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SUMPHARM > CV-Diuretics > Flashcards

CV-Diuretics Flashcards

1
Q

How much is reabsorbed into circulation at PCT?

A

65% Na, K, Cl, Mg, 85% NaHCO3, 100% Glucose and AA (aa-charged, membrane - repels). WATER passively resorbs

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2
Q

What DM medication is a diuretic but not studied for CHF?

A

SGLT-flozin. PCT inhib filter of glucose and Na

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3
Q

What other substance diuresis in PCT?

A

Peniclin, Creatine, uric acid, ABX, NSAIDs

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4
Q

What reduces NA reabosorbtion in the thick ascending loop of henle and reduces ADH aquaporins, which promotes what?

A

LOOPS-PG5 prostaglandins have additive effect with loop diruetics

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5
Q

This drug will block H+ and Na exchange, thus, Na will be reabsorbed, HCO3 will be excreted?

A

Carbonic anhydrase inhibotors-BLOCK carbonic anhydrase transporters. Na stays in lumen, H20 follows= Diuresis and Natriuesis

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6
Q

What two carbonic anhydrase inhib are used topically for glaucoma?

A

Dorzolamide, Brinzolamide

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7
Q

What two carbonic anhydrase inhib are used for glaucoma and mountain sickness?

A

Acetazolamide, Methazolamide- D/T effects of bicarb secretion from blood into aqueus humor, reduces IO pressure

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8
Q

Why are potent CAI not used as diuretics, unless emergency?

A

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

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9
Q

How else is CAI used other than eye and renal?

A

Remove bicarb from blood, reduces CSF volume= anticonvulsant effect. Edema- CHF, Mountain sickness,

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10
Q

How are all Diruretics eliminated?

A

Tubule excretion, that where they work

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11
Q

What are Renal affects of CAI

A

Hypokalemia, Hyperchloric metabolic acidiosis, Hyperglycemia,

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12
Q

What are CNS ADE of CAI?

A

Drowsiness, Parathesia

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13
Q

What are contraindications of CAI

A

Sufla allergy. Hematologic dz. Inc NH4

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14
Q

Which agent works at thick ascending limb of Henle Loop, TAL, where 25% Na, K, 2CL is resorbed, water is not permeable?

A

LOOP Diurectics

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15
Q

If Loops block Na/K ATPase pump, then K diffuses back in lumen creating a + charger. What happens to Mg and Ca w/ loops?

A

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)

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16
Q

Why are loops most efficacious?

A
  1. 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
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17
Q

What occurs first in resolving volume overload w/ loops?

A

Release blood flow thru vascular beds first, thus DEC pulmonary congestion sx prior to diuretic via PGs

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18
Q

When during the day should pts take Furosemide?

A

AM, and 4pm d/t polyuria. Dose 20-80mg/d BID- sulfa allergy alert

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19
Q

What is dose for Bumetanide?

A

Potent, 0.5-2mg/QD

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20
Q

What is does for Torsemide?

A

5-20mg QD

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21
Q

How do loops help with hypercalcemia, hyperkalemia?

A

LOOP cause hyopcalcemia. But must be given w/ saline to avoid dehydration 2. Loops cause hypokalemia at DCT d/t Na concentration

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22
Q

Overtime the diruectic effects of loops cause?

A
  1. 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
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23
Q

Which drug interaction affect the following with loops? 1. Diruresis 2. Hypokalemia 3. Hear loss 4. Anitdiureisis

A
  1. 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
24
Q

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?

A

Thiazides

25
Q

How is Thiazide effective with osteoporsis?

A

INC resorbtion of Ca at DCT. Also, Dec risk of Kidney stones

26
Q

Which agent as a long 1/2 thus QD dosing?

A

Chlorthalidone- 90% bound to RBC

27
Q

Where are TZDs secreted?

A

Proximal Tubule for activity

28
Q

Which condition is TZD used for early fluid overload?

A

CHF- reduce mortaility, Neprhotic syndrome

29
Q

Will thiazide word if Renal function below 15-25?

A

NO. Loops effect upto 5ml/min CrCL

30
Q

How do thiazide work with Diabetes insipidus?

A

Less fluid overload, thus nothing to urinate out.

31
Q

What should be checked during the 1st week with thiazide?

A

Hypokalemia, natremia,-shuts down Na/K exchanger. MG. 2. HYPER-glycemia, Uricemia, Calcium

32
Q

What are the ADE of thiazide to worn pts?

A

Orthostatic hypotensin, impotence, Steven Johnson Rash

33
Q

Why is bipolar a concern with thiazide?

A

Monitor Na level. Lithium may increase in serum.

34
Q

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?

A

Spiralactone

35
Q

Which agents inhibit Na flux w/in principal cells in lumen?

A

Amiloride, Triametrene

36
Q

These drug are aldosterone antagonist, which will inhibit Na/K channel activity, thus sparing K+?

A

Spiralactone, Eplerenone

37
Q

What is used in combo with HTN meds to dec effects of hypokalemia?

A

Spiralactone

38
Q

Avoid this in Kidney dz, bc usually increase this electroyle?

A

Spiralactone, CKI- INC K+. Use Thiazide, Loop for CKI

39
Q

What can be used in combo for Hepatic chirrhosis?

A

Loops and Spiralactone-dec. affects of RAAS

40
Q

What should be used with Loop in treatment of hypercalcemia?

A

Loop w/ saline- dec risk of sever dehydration

41
Q

This agent decrease aquaporins formation at the collecting duct, thus water is not resorbed?

A

Vasopressin antagonists

42
Q

Spiralactone can cause this in males?

A

Gynecomastia, impotence, BPH

43
Q

Which HTN agent used in combo with K sparing are caustic?

A

ACE, ARBs, BB, Potassium supplements, NSAIDs

44
Q

What prevent resorbtion of H2O in the PCT, and descending limb?

A

Mannitol- IV only poor PO

45
Q

With increase osmotic force, the contact time for what limits its resorbtion?

A

INC NA loss. Hyponatremia

46
Q

What are clinical uses of Mannitol?

A

Oliguria renal failure-will help them urinate, pulling water out from everywhere 2. DEC Intracranial pressure, 3. Acute angle closure gluacoma

47
Q

How does Mannital cause pulmonary edema?

A

Osmosis everywhere. Will pull water out from heart into lungs. CHF-give test dose to see if urine improves

48
Q

This hormone released with RAAS promotes Na resorbion and K+ loss w/in principal cells at the collecting duct?

A

Aldosterone- inc medullla osmlarity

49
Q

The intercalated cells promote this at the collecting duct?

A

alpha- proton secretion into lumen, beta- bicarb secretion

50
Q

Thes condition cause excess bleeding our volume loss, Diabets insipidus, esophageal variceal bleeding. What hormone will stop this?

A

ADH agonsits- Vasopressin promotes retention, vasoconstricts

51
Q

Which agents promote diuresis to help these conditions: SIADH, CHF, Hyponatremia

A

Conivaptan, Tolvaptan

52
Q

This agent is removed d/t irreversible liver damage?

A

Tolvaptan

53
Q

What ABX and antipyschotic can be used as an ADH antagonist, treat SIADH where the body retains too much water?

A

Demeclocyclin and Lithium

54
Q

What are overall benefits of diuretics?

A

thiazides- HTN reduce mortality, Loop- HTN, CHF, ok for RENAL dfx

55
Q

Should spiralocatone be used in DM pt with CKI?

A

NO bc thos pt have hyperkalemia. USE-thiazied and loops

SUMPHARM (26 decks)

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