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Pharmacology quiz 2 > Diuretics > Flashcards

Diuretics Flashcards

1
Q

What are carbonic anhydrase inhibitors used for?

A

Glaucoma, reduces pressure in the eye

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2
Q

What are the types of diuretics? Name one from each group.

A

Thiazide: HCTZ, Thiazide-like: chlorthalidone, Loop diuretic: furosemide, Potassium-sparing: spironolactone, Osmotic: mannitol

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3
Q

Where do thiazide diuretics work?

A

DCT

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4
Q

Who should not take thiazide diuretics or loop diuretics?

A

People with sulfa allergies - might be directly related to sulfa or just might be another allergy

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5
Q

How much sodium reabsorption is done by thiazides?

A

10% since cells of DCT are impermeable to water

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6
Q

What are the 2 thiazide drugs to know?

A

Chlorthiazide, HCTZ

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7
Q

What is the only injectable thiazide?

A

chlorthiazide

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8
Q

What are the uses for HCTZ?

A

HTN, HF

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9
Q

What is the initial effect of HCTZ on BP?

A

BP will drop initially then come back up slightly and normalize - when pts start the drug they will pee a lot and then not as much

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10
Q

Name the “ceiling diuretics” - what does it mean?

A

Thiazides, have to cap the doses (50mg) - increasing the dose beyond the max will have no effect

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11
Q

What ions are excreted with thiazides?

A

potassium, sodium, chloride, magnesium

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12
Q

What are the effects of thiazides?

A

loss of fluid, vasodilation, reduced peripheral vascular resistance

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13
Q

How long does it take a thiazide to drop BP?

A

1-3 weeks

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14
Q

When is calcium retention a problem in people taking thiazides?

A

If they have already high levels

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15
Q

What do high doses of thiazides show?

A

increased rates of mortality

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16
Q

What are the ADR for thiazides?

A

hyponatremia, hyperuricemia, volume depletion, hypercalcemia, hypersensitivity, hyperglycemia, hyperlipidemia, hypokalemia

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17
Q

What labs should be ordered to monitor electrolytes in people taking thiazides?

A

BMP with serum magnesium

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18
Q

What are the thiazide-like diuretics that are used in combination with other diuretics when pts become refractory to diuretic therapy?

A

Metolazone, indapamide

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19
Q

Which thiazide-like diuretic has the longest duration of action?

A

Chlorthalidone

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20
Q

What is chlorthalidone derived from?

A

carbonic anhydrase inhibitors

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21
Q

Where do loop diuretics work?

A

the ascending loop of henle

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22
Q

What percent sodium reapsorption occurs with loop diuretics?

A

25-30%

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23
Q

How is sodium reabsorbed by loop diuretics?

A

Na/K/Cl co transporter

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24
Q

How is sodium reabsorbed by thiazides?

A

Na/Cl transporter

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25
Q

What are the 3 loop diuretic you need to know?

A

bumetanide, torsemide, furosemide

26
Q

What are “high ceiling” diuretics?

A

loop diuretics - have huge doses

27
Q

What are the effects of loop diuretics?

A

increased excretion of Na, Cl, K, Mg, and Ca, reduced renal vascular resistance

28
Q

How is hypocalcemia avoided with loop diuretics?

A

most calcium is reabsorbed in the DCT

29
Q

What CrCl is too low to use loop diuretics?

A

40ml/min

30
Q

What is the bioavailability of oral furosemide?

A

50% - switch IV to oral and 2x the dose

31
Q

What is the best time to take loop diuretics?

A

5am/5pm

32
Q

What are uses for furosemide and torsemide?

A

HF, HTN

33
Q

What are uses for bumetanide?

A

HF

34
Q

What is the drug used primarily in treatment of states of volume excess (HF, nephrotic syndrome, acute and chronic renal insufficiency, cirrhosis)?

A

loop diuretics

35
Q

How soon is the onset of loop diuretics?

A

rapid onset with symptom relief in hours or days

36
Q

ADR for loop diuretics

A

Same as thiazides - more profound electrolyte loss (K and Mg) + ototoxicity

37
Q

What drugs thus far have ototoxicity?

A

ethacrynic acid, aminoglycoside, loop diuretics

38
Q

what are the 2 types of potassium sparing diuretics?

A

sodium channel blockers or aldosterone antagonists in the collecting tubules

39
Q

Name the sodium channel blockers (potassium sparing diuretics)

A

triamterene, amiloride (hook these up with HCTZ since they have very mild effects)

40
Q

What are the aldosterone antagonist potassium sparing diuretics?

A

spironolactone, eplereone

41
Q

How do aldosterone antagonist work?

A

blocks stimulation of the Na/K exchange sites in the collecting duct

42
Q

What type of diuretic has a hormonal effect?

A

spironolactone

43
Q

What are uses for spironolactone?

A

HF

44
Q

What are uses and effects for eplereone?

A

no hormonal side effects, HF, HTN

45
Q

ADR for sodium channel blockers?

A

leg cramps, high BUN, uric acid, and K

46
Q

ADR for aldosterone antagonists?

A

gastric upset (spironolactone), gynecomastia, menstrual irregularities

47
Q

What are potassium sparing diuretics used in conjunction with?

A

thiazides - blunt hypokalemia that may occur with diuretics

48
Q

What are uses for amiloride?

A

HF

49
Q

How is mannitol administered?

A

IV

50
Q

How do osmotic diuretics work?

A

inhibit sodium reabsorption in PCT and loop of henle

51
Q

What are uses for mannitol?

A

reduce ICP and ocular pressure - not used in HTN

52
Q

What are ADR of potassium supplements?

A

asymptomatic hyperkalemia, ECG changes, GI symptoms

53
Q

Who should not take potassium supplements?

A

people with renal insufficiency since they can’t get K out

54
Q

What is a potassium supplement you can give pts?

A

potassium chloride (K-Dur, Slow-K)

55
Q

If in the ED and a pt is hypokalemic, what is the best plan of action?

A

give 40 mEq/L of potassium chloride 2 doses 4 hours apart

56
Q

What do most patients on loop diuretics experience as their potassium levels?

A

3.5 mEq/L

57
Q

When should electrolytes be measured in a pt on a diuretic?

A

baseline, 1 week, 1 month, periodically

58
Q

What are 3 good uses for diuretics?

A

HTN, HF, kidney disease

59
Q

What should be considered when prescribing diuretics to geriatric populations?

A

fall in GFR decreases diuretic effect with thiazides - give low dose chlorthalidone

60
Q

What diuretics should be given to adolescents?

A

thiazides and spironolactones, avoid furosemide in premature infants with RDS, side effects might not be apparent (change in personality, eating or sleeping) patterns/restlessness)

Pharmacology quiz 2 (6 decks)

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