Drugs for Hypo/Hypernatremia

Question 1

“-volemia” refers to what measurement?

Answer 1

Na+ CONTENT

Question 2

Edema refers to what measurement?

Answer 2

Na+ CONTENT

Question 3

Na+ content is described how?

Answer 3

“-volemia”

Question 4

“-natremia” refers to what measurement?

Answer 4

Na+ concentration which is determined by the WATER amount

Question 5

What determines the Na+ concentration?

Answer 5

Water amount

Question 6

Na+ content does not equal Na+ concentration. Where are each measured and what system effects them?

Answer 6

Na+ content - ECF; RAAS system

Na+ concentration - Plasma; ADH

Question 7

This refers to the effect of a solution on the volume of the cell

Answer 7

Tonicity

Question 8

What happens to the cell with a hypotonic solution?

Answer 8

Cell swells

Question 9

What happens to the cell with a hypertonic solution?

Answer 9

Cell shrinks

Question 10

0.9% NaCl is?

Answer 10

Isotonic saline

Question 11

Effect of Isotonic Saline (nacl)?

Answer 11

Increased ECF volume

Question 12

Effect of Hypotonic Saline (0.45% nacl)?

Answer 12

Both ECF and ICF increase

Question 13

Effect of Hypertonic Saline (3-5% nacl)?

Answer 13

Increased ECF and decreased ICF

Question 14

Effect of Albumin?

Answer 14

Plasma volume increases

Question 15

Effect of 5% dextrose?

Answer 15

Increased total body water

Question 16

The body fluid volume and concentration must remain relatively constant. What ensures that happens?

Answer 16

Water and solutes are excreted separately

Question 17

Body Na+ content issues are reflected with hypo/hypervolemic ECF. What are the signs of Hypovolemic ECF?

Answer 17

• Decreased skin turgor, thirst and dry mucous membranes
• Oliguria
• Increased HR and decreased BP

Question 18

Body Na+ content issues are reflected with hypo/hypervolemic ECF. What are the signs of Hypervolemic ECF?

Answer 18

Weight gain and edema

- Bounding pulses

Question 19

What defines Hypernatremia?

Answer 19

Plasma [Na+] > 145

Question 20

What defines Hyponatremia?

Answer 20

Plasma [Na+] < 135

Question 21

Hypernatremia and Hyponatremia mean that there is a ____ problem

Answer 21

Water problem

Question 22

What are the symptoms for Hyponatremia?

Answer 22

SALT LOSS

• Stupor/coma
• Anorexia (N/V)
• Lethargy
• Tendon reflexes decreased
• Limp
• Orthostatic hypotension
• Seizures
• Stomach cramp

Question 23

What are the symptoms for Hyponatremia?

Answer 23

SALT LOSS

• Stupor/coma
• Anorexia (N/V)
• Lethargy
• Tendon reflexes decreased
• Limp
• Orthostatic hypotension
• Seizures
• Stomach cramp

Question 24

This class of drugs causes more solute loss than water loss

Answer 24

Diuretics

Question 25

This class of drugs causes more water loss than solute loss

Answer 25

Vaptans

Question 26

To treat Hyponatremia, what is the treatment for no or minimal symptoms?

Answer 26

Fluid restriction

Question 27

To treat Hyponatremia with moderate symptoms, what is the treatment?

Answer 27

Vaptans or Hypertonic NaCl

Question 28

To treat Hyponatremia, what is the treatment for severe symptoms?

Answer 28

Hypertonic NaCl

Question 29

When treating severe Hyponatremia with Hypertonic NaCl, if it is infused/corrected too fast, what side effect can occur?

Answer 29

Osmotic demyelination syndrome

Question 30

Vaptans can treat Hyponatremia. What is their MOA?

Answer 30

(-) ADH-regulated water reabsorption to promote excretion of free water

Question 31

Where do Vaptans work?

Answer 31

Collecting duct

Question 32

What are the 2 Vaptans for Hyponatremia?

Answer 32

Conivaptan | Tolvaptan

Question 33

How is Conivaptan given and what receptor does it work at?

Answer 33

IV | -- affinity to block both receptor types (V1A and V2)

Question 34

How is Tolvaptan given and what receptor does it work at?

Answer 34

Orally in the hospital setting | -- Selective V2 receptor antagonist

Question 35

Why must Tolvaptan be used for LESS than 30 days?

Answer 35

Chronic use can cause hepatotoxicity

Question 36

Besides Hyponatremia, what else is Tolvaptan used for?

Answer 36

Slows the progression of adult polycystic kidney disease

Question 37

What are some possible side effects of the Vaptans?

Answer 37

Orthostatic hypotension Fatigue and thirst Polyuria/bedwetting

Question 38

What are the symptoms of Hypernatremia?

Answer 38

TRIP - Tremors/twitching - Restlessness - Intense thirst - Pulmonary and peripheral edema

Question 39

What are the symptoms of Hypernatremia?

Answer 39

TRIP - Twitching/tremors - Restlessness - Intense thirst - Pulmonary and peripheral edema

Question 40

If a patient has Hypernatremia and hypovolemia, what type of saline should be given?

Answer 40

Isotonic

Question 41

If a patient has Hypernatremia and they are NOT hypovolemic, what type of saline should be given?

Answer 41

Hypotonic

Question 42

What is a drug to treat Hypernatremia?

Answer 42

Desmopressin (DDAVP)

Question 43

What is a drug to treat Hypernatremia?

Answer 43

Desmopressin (DDAVP)

Question 44

MOA for Demopressin?

Answer 44

V2 agonist (ADH analog) which increases water reabsorption

Question 45

With what conditions is Desmopressin used?

Answer 45

Central diabetes insipidus | Primary nocturnal enuresis

Question 46

What is a possible adverse effect of Desmopressin?

Answer 46

Hyponatremia

Question 47

What is a possible adverse effect with Desmopressin?

Answer 47

Hyponatremia

Question 48

Desmopressin can treat Hypernatremia. What is its MOA?

Answer 48

ADH analog that is a V2 agonist ==> increases water reabsorption