CVS drugs - Diuretics and anti-fat

Question 1

When is mannitol used?

Answer 1

Raised ICP

Question 2

Give a CI for mannitol

Answer 2

Congestive heart failure

Pulmonary oedema

Question 3

What is the mechanism of aciton of mannitol?

Answer 3

 Freely filtered at the glomerulus, but only partially, if at all, reabsorbed
 Passive water reabsorption is reduced by the presence of this non-reabsorbable solute within the tubule lumen

Question 4

What are two ADRs of mannitol?

Answer 4

Chills and fever

Question 5

When would you use thiazide diuretic?

Answer 5

Hypertension

Oedema

Question 6

Give mechanism of action of thiazide diuretics

Answer 6

Inhibit NaCl symporter in luminal membrane, more Na+ in tubule

Question 7

Give four ADRs of thiazide diuretics

Answer 7

Hypokalaemia 
Hyperuriciaemia
Impaired glucose tolerance 
Hyponatraemia 
Hyper calcaemia 
Metabolic alkalosis

Question 8

Give four thiazide DDIs

Answer 8

Steroids - Increase risk of hypokalaemia
Beta blockers - Hyperglycaemia
Digoxin - Hypokalaemia increases digoxin binding and toxicity
Carbamezapine - Increased risk of hyponatraemia

Question 9

When would you use loop diuretics?

Answer 9

Acute pulmonary oedema
Oliguria
Resistant heart failure
Hypertension

Question 10

What is the mechanism of action of loop diuretics?

Answer 10

Inhibit NKCC2 channel at thick ascending limb

Question 11

Give some ADRs of loop diuretics

Answer 11

 Hypokalaemia, Hyponatraemia, hyperuricaemia (can preciptitate gout), hypotension, hypovolaemia, metabolic alkalosis

Question 12

What can furosemide cause specifically?

Answer 12

Ototoxicity

Question 13

How do loop diuretics interact with digoxin?

Answer 13

May cause hypokalaemia, increasing digoxin binding

Question 14

How do aminoglycosides mess with digoxin?

Answer 14

Interact with loop diuretics and increases risk of ototoxicity and potential hearing loss

Question 15

Give two potassium sparing diuretics

Answer 15

Amiloride

Spironolactone

Question 16

When are potassium sparing diuretics used generally?

Answer 16

In conjunction with other diuretics for heart failure and hypertension

Question 17

What can spironolactone be used for specifically?

Answer 17

Hyperaldosteronism

Question 18

What does amiloride do?

Answer 18

Blocks Na+ reabsorption

Question 19

What are some ADRs of spironolactone?

Answer 19

Hyperkalaemia
Hyponatraemia
Spironolactone - gynaecomastia, mestural disorders

Question 20

How is digoxin a diuretic?

Answer 20

Inhibits tubular Na/K ATPase?

Question 21

How does Lithium work as a diuretic

Answer 21

ADH antagonist

Question 22

How do you treat hyperkalaemia?

Answer 22

IV calcium gluconate

Question 23

How do statins work?

Answer 23

 HMG-CoA Reductase inhibitor. Prevents cholesterol synthesis in the liver. Lower liver cholesterol concentration stimulates the production of LDL receptors, increasing the rate of LDL removal from plasma.

Question 24

What are three main ADRs of statins?

Answer 24

Myopathy
Arthralgia
Headaches

Question 25

What drugs effect statins significantly?

Answer 25

Cyp450 inducers/inhibitors

Question 26

How much do statins decrease things?

Answer 26

o LDL reduction of between 5-35%, o HDL raised by ~5% o Triglycerides reduction of 10-35%

Question 27

Give four lipid lowering drugs

Answer 27

Fibrates Statins Cholesterol absorption inhibitors Bile Acid Sequesterant

Question 28

What is the mechanism of fibrates?

Answer 28

PPAR-a agonist

Question 29

What is PPAR?

Answer 29

Major regulator of lipid metabolism in the liver | Activation promotes uptake, catabolization and utilization of lipids

Question 30

What do fibrates do?

Answer 30

LDL lowering HDL increase in 15-25% in hypertriglyceridaemia Decreases Triglycerides 25-50%

Question 31

Give some adverse drug reactions to fibrates

Answer 31

Gastrointestinal disturbances Impotence Dermatitis Headache

Question 32

What happens if you take fibrates with statins?

Answer 32

Myalgia and myopathy

Question 33

What do cholesterol absorption inhibitors act on?

Answer 33

Intestinal cholesterol uptake - NPC1L1 in brush border.

Question 34

What does a single dose of cholesterol absorption inhibitor do?

Answer 34

Reduces LDL by 15-20%

Question 35

Give two ADRs of cholesterol inhibitors

Answer 35

Diarrhoea, pain | Headache

Question 36

What do bile acid sequesterants do?

Answer 36

o Bind to bile acids in the intestine. This prevents their reabsorption and subsequent conversion of hepatic cholesterol into bile acids. Lower levels of hepatic cholesterol leads to increased LDL receptor expression and lowered plasma cholesterol concentration.

Question 37

Why don't bile acid sequestrants cause systemic ADRs?

Answer 37

Not well absorbed - Do cause | Nausea, vomiting, constipation, abdominal pain, flatulence, heart burn