CV-Diuretics Flashcards
How much is reabsorbed into circulation at PCT?
65% Na, K, Cl, Mg, 85% NaHCO3, 100% Glucose and AA (aa-charged, membrane - repels). WATER passively resorbs
What DM medication is a diuretic but not studied for CHF?
SGLT-flozin. PCT inhib filter of glucose and Na
What other substance diuresis in PCT?
Peniclin, Creatine, uric acid, ABX, NSAIDs
What reduces NA reabosorbtion in the thick ascending loop of henle and reduces ADH aquaporins, which promotes what?
LOOPS-PG5 prostaglandins have additive effect with loop diruetics
This drug will block H+ and Na exchange, thus, Na will be reabsorbed, HCO3 will be excreted?
Carbonic anhydrase inhibotors-BLOCK carbonic anhydrase transporters. Na stays in lumen, H20 follows= Diuresis and Natriuesis
What two carbonic anhydrase inhib are used topically for glaucoma?
Dorzolamide, Brinzolamide
What two carbonic anhydrase inhib are used for glaucoma and mountain sickness?
Acetazolamide, Methazolamide- D/T effects of bicarb secretion from blood into aqueus humor, reduces IO pressure
Why are potent CAI not used as diuretics, unless emergency?
Quick diurectic effect d/t Na/H block, but overtime becomes hyperchloremic metabolic acidosis b/c of bicarb loss in lumen. Body then corrects itself several days and diuresis becomes less effective. less bicarb/Na is lost. Urine becomes akaline
How else is CAI used other than eye and renal?
Remove bicarb from blood, reduces CSF volume= anticonvulsant effect. Edema- CHF, Mountain sickness,
How are all Diruretics eliminated?
Tubule excretion, that where they work
What are Renal affects of CAI
Hypokalemia, Hyperchloric metabolic acidiosis, Hyperglycemia,
What are CNS ADE of CAI?
Drowsiness, Parathesia
What are contraindications of CAI
Sufla allergy. Hematologic dz. Inc NH4
Which agent works at thick ascending limb of Henle Loop, TAL, where 25% Na, K, 2CL is resorbed, water is not permeable?
LOOP Diurectics
If Loops block Na/K ATPase pump, then K diffuses back in lumen creating a + charger. What happens to Mg and Ca w/ loops?
K+ charge in lumen normally pushes Mg and Ca to be resorbed. BUT if blocked, Mg and Ca stay in lumen= excretion= Hypomagesium and Hypocalcemia (rare)
Why are loops most efficacious?
- No llimitatiOn of acidosis 2. Induce PG syntheis via COX2 3. INC renal BF 4. Inhibtis Na/K/CL transport 5. DEC CHF 6. Nephrotic syndrome. 7 Cirrhoisis hepatic 8. HTN 9. ARF- flush casts out
What occurs first in resolving volume overload w/ loops?
Release blood flow thru vascular beds first, thus DEC pulmonary congestion sx prior to diuretic via PGs
When during the day should pts take Furosemide?
AM, and 4pm d/t polyuria. Dose 20-80mg/d BID- sulfa allergy alert
What is dose for Bumetanide?
Potent, 0.5-2mg/QD
What is does for Torsemide?
5-20mg QD
How do loops help with hypercalcemia, hyperkalemia?
LOOP cause hyopcalcemia. But must be given w/ saline to avoid dehydration 2. Loops cause hypokalemia at DCT d/t Na concentration
Overtime the diruectic effects of loops cause?
- DEC blood volume to Renal, so GFR is dec 2. Fluid and electrolyte depletion- orthostatic hypotension 3. Gout- d/t dehydration 4. Hearing dfx w/ rapid IV ONLY
Which drug interaction affect the following with loops? 1. Diruresis 2. Hypokalemia 3. Hear loss 4. Anitdiureisis
- Diruresis inc- Thiazides, HTN meds 2. Hypokalemia- Digoxin, amphotercine, steroids 3. Hear loss- aminoglycosides, erythromycin 4. Anitdiuresis- Indomethcin, NSAIDs d/t block of PGs. Bile acid sequetrants- cholestyramin, colesitpol
This agent keeps NaCl in the lumen thus inhibits resorbtion to blood stream at the Distal convulted tubule, and INC Ca resorbtion to treat osteoporosis?
Thiazides
How is Thiazide effective with osteoporsis?
INC resorbtion of Ca at DCT. Also, Dec risk of Kidney stones
Which agent as a long 1/2 thus QD dosing?
Chlorthalidone- 90% bound to RBC
Where are TZDs secreted?
Proximal Tubule for activity
Which condition is TZD used for early fluid overload?
CHF- reduce mortaility, Neprhotic syndrome
Will thiazide word if Renal function below 15-25?
NO. Loops effect upto 5ml/min CrCL
How do thiazide work with Diabetes insipidus?
Less fluid overload, thus nothing to urinate out.
What should be checked during the 1st week with thiazide?
Hypokalemia, natremia,-shuts down Na/K exchanger. MG. 2. HYPER-glycemia, Uricemia, Calcium
What are the ADE of thiazide to worn pts?
Orthostatic hypotensin, impotence, Steven Johnson Rash
Why is bipolar a concern with thiazide?
Monitor Na level. Lithium may increase in serum.
At the cortical collecting tubule, Na, K are resorbed bc more than expected Na is still here due to other diurectics. Thus, K+ may get exreted at CCT. This agent spares K+ from excretion into lumen?
Spiralactone
Which agents inhibit Na flux w/in principal cells in lumen?
Amiloride, Triametrene
These drug are aldosterone antagonist, which will inhibit Na/K channel activity, thus sparing K+?
Spiralactone, Eplerenone
What is used in combo with HTN meds to dec effects of hypokalemia?
Spiralactone
Avoid this in Kidney dz, bc usually increase this electroyle?
Spiralactone, CKI- INC K+. Use Thiazide, Loop for CKI
What can be used in combo for Hepatic chirrhosis?
Loops and Spiralactone-dec. affects of RAAS
What should be used with Loop in treatment of hypercalcemia?
Loop w/ saline- dec risk of sever dehydration
This agent decrease aquaporins formation at the collecting duct, thus water is not resorbed?
Vasopressin antagonists
Spiralactone can cause this in males?
Gynecomastia, impotence, BPH
Which HTN agent used in combo with K sparing are caustic?
ACE, ARBs, BB, Potassium supplements, NSAIDs
What prevent resorbtion of H2O in the PCT, and descending limb?
Mannitol- IV only poor PO
With increase osmotic force, the contact time for what limits its resorbtion?
INC NA loss. Hyponatremia
What are clinical uses of Mannitol?
Oliguria renal failure-will help them urinate, pulling water out from everywhere 2. DEC Intracranial pressure, 3. Acute angle closure gluacoma
How does Mannital cause pulmonary edema?
Osmosis everywhere. Will pull water out from heart into lungs. CHF-give test dose to see if urine improves
This hormone released with RAAS promotes Na resorbion and K+ loss w/in principal cells at the collecting duct?
Aldosterone- inc medullla osmlarity
The intercalated cells promote this at the collecting duct?
alpha- proton secretion into lumen, beta- bicarb secretion
Thes condition cause excess bleeding our volume loss, Diabets insipidus, esophageal variceal bleeding. What hormone will stop this?
ADH agonsits- Vasopressin promotes retention, vasoconstricts
Which agents promote diuresis to help these conditions: SIADH, CHF, Hyponatremia
Conivaptan, Tolvaptan
This agent is removed d/t irreversible liver damage?
Tolvaptan
What ABX and antipyschotic can be used as an ADH antagonist, treat SIADH where the body retains too much water?
Demeclocyclin and Lithium
What are overall benefits of diuretics?
thiazides- HTN reduce mortality, Loop- HTN, CHF, ok for RENAL dfx
Should spiralocatone be used in DM pt with CKI?
NO bc thos pt have hyperkalemia. USE-thiazied and loops
