A

No - increased risk of hyperkalaemia

22
Q

What are the indications of spironolactone?

A

Adjunct in heart failure
Liver cirrhosis and acites
Primary hyperaldosteronism

23
Q

What is the minimum eGFR for thiazides?

A

30ml/min/1.73m2

24
Q

What is the effect of thiazides on diabetes?

A

Increase in glucose

Indapamide has the lowest effect on glucose

25
Q

How can hypokalaemia affect the liver?

A

It can cause hepatic encephalopathy

26
Q

What is the effect of loop diuretics on patients with an enlarged prostate?

A

Can cause urinary retention

Although loops normally increase urine production

27
Q

Which diuretics can cause hypokalaemia

A

Loop

Thiazide

28
Q

Which diuretics can cause hyperkalaemia

A

Potassium sparing

29
Q

Should spironolactone be taken with or after food?

A

Yes

30
Q

In what condition are aldosterone antagonists contraindicated in?

A

Addisons Disease

31
Q

What diuretic can make urine look blue under certain lights?

A

Triamterene

32
Q

If a patient taking furosemide 40mg has resistant oedema, what can be done?

A

Switch to bumetanide 1mg

Pharmacy Pre-Reg 2020/2021 (18 decks)

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