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NUNA 680 - Pharm > Diuretics > Flashcards

Diuretics Flashcards

1
Q

GFR can be preserved by autoregulation within a MAP range of…

A

50-150 mmHg

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2
Q

Hypertensive patients have a _______ GFR when RBF is constant.

A

higher

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3
Q

What are the two mechanisms of autoregulation of RBF and GFR?

A

Myogenic and tubuloglomerular

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4
Q

Explain myogenic autoregulation

A

Increased arterial pressure stretches afferent arteriolar wall causing reflex constriction. Conversely, decreased arterial pressure causes arteriolar dilation.

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5
Q

Explain tubuloglomerular autoregulation.

A

Decreased renal blood flow causes decreased GFR which results in afferent arteriolar dilation, increasing GFR and RBF, restoring filtration

Causes renin to be released which stimulates angiotensin II which increases GFR

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6
Q

What are the components of urine?

A

Water, electrolytes, waste products, pharmacologic metabolites

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7
Q

Indications for diuretics

A

Hypertension; pulmonary/peripheral edema; electrolyte and pH imbalances; high ICP/brain bulk; prevent acute renal failure due to ischemic insult; drug clearance

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8
Q

Name classification of diuretics

A 
Thiazide
Loop
Osmotic
Potassium-sparing
Carbonic anhydrase inhibitors
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9
Q

Name 4 loop diuretics

A

Furosemide
Torsemide
Bumetanide
Ethacrynic Acid

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10
Q

Loop diuretic MOA

A

Inhibit reabsorption of NaCl in ascending loop; water follows NaCl, leading to a decrease in intravascular volume

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11
Q

What is the most effective diuretic class?

A

Loop diuretics

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12
Q

Which works faster, loop or thiazide diuretics?

A

Loop

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13
Q

Loop diuretics can be used to speed the…

A

excretion of drugs

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14
Q

Loop diuretics stimulate production of…

A

prostaglandins which lead to vasodilation and increase RBF; does NOT increase GFR

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15
Q

Indications for loop diuretics

A

Rapid intravascular fluid removal; hyperkalemia treatment; acute pulmonary edema; kidney stone extraction; reduce ICP (diuresis and decrease CSF production), sometimes with mannitol

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16
Q

Loop diuretic adverse effects

A

Hypokalemia
Digoxin toxicity
Large doses increase cAMP, patients RESISTANT to NMB
Small doses decrease cAMP, patients SENSITIVE to NMB
Ototoxicity (deafness)

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17
Q

Clinical implications of loop diuretic use

A

K+/fluid volume replacement may be needed
Cardiac dysrhythmias
Mild hyperglycemia

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18
Q

Name some thiazide diuretics

A 
Chlorothiazide
Chlorthalidone
Indapamide
Hydrochlorothiazide
Benzthiazide
Cyclothiazide
Metolazone
19
Q

MOA of thiazide diuretics

A

Inhibits reabsorption of NaCl in loop, proximal, and distal tubules; reduces edema and intravascular fluid volume; vasodilation by decrease in SNS in peripheral smooth muscles by decreasing total body Na+ stores; excretion of Na+, Cl-, Bicarb, Mg+, and K+

20
Q

Indications for thiazide diuretics

A

Hypertension, edema from CHF, renal failure

21
Q

Thiazide diuretics are often used in combination with…

A

antihypertensive drugs

22
Q

Which causes more K+ excretion, loop or thiazide diuretics?

A

Loop

23
Q

Clinical concerns with thiazide diurectics

A

Low K+, Mg+, Cl-, and hypochloremic metabolic alkalosis
Hyperglycemia, hyperuricemia (gout)
Dig toxicity, dysrhythmias, muscle weakness, neuropathy, NMB potentiation caused by hypokalemia
K+ and fluid volume replacement may be indicated

24
Q

Name two osmotic diuretics

A

Mannitol and urea

25
Q

Osmotic diuretic MOA

A

Osmotic diuresis by increased plasma osmolarity in proximal convoluted tubule and Loop of Henle; does NOT alter GFR
Large MW molecule is filtered but too large to reabsorb back
Causes acute osmotic expansion of intravascular fluid volume which is then filtered

26
Q

Osmotic diuretic adverse effects

A 
Mostly resolved when water is eliminated:
Rebound hypertension with non-intact BBB
Pulmonary edema
Exacerbated CHF
Electrolyte disturbances
27
Q

Indications for mannitol

A

Reduce ICP and brain bulk
Reduce refractory intraocular hypertension
Urinary excretion of toxic materials

28
Q

What kind of diuretic is spironolactone?

A

Aldosterone antagonist

29
Q

Spironolactone MOA

A

Competes with aldosterone, secrete Na+ and Cl-

30
Q

Aldosterone antagonists are often used in conjunction with…

A

thiazide diuretics

31
Q

Indications for aldosterone antagonist/spironolactone

A

CHF, liver cirrhosis edema (which are caused by increased aldosterone)

32
Q

SE of aldosterone antagonist

A

Hyperkalemia

33
Q

Name two potassium sparing diuretics

A

Triamaterene

Amiloride

34
Q

Potassium sparing diuretic MOA

A

Spares potassium independent of aldosterone
Weak diuresis via distal tubules and collecting ducts
Increased excretion of Na+, Cl+, Bicarb

35
Q

Potassium sparing diuretics are NOT used alone but in combination with…

A

Loop diuretics to limit K+ losses in the distal tubule

36
Q

Potassium sparing diuretic SE

A

Hyperkalemia - caution with ACEI and NSAIDs which cause increased K+

37
Q

Name two carbonic anhydrase inhibitors

A

Acetazolamide

Methazolamide

38
Q

MOA of carbonic anhydrase inhibitors

A

Works in proximal tubules blocking Na+ and bicarb and causing diuresis

39
Q

Carbonic anhydrase inhibitor indication

A

Glaucoma - reduce intraocular pressure by decreasing aqueous humor

40
Q

Carbonic anhydrase inhibitor side effects

A

Hyperchloremic metabolic acidosis
Drowsiness
Paresthesia
Renal calculi

41
Q

Vasopressin receptor antagonist “vaptan” MOA

A

Selective V2 receptor antagonist in renal collecting duct

Treat SIADH, CHF, liver cirrhosis; hyponatremia associated with normal volume status

Tolvaptan only FDA approved drug

42
Q

Dopamine receptor agonist MOA

A

D1 receptors in proximal renal tubule and loop of Henle cause increased RBF and GFR and natriuresis (Na+ excretion)

Dopamine and Fenoldopam

Low dose only (large dose causes sympathetic outflow)

43
Q

Atrial natriuretic peptide antagonist MOA

A

ANP produced in atria, ventricles, and renal system in response to atrial and ventricular distension;
Blocks basal Na-K-ATPase channel causing arterial/venous dilation, decreased venous return, decreased CO and natriuresis
Nasiritide only FDA approved drug

44
Q

MOA of neprilysin antagonist

A

Since Neprilysin metalloproteinase breaks down BNP and ANP, antagonist increases circulating levels of BNP and ANP, indirectly causing natriuresis

Used in combo with ACEI for natriuresis and dec BP in CHF patients

Entresto: sacubritril/valsartan
- SE: hypotension & hyperkalemia

NUNA 680 - Pharm (8 decks)

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