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PHARM EXAM 4 AND FINAL > Diruetics > Flashcards

Diruetics Flashcards

1
Q

What is the role of the kidney in salt water homeostasis?

A

regulate ECF volume and [ions] in the body

filter, excrete, reabsorbs necessary amount to keep body levels adequate

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2
Q

What are the major clinical indications for diuretic drug therapy?

A

Edema- generalized/local

Hypertension- essential, renal, aldosteronism

other- Hypo/Hypercalcemia, Urolithiasis, Glaucoma, Drug/Mineral toxicosis, metabolic acid/alkalosis, nephrogenic Disorders

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3
Q

What are the major classes of diuretic drugs?

A 
Osmotic diuretics
Loop diuretics
Thiazides
K sparing diuretics
CA inhibitors
Xanthines
Urinary Acidifiers
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4
Q

What is the mechanism of Osmotic Diuretics?

A

they are filtered into the nephron at the glomerulus, but cannot be reabsorbed

thus increase osmotic pull, preventing water and ion re-absorption

leading to diuresis

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5
Q

What is mannitol? What is it used for?

A

Osmotic Diuretic

increases PG, increasing medullary blood flow

effective for acute management of cerebral edema

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6
Q

What are the therapeutic uses of Mannitol?

A

cerebral edema- reduces intracranial pressure

acute glaucoma- reduces intraocular pressure

Renal Failure- increases GFR volume, maintains urine flow,

Tx of ischemia/nephrotoxin induced acute tubular necrosis

Poison elimination

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7
Q

What are the adverse effects of Mannitol?

A

contraindicated in animals w/ generalized/acute pulmonary edema

not recommended in animals with cerebral hemorrhage, will enter the brain and cause increased fluid accumulation and increased intracranial pressure

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8
Q

What is the mechanism of action of Loop Diuretics?

A

reduce ion re-absorption via inhibition of Na/K/2Cl- co-transporter in the luminal membrane of the the thick ascending loop of henley

inhibit Ca2+ and Mg2+ re-absorption due to change in electrical gradient (luminal positive potential)

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9
Q

What is the most common loop diuretic?

A

Furosemide (Lasix)

others are: Torsemide, Bumetidine, and Ethacrynic Acid (not used in SA)

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10
Q

What are the therapeutic uses of Furosemide?

A

edema- rapid mobilization, very effective for pulmonary edema

chronic heart failure- best class to use

Acute renal failure- use in combo w/ mannitol

hypercalcemia- increases urinary Ca2+ secretion in dog/cat (tx for Vit D toxicosis)

EIPH in Race horses

HyperK if Mannitol ineffective

Tx of ascites- combo w/ other drugs

Antihypertensive

Tx post-parturient udder edema- approved drug

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11
Q

What are the adverse effects of Furosemide?

A

fluid-electrolyte imbalance, especially hypoK/Cl-

ototoxicity- deafness due to above imbalance in the endolymph of inner ear

Dehydration, metabolic alkalosis, hyperuremia (Gout), hypocalcemia, muscle weakness, CNS depression

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12
Q

Does Furosemide interact w/ other drugs? Which ones?

A

increased ototoxicty/nephrotoxicity w/ aminoglycosides/cisplatin

NSAIDS reduce diuretic response of loop drugs

increased hypoK during cocontaminant tx w/ corticosteroids/amphotericin B

may alter requirements of insulin/other anti-diabetic drugs

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13
Q

When is furosemide/other loop diuretics contraindicated?

A

patients w/ anuria, renal failure, hepatic dysfunction, and diabetes

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14
Q

What is the mechanism of action of Thiazides?

A

inhibition of Na+/Cl- symporter in the distal collecting tubule

increase the re-absorption of Ca2+ due to stimulation of Na+/Ca2+ antiporter

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15
Q

What are the 4 thiazide drugs?

A

Chlorothiazide
Hydrochlorothiazide
Trichlormethiazide
CHlorthalidone

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16
Q

What are the therapeutic usesnof thiazides?

A

long term diuretic therapy- adjunct tx in dogs and cats w/ CHF, animals with resistance to furosemide

Tx of systemic hypertension

tx of post parturient udder edema- approved

Nephrogenic DI in combo w indomethican leads to reduced urine output in dogs w/ DI

Ca-oxalate crystal uroliths- decreases these stones in dogs

17
Q

What are the adverse effects of thiazides?

A

fluid-electrolyte imbalance
hypoK, gout, hyperCa w/ prolonged use
hyperglycemia/glucosuria- inhibition of proinsulin and insulin

Similar drug interaction as loop drugs

18
Q

What is the mechansim of action of K+ sparing drugs?

A

Na+ channel blockers, reduce luminal potential and the driving force for K secretion leads to decrease in K+ secretion

reduction in lumen negative potential decreases H+ secretion in intercalated cells

NET RESULT (of filtrate)
increase Na, Decreased K, Decreased H
19
Q

What are the K sparing drugs?

A

Trimaterene and Amiloride

20
Q

What is the mech of action of Aldosterone Antagonists?

A

competively bind aldosterone receptor, reducing the synthesis of aldosterone-induced proteins, inhibting their fx

Basically- inhibit Na/K channels, Na/K ATPase, Mitochondrial ATP pdx

Leads to a net result is same as K sparing
increase Na, Decreased K, Decreased H

21
Q

What are the aldosterone antagonists?

A

Spironolactone and Potassium canrenoate

22
Q

What are the therapeutic uses of aldosterone antagonists?

A

**used in conjunction w/ loop/thiazides

chronic tx of CHF

primary/secondary aldosteronism

tx of ascites

23
Q

What are the adverse effects of aldosterone antagonists?

A

hyperK

metabolic acidosis

24
Q

What are the CA inhibitors?

A

Carbonic Anhydrase inhibitors
reduce the # of H+ ions available for NA/K exchange

results in increased Bicarb, K+ excretion, and Cl- retention

leads to hyperchloremic acidosis

25
Q

What are CA inhibitors used for?

A

glaucoma and metabolic alkalosis

HYPP in horses

26
Q

What do Xanthines do?

A

increase renal blood flow and increase GFR

decreases Na re-absorption in the PCT

used to increase urine output

27
Q

What are Urinary Acidfiers?

A

Take a fucking wild guess

lowers the pH of the ECF and Urine

liver converts to NH3, H+ and CL-, H+ buffered by bicard in the plasma; increased Cl- load to kidney pdx loss of NA+ and Cl- and mild diuresis

28
Q

What is Methionine?

A

Urinary acidifier, S)4 excretion in urine as H2SO4

promotes the excretion of ionizable drugs or poisons by urinary acidifcation

will also dissolve/prevent uroliths

29
Q

REVIEW SLIDE ON RENIN ANGIOTENSIN SYSTEM

A

DO IT

PHARM EXAM 4 AND FINAL (13 decks)

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