Diuretics SEM 1 Flashcards
There is substantial risk for adverse effects with diuretic use, thus it is important to understand their pharmacokinetics and pharmacology. True or False?
TRUE
MODULE QUIZ QUESTION
Diuretics are classified by which of the following:
Select all that apply.
A. Mechanism by which they inhibit
B. Adverse effects
C. Endogenous compounds
D. Predominant site of action
A and D
Which of the following is true regarding Diuretics and nephrotoxicity?
A. Inappropriate use of diuretics is the cause of renal damage with their use
B. Diuretics clearance of venous congestion results in renal damage
C. Diuretics are inherently nephrotoxic
D. Diuretics action on various ion channels causes increased renal oxygen demand
A
CA Inhibitors mechanism of action is a result of:
A. Increases reabsorption of sodium bicarbonate in the distal dubule
B. Increases reabsorption of sodium bicarbonate in the distal tubule
C. Inhibits reabsorption of sodium bicarbonate in the proximal tubule
D. Increases reabsorption of sodium bicarbonate in the proximal tubule
C
Hypokalemic alkalosis is a common adverse reaction related to which of the following diuretic classes: Select all that apply. A. Distal convoluted tubule diuretics B. CA Inhibitors C. Potassium sparing diuretics D. Loop diuretics
A , B and D
Which agent produces its action by acting on the proximal tubule?
A. Potassium-sparing diuretics
B. Thiazide diuretics
C. Loop diuretics
D. Inhibitors of carbonic anhydrase
D
Thiazide diuretics exert their effects through:
A. Encourage glucose excretion in the distal convoluted tubule
B. Increase GFR
C. Inhibit sodium reabsorption in the proximal convoluted tubule
D. Inhibit sodium reabsorption in the distal convoluted tubule
D
Loop diuretics exert their effects through:
A. Blockade of Na/K/Cl channel in ascending loop of Henle
B. Blockade of K channel in the descending loop of Henle
C. Blockade of Na channels in the ascending loop of Henle
D. Blockade of Na/K/Cl channel in the descending loop of Henle
C
Which of the following is true regarding concurrent use of Thiazide diuretics in combination with a loop diuretic?
A. Thiazides increase chronic furosemide resistance
B. Effect albumin’s absorption of furosemide
C. Increased hepatic toxicity
D. Avoidance of rebound water retention through sodium excretion
D
All of the following are true regarding Lasix pharmacokinetics, except:
A. Lasix is metabolized by the liver
B. Lasix is freely filtered into the tubule to exert its effects
C. IV Lasix peak action occurs at 30 minutes
D. Lasix has a consistent oral bioavailability at 50%
C
Which of the following is true regarding loop diuretic dose dependence?
A. There is greater efficacy above ceiling concentration
B. There is still mild efficacy below the threshold concentration
C. IV administration achieves higher levels and longer duration of action
D. Effect depends on the duration of time that the concentrations are above threshold concentration
D
What are the 5 key Steps of Strategy for Electrolyte-neutral, Large-Volume Diuresis ?
1) Start by REDUCING ONGOING FLUID INTAKE where possible , D/C potentially nephrotoxic drugs (NSAIDS, ACE Inhibitors, ARB)
2) LOOP DIURETIC is primary agent, titrate for target urine output. FUROSEMIDE (20-160 mg IV q 6 hrs)
3) Assess Na+. If > 135 mEq/L add a THIAZIDE (prevents hypernatremia & augments diuresis): INDAPEMINDE 2.5-5mg PO OD or if NPO, IV Chlorothiazide (500-1000 mg OD or q12hrs). If Na+ > 145, also give free water.
4) Assess for Metabolic Alkalosis (Contraction alkalosis) - if YES add ACETAZOLAMIDE (mild 1000 mg IV q 24 hrs, Severe 1000mg IV q 12 hrs), if Not go directly to step 5
5) Consider adjunctive SPIRONOLACTONE if anticipating large-volume diuresis over several days (Contraindicated in Hyperkalemia or Metabolic Acidosis)
Check electrolytes often and intervene as necessary
Which of the following are considered to be a Thiazide ? Choose All That Apply:
A) Hydrochlorothiazide B Bumetanide C) Indapamide D) Metolazone E) Amiloride F) Eplerenone G) Chlorthalidone
A, C, D, and G
What are the two main LOOP DIUERTICS
FUROSEMIDE and BUMETANIDE
