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Hypertension > Diuretics > Flashcards

Diuretics Flashcards

1
Q

What are the classes of diuretics?

A 
thiazides
loop
K sparing
CA inhibitors
Osmotics
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2
Q

Osmotic diuretics increase urine flow with _____ salt excretion.

A

low

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3
Q

Osmotic diuretics can cause an immediate inital ________ of the ECF.

A

expansion

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4
Q

Mechanism of action for osmotic diuretics.

A

Osmotics distribute throughout the ECF and water moves out of the cells down the osmotic gradient. Expansion of ECF increases renal blood flow.

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5
Q

Osmotic diuretics increases the excretion of which electrolytes?

A

All: Na, K, Ca, Mg, Cl, HCO3, PO4

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6
Q

What are the osmotic diuretic agents?

A

Mannitol
Glycerin
Isosorbide

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7
Q

Which osmotic diuretics are IV?

A

Mannitol

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8
Q

Which osmotic diuretics are PO?

A

glycerine and isosorbide

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9
Q

In what case would mannitol be contraindicated?

A

frank renal failure

pulmonary edema

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10
Q

When is mannitol most commonly used?

A 
shock
brain edema (trauma)
rhabdomyolysis
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11
Q

When are glycerin and isosorbide commonly used?

A

before ophthalmic surgery

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12
Q

What are the carbonic anhydrase inhibitor agents?

A

Acetazolamide (Diamox)
dichlorphenamide (Daranide)
methazolamide (Neptazane)

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13
Q

What is the carbonic anhydrase inhibitor ending?

A

-amide

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14
Q

What is one of the main limitations of carbonic anhydrase inhibitors?

A

excessive bicarbonate secretion and subsequent metabolic acidosis

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15
Q

What are carbonic anhydrase inhibitors generally used for?

A

open-angle glaucoma
altitude sickness
alkalosis in CHF patients

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16
Q

Mechanism of action of carbonic anhydrase inhibitors

A

reversible inhibition of carbonic anhydrase which prevents the formation of CO2 and the recovery of HCO3 from the tubule

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17
Q

Carbonic anhydrase inhibitors are contraindicated in what groups?

A

pregnancy
hepatic cirrhosis
severe COPD

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18
Q

What overdose situations would you use carbonic anhydrase inhibitors?

A

aspirin and barbituate

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19
Q

What are the benzothiazide diuretic agents?

A 
chlorothiazde
hydrochlorothiazide
hydroflumethiazide
methylchlothiazide
polythiazide
chlorthalidone
indapamide
metolazone
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20
Q

What is the mechanism/site of action of benzothiazides?

A

Block the Na/Cl transporter in the early distal tubule

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21
Q

What are the therapeutic uses of benzothiazides?

A

HTN
diabetes insipidus
kidney stones

22
Q

What is the first line diuretic (and antihypertensive)?

A

HCTZ

23
Q

Benzothiazides provide _____ diuresis.

A

mild/safe

24
Q

Benzothiazides lower BP by __-__ mm Hg

A

15-20

25
Q

How do benzothiazides improve diabetes insipidus?

A

In normo-natremic individuals, thiazides causes mild hyponatremia. This causes increased Na and water reabsorption in the proximal tubule meaning that less water reaches the distal tubule and thus urine output is decreased.

26
Q

How do benzothiazides treat kidney stones?

A

Thiazides decrease Ca exretion by unknown mechanism.

27
Q

What are the major adverse effects of benzothiazides?

A

hyPOkalemia
hyPOmagnesia
hyPERglycemia
hyPERlipidemia

28
Q

Chlorthalidone is about ___x as potent as HCTZ and has about ___x the half life.

A

1.5x as potent

18x longer half-life

29
Q

What are the loop diuretic agents?

A

furosemide (Lasix)
bumetanide (Bumex)
ethacrynic acid (Edecrin)
torsemide (Demadex)

30
Q

For what conditions are loop diuretics commonly used?

A

edema
hypercalcemia
HTN unresponsive to thiazides
renal failure

31
Q

Mechanism/site of action of loop diuretics

A

Blockade of the Na/K/2Cl uptake in the TALH

32
Q

Loop diuretics promote __ _______, potentially to a serious level.

A

K excretion

33
Q

Along with K, what other electrolytes do loop diuretics promote excretion?

A

Ca and Mg

34
Q

In the use of loop diuretics, renin secretion is/isn’t suppressed.

A

Renin secretion is not suppressed

35
Q

In the use of loop diuretics, GFR is/is not reduced.

A

GFR is not reduced

36
Q

What are the adverse effects with loop diuretics?

A 
electrolyte imbalances
ototoxicity
GI disturbances, bleeding, diarrhea
pancreatitis
lupus erythematosis
37
Q

Which loop diuretic agent is most common cause of ototoxicity?

A

ethacrynic acid

38
Q

What condition can be revealed by loop diuretics and thiazides?

A

gout

39
Q

Loop diuretics cause ____ diuresis.

A

high/potent

40
Q

Loop diuretics can interact with warfarin, causing _______ anticoagulation.

A

increased

41
Q

What are the K sparing diuretic agents?

A

Spironolactone
Eplerenone
Triamterene
Amiloride

42
Q

In what conditions are K sparing diuretics used?

A 
HTN
CHF
ascites (cirrhosis)
primary and secondary aldosteronism
hypokalemia
43
Q

How/where do the K sparing diuretics Triamterene and Amiloride work?

A

Triamterene and Amiloride block the Na channel in the late distal tubule and collecting duct.

44
Q

How/ where do the K sparing diuretics Spirololactone and Eplerenone work?

A

Spironolactone and Eplerenone are competitive antagonists of aldosterone at the mineralocorticoid receptor. They block the binding of aldosterone and thus decrease the synthesis and activity of the luminal Na channel.

45
Q

K sparing diuretics are _____ effective than ARBs in African Americans.

A

more

46
Q

Triamterene and Amiloride are/are not dependent on aldosterone levels.

A

are not

47
Q

Spironolactone and Eplerenone are/ are not dependent on aldosterone levels.

A

are

48
Q

K sparing diuretics are most effective when combined with _______ ________.

A

other diuretics

49
Q

Eplerenone has _______ specificity for MR than spironolactone.

A

greater

50
Q

What are the adverse effects of K sparing diuretics?

A

Hyperkalemia
gynecomastia and impotence
menstruel irregularities and hirsutism
gastric bleeding

51
Q

Eplerenone is metabolized by _____ and shouldn’t be used with inhibitors.

A

CYP3a4

Hypertension (8 decks)

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