Diuretics and hypertension

Question 1

BP equation

Answer 1

cardiac output x peripheral vascular resistance

Question 2

primary hypertension makes up

Answer 2

85-90%

Question 3

risk factors of HTN

Answer 3

family history, sex, diet, smoking, diabetes, hyperlipedemia, age, race

Question 4

the goal of pharmacotherapy

Answer 4

reduce diastolic blood pressure to reduce incidence of end organ damage

Question 5

drugs work to

Answer 5

reduce CO and reduce PVR by vasodilation and decrease blood volume

Question 6

4 targets of therapy

Answer 6

Brain (control autonomic output from CV control center), heart (reduce CO), Kidney (RAAS), vasculature (vasodilators)

Question 7

Things to consider when making therapy decisions

Answer 7

JNC8, compensatory responses, ADR, cost, factors with compliance, baseline BP

Question 8

the principle of diuretics

Answer 8

where Na goes, water will follow, ussed for HTN, edema, CHF, hepatic cirrhosis, diabetes insipidus, renal diseases

Question 9

Three major mechanisms involved in excretion

Answer 9

glomerular filtration (in bowman’s capsule), tubular secretion (active transport), reabsorption (urine back to plasma)

Question 10

Glomerulus is responsible for

Answer 10

filtering water and ions

Question 11

Proximal convoluted tubule

Answer 11

50% of filtered water is reabsorbed, glucose and bicarb also, contains pumps for tubular secretion of drugs into urine, diuretic activity of acetazolamide and mannitol

Question 12

Descending Loop of henli

Answer 12

water can still be reabsorbed, Na and K also move back into plasma, diuretic activity of mannitol, loop diuretics and thiazide diuretics

Question 13

Ascending loop of henli

Answer 13

K and Na (thicker portion has Na only) reabsorbed, often called diluting loop, diuretic activity is loop diuretics

Question 14

distal convoluted tubule

Answer 14

Na, H2O and Ca reabsorbed, hormonal involvement, K and urea secreted back into urine, macula densa serve as feedback for detecting amount of Na reabsorption

Question 15

If a high amount of Na is detected in DCT…

Answer 15

a message is sent to slow filtration

Question 16

Collecting duct

Answer 16

85% of filtered Na has been reabsorbed, all drugs that act prior to this point can cause K loss and can be significant, diuretic activity: K sparing diuretics and osmotic diuretics

Question 17

we give drugs to alter gradients and pull water to…

Answer 17

the urine

Question 18

any time Na is reabsorbed…

Answer 18

the urine will be left with a negative charge, this is compensated for by secreting K in the urine

Question 19

Carbonic anhydrase inhibitors

Answer 19

CA is an enzyme responsible for facilitating H and Na exchange that results in reabsorption, blocking these causes diuretic effect; least used

Question 20

where do carbonic anhydrase inhibitors work

Answer 20

in the proximal convoluted tubule

Question 21

Acetazolamide

Answer 21

CA inhibitors; decrease Na, HCO and H2O reabsorption, IV, PO and opthalmic drops, used for alkalinization, metabolic alkalosis, glaucoma, acute mt disease, renal stones, cheap, old, not used

Question 22

Methazolamide

Answer 22

CA inhibitor never used for anything

Question 23

Loop diuretics

Answer 23

block Na, K, Cl transporter blocks reabsorption, which eliminates reabsorption K intracellularly which limits need for K only transporter, reduces amt of Ca and Mg moving in and out of urine

Question 24

Uses of loop diuretics

Answer 24

most efficacious of diuretics, edamatous conditions (CHF etc) acute pulmonary edema, hypercalcemia, hyperkalemia, acute renal failure

Question 25

ADR of loop diuretics

Answer 25

hypokalemia, hyperuricemia, hypomagnesemia, dehydration

Question 26

Considering extremes with diuretics

Answer 26

Thanksgiving, can take more, if ill can take less

Question 27

Furosemide (Lasix)

Answer 27

Loop diuretic, 20-80mg PO once daily, dosing 1mg IV=2mg PO**, CHF, not recommended for HTN, may need KCl supp, maybe sulfa alergy?, old, cheap

Question 28

Bumetanide (Bumex)

Answer 28

Loop Diuretic, More potent than lasix (1:40), 1 mg IV= 2 mgPO, CHF but not first line, end stage/advanced, ADR hypokalemia, old and cheap

Question 29

Torsemide (demadex)

Answer 29

Loop diuretic, IV and PO, most infrequently used, 1:2 to lasix

Question 30

Ethacryanic acid (Edecrine)

Answer 30

Loop diuretic, IV and PO, prodrug, DOC for sulfa allergy, very little if any use

Question 31

Thiazide diuretics

Answer 31

block Na/Cl transporter, which drives Na into cell and Ca into blood, increased excretion of Na and H2O and K, and increase reabsorption of Ca, HTN

Question 32

Thiazide like diuretics

Answer 32

hydrocholrothiazide, chlorthalidone, indapamide, metolazone

Question 33

ADR of thiazide diuretic

Answer 33

Hypokalemia, hypercalcemia, hyperuricemia, hyperlipidemia, impaiired carbohydrate tolerance, hyponatremia

Question 34

Hydrochlorothiazide (Hydrodiuril)

Answer 34

HCTZ, thiazide, PO only, DOC for many HTN pt, combo therapy, compromises kidney fx, old and cheap

Question 35

Metolazone (Zaroxolyn)

Answer 35

thiazide diuretic, potent (1:10 HCTZ), HTN, CHF*(stage 3 and 4) and edema, often KCl supp

Question 36

Indapamide

Answer 36

Thiazide diuretic, HTN and edema, once daily, rarely used

Question 37

Chlorthalidone

Answer 37

thiazide diuretic, HTN and edema, once daily, rarely used, combo with atenolol

Question 38

Potassium sparing diuretics

Answer 38

aldosterone antagonist or Na channel blockers

Question 39

aldosterone antagonists

Answer 39

spironolactone, eplernone, block receptors, which increase Na passing into collecting duct for urine excretion, no K effect

Question 40

Na channel blockers

Answer 40

Triamterene, amicride, block epithelial Na channels directly, which reduces Na reabsorption and reduced K excretion, and increase Na passing in to collecting duct

Question 41

Spironolactone (aldactone)

Answer 41

aldosterone antagonist, PO, adjust for renal, high protein bound, use CHF, edema, ascites, also hypokalemia, HTN, acne, aldosteronism; avoid in renal failure; ADR: hyperkalemia, fatigue, nausea etc; take w/ food

Question 42

Which is most common aldosterone antagonist

Answer 42

spironolactone (aldactone)

Question 43

Eplerenone (inspra)

Answer 43

aldosterone antagonist, rare CHF, HTN, ADR: hyperkalemia, hypertriglyceridemia, niche: absent hormonal adrs

Question 44

Triamterene

Answer 44

Na channel blocker, never used by self, HTN, edema, ADR: hyperkalemia, dehydration, black box for hyperkalemia

Question 45

Amiloride

Answer 45

Na channel blocker, rare use by self, HTN not CHF, once daily, ADR: hyperkalemia, hyperchloremic metabolic acidosis

Question 46

osmotic diuretics

Answer 46

Mannitol, via osmotic pressure, excreted but not reabsorbed, neither is H2O, used to reduce ICP, ADR: extracellular volume expansion, dehydration, hypernatremia

Question 47

Antidiuretic hormoone antagonists

Answer 47

Demeclocycline, antibiotic, reduces H2O reabsorption by inhibiting effects of ADH in collecting tubule, use hyponatremia, SIADH, ADR: diabetes insipidus, renal failure

Question 48

Most common used Diuretic

Answer 48

loop (furosemide and bumetanide) and Thiazide (hydrochlorothiazide)

Question 49

All diuretics are associated with

Answer 49

increase Na and H2O excretion, risk dehydration and hyponatremia

Question 50

It is important to keep in mind levels of

Answer 50

potassium, need it excreted or reabsorbed

Question 51

when should pt take diuretics

Answer 51

in the morning