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Pathophysiology & Pharmacology 218 > Diuretic, ACE Inhibitors and Angiotensin II receptor blockers (Week 3) > Flashcards

Diuretic, ACE Inhibitors and Angiotensin II receptor blockers (Week 3) Flashcards

1
Q

Commonly used anticoagulants

A
  • Warfarin
  • Heparin (Unfractionated
  • Low molecular weight heparins (Tinzaparin, Enoxaparin, Dalteparin)
  • Apixaban
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2
Q

Classifications of Diuretic Drugs

A
  • Carbonic anhydrase inhibitors
  • Loop Diuretics
  • Osmotic Diuretics
  • Potassium-sparing diuretics
  • Thiazide and Thiazide-like diuretics
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3
Q

Action of Loop Diuretics

A

Act primarily on the thick ascending limb of the loop of Henle, blocking chloride and sodium resorption…..

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4
Q

Movement of Loop Diuretics

A

Absorption:
Distribution:
Metabolism: Kidneys
Excretion: Urine

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5
Q

Common Adverse Effects of Loop Diuretics

A

CNS: Dizziness, headache, tinnitus, blurred vision
GI: Nausea, vomiting, diarrhea
Hemat: Agranulocytosis, thrombocytopenia, neutropenia
Metabolic: hypokalemia, hyperglycemia, hyperuricemia, hyponatremia, hypochloremia, hypocalcemia, hypomagnesemia, metabolic alkalosis in severe cases

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6
Q

Indications of Loop Diuretics

A

Manage edema associated with heart failure and kidney or liver disease, to manage hypertension, and to increase the kidney increase of calcium in patients with hypercalcemia. May also be indicated with heart failure from diastole dysfunction.

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7
Q

Action of Loop Diuretics

A

Act primarily on the thick ascending limb of the loop of Henle, blocking chloride and sodium resorption…..

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8
Q

Contraindications of Loop Diuretics

A
  • Known drug allergy
  • hepatic coma
  • severe electrolyte loss
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9
Q

Interactions of Loop Diuretics

A

Loop diuretics have neurotoxic and nephrotoxic properties and produce additive effects when given in combination with other drugs with similar toxicities.

  • Aminoglycosides
  • Vancomycin
  • Corticosteroids
  • Digoxin
  • Lithium Carbonate
  • NSAIDs
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10
Q

Administration of Loop Diuretics

A

Dosage varies with drug and age of pt.
Mannitol - IV
Furosemide - IM, IV, PO

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11
Q

Examples of Thiazide Diuretics

A
  • acetazolamide

- methazolamide

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12
Q

Movement of Thiazide Diuretics

A

Absorption:
Distribution:
Metabolism:
Excretion: Kidneys

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13
Q

Action of Thiazide Diuretics

A
  • Site if action is at the convoluted tubule, where it inhibits the resorption of sodium, potassium, and chloride.
  • Results in osmotic water loss.
  • Cause direct relaxation of the arterioles, which reduces afterload
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14
Q

Contraindications of Thiazide Diuretics

A
  • Known drug allergy
  • Hyponatremia
  • Hypokalemia
  • Severe Kidney or Liver Dysfunction
  • Adrenal Gland insufficiency
  • Cirrhosis
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15
Q

Adverse Effects of Thiazide Diuretics

A

CNS: Dizziness, headache, blurred vision
GI: Anorexia, nausea, vomiting, diarrhea
GU: Erectile dysfunction
Hemat: Jaundice, leukopenia, agranulocytosis
Integumentary: Urticaria, Photosensitivity
Metabolic: Hypokalemia, glycosuria, hyperglycemia, hyperuricemia, hypochloremic alkalosis

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16
Q

Management of OD in Thiazide Diuretics

A

An overdose can lead to an electrolyte imbalance resulting from hypokalemia. Treatment includes electrolyte replacement.

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17
Q

Symptoms of OD of Thiazide Diuretics

A
  • anorexia
  • nausea
  • lethargy
  • muscle weakness
  • mental confusion
  • hypotension
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18
Q

Interactions of Thiazide Diuretics

A
  • corticosteroids, antagonism
  • diazoxide, additive (hypokalemia)
  • digoxin, incr. digoxin toxicity
  • oral hypoglycemics
  • excessive consumption of licorice, hypokalemia
  • Lithium, decreased clearance (incr. lithium toxicity)
  • NSAIDs, inhibition of kidney prostaglandins (decr. diuretic activity.
19
Q

Indications of Thiazide Diuretics

A

Treatment of:

  • edema of various origins
  • idiopathic hypercalciuria
  • diabetes insipidus
  • Heart failure due to diastolic dysfunction
20
Q

Administration

A

PO varies by age

21
Q

Examples of Potassium-Sparing Diuretics

A
  • spironolactone
  • amiloride
  • eplerenone
  • triamterene (only in combination with hydrochlorothiazide)
22
Q

Movement of Potassium-Sparing Diuretics

A

Absorption:
Distribution:
Metabolism:
Excretion:

23
Q

Action of Potassium-Sparing Diuretics

A
  • Acts in the collecting ducts and distal convoluted tubules
  • Interferes with sodium-potassium exchange
  • Blocks the resorption of sodium and water induced by aldosterone
  • Relatively weak and usually used adjunctive to thiazide as it counteracts its adverse effect of potassium loss
24
Q

Contraindications of Potassium-Sparing Diuretics

A
  • Known drug allergies
  • Hyperkalemia
  • Severe kidney failure
  • Anuria
  • Triamterene for liver failure
25
Q

Common Adverse Effects of Potassium-Sparing Diuretics

A

CNS: Dizziness, headache
GI: Cramps, nausea, vomiting, diarrhea
Other: Urinary frequency, weakness, hyperkalemia

26
Q

Interactions of Potassium-Sparing Diuretics

A
  • Lithium, incr. lithium toxicity
  • ACE inhibitors, hyperkalemia
  • Potassium supplements, hyperkalemia
  • NSAIDs, inhibit kidney prostaglandins, diminished diuretic response
27
Q

Indications of Potassium-Sparing Diuretics

A 
Spironolactone and triamterene
- hyperaldosteronism
- hypertension
- potassium loss from potassium wasting
Spironolactone 
- preventing remodeling in HF
28
Q

Examples of Angiotensin II Receptor Blockers

A
  • losartan
  • eprosartan mesylate
  • valsartan
  • irbesartan
  • candesartan cilexetil
29
Q

Action of Angiotensin II Receptor Blockers

A

ARBs block the binding of angiotensin II to type 1 angiotensin II receptors. These receptors are thought to play a role in raising BP.

30
Q

Movement of Angiotensin II Receptor Blockers

A

Absorption:
Distribution:
Metabolism:
Excretion:

31
Q

Contraindications of Angiotensin II Receptor Blockers

A
  • Drug allergy
  • Pregnancy
  • Lactation
  • Use cautiously in older adults and patients with kidney dysfunction
  • Assess BP before and during treatment
32
Q

Most Common Adverse Effects of Angiotensin II Receptor Blockers

A
  • Upper Respiratory Infections

- Headache

33
Q

Interactions of Angiotensin II Receptor Blockers

A
  • NSAIDs, decreased antihypertensive
  • Lithium, Incr. lithium concentrations
  • Phenobarbital, Increases metabolism
  • Potassium Supplements and potassium-sparing diuretics, additive potassium-increasing affects
34
Q

Management of Toxicity and OD of Angiotensin II Receptor Blockers

A

Manifests as hypotension, tachycardia, and sometimes bradycardia.
Treatment is symptomatic and supportive. Includes IV fluids to expand blood volume.

35
Q

Indications of Angiotensin II Receptor Blockers

A

Treatment of Heart Failure and Hypertension

36
Q

Examples of Angiotensin-Converting Enzyme (ACE) Inhibitors

A
  • Benazepril hydrochloride
  • Captopril
  • Cilazapril
  • Enalapril sodium
  • Fosinopril sodium
  • Lisinopril
  • perinopril erbumine
  • quinapril
  • ramipril
  • trandolapril
37
Q

Movement of Angiotensin-Converting Enzyme (ACE) Inhibitors

A

Absorption:
Distribution:
Metabolism:
Excretion:

38
Q

Action of Angiotensin-Converting Enzyme (ACE) Inhibitors

A

Inhibit angiotensin-converting enzyme, which converts angiotensin I to angiotensin II. Angiotensin II is a potent vasoconstrictor and induces aldosterone secretion by adrenal glands. Aldosterone stimulates water and sodium resorption, which raises BP. By inhibiting these processes, BP is lowered.

39
Q

Contraindications of Angiotensin-Converting Enzyme (ACE) Inhibitors

A
  • Drug allergy esp. with hx of angioedema rx

- Baseline of potassium of 5 mmol/L

40
Q

Adverse Effects of Angiotensin-Converting Enzyme (ACE) Inhibitors

A
  • fatigue, dizziness, mood changes, headaches
  • dry non-productive cough
  • first dose hypotension
  • loss of taste, hyperkalemia, rash, anemia, neutropenia, thrombocytosis, agranulocytosis
  • in severe HF, kidney failure can occur
  • monitor potassium levels
  • inflammation of submucosal tissues, can progress to anaphylaxis
  • angioedema
41
Q

Toxicity and OD Management of Angiotensin-Converting Enzyme (ACE) Inhibitors

A
  • Manifests as hypotension
  • Treatment is symptomatic and supportive. Includes IV fluids to expand blood volume.
  • Hemodialysis is effective for the removal of captopril and lisinopril
42
Q

Interactions of Angiotensin-Converting Enzyme (ACE) Inhibitors

A
  • NSAIDs can reduce antihypertensive effect
  • Other antihypertensives can have a hypotensive effect
  • Lithium, can cause lithium toxicity
  • Potassium supplements and potassium-sparing drugs can cause hyperkalemia
43
Q

Indications of Angiotensin-Converting Enzyme (ACE) Inhibitors

A
  • Heart Failure
  • HTN with pt that has HF
  • stops the progression of left ventricular hypertrophy
  • Prevents the progression of diabetic nephropathy

Pathophysiology & Pharmacology 218 (20 decks)

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