CHAPTER 2: CVS: Oedema

Question 1

What are the two types of diuretics used? (2)

Answer 1

1. Thiazides

2. Loop

Question 2

Can both loop and thiazide diuretics be used?

Answer 2

Yes, in patients with oedema resistant to just one diuretic

Question 3

What can vigorous diuresis induce?

Answer 3

Hypotension

Question 4

How long after administration do thiazide diuretics act?

Answer 4

Within 1-2 hours

Question 5

What is the duration of action of thiazide diuretics?

Answer 5

12-24 hours

Question 6

Low dose thiazide diuretics produce good BP lowering effects, what can higher dose lead to changes in? (electrolytes)

Answer 6

1. Potassium (hypokalaemia)
2. Sodium (hyponatreamia)
3. Uric acid
4. Glucose
5. Lipids

Question 7

What are the thiazide diuretics of choice? (2)

Answer 7

1. Chlortalidone

2. Indapamide

Question 8

Which thiazide diuretic licensed for use in mild to moderate heart failure is no longer first line?

Answer 8

Bendroflumethiazide

Question 9

Which thiazide diuretic can be given on alternate days due to its long duration of action?

Answer 9

Chlortalidone

Question 10

In which condition is chlortalidone really useful in?

Answer 10

Ascites due to cirrhosis in stable patients

Question 11

Which thiazide diuretic lowers BP with less metabolic effects?

Answer 11

Indapamide

Question 12

What is the man indication for loop diuretics?

Answer 12

Pulmonary oedema due to left ventricular failure

Question 13

Which 2 conditions can diuretics exacerbate?

Answer 13

1. Diabetes

2. Gout

Question 14

If a patient with an enlarged prostate is being treated with diuretics, what may occur?

Answer 14

Urinary retention - reduce dose and potency

Question 15

How long does it take for loop diuretics to start working?

Answer 15

1 hour

Question 16

What is the duration of action of loop diuretics?

Answer 16

6 hours

Question 17

Can loop diuretics be given twice daily?

Answer 17

Yes, as long as they don’t interfer with sleep

Question 18

Give an example of a potassium sparing diuretic

Answer 18

Amiloride

Question 19

Why are potassium sparing diuretics and aldosterone antagonists given with loop diuretics?

Answer 19

To retain potassium - more effective alternative to potassium supplements

Question 20

Give an example of an aldosterone antagonist

Answer 20

Spironolactone

Question 21

Can potassium supplements be given with potassium-sparing diuretics or aldosterone antagonists?

Answer 21

No

Question 22

What should be corrected before treatment with diuretics? (2)

Answer 22

1. Hypotension

2. Hypovoleamia

Question 23

In which population should lower initial doses of diuretics be used? They are more susceptible to side effects

Answer 23

Elderly

Question 24

Are diuretics indicated for simple gravitational oedema?

Answer 24

No

Question 25

What should be advised to manage simple gravitational oedema? (3)

Answer 25

1. Increased movement 2. Raising legs 3. Stockings

Question 26

What are the notable drug interactions with diuretics? (5)

Answer 26

1. Digoxin - toxicity due to hypokalaemia 2. Lithium - toxicity due to impaired renal function and hyponatreamia (body can't tell the difference so will retain it) 3. Potassium sparring diuretics 4. ACE inhibitors 5. NSAIDs