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Pharm 2 > Class 12 deck 2 > Flashcards

Class 12 deck 2 Flashcards

1
Q

What are the 4 K sparing diuretics?

A
  • Amiloride
  • Triamterene
  • Spironolactone
  • Eplerenone
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2
Q

How do amiloride and triamterene work?

A

-Directly on renal tubules transport mechanisms in the convoluted tubules. (independent of aldosterone)

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3
Q

How do spironolactone and eplerenone work?

A
  • Compete for aldosterone receptors in distal tubule to block Na reabsorption, and K secretion
  • Works only when aldosterone is present
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4
Q

amiloride and triamterene does what to the elecctrolytes?

A
  • Increase secretion of Na, chloride and Bicarb

- Increase in urine PH (alkaline)

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5
Q

How are amiloride and triamterene different?

A
  • Amiloride is more potent
  • Amiloride is incompletely absorbed / Triamterene is readily absorbed
  • Amiloride is not metabolized / Triamterene is metabolized (metabolites)
  • Elimination: amiloride 18 hours/ triantrene 3-5 hours
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6
Q

What are the uses K sparing diuretics?

A

-Used with Loops or Thiazides to augment diuresis and limit K loss

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7
Q

How do k sparing compare with other diuretics?

A
  • Act more distally, and are less effective

- No hyperuricemia

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8
Q

How does aerosilized amiloride help cystic fibrosis?

A

-Improves sputum viscosity

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9
Q

What is the principle side effect with K sparing? And what drugs increase this problem?

A
  • HyperK

- NSAIDs, ACEI, Beta blockers

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10
Q

How long will spironolactone take to work and last?

A
  • 2-4 days to take full effect

- 48-72 hours after discontinuation

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11
Q

Spironolactone pharmacokinetics?

A
  • 1st pass metabolism
  • binds to plasma proteins
  • Canrenone is major metabolite
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12
Q

What are the clinical uses of spironolactone?

A
  • Edema due to CHF and cirrhosis

- Antihypertensive (used with thiazides)

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13
Q

What is the major side effect of spironolactone? and how do the side effects compare with thiazides side effects?

A
  • Hyper K

- No hypoK, HyperMag, or Hyperurecimia

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14
Q

How does diamox (caronic anhydrase inhibitor) work?

A
  • Inhibits carbonic anhhydrase in proximal renal tubules
  • Excretion of H is diminished
  • Loss of Bicarb
  • Cl is retained (balance loss of bicarb)
  • Excretion of K in exchange for Na
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15
Q

What is the overall net effect of diamox?

A

-Excretion of alkaline urine in a hyperchloremic metabolic acidosis

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16
Q

Acetazolamide (Diamox®) Diuretic action is not altered by _____ or _____ acidosis.

A

Metabolic / respiratory

17
Q

What are the clinical uses of diamox?

A
  • Altitude sickness
  • Decrease IOP
  • Decrease CSF
  • Inhibit seizures
  • Familial periodic paralysis
  • stimulate ventilation in patients who are hypoventilating
18
Q

How does diamox effect COPDers?

A

-Loss of bicarb may lead to respiratory acidosis leading to CNS depression

19
Q

What are the dopamine receptor agonist drugs?

A
  • Dopamine

- Fenoldapam

20
Q

What does dopmaine receptor 1 do in the kidneys?

A
  • Increase cAMP
  • Vasodilate increasing RBF and GFR
  • Inhibits Na reabsorption
  • Promotes naturesis
21
Q

What does dopmaine receptor 2 do in the kidneys?

A

-Inhibit NE release

22
Q

What does low dose dopamine do? high dose?

A
  • Low = DA1 and DA2

- High = Beta1 increase CO, renal perfusion and RBF

23
Q

What receptors does fenoldopam work on?

A
  • Post synaptic DA1

- Weak 5HT-3

24
Q

What does fenoldopam infusion do?

A
  • Renal vasodilation

- Increased RBF

25
Q

What will higher doses of fenoldopam do?

A

-Decrease BP

26
Q

What are the uses of fenoldopam?

A

-Antihypertensive

27
Q

All diuretics can cause what two things?

A
  • Hypovolemia

- Azotemia

28
Q

What are the common side effects of both Loop and thiazides?

A
  • Hypokalemic metabolic alkalosis
  • Hyperglycemia
  • Hyperuricemia (clinical gout)
29
Q

What are the side effects of thiazides?

A
  • Hypercalcemia (sarcoidosis)

- Hyponatremia (patients who drink lots of water)

30
Q

What are the common side effects of K sparing?

A

-HyperK (especially those on ACEi and ARB)

31
Q

Emergent treatment is needed for hyper K when?

A
  • EKG changes (Tall T, loss of P, Wide QRS)
  • rapid Rise in serum K
  • Decreased renal function
  • Acidosis
32
Q

How to treat acute hyperK?

A
  • IV calcium (lowers threshold)
  • Shift K from vascular to cells using Insulin, D50, and inhaled bets 2 (albuterol)
  • Lower total body K (Diuretics, Kayexalate, Dialysis)
33
Q

Calcium must be used with caution with patients on ____, ______ could be used as an alternative

A
  • Dig

- Mag

Pharm 2 (23 decks)

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