Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

pharmocology > Diuretics > Flashcards

Diuretics Flashcards

1
Q

two aspects of perfusion think renal function

A

bad renal function, how its addressed on bypass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

PROXIMAL CONVULTED TUBULe diuretics

A

CARBONIC ANHYDRASE INHIBTORS ADENOSINE ANTAGONIST

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

thick ascending limb loop of henle drugs diuretics

A

loop diuretics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

distal convoluted tubule diuretics

A

thiazides

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

cortical collecting tubule diuretics

A

K sparing diuretics adenosine antagonists

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

medullary collecting ducts diuretics

A

vasopressin antagonists

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

common uses for diuretiucs

A

CHF,HEPATIC ASCITES,NEPHROTIC SYNDROME,HTN,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Hepatic ascites

A

increased portal vein pressure liver starts to sweat fluid. end stage liver failure colloid pressure decreases because of decreased protein. goes into abdomen. think african kids starving

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

nephrotic syndrome

A

high aldosterone levels. lose glucose amino acids and proteins. colloid pressure goes down. causes fluid overload

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

htn

A

stiff arteries need fluid relief

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

diuretic categories

A

carbonic anhydrase inhibitors. loop diuretics, thiazides, potassium sparing diuretics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

1: Carbonic Anhydrase (CA) Inhibitors

A

least important to us not very strong. • *Work by inhibiting carbonic anhydrase in the proximal tubule epithelium
• Carbonic anhydrase catalyzes
• With CA blocked, the reaction shifts to the right and bicarbonate accumulates in the urine.
odium is less able to be exchanged for H+ in the tubules so H+ is retained while Na+ is lost (with the bicarbonate).
* Sooo…urine becomes more alkaline (explain), water follows the bicarbonate into the tubules (causing diuresis) and the patient experiences a metabolic acidosis (explain again).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

-Acetazolamide

A

(Diamox) Carbonic Anhydrase (CA) Inhibitor. Rarely used in cardiovascular surgery (why?) causes metabolic acidosis
-You may see patients on acetazolamide who have glaucoma
…or high-elevation sickness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

2: Loop Diuretics

A

• Act on the ascending Loop of Henle

-Also called “High Ceiling” diuretics because the dose-response curve is close to linear (that is, there’s no “ceiling”)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

how loop diuretics work

A

Loop diuretics work by blocking the co-transport of Na+/K+/2Cl ̄ from the tubular lumen back into circulation.
• So much NaCl is not resorbed that downstream nephron sites cannnot compensate for that loss.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

loop diuretics are most

A

efficacious (what’s this?) of all diuretics and work incredibly fast (within minutes when given IV).
• Called the “yellow zipper” drugs of human medicine (or the “waiting room puddle” drugs in veterinary medicine) work fast. good for bypass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

loop diuretics additional mechanism

A

Loops” also work to increase renal blood flow by inducing the expression of COX-2
• COX-2 is referred to as the “ungood” cyclooxygenase NSAIDS (what’s this?) preferentially block in inflamed tissues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

cyclooxygenase produces

A

prostaglandins which are powerful

vasodilators of renal arteries.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

nsaids may

A 
may interfere with loop diuretic function in
compromised patients (hepatic cirrhosis,
nephrotic syndrome)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

loop diuretics doc for

A

patients w/ renal function. pulmonary edema because they act fast

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

doc for hypercalcemia and hyperkalamia

A

loop diuretics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

loop diuretics aka

A

non potassium sparing diuretics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

loop diuretics perfusion uses

A

1) Get rid of extra fluid on bypass (duh!)
*Chemical “hemoconcentrators”
2) Get rid of excess K⁺
What is normal K⁺ again?
3) Help maintain urine production/renal
function (**!!!) in low output states on
bypass (what might these be?) may be deliterious. may be giving lasix when you dont need it like when youre down on flow

24
Q

sides of loops

A

hypotension,hyperuricemia, hypokalemia,hypomagnesemia,ototoxicity (aminoglycoside antibiotics)

25
Q

furosemide

A

lasix. • Very commonly used during and peri-bypass.
• Very inexpensive
• Has been used forever
• Wide margin of safety/therapeutic window
therefore the potential for “We always put
some lasix in the pump” mentality
• ~2 hour duration of action when given IV (on
pump)

26
Q

ethacrynic acid

A

edecrin. Loop diuretic. Less commonly used than furosemide
• Like furosemide but greater potential for
oxotoxicity

27
Q

Bumetanide and Torsemide

A 
(Bumex) and  (Demadex). -Like furosemide and ethacrynic acid
-Much less frequently used
-Generally utilized as “physician’s
preference” or when desired response is
not achieved by furosemide.
28
Q

Thiazide Diuretics

A 
Act on the cortical
region of the Ascending
Loop of Henle
*Also called “Ceiling Diuretics” because of their
“flattening” dose/response curve
29
Q

thiazide diuretics. how they work

A

-Thiazide diuretics work blocking Na⁺/Cl¯
transport/reabsorption on the luminal side of
the thick part of the Ascending Loop of Henle
and the Distal Convoluted Tubule.
-Consequently, NaCl concentrates in the
tubular fluid (and H₂O obediently follows =
increased urine production)

30
Q

thiazide caveot

A

This also means that thiazides have to
actually get into the tubular lumens via renal
excretion…
…so thiazides lose efficacy in patients with
decreased renal function. need high urine production to get in. lasix can work on blood side

31
Q

Thiazide Diuretics similar to loops because

A

Like “Loops”, thiazides increases renal blood
flow through COX-2 inducement of
prostaglandin synthesis.
• Structurally related to Acetazolamide, but
cause much more diuresis.

32
Q

original diuretic used for edema

A

chlorothiazide. *Chlorothiazide is the only thiazide available
for parenteral use (of relevance to you!)
*Typical adult pump dose is 500mg

33
Q

thiazide effects on electrolytes

A

increased urinary excretion of Na,K, vol. decrease excretion of calcium (sparing)

34
Q

Thiazide Diuretics

Perfusion Uses

A

Like the “Loops” thiazides get rid of extra
(edema) fluid and potassium.
- systemic vascular resistance due to
relaxation of arteriolar smooth muscle
*So how do these two effects
synergize?getting rid of fluid and creating more capacitance for fluid by dilating
These are “second-line” treatments (after
“Loops” for the edema of heart failure.
-HTN

35
Q

thiazide advantage over loop

A 
Thiazides promote the reabsorption of
calcium.
*Compared to “Loops”, long-term
use results in significantly less
decrease in bone density (hip
fractures are decreased by 1/3rd)
36
Q

ince thiazides can (uniquely) cause the
production of hyperosmolar urine (what’s
this?) it’s used in diabetes insipidus (?)

A

allows people to concentrate urine because of lack of adh

37
Q

potassium sparing diuretics

A

• Function in the collecting tubules (ducts) to

prevent Na⁺ reabsorption and K⁺ excretion. Antagonize aldosterone

38
Q

mineralocorticoids(aldosterone) is produced

A

in glomerulosa

39
Q

zona fasciculata

A

glucocorticoids

cortisol

40
Q

Zona reticularis

A

androgens

testosterone precursors

41
Q

Potassium-Sparing Diuretics
• Used to treat HTN, often in combination
with

A

thiazides. not efficacious by themselves

42
Q

potassium sparing are problematic in

A

patients with hyperkalemia

(like who?) like patients on bypass or renal failure

43
Q

Potassium-Sparing Diuretics

Direct Aldosterone Antagonists

A

Resemble sex steroids chemically. Used as adjunctive therapy in heart failure
– Statistically decreases mortality and helps
prevent pathological “remodeling” of the heart

44
Q

diuretic of choice for

liver failure patients with edema

A

*Spironolactone

45
Q

Potassium-Sparing Diuretics
Direct Aldosterone Antagonists
***Ineffective when

A

used on patients with Addison’s Disease because they have hypo adrenal function. not producing aldosterone. so giving this drug will have no effect

46
Q

Potassium-Sparing Diuretics

Indirect-Acting Aldosterone Antagonists

A

*Block the Na⁺ transport channels affected by
aldosterone rather than aldosterone itself.
-VERY similar to direct aldosterone
antagonists except they can be used in
Addison’s Disease patients (why?)

47
Q

5: Osmotic Diuretics

A 
Small non-metabolized molecules filtered
through the glomerulus that osmotically
carry water with them. Given parenterally as they cause severe
diarrhea if given orally (why?) good for renal patients
• Mannitol very commonly given on bypass
 or added to the prime solution
• Urea and glucose rarely
 (if ever) used (so feel free to ignore)
48
Q

Osmotic Diuretics works

A

Work in the proximal tubule and the
descending Loop of Henle which permit the
free passage of H₂O

49
Q

Osmotic Diuretics

Perfusion Relevance

A

Commonly used to “draw” fluid into the
intravascular space and decrease interstitial
edema but…why might this be controversial? because it increases hct.

50
Q

Osmotic diuretics used to maintain flow

A

for renal failure. prevents accumulation of crap in kidneys. also good for cerebral edema. good for patients who smash their head

51
Q

Osmotic Diuretics -Problematic in patients

A 
oliguric(little urine)/anuric (no urine)
renal failure (why?) will go into urine and pull fluid and cause htn.
52
Q

dont give mannitol when urine output is less than

A

<50ml/hour for three

hours after a 12.5 gram IV dose, AVOID.

53
Q

Mannitol is excreted (not metabolized) within

A

one hour, so repeat doses can be given.
-MUST be given slow IV or profound transient
hypotension will occur due to skeletal muscle
vasodilation
“And I will be quite
ANNOYED. crank up flow it will wear off

54
Q

Mannitol (Osmitrol) is a small molecule

A

categorized as a “sugar alcohol” With its familiar cousins xylitol and sorbitol.

55
Q

Mannitol is usually supplied

A 
as a 20% solution.
*What does this mean??! 20g per 100 ml
• RULE #1 when giving mannitol:
“Check the bag/bottle
for precipitated
crystals!!!!
56
Q

Check the mannitol bag/bottle
for precipitated
crystals!!!! because

A

beacause it will concentrate in the crystalsand you wont be giving as much plus its crystals dummy

pharmocology (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions