Diuretics

Question 1

What was the first diuretic? How does it work?

Answer 1

Mercury

inhibits sodium reabsorption at the proximal tubule, making them stay in and go to urine

Question 2

What are the 2 osmotically active drugs?

Answer 2

Laxatives (in colon)
Osmotic Diuretics

the drugs are hyperosmotic and suck water out into the tubule

Question 3

Osmotic Diuretics-
where filtered?
MOA?

Answer 3

colon

prevent reabsorption of Na/H2O in proximal tubule

Question 4

What is the risk with osmotic diuretics?

Answer 4

cause rapid and transient shift of fund from tissues to blood vessels, which increases cardiac workload

Question 5

What do you monitor patient for on osmotic diuretic?

Answer 5

Flash pulmonary edema

Increased cardiac workload

Question 6

How is mannitol administered? Other indications?

Answer 6

IV osmotic diuretic- also for cerebral edema to manage elevated ICP

Question 7

What are 2 other osmotic diuretics?

Answer 7

Glycerin (weight lifters/body builders drink it)

Urea

Question 8

How does an aquaretic work? What is it used for?

Answer 8

Interferes with the activity of ADH

Indicated for SIADH, not hypertension

Question 9

What is the only aquaretic?

Answer 9

Demeclocycline- technically a tetracycline antibotic used in patients with SIADH (patient in neuro ICU with brain tumor/lesion/trauma)

Question 10

How do sulfur compounds work?

Answer 10

produce mild diuresis that was characterized by a highly alkaline urine.

they inhibit carbonic anyhydrase

CA-I, thiazides, loop diuretics

Question 11

What does carbonic anhydrase do?

Answer 11

enzyme in the kidneys that is responsible for the reabsorption of bicarbonate.

Question 12

What is the major risk of Carbonic Anhydrase Inhibitors?

Answer 12

HYPOkalemia

you waste K+ along with HCO3

Question 13

What is the main use of Carbonic Anhydrase Inhibitors?

Answer 13

glaucoma– they lower intraocular pressure with a role in aqueous humor production

Question 14

What must you monitor with CAIs?

Answer 14

cross sensitivity with sulfonamides

Question 15

How do CAIs effect blood and urine

Answer 15

Urine pH increases (alkalotic)
Blood pH decreases (acidodic)

so careful with other drug products

Question 16

What is another use for CAIs?

Answer 16

altitude sickness– hemoglobin discharges O2 if body is slightly acidic

Question 17

What is the name of the CAI

Answer 17

Acetazolimide

Question 18

CPP equation, how do you increase it?

Answer 18

MAP - ICP

increase MAP (epi) or decrease ICP (manitol)

Question 19

Thiazide diuretics alter what ions and how?

Answer 19

Decrease Mg+, K+

Increase uric acid, glucose, Ca

Question 20

What is the main thiazide?

Answer 20

Hydrocortithiazide

Question 21

Where does thiazide work?

Answer 21

Distal tubule to prevent reabsorption of Na/H2O

Question 22

Efficacy of thiazides?

Answer 22

Medium

Question 23

Why is thiazide questionable if CrCl

Answer 23

drug must reach distal tubule to work

Question 24

Be careful to monitor what 2 things with thiazides?

Answer 24

Sulfonamide cross-sensitivity

wear sunscreen- causes photosensitivity

Question 25

What is the efficacy of Loop Diuretics?

Answer 25

High, high ceiling

Question 26

What are the 2 loop diuretics with high bioavailiabilty? These are good in patients with what?

Answer 26

Bumetanide Torsemide use in CHF with intestinal edem

Question 27

Name another loop diuretic

Answer 27

Furosemide (lasix)

Question 28

How are loop diuretics administered?

Answer 28

IV or PO

Question 29

Loop diuretics alter what ions?

Answer 29

Decrease K, Ca | Increase uric acid, glucose

Question 30

What is a side effect of loop diuretics?

Answer 30

tinitis (ototoxicity) from pushing drug too quickly

Question 31

What is the starting dose of loop diuretics? Max dose?

Answer 31

20 mg / day 2500 mg / day (CHF)

Question 32

Vitamin P refers to what?

Answer 32

Lasix (furosemide)

Question 33

What is drug of choice in post-menopausal women with HTN?

Answer 33

Thiazides causes Ca retention (good for osteoporosis)

Question 34

In cancer patients use what diuretic?

Answer 34

Loop diuretics, they have hypercalcemia

Question 35

What is the other name for aldosterone antagonists?

Answer 35

Potassium sparing diuretics Hyperkalemia results

Question 36

How does aldosterone work?

Answer 36

binds to receptors on distal tubule to stimulatie Na/H2O reabsorption and excretion of K

Question 37

What is the main aldosterone antagonist? Efficacy?

Answer 37

Spironolactone Low efficacy (use 2nd or 3rd line)

Question 38

What is the adverse effect of spironolactone?

Answer 38

Gynecomastia (estrogenic anti-androgenic effects)

Question 39

Uses of spironolactone?

Answer 39

HTN Hirtuism Cirrhosis

Question 40

Where is aldosterone metabolized?

Answer 40

Liver

Question 41

Spironolactone should be taken with what?

Answer 41

FOOD

Question 42

Why caution with salt substitutes, with what drugs?

Answer 42

K+ is the base, so caution with aldosterone antagonists (hyperK already a risk)

Question 43

What is the 2nd generation aldosterone antagonist?

Answer 43

Eplerenone | does nothing to sex hormones

Question 44

Which diuretic is best for patients with gout?

Answer 44

Spronolactone

Question 45

Name the 2 non steroidal K sparing diuretics

Answer 45

Triamterene | Amiloride

Question 46

Which patients do NS K+ sparing diuretics work in?

Answer 46

adrenalectomized patients | no adrenal glands

Question 47

NS K+ sparing diuretics result in what ion changes?

Answer 47

Increased K, Ca | Decreased Mg

Question 48

What is a popular combination of drugs to remain neutral K

Answer 48

HCTZ (hydrochlorothiazide) | Triamterene

Question 49

Efficacy of NS K sparing diuretics?

Answer 49

LOW

Question 50

Potassium chloride is dosed how?

Answer 50

MEq 10-20 MEq PO for 30-60 days

Question 51

Name the 5 hyperkalemia treatments

Answer 51

``` Potassium wasting diuretic SPS Bicarbonate Insulin/D5W Calcium chloride (emergency) ```