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Pharmacology II > Diuretics > Flashcards

Diuretics Flashcards

1
Q

Thiazide Diuretic

A

hydrochlorothiazide

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2
Q

Thiazide-like Diuretic

A

chlorthalidone

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3
Q

Loop Diuretic

A

furosemide

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4
Q

Potassium-sparing Diuretic

A

spironolactone

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5
Q

Osmotic Diuretic

A

mannitol

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6
Q

Where do loop diuretics works?

A

thick ascending limb

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7
Q

Where do thiazide diuretics work?

A

distal convoluted tubule

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8
Q

sodium reabsorption of thiazide diuretic

A

10%

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9
Q

thiazide diuretic agents

A

chlorothiazide

hydrochlorothiazide

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10
Q

only thiazide diuretic available in injectable form

A

chlorothiazide

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11
Q

indications for hydrochlorothiazide

A

management of mild-to-moderate hypertension

treatment of edema in heart failure and nephrotic syndrome

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12
Q

indications for chlorothiazide

A

management of hypertension

adjunctive treatment of edema

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13
Q

indications for methylchlothiazide

A

management of hypertension

adjunctive therapy of edema

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14
Q

Increasing the dose beyond the normal dose does not increase diuretic effect

A

“ceiling” diuretic

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15
Q

ceiling number for hyrdochlorothiazide

A

50 mg/ day

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16
Q

effects of thiazide diuretics

A

increased excretion of sodium and chloride

loss of potassium

loss of magnesium

decreased urinary calcium excretion

reduced peripheral vascular resistance

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17
Q

How long does it take for thiazides to produce a stable reduction in blood pressure?

A

1 to 3 weeks

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18
Q

Describe the kinetics of thiazide diuretics.

A

1 to 3 weeks to produce a stable reduction in blood pressure.

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19
Q

ADRs of thiazide diuretics

A

Hyponatremia

Hyperuricemia

Volume depletion

Hypercalcemia

Hypersensitivity

Hyperglycemia

Hyperlipidemia

Hypokalemia

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20
Q

Hydrochlorothiazide

A

Hydrochlorothiazide
25 mg
one tablet daily

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21
Q

Cells in the distal convoluted tubule are ____________ to water.

A

impermeable

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22
Q

thiazide like diuretics

A

chlorthalidone
metolazone
indapamide

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23
Q

characteristics of chlorthalidone

A

cheap!

long duration of action

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24
Q

These thiazide-like diuretics work well with other diuretic agents.

A

Metolazone

Indapamide

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25
Q

characteristics of metolazone

A

more potent than the thiazides

causes sodium excretion even in advanced renal failure

26
Q

characteristics of indapamide

A

low doses - significant antihypertensive effect with minimal effect

gastrointestinal tract excretion - less likely to accumulate in patients with renal failure

27
Q

Chlorthalidone

A

Chlorthalidone
50 mg
one tablet daily

28
Q

Where do loop diuretics work?

A

ascending loop of Henle

29
Q

Cells of the ascending loop of Henle are _________ to water.

A

impermeable

30
Q

sodium resorption of loop diuretics

A

25 - 30%

31
Q

loop diuretic agents

A

Bumetanide - Bumex
Torsemide - Demadex
Furosemide -Lasix
Ethacrynic acid - Edecrin

32
Q

effects of loop diuretics

A

increased excretion of sodium and chloride

loss of potassium

loss of magnesium

increased urinary calcium concentration

reduced renal vascular resistance/increased renal blood flow

33
Q

“high-ceiling” diuretics

A

loop diuretics

34
Q

Furosemide

A

Furosemide
40 mg
one tablet twice daily

35
Q

indications for furosemide

A

management of edema associated with heart failure and hepatic or renal disease

acute pulmonary edema

treatment of hypertension (alone or in combination with other antihypertensives)

36
Q

indications for bumetanide

A

management of edema secondary to heart failure or hepatic or renal disease (including nephrotic syndrome)

37
Q

indications for torsemide

A

management of edema associated with heart failure and hepatic or renal disease (including chronic renal failure)

treatment of hypertension

38
Q

creatinine clearance indicating renal impairment in loop diuretics

A

<40 ml/min

39
Q

bioavailability of furosemide oral

A

~50%

40
Q

bioavailability of torsemide and torsemide oral

A

~70%

41
Q

The onset of loop diuretics allows for symptom relief…

A

…relatively rapidly - within hours to days.

42
Q

Loop diuretics are used for…

A 
... treatment of states of volume excess:
heart failure
nephrotic syndrome
acute chronic renal insufficiency
cirrhosis
43
Q

ADRs of loop diuretics

A

same as thiazides only electrolyte loss is more profound (sodium and magnesium depletion)

Ototoxicity

44
Q

What may need to be supplemented with loop diuretics?

A

Potassium

Magnesium

45
Q

Where do potassium-sparing diuretics work?

A

collecting tubule

46
Q

sodium reabsorption of potassium-sparing diuretics

A

3-5%

47
Q

loop diuretic - sodium channel blocker agents

A

Triamterene

amiloride

48
Q

loop diuretic - aldosterone antagonists

A

Spironolactone

eplerenone

49
Q

How do loop diuretic aldosterone antagonists work?

A

blocks stimulation of sodium/potassium exchange sites in collecting tubule (1-3% net diuretic effect)

sodium loss for diuretic effect but potassium retained

spironolactone - hormonal effect

works with high levels of aldosterone and vice versa

50
Q

ADRs of Triamterene/amiloride

A

leg cramps
increased BUN
potassium retention
increased uric acid

51
Q

ADRs of aldosterone antagonists

A

gastric upset (spironolactone)
gynecomastia (males)
menstrual irregularities

52
Q

Amiloride

A

Amiloride
10 mg
one tablet daily

53
Q

Spironolactone

A

Spironolactone
25 mg
one table twice per day

54
Q

How is mannitol administered?

A

intravenoussly

55
Q

MOA of mannitol

A

inhibits sodium reabsorption in proximal convoluted tubule and Loop of Henle

56
Q

osmotic diuretic agent

A

Mannitol

57
Q

MOA of potassium supplementation

A

electrolyte replenishment

58
Q

ADRs of potassium supplementation

A

asymptomatic hyperkalemia
ECG changes
GI symptoms

59
Q

asymptomatic hyperkalemia occurs at

A

6.5 - 8 mEq/L

60
Q

Watch for patients with renal insufficiency for…

A

potassium supplementation.

61
Q

Potassium Supplementation Agents

A

potassium chloride
K-Dur
Slow-K

62
Q

Mannitol

A

Get an intensivist involved!!!

Pharmacology II (9 decks)

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