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Pharmacology 2 > Diuretics > Flashcards

Diuretics Flashcards

1
Q

What was the first diuretic? How does it work?

A

Mercury

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

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2
Q

What are the 2 osmotically active drugs?

A

Laxatives (in colon)
Osmotic Diuretics

the drugs are hyperosmotic and suck water out into the tubule

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3
Q

Osmotic Diuretics-
where filtered?
MOA?

A

colon

prevent reabsorption of Na/H2O in proximal tubule

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4
Q

What is the risk with osmotic diuretics?

A

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

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5
Q

What do you monitor patient for on osmotic diuretic?

A

Flash pulmonary edema

Increased cardiac workload

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6
Q

How is mannitol administered? Other indications?

A

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

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7
Q

What are 2 other osmotic diuretics?

A

Glycerin (weight lifters/body builders drink it)

Urea

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8
Q

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

A

Interferes with the activity of ADH

Indicated for SIADH, not hypertension

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9
Q

What is the only aquaretic?

A

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

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10
Q

How do sulfur compounds work?

A

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

they inhibit carbonic anyhydrase

CA-I, thiazides, loop diuretics

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11
Q

What does carbonic anhydrase do?

A

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

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12
Q

What is the major risk of Carbonic Anhydrase Inhibitors?

A

HYPOkalemia

you waste K+ along with HCO3

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13
Q

What is the main use of Carbonic Anhydrase Inhibitors?

A

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

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14
Q

What must you monitor with CAIs?

A

cross sensitivity with sulfonamides

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15
Q

How do CAIs effect blood and urine

A

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

so careful with other drug products

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16
Q

What is another use for CAIs?

A

altitude sickness– hemoglobin discharges O2 if body is slightly acidic

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17
Q

What is the name of the CAI

A

Acetazolimide

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18
Q

CPP equation, how do you increase it?

A

MAP - ICP

increase MAP (epi) or decrease ICP (manitol)

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19
Q

Thiazide diuretics alter what ions and how?

A

Decrease Mg+, K+

Increase uric acid, glucose, Ca

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20
Q

What is the main thiazide?

A

Hydrocortithiazide

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21
Q

Where does thiazide work?

A

Distal tubule to prevent reabsorption of Na/H2O

22
Q

Efficacy of thiazides?

A

Medium

23
Q

Why is thiazide questionable if CrCl

A

drug must reach distal tubule to work

24
Q

Be careful to monitor what 2 things with thiazides?

A

Sulfonamide cross-sensitivity

wear sunscreen- causes photosensitivity

25
Q

What is the efficacy of Loop Diuretics?

A

High, high ceiling

26
Q

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

A

Bumetanide
Torsemide

use in CHF with intestinal edem

27
Q

Name another loop diuretic

A

Furosemide (lasix)

28
Q

How are loop diuretics administered?

A

IV or PO

29
Q

Loop diuretics alter what ions?

A

Decrease K, Ca

Increase uric acid, glucose

30
Q

What is a side effect of loop diuretics?

A

tinitis (ototoxicity) from pushing drug too quickly

31
Q

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

A

20 mg / day

2500 mg / day (CHF)

32
Q

Vitamin P refers to what?

A

Lasix (furosemide)

33
Q

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

A

Thiazides

causes Ca retention (good for osteoporosis)

34
Q

In cancer patients use what diuretic?

A

Loop diuretics, they have hypercalcemia

35
Q

What is the other name for aldosterone antagonists?

A

Potassium sparing diuretics

Hyperkalemia results

36
Q

How does aldosterone work?

A

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

37
Q

What is the main aldosterone antagonist? Efficacy?

A

Spironolactone

Low efficacy (use 2nd or 3rd line)

38
Q

What is the adverse effect of spironolactone?

A

Gynecomastia (estrogenic anti-androgenic effects)

39
Q

Uses of spironolactone?

A

HTN
Hirtuism
Cirrhosis

40
Q

Where is aldosterone metabolized?

A

Liver

41
Q

Spironolactone should be taken with what?

A

FOOD

42
Q

Why caution with salt substitutes, with what drugs?

A

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

43
Q

What is the 2nd generation aldosterone antagonist?

A

Eplerenone

does nothing to sex hormones

44
Q

Which diuretic is best for patients with gout?

A

Spronolactone

45
Q

Name the 2 non steroidal K sparing diuretics

A

Triamterene

Amiloride

46
Q

Which patients do NS K+ sparing diuretics work in?

A

adrenalectomized patients

no adrenal glands

47
Q

NS K+ sparing diuretics result in what ion changes?

A

Increased K, Ca

Decreased Mg

48
Q

What is a popular combination of drugs to remain neutral K

A

HCTZ (hydrochlorothiazide)

Triamterene

49
Q

Efficacy of NS K sparing diuretics?

A

LOW

50
Q

Potassium chloride is dosed how?

A

MEq

10-20 MEq PO for 30-60 days

51
Q

Name the 5 hyperkalemia treatments

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

Pharmacology 2 (8 decks)

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