Diuretics, ACEs, ARBs, CCBs Flashcards
1
Q
hydrochlorothiazide, indapamide, chlorothiazide, chlorthalidone, methylclothiazide
A
thiazide diuretics
2
Q
furosemide, bumetanide, ethacrynic acid, torsemide
A
loop diuretics
3
Q
amiloride, spironolactone, triamterene
A
potassium-sparing diuretics
4
Q
prototype: thiazide
A
hydrochlorothiazide
5
Q
prototype: loop
A
furosemide
6
Q
prototype: potassium-sparing (2)
A
spironolactone & triamterene
7
Q
which diuretic acts in the ascending loop of Henle to inhibit sodium and chloride reabsorption?
A
loop diuretics
8
Q
indications for loop diuretics (4)
A
- edema r/t HF
- edema r/t renal disease or liver failure
- hypertension that cannot be control with thiazide or potassium sparing diuretics
- patients who need diuretic therapy but have low renal blood flow
9
Q
ototoxicity is a side effect in which diuretic class?
A
loop diuretics
10
Q
electrolytes excreted with the majority of diuretics
A
sodium, chloride, potassium, hydrogen, calcium, magnesium
11
Q
most powerful diuretic class?
A
loop diuretics
12
Q
diuretic class most commonly used in HF
A
loop diuretics (furosemide)
13
Q
which diuretic class is effective in treating pulmonary edema & mod./severe CHF
A
loop diuretics
14
Q
adverse effects with loop diuretics include (5)
A
- electrolyte imbalances (hypokalemia, hyponatremia, hypochloremia, hypomagnesemia, hypocalcemia)
- dehydration
- hypovolemia/hypotension
- hyperuricemia
- ototoxicity
15
Q
drug interactions with loop diuretics (6)
which one is a positive interaction?
A
- potassium sparing diuretics (positive, helps counterbalance K+ loss)
- NSAIDs
- digoxin
- ototoxic drugs
- lithium
- antihypertensive drugs (hypotension)
16
Q
which class of medications can blunt loop diuretic effects?
A
NSAIDs
17
Q
monitoring for loop diuretics
A
- monitor BP & pulse
- daily weights
- intake and output
- monitor for decreased edema
18
Q
which diuretic acts in the distal convoluted tubule, decreasing reabsorption of sodium and increasing sodium & water excretion into the urine?
A
thiazides
19
Q
which diuretic class is associated with HYPERcalcemia?
A
thiazides
20
Q
indications for thiazide diuretics (2)
A
- essential HTN
- edema in mild HF
21
Q
which diuretic class is ineffective in patients with eGFR < 30-40?
A
thiazide
22
Q
if eGFR < 30-40, which diuretic class should be used?
A
furosemide
23
Q
thiazides should be used in caution with patients suffering what kind of impairments?
A
renal and liver
24
Q
the eGFR in which thiazides have their best efficacy
A
when eGFR is normal (> 90 mL/min), thiazides are most effective
- These drugs are ineffective when GFR is < 15-20 mL/min
25
the ability of thiazides to promote diuresis is dependent on what?
adequate kidney fx
26
adverse effects for thiazide diuretcs (6)
- hypokalemia
- hypomagnesemia
- HYPERcalcemia
- HYPERglycemia
- HYPERuricemia
- HYPERlipidemia
27
which diuretic should be used cautiously with gout?
thiazide
28
which diuretic should be used cautiously with diabetes?
thiazide
29
drug interactions with thiazide diuretics (5)
| which one is a positive interaction?
- potassium sparing diuretics (positive, helps counterbalance K+ loss)
- NSAIDs
- digoxin
- lithium
- antihypertensive drugs (hypotension)
30
drug interaction differences between loop & thiazide diuretics?
thiazides CAN be combined with ototoxic agents without increasing risk of hearing loss
31
In treatment of hypertension, what determines the use of a loop diuretic vs thiazide diuretic?
Loop diuretic will only be used in place of thiazide diuretic when HTN is uncontrolled with other diuretics
32
diuretic class most commonly used in HTN
thiazide
33
monitoring for thiazide diuretics
- monitor BP & pulse
- daily weights
- intake and output
- monitor for decreased edema
34
which diuretic acts on the late distal tubule and collecting duct?
potassium-sparing (triamterene)
35
which diuretic blocks the action of aldosterone?
| what does this cause?
potassium-sparing (spironolactone)
| --> causes retention of potassium & increased excretion of sodium
36
indications for potassium-sparing diuretics (3)
HTN, edema, HF
37
adverse effects of potassium-sparing diuretics (2)
- hyperkalemia
| - endocrine effects (gynecomastia & impotence)
38
which diuretic is associated with hyperkalemia
potassium-sparing diuretics
39
are potassium-sparing diuretics used as monotherapy?
no - generally combined with thiazide or loop
40
drug interaction of potassium-sparing diuretics with thiazides and loop diuretics
counteracts the potassium-wasting effects of the more powerful diuretic
41
agents that raise potassium levels must be used with caution in which diuretic class? what are these agents?
potassium-sparing (salt substitutes, potassium supplements, or another K+ sparing diuretic) in addition to ACEs, ARBs, and DRIs
42
monitoring for potassium-sparing diuretics
- monitor K+ level
43
contraindications for potassium-sparing diuretics
those with hyperkalemia
44
caution should be used in potassium-sparing diuretics for patients taking what?
ACEs, ARBs, or DRIs
45
caution should be used with thiazides for patients with what conditions (4) or taking what meds (3)?
- cardiac disease
- renal impairment
- diabetes
- history of gout
- dig, lithium, anti hypertensives
46
caution should be used with loop diuretics for patients with what conditions (4) or taking what meds (5)?
- cardiac disease
- renal impairment
- diabetes
- history of gout
- dig, lithium, ototoxic drugs, NSAIDs, anti hypertensives
47
3 determinants of BP
1. mean arterial pressure
2. cardiac output
3. peripheral vascular resistance
48
most commonly used diuretic for HTN
thiazide
49
most cost effective diuretic used for HTN
thiazides
50
ACE inhibitor prototype
captopril
51
-prils belong to what drug class?
ACE inhibitors
52
benazepril, captopril, enalapril, enalaprilat, fosinopril, lisinopril, moexipril, perindopril, quinapril, ramipril, trandolapril
ACE inhibitors
53
which drug class reduces levels of angiotensin II and increases levels of bradykinin
ACE inhibitors
54
main difference between mechanism of actions between ACEs and ARBs
ARBs block the actions of angiotensin II, whereas ACE inhibitors block the formation of angiotensin II
55
contraindications for ACE inhibitors (3)
1. Pregnancy
2. Bilateral renal artery stenosis (or stenosis in artery to single remaining kidney)
3. History of hypersensitivity reactions (especially angioedema) to ACE inhibitors
56
caution should be used when prescribing ACEs to which patients (3) or taking which meds (4)?
- salt/volume depletion
- renal impairment
- collagen vascular disease
OR
- K+ supplements, salt substitutes, K+ sparing diuretics
- ARBs
- aliskiren
- lithium
57
indications for ACE inhibitors (6)
- HTN
- HF
- MI
- diabetic & non-diabetic nephropathy
- prevention of MI, stroke and death in pt. with high CV risk
- diabetic retinopathy
58
adverse effects with ACEs (what's the big one?) (7)
COUGH
- hypotension** first dose hypotension
- rash
- angioedema
- hyperkalemia
- renal failure
- neutropenia
59
drug interactions for ACE inhibitors(5)
- diuretics
- antihypertensive agents
- drugs the elevate potassium levels
- lithium
- NSAIDs
60
first line hypertensive medication classes (4)
- thiazides
- ACEs
- ARBs
- CCBs
61
which drug class is good for patients with HTN & DM or HTN & CHF?
ACEs
62
which drug class can slow the progression of neuropathy?
ACEs
63
monitoring for ACEs (5)
- monitor BP closely
- obtain CBC
- monitor for reduced BP (140/90)
- monitor for reduced s/s HF
- monitor for protienuria & GFR
64
which drug class blocks the angiotensin II receptor, inhibiting the action of angiotensin II
ARBs
65
-sartan belongs to which drug class?
ARBs
66
ARB prototype
losartan
67
azilsartan, candesartan, eprosartan, irbesartan, losartan, olmesartan, telmisartan, valsartan
ARBs
68
which drug class is an alternative to ACE inhibitors if cough is a problem?
ARBs
69
indications for ARBs (7)
- HTN
- HF
- diabetic nephropathy
- MI
- Stroke prevention
- prevention of MI, stroke, and death in those with high CV risk
- diabetic retinopathy
70
adverse effects for ARBs (8)
- hyperkalemia
- fatigue, headache, dizziness
- insomnia
- sinus congestion
- angioedema
- renal failure
* lower incidence of cough bc ARBs don't affect bradykinin*
71
contraindications for ARBs (3)
1. Pregnancy
2. Bilateral renal artery stenosis (or stenosis in artery to single remaining kidney)
3. History of hypersensitivity reactions (especially angioedema) to ARBs
72
monitoring for ARBs (3)
- monitor for reduced BP (140/90)
- monitor for reduced s/s HF
- monitor for protienuria & GFR
73
important drug interaction for ARBs
hypotensive effects of ARBs are additive with those of other antihypertensive drugs...when ARB is added, other drugs may require reduction
74
use cautiously in patients with HF, liver impairment or patients taking digoxin or beta blockers (2)
verapamil & diltizem
75
3 classes of CCBs
1. diphenyalkylamines
2. benzothiazipines
3. dihydropyridine
76
diphenyalkylamines
verapamil
77
benzothiazipines
diltiazem
78
dihydropyridines
nifedipine
79
agent that affects the heart & blood Vessels
verapamil
80
agent that act maiNly on blood vessels
nifedipine
81
prototype CCBs (2)
verapamil & nifedipine
82
therapeutic uses for verapamil (3)
- angina
- essential HTN (2nd line)
- cardiac dysrhythmias
83
contraindications for verapamil & diltiazem (3)
- severe hypotension
- sick sinus syndrom
- second or third degree AV block
84
adverse effects include: cardiosuppression (brady, AV block, & HF), peripheral edema, and constipation*
verapamil (and diltiazem)
85
drug interactions include: digoxin, beta blockers, and grapefruit juice
verapamil (and diltiazem)
86
which medication class should be used cautiously with hypotension, sick sinus syndrome, second/third degree AV block, angina (d/t RT), and HF?
nifedipine
| dihydropyridines
87
which drug can treat angina and essential HTN?
nifedipine
88
reflex tachycardia, gingival hyperplasia, eczema, & peripheral edema are adverse reactions of what drug?
nifedipine
89
positive drug interaction associated with nifedipine
beta blockers (to prevent reflex tachycardia)
90
how do beta blockers interact with nifedipine?
| how they interact with verapamil & diltiazem?
```
nifed = decreases cardiac affects
verapamil = intensify adverse effects
```
91
which CCBs can worsen HF & cause bradycardia?
verapamil & diltiazem
92
which CCB is associated with constipation
verapamil
93
which CCB has an increased risk of MI when used for HTN?
nifedipine
