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Cardiovascular > Diuretics and RAAS antagonists of HF > Flashcards

Diuretics and RAAS antagonists of HF Flashcards

1
Q

Diuretics act on ___ surface

A

Luminal

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2
Q

___ interact with membrane transport proteins

A

Thiazides, Furosemides, Triamterene

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3
Q

___ interact with enzyme and ___ interact with hormone receptors

A

acetazolamide, apironolactone

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4
Q

___ osmotic effect

A

Mannitol

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5
Q

___ is a carbonic anhydrase inhibitor

A

acetazolamide

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6
Q

CA inhibitors causes ____ in ____ (what and where)

A

decrease NaHCO3 reabsorption

PCT

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7
Q

Loop of henle water removal in ___ limb and Na ___ in ___limb

A

descending

NaCl Reabsorption in accending

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8
Q

Na reabsorpted in ascending limb via ______?

A

NKCC2 (NaK2Cl co transporter

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9
Q

Loop diuretics do what?

A

inhibit NKCC2
Mg/Ca excretion (K intracell high, difuse back to lumen (K channel) drives Mg/Ca reabsorption)
Increase RBF

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10
Q

Uses of Loop Diuretics

A

CHF (volume overload)
Refractory edema (+thiazide, aldosterone antagonists)
Hypercalceimia
Acute Pul Edema

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11
Q

HF have ___ diuretic response due to:?

A

decreased

Decrease drug delivery to kidney, decrease RBF, hypoperfusion activatoin of RAS/SNS

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12
Q

Loop diuretic adverse effects

A 
hypokalemic metabolic alkalosis (increase K/H secretion)
Ototoxicity
Hyperuricemia/hyperglycemia
Hypomagnesemia
Hypotension (overdose)
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13
Q

Hypokalemia predisposes pt to ___?

A

ectopic pacemakers/arrhythmias

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14
Q

Loop diuretics includes?

A

Furosemide (most common)

Bumetanide, torsemide (higher F and longer t1/2)

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15
Q

DCT is _____ to H2O

A

impermeable

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16
Q

Na is reabsorpted in DCT via ___?

A

NCC (NaCl co transporter)

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17
Q

Ca reabsorption occurs via ___?

A

Na/Ca exchanger

18
Q

NCX in DCT is regulated by

A

PTH (Parathyroid hormone)

19
Q

Thiazides inhibits ___

A

NCC (increase NaCl excretion)

20
Q

Thiazides _______ Ca

A

increase reabsorption of Ca

low Na intracellular, activates NCX, decrease Ca intracell, Ca reasborbed from urine

21
Q

Thiazides drugs include ___?

A

hydrochlorothiazide (prototype 2x/day)

chlorthalidone/metolazone - longer duration

22
Q

Thiazide adverse efects

A 
Hypokalemia
hyperaldosteronism (volume decrease)
hyperglycemia/glycosuria
Hyperuricemia (precipitate gout attack)
hyperlipidemia (HTN risks)
Allergic - sulfonamide
23
Q

Thiazide acts in ___

A

DCT

24
Q

Aldosterone acts on __

A

collecting tubules

25
Q

K excretion is ____ to Na ______ in CT

A

coupled,

Na reabsorption

26
Q

Aldosterone acts on CT by ____?

A

gene transcription - increase number/activity of Na/K-atpase

27
Q

Trimaterne, amiloride diuretics acts by ___ at __

A

direct Na Channel block
CT
(less Na reabsorb = less K excreted

28
Q

Apironolactone/eplerenone act by ____ at __

A

competitive antagonist at aldosterone receptor
CT
- decrease Na reabsorption, decrease K excretion

29
Q

Uses of potassium sparing diuretics

A

CHF - aldosterone antag (also at heart)
Hyperaldosteronism
PCOS Hirustism - block androgens
HTN

30
Q

Aldosterone antagonists important actions ____?

A

anti-remoding (less hypertrophy/fibrosis)

Increase K serum = less arrhythmias

31
Q

Potassium sparing diuretics include?

A

spironolactone/eplerenone (aldosterone receptor)

Triamterene/amiloride (diuretcs Na)

32
Q

Potassium sparing diuretics include?

A 
Hyperkalemia EKG changes (Avoid NSAID)
Endocrine abn (spiro - gynescomastia)
33
Q

ACEI includes

A

lisinopril, captopril, enalapril, moexipril, benazepril

34
Q

ACEI mechanism of action

A 
block ATII induced vasoconstriction (decrease pre/afterload)
block ATII myocardial hypertrophy/remodeling 
(aldosterone)
Increase BK (block inactivatio - vasodilates)
Increase endothelial function - NO
Reduce SNS
35
Q

ACEI uses

A

HTN
CHF
Delay progression of diabetic enphropathy

36
Q

ACEI are ___ (except) converted to ____ by ___

A

prodrugs (lisinopril, captopril)
Active metabolite
by de-esterification in liver

37
Q

ACEI Eliminated by:

A

renal (except Moexi + Fosino)

38
Q

ACEI Adverse effect

A 
dry cough,
hyperkalemia
HTN/acute renal failure (RA stenosis), angioedema
Neurtropenia/proteinuria
NOT FOR PREGNANCY
39
Q

Angiotensin II receptor antagonists acts on

A

AT1 receptor

40
Q

ARB are ACEI without ____

A

cough and less angioedema

Cardiovascular (11 decks)

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