Diuretics Flashcards
Oliguria
the production of abnormally small amounts of urine
Polyuria
the production of abnormally large amounts of urine
Mannitol MOA PO
poor lipid soluble, not well absorbed, acts as a cathartic drug, purgative, voids the intestines
Mannitol MOA IV inj (acts at 2 sites)
thick ascending loop of Henle and proximal tubule
the most effective diuretics are ____ diuretics, acting at
loop diuretics acting at the thick ascending loop of Henle, inhibiting sodium reabsorption
the second most effective diuretics are ____ diuretics, acting at
thiazide diuretics acting at the early distal tubule
the third most effective diuretics are carbonic anhydrase inhibitors and osmotic diuretics, acting at
act at proximal tubule
the least effective are ____ diuretics, acting at
potassium-sparing diuretics, acting at the collecting duct and late distal tubule
Mannitol is a ____ diuretic
moderate
The effect on electrolyte imbalance is not significant with administration of mannitol. True or False
True
______: Osmotic diuretics increase renal blood flow and perfusion, which can be useful in the treatment of oliguric renal failure; the most sensitive tissue to blood flow changes is the kidney - if the kidney does not get enough blood supply, it stops working (it is the first organ to shut down - ACUTE RENAL FAILURE).
Mannitol
Mannitol is very ____philic.
hydro
Mannitol leaves the vascular compartment via _____ in the endothelium of blood capillaries; fenestrations in the capillaries are wide allowing any free drug to pass out of the vascular compartment. Since the fenestrations in the GI tract are narrow, mannitol is not absorbed well.
fenestrations
Mannitol cannot pass through fenestrations guarded by barriers; the strongest barrier using tight junctions in the body is the ____-____ barrier.
blood-brain
Mannitol cannot cross the blood-brain barrier. True or False
True
Both the vascular and interstitium are considered as one compartment. Mannitol is only used to treat ____ ____.
localized edema
Mannitol can pull water from the brain and the eye; therefore in addition to local edema it is indicated in the treatment of glaucoma (chronic) to decrease ___. It does not cross the barrier of the eye, but pulls excess vitreous humor from the eye.
IOP (intraocular pressure)
Mannitol MUST be given __.
IV
Mannitol can also be used in cases of ______ and acute/chronic ______ failure.
toxicity; renal
Mannitol is contraindicated in cases of _____ _____; it will exacerbate the condition.
generalized edema
MANNITOL INDICATIONS (5)
1) CEREBRAL EDEMA 2) GLAUCOMA 3) ACUTE RENAL FAILURE 4) MOBILIZATION OF EDEMA FLUID 5) DRUG OVERDOSE PATIENTS
MANNITOL CONTRAINDICATIONS
1) HEAD TRAUMA OR CEREBRAL HEMORRHAGE (DAMAGE TO THE BLOOD BRAIN BARRIER CAN ALLOW MANNITOL TO CROSS THE BARRIER AND EXACERBATE CEREBRAL EDEMA)
loop diuretics are also called ____ ____ diuretics: act at the _____, are the ____ effective diuretics but also the ____ serious changes to electrolyte balance
high ceiling; thick ascending loop of Henle; most; most
3 major loop diuretics (the “mides”): a patient that is allergic to one may be allergic to another: HYPERSENSITIVITY REACTIONS
furosemide (lasix/salix), bumetanide, ethacrynic acid
the “mides” are all weak _____
acids
excretion = filtration - reabsorption + secretion
finish later
acids can compete; drug-drug interactions are possible; active tubular secretion
finish later
Furosemide ADMIN
IV INJ or PO
Furosemide MOA
next day
osmotic diuretics and loop diuretics both increase renal blood flow and perfusion. true or false
true
main MOA loop diuretics: inhibit the ________ in the thick ascending loop of Henle
Na+ K+ 2Cl symporter
secondary MOA loop diuretics: inhibit paracellular reabsorption of 5 electrolytes
sodium, potassium, magnesium, chloride, calcium
thus loop diuretics can be used to treat
hypercalcemia
which diuretics cause the most significant electrolyte imbalance
loop
the most severe electrolyte imbalance that can result is _____ with systemic alkalosis
potassium (hypokalemia); treat with a slow single IV injections as not to trigger a severe spike in K+
systemic lifelong hypertension should not be treated with loop diuretics. true or false
true
loop diuretics are often combined with _______ (normal) in order to treat hypercalcemia
saline; to compensate for the loss of electrolytes that will occur with the use of a loop diuretic
blood from the nose of a horse after exercise can be indicative of exercise-induced _____ ______; loop diuretics can be used to treat this
pulmonary hemorrhage
loop diuretics can be used to treat toxins because renal excretion will be increased. true or false
true
never use a diuretic in an already dehydrated/hypovolemic patient. true or false
true
acute poisoning leads to ______, ______
vomiting, diarrhea
_______ or _______ are used in cases of poisoning
mannitol and furosemide
mannitol is less efficacious and less likely to cause electrolyte imbalance than furosemide and is therefore the better choice for treatment of poison toxicity. true or false
true
increased venous capacitance causes a _____ in blood pressure
decrease
ototoxicity is ear damage to the extent of deafness due to electrolyte balance in the _______ of the inner ear
endolymph
_________ are a class of antibiotics including streptomycin and gentamicin, can also cause ototoxicity; DO NOT USED aminoglycosides together with loop diuretics as the risk of ototoxicity is higher
aminoglycosides
hyperurecemia can cause ______ when uric acid precipitates out and causes stone formation
uroliths
loop diuretics given IV and PO with the exception of ____ which should only be given IV
mannitol
thiazide diuretics act in the _____ _____ ____
early distal tubule
thiazide diuretics are administered only
PO
hydrochlorothiazide and chlorothiazide are examples of _______ diuretics
thiazide
thiazide diuretics inhibit the ______ symporter in the distal convoluted tubule resulting in inhibition of tubular reaborption of sodium, chloride and diuresis
sodium-chloride
one of the most common uroliths in animals is _____
calcium oxylate crystals form - high oxalic acid contant
thiazide diuretics can be used to treat ______ edema
generalized
one of the oldest used and most effective drugs used in hypertension in people is ______ because they are others such as calcium blockers and beta blockers cause greater electrolyte imbalances (ace inhibitors and beta blockers lower serum potassium), also because they are inexpensive in comparison
thiazide diuretics
adverse effects for thiazide diuretics are similar to those of loop diuretics but less severe. true or false
true
thiazide diuretics can cause __________ by increasing triglycerides in the plasma, increasing risk factors in hypertensive patients
hyperlipidemia
only ______ diuretics can induce hyperlipidemia
thiazide
glomerular filtration (mainly) and active tubular secretion by the kidney rids the body of thiazide diuretics. true or false
true
thiazide diuretics DO NOT increase renal blood flow, causing issue when they cannot reach their site of action in patients with compromised renal blood flow, leading to significant decrease in efficacy. true or false
true
spironolactone acts on aldosterone at the ________ and is therefore a potassium-sparing diuretic
mineralocorticoid receptors in the distal tubule and collecting duct
addison’s disease is characterized
sodium
spironolactone is given
PO
spironolactone MOA resulting in excretion of NaCl and diuresis as well as retention of potassium and proton
competitively blocks aldosterone binding to aldosterone receptors (MR, mineralocorticoid receptor)
spironolactone are often combined with __________ or __________ diuretics in the treatment of congestive heart failure 1) even out potassium 2) manage high aldosterone caused by this condition
loop or thiazide
spironolactone can also be used in primary or secondary
hyperaldosteronism
loop diuretics may lead to systemic alkalosis where as potassium sparing diuretics such as spironolactone may lead to
systemic acidosis
glucocorticoids, mineralocorticoids and sex hormones (both male and female) are all examples of ______ hormones
cholesterol
_______ can decrease efficacy of endogenous estrogens and testosterones since they mimic cholesterol hormones
spironolactone
spironolactone are well absorbed because they are steroids and therefore very ____ soluble
lipid
the degree of metabolism of drugs is proportional to the lipid solubility of the drug. true or false
true
triamterene and amiloride MOA unique
block sodium channels in the late distal tubule and collecting duct; these are unique sodium channels
triamterene and amiloride can be used to counterbalance ______
hypokalemia
most diuretics act on the ______ side
luminal
receptors for triamterene and amiloride are found at the ______ side
opposite lumen (basolateral???)
administer triamterene and amiloride
PO
Carbonic anhydrase inhibitors are no longer used as diuretics, despite the fact that they have a diuretic effect, because they cause _____ _____.
systemic acidosis
Acetazolamide, Brinzolamide, Dorzolamide and Methazolamide inhibit carbonic anhydrase primarily in the _____ _____ and secondarily in the _____ _____.
proximal tubule; collecting duct
Brinzolamide and Dorzolamide are ophthalmic drugs used to inhibit carbonic anhydrase in the eye; lowers IOP by decreasing the formation of _____ _____.
aqueous humor
Hypokalemia, hypoglycemia, mild systemic acidosis, all side effects of
the
