CV - diuretics and RAAS antagonists Flashcards
specific goals of heart failure management with pharmacology
reduction of congestion
modulation of neurohormonal activation
improve flow
what is the primary class of drugs involved in reduction of congestion?
diuretics
what are the primary classes of drugs involved in modulation of neurohormonal activation?
RAAS antagonists
beta-blockers
what is the primary class of drugs involved in improvement of flow?
vasodilators
what is the most common loop diuretic?
furosemide
name five additional diuretic agents
hydrochlorothiazide spironolactone mannitol torsemide bumetanide
what must be monitored when using aldosterone antagonists?
serum K+
pH
diuretics interfere with __________ reabsorption, thus decreasing the amount of __________ that is absorbed and resolving the __________.
Na+
water
edema
what is the mechanism of action of thiazides and furosemide?
interactions with membrane transport proteins
what is the mechanism of spironolactone?
interactions with hormone receptors
what is the mechanism of mannitol?
osmotic effects preventing water reabsorption
a decrease in __________ reabsorption means more __________ at the __________, ultimately resulting in more __________ and __________ loss and leading to __________.
Na+ Na+ collecting tubule H+ K+ hypokalemic metabolic alkalosis
you reabsorb most Na+ in the __________.
proximal convoluted tubule
name the three loop diuretics with which we are concerned
furosemide
bumetanide
torsemide
thiazides and loop diuretics are secreted into the __________ from the __________ and use the same transporter as __________, thus preventing __________ from being transported and leading to __________.
urine blood uric acid uric acid hyperuricemia
all of the loop diuretics are __________ derivatives except __________.
sulfonamide
ethacrynic acid
__________ can be used if sulfonamide allergy.
ethacrynic acid
what are the most significant adverse affects of loop diuretics?
hypokalemic metabolic alkalosis
hyperuricemia
thiazide diuretics inhibit the __________ cotransporter.
Na+/Cl-
thiazides increase reabsorption of __________, unlike loop diuretics which decrease serum __________ levels.
Ca++
a decrease in __________ reabsorption means more __________ at the collecting tubule, ultimately resulting in more __________ and __________ loss, leading to __________.
Na+ Na+ K+ H+ hypokalemic metabolic alkalosis
name two thiazide diuretic agents
hydrochlorothiazide
chlorthalidone
thiazide diuretics are secreted by the organic acid secretory system, thus competing with __________ secretion and increasing the risk of __________.
uric acid
gout attack
what are the adverse reactions associated with thiazide diuretics?
hypokalemia
predisposition to ectopic pacemakers
hyperglycemia
gout
what are the two classes of potassium-sparing diuretic agents, and which are used in heart failure?
aldosterone receptor antagonists
collecting tubule sodium channel blockers
aldosterone antagonists are used in heart failure
aldosterone antagonists are used in heart failure, primarily due to their __________ actions via block of __________ receptors.
cardiac anti-remodeling actions
cardiac aldosterone receptors
name two K+-sparing diuretics
spironolactone
eplerenone - not an aldosterone antagonist
what are the adverse reactions associated with aldosterone antagonist K+-sparing diuretics?
hyperkalemia
gynecomastia
name the aldosterone antagonist K+-sparing diuretic we need to know
spironolactone
beta-blockers improve cardiac function in heart failure by __________.
cardiac anti-remodeling effects
a male patient is placed on a new medication for heart failure and notes that his breasts have become tender to the touch. which medication is he most likely taking?
spironolactone
once renal function is below 50%, you begin to loose efficacy in all diuretic classes except __________.
loop diuretics
what does the “pril” suffix denote?
RAAS antagonists - ACE inhibitors
