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Pharm II Exam 2 > Diuretics > Flashcards

Diuretics Flashcards

1
Q

CA inhibitors

A

Acetazolamide
Dorzolamide (topical)
Brinzolamide (topical)

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2
Q

Where do CA inhibitors work

A

proximal tubule

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3
Q

Use of CAI

A

Bicarb diuresis
Alkalinization of urine (increase weak acid excretion) alkalosis (metabolic or respiratory)
Moutain sickness (resp alkalosis)
GLAUCOMA (topicals) – dec CSF and aqueous humor

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4
Q

Kinetics of CAI

A 
renal excretion: dose adjust in renal insufficiency
oral absorption (30 min)
not used as long term diureti - H accumulation
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5
Q

Why is CAI not used as long term diuretics

A

metabolic process eventually cause H+ to build up in cell and eventually NHE will begin to work again

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6
Q

SE of CAI

A

Hyperchloremic metabolic acidosis (excreted as NaHCO3)
Hypokalemia (Na/K ATPase)
Renal stones (inc. calcium in urine)
Hyperuricemia (compete)

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7
Q

Contraindications for CAI

A 
hepatic cirrhosis (alkalinization of urine decreases ammonia excretion)
sulfonamide hypersensitivity
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8
Q

Loop diuretics

A

Furosemide
Bumetanide
Torsemide
Ethacrynic acid

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9
Q

Which loop diuretic is not a sulfa?

A

Ethacrynic acid

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10
Q

What works best at low GFR?

A

loop diuretics

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11
Q

Use of loop diuretics

A

HF
Pulmonary edema (vasodilator effect)
Edema due to impaired renal function
HYPERCALCEMIA

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12
Q

MOA of loops

A

Inhibit NKCC2, thereby also inhibit Mg and Ca absorption

Induce kidney PGs (vasodilation, decreases salt transport)

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13
Q

SE of loop diuretics

A

High potentcy- abnormal fluid and electrolytes
HYPOKALEMIC METABOLIC ALKALOSIS (Na/K and Na/H in distal tubule exchange)
Hypocalcemia and hypomagneseia
Hyperuricemia
GI
IRREVERSIBLE OTOTOXCITY

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14
Q

Worse ototoxicity

A

ethacrynic acid

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15
Q

Ototoxicity is worse when given with

A

amingolycosides

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16
Q

Contraindictions of loops

A 
sulfa allergy (except ethacrynic acid)
Drug interactions
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17
Q

Overzealous use of loops is dangerous in

A

Hepatic cirrhosis
borderline renal failure
HF

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18
Q

Drug interactions of loop

A

COX inhibitors (PG synthesis required- vasodilation)
aminoglycoside (ototoxic)
litium (loss of Na increases Li retention and toxicity)
Digoxin (loss of K increases toxicity)

19
Q

Most widely used diuretic

A

thiazides

20
Q

Dependent on PG synthesis

A

CAI

Thiazides

21
Q

Thiazide drugs

A 
Hydrochlorothiazide
Chlorothiazide
Chlorthalidone
Metolazone
Indapamide
Quinethazone
22
Q

MOA of thiazide

A

inhibit NCC in early distal tubule (Na-Cl symporter)

Inc. ATP-dep K+ channel opening- vasodilation (dec. insulin secretion)

effect dependent on PG synthsis

23
Q

Use of thiazides

A

HTN!
HF - not as effective as loops
nephrolithiasis - dec Calcium excretion due to increaed activity of PTH-dep calcium channels (Na pushes Ca through)
nephrogenic DI

24
Q

Thiazide with longest duration

A

Chlorthalidone (preffered because of this)

25
Q

Indapamide

A

Excreted 50/50 liver and kidney (renal insufficiency)
No increase in lipid levels
Vasodilation (CCB)

26
Q

Good thiazide for renal insufficiency

A

indapamide

27
Q

SE of thiazides

A 
Hypokalemic metabolis alkalosis
Hyperuricemia
Magnesium loss
Iodide/bromide loss
HYPERGLYCEMIA
Elevated lipid levels (except indapamide)
28
Q

Contra to thiazides

A 
sulfa
inhibited by NSAIDs (depend on PG)
Digitalis (hypkalemia)
Diabetics (hyperglycemia)
Lithium (low Na)
29
Q

Metolazone

A

produces diuresis in patients w/ reduced GFR (exception to the thiazides)

30
Q

Used in low GFR

A

loop diuretics

Metolazone (thiazide)

31
Q

Classes of potassium sparing diuretics

A

aldosterone antagonist

direct inhibitor of Na flux

32
Q

Where do potassium sparing diuretics work

A

distal tuble/CD

33
Q

DOC for lithium induced DI

A

Amiloride

34
Q

Do not cause hyperuricemia

A

Amiloriide

Triameterene

35
Q

MOA of Amiloride, triamterene

A

inhibit eNaC channel in distal tubule/CD -

36
Q

SE of amiloride and triamterene

A

Hyperkalemia (chronic or in combo w/ other K sparing)

N/V/leg cramps dizziness

37
Q

Contra of amiloride/triamterone

A

Hyperkalemia (burns)

38
Q

Not dependent on sodum

A

mannitol, isosorbide, glycerin, urea (osmotic diuretics)

39
Q

DOC for central DI

A

Desmopressin

40
Q

SE of desmopressin

A

hyponaremia

GI, H/a, dizziness, allergic reaction

41
Q

SIADH DOC

A

Conivaptan or tolvaptan (outpatient)

42
Q

Conivaptan administration

A

IV only

43
Q

Tolvaptan administration

A

oral, send home on medication

44
Q

Contraindication of vaptans

A

Hypovolemic hyponatremia

Pharm II Exam 2 (4 decks)

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