Drugs for Hypo/Hyperkalemia

Question 1

At what plasma level of K is hyperkalemia

Answer 1

> 5.2 mEq/L

Question 2

At what plasma level of K is hypokalemia

Answer 2

< 3.7 mEq/L`

Question 3

in acidemia does K move in or out of the cell?

Answer 3

K+ moves out to exchange with H+

Question 4

in alkalemia does K move in or out of the cell

Answer 4

K+ moved in to exchanged with H+

Question 5

Which factors move Potassium out of the cell

Answer 5

a-Agonist 
Insulin deficiency 
Aldosterone 
B2-Blockers 
Acidosis 
Hyperosmolarity 
Exercise 
Cell Lysis

Question 6

What factors move potassium into the cell

Answer 6

Insulin***
B2-Agonist 
Aldosterone deficiency 
a-blockers 
Alkalosis 
Hypoosmolarity

Question 7

What is the overall effect of high sodium diet on K homeostasis

Answer 7

No net change

increase Na decreases aldosterone -> no K secretion
increase Na increases GFR -> increase K secretion

balances out

Question 8

What is the effect of hypokalemia on tissue membrane polarization

Answer 8

hyperpolarization

Question 9

What is the effect of hyperkalemia on tissue membrane polarization

Answer 9

depolarization

Question 10

What is the MOA of furosemide

Answer 10

Blocks Na-K-Cl cotransporter in loop of henle

Question 11

What are the adverse effects of furosemide

Answer 11

hypokalemia, hyponatremia, hypocalcemia, hyperglycemia, hyperuricemia, ototoxic, sulfonamide allergy

Question 12

If you wanted a loop diuretic with a longer half life and better oral absorption what drugs would you pick

Answer 12

torsemide

bumetanide

Question 13

if you wanted a loop diuretic to bypass the sulfa allergy, what drug would you pick

Answer 13

ethacrynic acid

Question 14

What is the MOA of HCTZ

Answer 14

blocks Na-Cl cotransporter

Question 15

If you wanted a thiazide diuretic with a longer half-life than HCTZ what drug would you pick

Answer 15

Chlorthalidone

metolazone

Question 16

What is the MOA of Amiloride

Answer 16

Blocks ENAc in the collecting ducts, counteracts K loss

Question 17

What are the toxicities of Amiloride

Answer 17

Hyperkalemia, hyponatremia, hypovolemia

triamterene alternative

Question 18

What is the MOA of spironolactone

Answer 18

Aldosterone receptor blocker and partial agonist at androgen receptor

Question 19

What are the toxicities of spironolactone

Answer 19

hyperkalemia, amenorrhea, hirsutism, gynecomastia

eplerenone: is more selective for aldosterone

Question 20

What is the major concern when using witch craft alternative diuretics such as dandelion leaves, fennel or St john wort

Answer 20

potential drug interactions that will diminish or enhance the actions of other drugs.

Question 21

If you have a patient with Acidemia, Normal Anion Gap, and Normal serum Creatinine. What does that patient have?

Answer 21

Renal Tubular Acidosis

Question 22

hypokalemia mneumonic

Answer 22

GRAPHIC IDEA

GI Loss
Renal Tubular Acidosis (type I and II)
Aldosterone
Paralysis 
Hypothermia
Insulin Excess
Cushing Syndrome

Insufficient Intake
Diuretics
Elevated B-adrenergic activity
Alkalosis

Question 23

What are the goals of the treatment of hypokalemia

Answer 23

• Prevent life threatening conditions
• Replace K+ deficit
• Diagnose underlying cause

Question 24

In the treatment of hypokalemia, what is the amount needed to to replace acute and chronic hypokalemia

Answer 24

acute: 100mEq -> increase .27 mEq/L

Chronic: 200-400 mEq -> 1 mEq/L

Question 25

What is the hyperkalemia mnemonic

Answer 25

RED FETS

Renal Disease
Excessive Intake
Drugs

Factitious
Endocrine (addisons)
Tissue Release
Shifts out of cell

Question 26

What are the three categories of treatment of hyperkalemia?

Answer 26

Antagonize cardiac effects - give Ca

Redistribute K into cells -> insulin and glucose, B2-agonist

Facilitate K+ elimination - K losing diuretic