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Pharmacology 680 > Diuretics > Flashcards

Diuretics Flashcards

1
Q

Forces Favoring Filtration

A

Glomerular hydrostatic pressure 60

Bowman’s capsule colloid osmotic pressure 0

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2
Q

Forces Opposing Filtration

A

Bowman’s capsule hydrostatic pressure 18

Glomerular capillary colloid osmotic pressure 32

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3
Q

GFR is normally preserved by

A

maintaining a constant RBF over a range of systemic blood pressures with MAP 50 to 150 mmHg

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4
Q

these patients have a higher GFR when RBF is constant

A

hypertensive

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5
Q

describe the Myogenic Autoregulation of RBF and GFR

A

↑ arterial pressure stretches afferent arteriolar wall then a reflex constriction occurs
↓ Arterial pressure causes arteriolar dilation

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6
Q

describe Tubuloglomerular Autoregulation of RBF and GFR

A

↓ RBF = ↓ GFR which results in afferent arteriolar dilation which increase GFR and RBF and restore filtration
Renin released = angiotensin II = ↑ GFR

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7
Q

what is urine made of?

A

electorlytes
waste products
metabolites

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8
Q

Urine excretion is equal to

A

Filtration rate – reabsorption rate + secretion rate

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9
Q

Diuretic Uses 6

A

Reduce HTN (decrease intravascular fld vol.)
Treat pulmonary and peripheral edema
Electrolyte and pH corrections (hyperkalemia)
Reduce ICP, brain bulk
Prevent ARF due to ischemic insult
Drug clearance

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10
Q

how are diuretics classified?

A

Site of action on renal tubules

How they excrete solute

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11
Q

Main classifications diuretics?

A 
Thiazide diuretics
Loop diuretics
Osmotic diuretics
Potassium-sparing diuretics
Carbonic anhydrase inhibitors
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12
Q

4 Loop Diuretics

A

Furosemide (Lasix)
Torsemide (Demadex)
Bumetanide (Bumex)
Ethacrynic Acid (Edecrin) no longer avail.

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13
Q

moa loop diuretics

A

Inhibit reabsorption of NaCl in

ascending loop

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14
Q

Most effective diuretic class

A

Loop Diuretics

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15
Q

what are Loop Diuretics used for?

A

Used more to decrease intravascular fluid volume and for rapid excretion of drugs

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16
Q

Do loop diuretics increase GFR?

A

nope

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17
Q

loop diuretics Stimulates production of prostaglandins which produces

A

Vasodilation

Increased RBF

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18
Q

Loop Diuretics (Lasix) indications 5

A 
Rapid intravascular fluid removal 
Hyperkalemia treatment
Acute pulmonary edema
Kidney stone extraction, lithotripsy
Reduce intracranial pressure
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19
Q

what can be used in combination with mannitol and why?

A

Systemic diuresis and ↓ CSF production to reduce ICP

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20
Q

hypokalemia is Loop Diuretics Concern, which causes

A

Shown to deplete myocardial K+ stores
Potential digitalis toxicity
Enhanced NMB effects

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21
Q

what does lasix do in large doses 1-4 mg/kg in regards to NMB

A

inhibits phosphodiesterase, increasing cAMP (same as azathioprine, Imuran) – makes patients resistant to NMB

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22
Q

what does lasix <1mg/kg do in regards to NMB with small doses?

A

decreased cAMP production – makes patients sensitive to NMB.

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23
Q

big concern of loop diuretics we have known since nursing school

A

ototoxic

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24
Q

loop diuretics cause many imbalances, what should you be ready for?

A 
Potassium replacement may be indicated
Cardiac dysrhythmias can occur
Fluid volume replacement may be indicated
Orthostatic hypotension
Hemoconcentration, (increased Hct, BUN)
Mild hyperglycemia
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25
Q

thiazide diuretics typically end with

26
Q

MOA thiazide diuretics

A

Inhibits reabsorption of NaCl in loop, proximal and distal tubules

27
Q

thiazide diuretics are used in Treatment for

A

Hypertension
Edema from CHF
Renal failure

28
Q

how do thiazides ↓ HTN by diuresis, vasodilation

A

↓ SNS in peripheral vascular smooth muscle due to ↓ total body Na+ stores

29
Q

Thiazide Diuretics Concerns

A

↓ K+, ↓ Mg+, ↓ Cl-, hypochloremic metabolic alkalosis
Hyperglycemia,
Hyperuricemia

30
Q

Hypokalemia can further lead to

A 
Increased potential for digitalis toxicity
Cardiac dysrhythmias
Muscle weakness
Neuropathy
Potentiation of NMBA
31
Q

one different implication when using thiazide diuretics?

A

gouty arthritis

32
Q

Osmotic Diuretics

A

Mannitol

Urea

33
Q

MOA of osmotic diuretics?

A

Osmotic diuresis
Increased plasma osmolarity
Proximal convoluted tubule,Loop of Henle
Does not alter GFR

34
Q

osmotic diuretics are Large molecular weight molecules which means?

A

Filtered but is too large to reabsorb back.

Acute expansion of intravascular fluid volume

35
Q

these are used in craniotomies to reduce brain bulk?

A

Osmotic Diuretics

36
Q

Osmotic Diuretic Side Effects?

A 
Increased intravascular fluid volume until filtered
Rebound HTN in non-intact BBB
Pulmonary edema
Can exacerbate CHF 
Electrolyte disturbances
37
Q

3 uses for mannitol?

A

Reduction of intracranial pressure and brain
mass
Reduction of high intraocular pressure when
unable to lower pressure by any other
mechanism
Urinary excretion of toxic materials

38
Q

Allows secretion of Na+ and CL-

Used in combination with thiazide diuretics

A

Aldosterone Antagonist [spirinolactone]

39
Q

Aldosterone Antagonist are used for what type of patients?

A

CHF
Liver Cirrhosis
**Both conditions lead to increased aldosterone

40
Q

side effect of spirinolactone?

A

hyperkalemia - aldosterone gets rid of K and this drug blocks aldosterone

41
Q

moa k sparing diuretics

A

Spares potassium independent of Aldosterone

Weak diuretic effects

Distal tubules and collecting ducts

42
Q

Triamaterene, Amiloride [k sparing] cause

Increased excretion

A

Na+, Cl-, Bicarb NOT K — Used in combination with loop diuretics to limit potassium losses in the distal tubule

43
Q

Potassium Sparing Diuretics side effect

A

hyperkalemia

44
Q

Use k sparing cautiously with

A

in patients at risk for hyperkalemia

Patients using ACEI and NSAIDs (both cause increased K+)

45
Q

Works in proximal tubules

Inhibiting CA blocks Na+bicarb & causes diuresis

A

Carbonic Anhydrase Inhibitors (CAI

46
Q

Carbonic Anhydrase inhibitors used in

A

Used in glaucoma to reduce intraocular pressure by decreasing aqueous humor

47
Q

Carbonic Anhydrase Inhibitors (CAI) Side Effects

A

Hyperchloremic metabolic acidosis
Drowsiness
Paresthesia
Renal calculi

48
Q

Vasopressin Receptor Antagonist Only U.S. FDA approved drug

49
Q

Vasopressin Receptor Antagonist specifically used for

A

SIADH, CHF, Liver cirrhosis

Treats hyponatremia assoc. with normal volume status

50
Q

MOA of Vasopressin Receptor Antagonist

A

Renal collecting duct V2 receptors

51
Q

D1 receptors in proximal renal tubule & loop of Henle cause

A

Increased renal blood flow
Increased glomerular filtration rate (GFR)
Natriuresis

52
Q

2 things that activate D1 receptors

A

Dopamine & Fenoldopam

53
Q

what dose of dopamine works to activate D1

A

low dose only (1-3 mcg/kg/min)

larger doses = sns stimulation

54
Q

natriuretic peptides Block basal Na-K-ATPase channel which causes

A

Vasodilation & venous dilator = decrease venous return = decrease cardiac output
Sodium excretion

55
Q

Produced in atria, ventricles, and renal system
Stimulated by atrial and ventricular distention
Increased wall stress, volume overload, and HTN during heart failure

A

Atrial natriuretic peptides(ANP)&Brain natriuretic peptides(BNP)

56
Q 
Only U.S. FDA approved drug in natriuretic peptide class
Hypotension is primary side effect
A

Nesiritide (Natrecor): IV infusion with short half life (18 min)

57
Q

metalloproteinase breaks down BNP and ANP

A

Neprilysin (NEP) Antagonist

58
Q

NEP antagonists cause an increase

A

in circulating levels of both BNP & ANP “indirectly” causing natriuresis

59
Q

Neprilysin (NEP) Antagonist used in combo with

A

ACEI to achieve both natriuresis and reduction in BP for CHF patients

60
Q

Entresto: sacubritril/valsartan side effects

A

Hypotension and hyperkalemia

Pharmacology 680 (19 decks)

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