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CPR Exam 2 > Diuretics > Flashcards

Diuretics Flashcards

1
Q

Effects of Hyperkalemia (4) and Hypokalemia (4)

A

Hyperkalemia
Tall T waves
Wide QRS
Flat P waves
Bradycardia

Hypokalemia
Flat T waves
ST depression
Tall U waves
Atrial arrhythmia

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2
Q

Loop Diuretics

A
  • Furosemide
  • Torsemide
  • Bumetanide
  • Ethacrynic Acid
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3
Q

Thiazide Diuretics

A
  • Hydrochlorothiazide
  • Metolazone
  • Chlorthalidone
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4
Q

K+ Sparing Diuretics

A
  • Na+ Channel blockers
    • Amiloride
    • Triamterene
  • Aldosterone ANT
    • Sprinonolactone
    • Eplerenone
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5
Q

Carbonic Anhydrase Inhibitors

A

Acetazolamide

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6
Q

Aquaretics

A
  1. Conivaptan
  2. Tolvaptan
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7
Q

Osmotic Diuretics

MOA:

Drug:

SE:

TX:

A
  • Increase urine flow b bc it cannot be reabsorbed, so pulls water from cells in PT and LoH
  • Mannitol​
  • SE:
    • ​Volume overload
      • Acute ​increase in extracellular volume bc sucks out of cells; can worsen HF
    • Dehydration
      • ​HA, N/V
    • Electrolyte imbalance
  • TX:
    • ​Decrease ICP
    • Decrease in intraocular pressure
    • Prophalx against renal failure; keeps fluid in tubules to prevent collapse when GFR is low
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8
Q

K+ sparing diuretics (often used …)

Act on what part of the nephron?

A
  • combo with others to enhance effects and counteract hypokalemia bc loop diurects and thiazides cause hypokalemia
    • only cause slight dluresis.
  • Cortical CD
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9
Q

Potassium Sparing Diuretics
MOA (2) Examples for Each MOA (2)

A
  • Na+ channel blockers (ENaC) in CD: Less Na+ into the cell => decreased Na/K exchange via Na/K ATPase on BL side => increased retention of K+ and SMALL increase in Na+ secretion

(Amiloride and Triamterene)

  • Aldosterone ANT (competitive) in principal cells: Blocks aldosterone receptor => prevents transcription of Na+ channel and Na/K ATPase => prevents reabsorption of Na+ and water

(Spironolactone and Eplerone)

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10
Q

Amiloride/Triamterene
Use and Adverse Effects (6)

How is triamterene different?

A

​Uses: Counteract K+ loss in other tx for HTN, HF

  1. Hyperkalemia (BBW) /Hyperchloremia (high K and Cl)
  2. Hyponatremia
  3. Metabolic Acidosis
  4. Dizziness
  5. Fatigue
  6. N/V/D
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11
Q

Spironolactone/Eplerone
Uses (3) and Adverse (4)

A

Uses: counteract K+ loss in HTN, HF, ascities

  1. Primary Hyperaldosteronism
  2. Post-MI/ reduce Fibrosis
  • Hyperkalemia
  • Hyponatremia
  • Can + receptors for testosterone and progesterone (partial androgen AGO)
    • W: Amenorrhea and hirsutism
    • M: Gynecomastia and Impotence
      *
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12
Q

how is eplerenone different from spironolactone

A

more selective aldosterone ANT

lacks sulfure

Use: tx fibrosis in post MI or combo with HTN

Less gynocostoma

10x more expensive

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13
Q

Carbonic Anhydrase Inhibitor
MOA: Example, Uses (3) and Adverse Effects (3)

A

Acetazolamide: weak diuretic

MOA: Bicarb is maintained in lume => cannot power the Na+/H+ exchanger (reabsorbs Na+ and secretes H+) => decrease absorption of Na+ => more Na+ in the urine => more water in urine

Treats:

  1. Metabolic alkalosis
  2. Glaucoma
  3. Acute Mountain Sickness (alt sickness)

Causes:

  • Hypokalemia
  • Hyperchloremic acidosis
  • Nephrolithiasis
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14
Q

Which two diuretic classes are contraindicated in pregnancy?

A

Loop and thiazide

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15
Q

__________, which work in the _____, have the greatest diuretic effect by blocking what receptor?

A
  • Loop diuretics
  • TAL
  • Na/K/2Cl Cotransporter
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16
Q

Normally, how does the NK2Cl co-transporter work in the TAL?

A
  • Na/K/Cl are present in urine and reabsorbed via the NK2Cl co-transporter. This (+) charge in lumen allows paracellular reabsorption of Mg/Ca2+ into the urine.
    • Cl- moves into the blood via Cl- channel on the BL side
    • Na/K ATPASe will move Na+ into the blood
    • K+ leaks back into urine via K+ channels
17
Q

Loops diuretics cause excretion of ____

A
  1. Na
  2. K
  3. Cl
  4. Ca
  5. Mg
18
Q

Loop Diuretics
MOA and Adverse Effects (7)

A
  1. Largest Na+ loss (also K+/Ca2+/Mg2+/Cl- lost) - electrolyte imbalance
  2. Metabolic Alkalosis
  3. Acute hypovolemia => shock, hypotension, cardiac arrhythmia;
  4. Ototoxicity
  5. Sulfa Allergies
  6. Hyperglycemia
  7. Furosemid and ethycrinic acid can cause: Hyperuricemia => worsen gout
19
Q

Loop Diuretics (all sulfa drugs)
Examples with Uses (4)

A
  • Furosemide: Pulmonary edema, HTN, liver disease and low GFR pts.
  • Torsemide: edema w Heart failure
    • better oral absortption and longer 1/2 life
  • Bumetanide: predictable oral absorption
  • Ethacrynic acid: non-sulfa (use in case of allergy)
20
Q

Do NOT use ______ in patients with low GFR

A

thiazides

21
Q

_______ are Ca2+ Sparing drugs

A

Thiazides

22
Q

Thiazides act on _______ in the ________ to cause weak diuresis

A
  • Na/Cl Co-transporter
  • early DT
23
Q

Thiazides inhibit _________ to cause ________.

A
  • Na/Cl Cotransporter in the early DT
  • Increase Na, Cl- excretion => increase urine output
24
Q

Thiazides Adverse Effects (4)

A
  1. Hypokalemia (d/t increased delivery of Na+ to distal)
  2. LARGEST Mg2+ LOSS!!!!
  3. Metabolic alkalosis
  4. Sulfa allergies
  5. Hypercalcemia/Hyperglycemia/Hyperuricemia (worsen gout)/ hyperlipdemia d.t decrease insulin secretion and increased hepatic glucose production
25
Q

Thiazide uses:

A
  • Hydrocholorthiazide (most widely used; not useful w people w low GFR but treats NDI, Ca+ nephrolithiasis/kidney stones)
  • chlorothalidone (best for HTN)
  • Metolozone

CPR Exam 2 (29 decks)

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