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diuretics Flashcards

1
Q

Carbonic Anhydrase Inhibitors MOA

A

Inhibit formation of H+ and bicarb from H20 and CO2 via inhibition of CA and decrease resorption of NaHCO3

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2
Q

MOA of Loop diuretics

A
  • Inhibit NaCl reabsorp TALOH
  • Inhibit Na/K/2Cl transporter (lots of solutes in tubule; increase diuretic effect)renal prostaglandin prod via COX2 incr renal blood flow & inhibits Na reabsorption in the loop

Effects on blood flow thru vascular beds: relieve pul congestion prior to diuretic effect

*NOT shown to mortality

can cause you to loose magnesium and Ca

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3
Q

DTC

A

under the influence of parathyroid hormone

independent of Na
but if Na/Cl transport is blocked more Ca will be reabsorbeD?

18:mins

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4
Q

Early collecting tubule Na is reabsorbed under the presence of

A

aldosterone

Na and K is exchanged (not co transport) but you will see more K loss

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5
Q

ADH works where

A

collecting tubule

seen with decrease in serum Na

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6
Q

adenosine inhibitors

A

increase renal blood flow

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7
Q

Prostaglandins enhance the effect of what diuretics? how?

A

Role of 5 PG synthesized and with receptors in kidney poorly understood

PGE2 reduces Na reabsorption in TAL of Henle’s loop and ADH-mediated water transport in collecting tubule – enhance loop diuretics

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8
Q

if someone is on a loop diuretic what happens with protoglandins

A

increase production of prostaglandin (will be decreased under the presence of a Nonsteroidal anti-Inflammatory drug like indomethacin)

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9
Q

Made in distal tubule
Blunts sodium reabsorption
Vascular effects - decreases afferent tone and increases efferent tone leading to a increase in GFR

A

Natriuretic Peptides

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10
Q

MC: Acetazolamide (PO, ER, IV)

MC: Methazolamide (PO)

A

Carbonic Anhydrase Inhibitors(least important)

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11
Q

Carbonic Anhydrase Inhibitors MOA for glaucoma

A

Ciliary body secretes bicarbonate from blood into aqueous humor
Reduce formation of aqueous humor, thereby lowering IO pressure

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12
Q

Carbonic Anhydrase Inhibitors MOA for HTN

A

Works in PT

  • increase excretion of HCO3, Na, K
  • Decrease in H2O reabsorption- (increase rine vol & more alkaline)
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13
Q

all diuretics are eliminated

A

through the kidney

some like methazolamide is also metabolize din the liver

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14
Q

what are the main indications for carbonic anhydrase inhibitors

A

glaucoma
altitude sickness

used to be used to high BP
metabolic acidosis

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15
Q

why do we see hyperglycemia with carbonic anhydrase inhibitors

A

low potassium results in low absorption of glucose

also see reduced release of glucose

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16
Q

CNS symptoms with carbonic anhydrase inhibitors

A
  • CNS (ie. drowsiness, malaise, HA, confusion, depression,irritable, nervous, excitement, dizzy) paresthesias: numbness, tingling of tongue, lips, anus) decrease electrolyte
    o w/ high doses
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17
Q

what allergy do we worry about with carbonic anhydrase inhibitors

A
  • Hypersensitivity (sulfas)
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18
Q

hematological concerns with carbonic anhydrase inhibitors

A
  • Hematologic: anemia, leukopenia, thrombocytopenia (RARE)
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19
Q

this diabetic medication has diuretic properties.

A

SGLT2 - block Na & Glucose reabsorption.

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20
Q

increase prostaglandin production seen with can have what effect on edema

A

relieve edema even before you see diuretic effect

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21
Q

MOA of loop diuretics

A

Inhibit NaCl reabsorp Thick ascending loop of henley
Inhibit Na/K/2Cl transporter (lots of solutes in tubule; increase diuretic effect)

renal prostaglandin prod via COX2 increase renal blood flow & inhibits Na reabsorption in the loop

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22
Q

ADE of loop diuretics

A
  • Hypo-K, metabolic alkalosis
  • Hypo-Mg (check K and Mg)
  • Increases UA levels (gout)
  • Orthostatic hypotension
  • Ca loss
    Otic effects: Tinnitus, hearing impairment/loss
  • Hyperglycemia, glycosuria
  • Hypersensitivity (sulfas)
  • Electrolyte sx’s
  • GI: N/V/D, anorexia, constipation
  • Nervous, dizzy, lightheadedness, HA, paresthesias
  • Hematologic: anemia, leukopenia, thrombocytopenia (rare)
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23
Q

DI with loop diuretics

A
  • Digoxin-hypoK ír isk of toxicity
  • Other diuretics: additive HoTN agents
  • K+ loss drugs (amphloterocmin, corticosteroids)
  • Erythro/AG Auditory tox
  • Indomethacin –> dec. efficacy of loop diuretics
  • Cholestyramine, colestipol ( absorption -bind to everything)
  • Hypotension: additive effects
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24
Q

very significant DI seen with loop and thiazide seen with Indomethacin as a result of

A

prostaglandin production is inhibited by indomethacin

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25
thiazide that has been studied the most
- Chlorthalidone**
26
Thiazide MOA
distal tubule co-transpoter sodium and chloride - Inhibit NaCl resorpt (DCT) increase prostaglandin too
27
chlorthalidone 1/2 life
40 hrs because 90% are bound to RBC
28
HYDROCHLOROTHIAZIDE 1/2 life
5.6-9 hrs do not use if blood pressure is uncontrolled because very short half life
29
DOC: uncomplicated HTN
Thiazide Diuretic
30
DI with thiazide
all the same as loop diuretics in addition Same as Loops - Lithium thiazides lithium levels Li toxicity - Ca2+ salts hyper-Ca from renal tubular reabsorption of Ca Thiazides + loops used for severe renal dysfunction - Check K w/i 1st/2nd wk of tx
31
MOA of potassium sparing diuretics
Inhibit Na resorption in distal tubule - Amil/Tria: inhibits Na flux thru ion channels of principal cell - Spiron/epler: aldosterone antagonist - Depends on prostaglandin production
32
K-sparing diuretics that act on Channels
- Tramterene | - Amiloride
33
K-sparing diuretics that Block Aldosterone
Block Aldosterone - Spironolactone - Eplerenone (more specific)
34
K-sparing diuretics Combo + HCTZ
Dyazide - Maxzide - Moduretic - Aldactazide
35
used in the presence of -Oliguric renal failure (prevent anuria)
- Osmotic diuretics - Mannitol (IV Oliguric renal failure (prevent anuria) - Decrease ICP prior to/during neurosurgery - Decrease IOP acute angle-closure glaucoma
36
MOA of mannitol
Prevents normal resorpt of H20 via osmotic force (PCT, descending) (large sugar molecule)
37
- ConivaptAN (po) - TolvaptAN (IV) drug class
ADH ANTagonist | AVP V1A &V2 antagonist - diuretic
38
- ConivaptAN (po) - TolvaptAN (IV) indications
- HTN, Ortho HoTN, hypoK, constipation, diarrhea, HA
39
-TolvaptAN warning
select liver damage short term only
40
Demeclocycline -Lithium are both what types of drugs and what are their indications
Other ADH ANTagonists used to treat SIADH
41
- ConivaptAN (po) - TolvaptAN (IV) ADE
- Nephrogenic DI severe hypernatremia
42
dose adj in loop diuretics with renal failure
based on osmolairc volume
43
poor blood pressure control might be an issued with thiazides why?
short 1/2 life?
44
neprolithiasis might be useful to us
THIAZIDE
45
methazolamide drug class and where it acts
CAI | PCT
46
ADE of CAI
sulfa hypersensitivity HYPERGLYCEMIA metbaolic acidosis drowsiness paresthesia
47
name all CAI
``` acetazolamide methalzolamide dorzolamide brinzolamide dichlorhenamide ```
48
dosage of acetazolamide
250mg 1-4x a day for glaucoma 250 mg -1g qd for altitude sickness
49
three major loop diuretics
furosemide bumetanide torsemide
50
inidcations for loop
Edema due to congestive heart failure, acute pulmonary edema, nephrotic syndrome, and hepatic cirrhosis HF – used for control of fluid overload, not shown to reduce mortality, used for symptomatic relief Hypertension – in patients with reduced renal function where thiazide diuretics may not be effective
51
Hypokalemic metabolic alkalosis Mg+ loss (check K+ and Mg+) Ca+ loss - may be compensated by reabsorption in distal tubule if dehydrated and and increase Vit-D dependent reabsorption in gut Increased uric acid levels - gout are all sxs
loop diuretics
52
how would you treat HTN in a pt wiht reduced renal function
loop
53
NSAIDS can affect the function of what two diuretics
loop and thiazide | through PG
54
Cholestyramine can decrease absorption of
furosemide
55
increases urine volume
Diuretic
56
increases sodium excretion
naturuietic
57
increases solute free water excretion
aquaretic
58
high altitude sikness occurs over
>9000 ft --> pulm edema
59
why due you have to be careful with salt and thiazides
more salt consumed the more K you will lose
60
which diuretics do you use in HF
fluid volume mngmt with thiazides but usually loop because renal function isn't great
61
which diuretic would you primarily use for HTN
thiazides CrCl>30 and not CKD 4 or 5
62
kidney disease what diuretic would you use
rentention of Na and water use thiazide or loop
63
what diuretic would you use with hepatic cirrohsis
low albumin causes activation of RAAS spironalactone can be very effective loop alone may be inefective
64
calcium kidney stones what diuretic would you use
thiazides (increases reabsorption)
65
hypercalcemia
loop blocks Ca reabsopriton
66
diabetes insipidus
thiazides reduce plasma volume reduce plasma volume and GFR leads to greater Na water reabsorption and less fluid present in collecting tubule

Pharm II (16 decks)

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