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Pharm > Chapter 41: Diuretics > Flashcards

Chapter 41: Diuretics Flashcards

1
Q

What three things does the renal system help regulate?

A

ECF volume and compensation, acid-base balance, excretion of metabolic wastes and foreign substances.

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2
Q

What does the renal system play a significant role in doing?

A

drug elimination

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3
Q

What are the essential physiological functions of the renal system?

A

Stimulates erythropoiesis and activates vitamin D

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4
Q

What is the active form of of vitamin D?

A

Calcitriol

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5
Q

Kidneys are the site of what?

A

Parathyroid hormone functioning

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6
Q

What 2 ions are the most prevalent of the filtrate?

A

Sodium and chloride

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7
Q

What is the first step in urine formation?

A

Filtration

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8
Q

What is the best measure of overall function of the kidney

A

GFR

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9
Q

What types of particles are easily filtered through the kidneys?

A

Small, water soluble, lipid phobic, and ionized

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10
Q

What type of process is filtration?

A

Non-selective

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11
Q

What percent of filtered sodium and chloride is reabsorbed at the proximal convoluted tubule?

A

65%

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12
Q

What type of transport does solutes use?

A

Active transport

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13
Q

What has almost 100% reabsorption in the proximal convoluted tubules?

A

Filtered bicarbonate and potassium

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14
Q

What type of solute does water use?

A

Passive transport (osmotic pressure)

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15
Q

What is absorbed equally in the proximal convoluted tubules?

A

solutes and water

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16
Q

What percent of filtered sodium and chloride is reabsorbed at the early distal convoluted tubule?

A

10%

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17
Q

What percentage of sodium and chloride is reabsorbed in the loop of henle?

A

20

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18
Q

What type of diuretics work at the early distal convoluted tubules?

A

Thiazide diuretics

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19
Q

What type of diuretics is more potent?

A

Loop diuretics

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20
Q

What two processes happen at the distal nephron?

A

sodium and potassium exchange

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21
Q

What is aldosterone’s main goal

A

to reabsorb sodium

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22
Q

What determines the final concentration of urine

A

ADH

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23
Q

What test can you use to find urine weight?

A

Specific gravity

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24
Q

What is the normal specific gravity

A

0.010-0.030

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25
Q

Aldosterone causes stimulation of the distal nephron cells to do what?

A

Synthesize more protein pumps responsible for sodium and potassium transport

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26
Q

Amount of diuresis is directly related to what?

A

The amount of sodium and chloride that is not reabsorbed (because diuretics are blocking the reabsorption)

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27
Q

The form of the drug depends on what?

A

The pH of urine

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28
Q

Diuretics are widely used in the management of what 2 conditions

A

Edematous and non edematous

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29
Q

Diuretics are drugs that promote the renal excretion of what three things?

A

sodium, chloride, and water

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30
Q

What are examples of edematous conditions?

A

heart failure, liver failure, and renal failure

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31
Q

What is an example of a nonedamatous condition?

A

HTN (by depleting sodium)

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32
Q

What are two common adverse effects of diuretics?

A

Hypovolemia and electrolyte and acid-base imbalances

33
Q

Diuretics are sometimes used to prevent renal failure by what>

A

d/t their ability to maintain urine flow

34
Q

What are the two subcategories of potassium sparing diuretics?

A

aldosterone antagonists and non aldosterone antagonists

35
Q

What diuretics are used primarily to reduce IOP & NOT increase urine production

A

Carbonic Anhydrase inhibitor

36
Q

What is the prototype for loop diuretics?

A

Furosemide

37
Q

How does furosemide work?

A

Inhibits sodium & chloride reabsorption in the ascending limb of the loop of henle.
(prevents passive reabsorption of water)

38
Q

Due to furosemide’s ability to cause significant diuresis, what can this drug lead to?

A

Severe dehydration

39
Q

What type of diuretic is effective in patient’s with renal impairment

A

Furosemide (lasix) / loop diuretic

40
Q

What diuretic has a high ceiling effect?

A

Furosemide

41
Q

When would furosemide be given IV route?

A

In situations needing rapid and massive mobilization of fluids.

42
Q

How is effectiveness monitored while on diuretics?

A
  • daily weight
    -comparing urine output (output should exceed intake)
    -decreased edema
    -clear lung sounds
43
Q

what serum levels are decreased in patients who are taking loop diuretics

A

sodium, potassium, chloride, calcium, magnesium, HDL

44
Q

If a patient is taking loop diuretics begins to complain about joint pain while on furosemide, what would we be concerned about?

A

the patient could be developing gout

45
Q

what are some drug-drug interactions with loop diuretics?

A

antihypertensives, digoxin, amino-glycosides, lithium, NSAIDs, and potassium sparing diuretics

46
Q

what effects can NSAIDs have on furosemide?

A

can blunt the effects of furesomide

47
Q

What are some potential adverse effects seen with furosemide?

A

-hypovolemia
-hypokalemia
-hyponatremia
-hypochloremia
-dehydration
-ototoxicity
-hypotension
-dysthymias (potassium)
-acid-base imbalance (metabolic alkalosis0 loss of hydrogen ions)

48
Q

using gentamicin along with fursomide can increase the risk of what

A

ototoxicity

49
Q

What drug has a positive interaction with furosemide?

A

Potassium-sparing diuretics

50
Q

What diuretic is used as first-line treatment for HTN?

A

hydrochlorothiazide

51
Q

promotion of diuresis while taking a thiazide diuretic is dependent on what

A

adequate renal function

52
Q

hydrochlorothiazide has the same adverse effects as furseomide except for what two things

A

ototoxicity and hypocalcemia

53
Q

What diuretic would you be concerned with a sulfa allergy?

A

hydrochlorothiazide

54
Q

what effect does hydrochlorothiazide have on bones?

A

helps preserve bone integrity

55
Q

What diuretic protects against post-menopausal osteoporosis?

A

hydrochlorothiazide

56
Q

thiazide diuretics have the same drug-drug interactions as loop except for what drug

A

amino-glycosides (gentamicin)

57
Q

what can thiazide diuretics help prevent against?

A

calcium induced renal calculi

58
Q

Due to the enhanced action of ADH that thiazide diuretics have, what can these drugs be used for?

A

diabetes insipidus

59
Q

What is an indirect-acting potassium-sparing diuretic?

A

Spironolactone

60
Q

what type of adverse effects does spironolactone have?

A

endocrine and androgenic effects like gynecomastia, impotence, hirsituitism

61
Q

What must be present for spironolactone to be effective?

A

Aldosterone

62
Q

what are the four properties of mannitol

A

freely filtered at the glomerulus, undergoes minimal tubular reabsorption and metabolism and it is pharmacologically inert

63
Q

How long does it take to develop therapeutic effects?

A

up to 48 hours (delayed)

64
Q

what type of diuretic has no actions on it’s own

A

osmotic diuretics (mannitol)

65
Q

what two things are mannitol helpful for?

A

oliguria and anuria

66
Q

Spironolactone acts at the late distal tubule to decrease what two things?

A
  • sodium reabsorption
  • potassium secretion
67
Q

the degree of diuresis while taking mannitol is directly related to what

A

the concentration of mannitol in the filtrate

68
Q

mannitol has no effect on what?

A

electrolyte excretion

69
Q

mannitol can be used for what other clinical things?

A

prevention of renal failure, reduction of ICP due to cerebral edema and reduction of IOP before opthalamic surgeries

70
Q

what is a major ADR for mannitol?

A

edema

71
Q

due to the possibility of edema while taking an osmotic diuretic, what patients should we be cautious about giving this drug to?

A

patients who are experiencing heart failure and peripheral edema

72
Q

Can spironolactone be combined with other diuretics?

A

Yes, it is a weak diuretic so it is usually combined.

73
Q

Which diuretic has cardioprotective effects?

A

Spironolactone

74
Q

What is an example of a direct-acting potassium sparing diuretic?

A

Triamterene

75
Q

Which potassium-sparing diuretic works more rapidly? Spironolactone or triamterene?

A

triamterene

76
Q

What is the major adr for potassium-sparing diuretics?

A

Hyperkalemia

77
Q

What may be needed for hyperkalemia r/t the use of potassium-sparing diuretics?

A

Insulin or Kayexalate

78
Q

What are 4 drug-drug interactions with potassium-sparing diuretics?

A

-potassium supplements
-ACE-inhibitors
-Angiotensin receptor blockers (ARBS)
-Direct renin inhibitors (DRI)

79
Q

What should patients avoid in potassium-sparing diuretics?

A

foods high in potassium (bananas, potatoes, strawberries, salt substitutes)

Pharm (11 decks)

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