Drugs Used for Heart Failure and Hypertension 2

Question 1

diuretics will help eliminate

Answer 1

potassium

Question 2

most of the time when giving a diuretic pt will have

Answer 2

low potassium

Question 3

Hyperkalemia– Add a thiazide diuretic to the “pril” and voilá!

Answer 3

Capozide (captopril + thiazide); Vaseretic (enalapril +thiazide); Prinizide (lisinopril + thiazide); Zestorectic (as above); Lotensin HCT (benazepril + hydrochlorothiazide)

Question 4

when ACE inhibitors are combined with potassium

Answer 4

Decrease foods containing potassium; -sparing agents spironolactone (Aldactone) or eplerenone (Inspra)

Question 5

foods high in potassium**

Answer 5

Banana (1 med) 422 mg; Potato (with skin) 540 mg; French fries (1med) 924 mg; Halibut (3 oz) 490 mg; Spinach (1c) 839 mg; Pasta sauce (1c) 940 mg; Oranges (1 m) 237 mg; Prunes (10) 615 mg; dried fruits

Question 6

“Sartans”–ARBs

Answer 6

Angiotensin receptor blockers (bypass ACE) and work by blocking the tissue receptors from angiotensin

Question 7

Who are they? The “Sartan Sisters”…

Answer 7

losartan—Cozaar; valsartan—Diovan; candesartan—Atacand; irbesartan—Avapro
; telmisartan—Micardis; olmesartan—Benicar

Question 8

sartan side effects

Answer 8

Decreased side effects such as cough and angioedema

Question 9

ARBs as a safe haven for the side effects *

Answer 9

of the “prils”

Question 10

Are the “sartans” safe for patients with a history of angioedema from the “prils”

Answer 10

Appears to be about an 8% rate of cross-reactivity; Given this limited percentage, switching to an ARB should not be considered an absolute contraindication in all patients with ACE-inhibitor induced angioedema; Switch cautiously

Question 11

For CHF, add drugs that block

Answer 11

aldosterone—spironolactone (Aldactone) and eprelrenone (Inspra): Known as K+ SPARING DIURETICS

Question 12

spironolactone (Aldactone) **

Answer 12

blocks aldosterone

Question 13

RALES (1999)

Answer 13

(Random Aldactone Evaluation Study)—adding Aldactone postpones or prevents 200 deaths/1000 people w/CHF

Question 14

Potassium Sparing Diuretics

Answer 14

These drugs work by blocking sodium and water RETENTION. Sodium and water are lost through the urine BUT POTASSIUM is REABSORBED.

Question 15

For every 1000 new spironolactone prescriptions in heart failure patients,

Answer 15

there are 50 more hospitalizations for hyperkalemia

Question 16

with potassium sparking diuretics be careful to check

Answer 16

potassium levels within the first week

Question 17

FIVE classes of diuretics are available:

Answer 17

Loop diuretics, thiazide diuretics, potassium sparing diuretics, osmotic diuretics

Question 18

What are diuretics?

Answer 18

Simply put, drugs that induce a state of increased urine flow are referred to as diuretics. All of the above classes have varying strengths in terms of their diuretic potential.

Question 19

potassium sparing diuretics compared to loop diuretics —

Answer 19

The potassium-sparing diuretics increase the secretion of sodium and water by 2% compared to the Loop diuretics of over 20%.

Question 20

loop diuretics are

Answer 20

most popular and strong diuretics

Question 21

thiazide diuretics

Answer 21

similar to loop but milder

Question 22

Why would anyone want to diurese?

Answer 22

if you have a fluid retaining disorder, such as heart failure, a diuretic could save your life. Or if you have high blood pressure, also known as hypertension, diuretics decrease blood volume which in turn decrease blood pressure.

Question 23

Premenstrual dysphoric disorder

Answer 23

is also a fluid retaining disorder with homicidal tendencies…diuretics are helpful during this time as is the drug Sarafem/(Prozac/fluoxetine)

Question 24

loop diuretics examples

Answer 24

bumetanide (Bumex), furosemide (Lasix)

Question 25

where loop diuretics do their business

Answer 25

loop of henle

Question 26

most potent loop diuretic

Answer 26

Bumetanide is the most potent (40 times more potent than furosemide)(so 40mg of Lasix = 1 mg of Bumex so watch those doses!!!), and ethacrynic acid, the oldest, has the most side effects and is usually considered “the last resort.”

Question 27

The Loop of Henle has two components—

Answer 27

a downward slide, also known as the descending loop, and an upward hill, known as the ascending loop.

Question 28

all the action of the diuretics happens in the

Answer 28

the ascending loop.

Question 29

The ascending loop has an

Answer 29

active proton pump that pumps sodium, potassium and chloride into the tissue surrounding the loop (medullary interstitium)

Question 30

because

Answer 30

water cannot passively accompany the electrolytes into the surrounding tissue.; So, water stays in the ascending loop and the electrolytes are pumped into the surrounding tissue; This results in a hypotonic loop and a hypertonic (highly concentrated) tissue

Question 31

So, how do the loop diuretics work?

Answer 31

They ihibit the pumping of the electrolytes into the surrounding tissue and therefore the medullary interstitium does not become concentrated.The electrolytes stay in the lumen of the loop and water is retained throughout the rest of the tubular system until it exits by way of the urine.

Question 32

The electrolytes stay in the

Answer 32

lumen of the loop and water is retained throughout the rest of the tubular system until it exits by way of the urine.

Question 33

If the electrolytes pass into the toilet,

Answer 33

so does the water. Of all the diuretic classes, loop diuretics are most effective.Watch for signs and symptoms of hypokalemia

Question 34

hypokalemia levels

Answer 34

when below 3.5 mEq/L

Question 35

hypokalemia symptoms **

Answer 35

Leg cramps; Muscle weakness; Ventricular dysrhythmias; EKG changes

Question 36

treatment of hypokalemia

Answer 36

Oral Potassium Chloride and Intravenous potassium chloride

Question 37

Oral Potassium Chloride:

Answer 37

K-Dur, Micro-K; Take with full glass of water to minimize GI upset (N/V, diarrhea)

Question 38

Intravenous potassium chloride:

Answer 38

MUST BE DILUTED (40 mEq/Liter and INFUSED SLOWLY (no faster than 10 mEq/hr

Question 39

The thiazide diuretics include

Answer 39

hydrochlorothiazide (Hydrodiuril)**, chlorthalidone, chlorothiazide (Diuril), indapamide (Lozol), and metolazone (Zaroxolyn).

Question 40

The thiazide diuretics work in the

Answer 40

distal convoluted tubule (DCT) by inhibiting another transporter system—sodium/chloride transporter system. About 10% of the filtered sodium is reabsorbed through this system.

Question 41

Thiazide diuretics BLOCK the reabsorption

Answer 41

of the 10% of sodium.

Question 42

side note about calcium

Answer 42

calcium excretion is regulated by parathyroid hormone. Calcium and sodium compete for excretion at the DCT; sodium is excreted, calcium is reabsorbed…

Question 43

Thiazide diuretics are GOOD for the

Answer 43

bones

Question 44

perfect use of thiazide diuretics

Answer 44

n the high-risk osteopenic, osteoporotic little ol’ lady with hypertension

Question 45

lasix

Answer 45

(lasts six hours)—40 mg x serum creatinine = dose (40 x 2.5 = 100 mg Lasix)

Question 46

Thiazides can be used for *

Answer 46

for Stage 1 heart failure

Question 47

Diuretics should be adjusted to maintain

Answer 47

euvolemia as reflected by daily-recorded weights that are within 2 lb of the patients predetermined dry weight

Question 48

with diuretics watch

Answer 48

Watch the electrolytes! K and magnesium loss

Question 49

don’ts with diuretics

Answer 49

Don’t over diurese! Don’t take diuretic at bedtime!

Question 50

thaizade diuretics have remarkably less

Answer 50

less sodium excretion than loop diuretics