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Pharm Fall 2019 > Ex5 Diuretics > Flashcards

Ex5 Diuretics Flashcards

1
Q

Acetazolamide

A

Carbonic anhydrase inhibitor

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2
Q

MOA Acetazolamide

A

inhibits carbonic anhydrase in proximal tubule

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3
Q

Clinical uses Acetazolamide

A

Diuresis
Chronic open-angle glaucoma
Metabolic Alkalosis

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4
Q

Acetazolamide clearance

A

via kidneys

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5
Q

Acetazolamide onset, peak, duration

A

onset/peak/duration - fast

duration – 4hours

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6
Q

How should Acetazolamide be adjusted for renal patients?

A

CrCl <10 = avoid

CrCl 10-50 = one dose will correct alkalosis

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7
Q

Acetazolamide AEs

A

Metabolic Acidosis (be careful to OVERcorrect alkalosis)
Hyperchloremia
Hypotension
Hypokalemia/natremia/phosphatemia/magnesemia/calcemia

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8
Q

Avoid Acetazolamide with

A

NS - could worsen hyperchloremic acidosis

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9
Q

Loop diuretics

A

ethacrynic acid
furosemide
bumetadine

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10
Q

Clinical uses of loop diuretics

A 
diuresis (heart/liver/renal failure)
HTN
acute pulm edema
hyperkalemia
hyperphosphatemia, hypercalcemia
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11
Q

Ethacrynic Acid IV Onset, Peak, Duration

A

Fast
O: 5min
P: 15min
D: 2h

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12
Q

Severe sulfa allergy in patient who needs diuresis – tx?

A

Ethacrynic Acid

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13
Q

Fast rates of IVP loop diuretics may cause

A

ototoxicity (limit to 10mg/min)

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14
Q

Most diuretics are excreted via

A

kidneys

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15
Q

Dialyzable diuretics

A

Acetazolamide (HD: 20-50%)
Ethacrynic Acid: minimal
Mannitol (14% with 6h session)
Triamterene: Yes

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16
Q

Renal impairment - how to dose diuretics?

A

MUCH larger dose (i.e. Furosemide=100mg)

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17
Q

Torsemide careful with?

A

Duration: 6-8h; only PO

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18
Q

Highest risk of ototoxicity

A

Ethacrynic Acid

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19
Q

Braking Phenomenom

A

Loop diuretic tolerance

-hypertrophy in renal tubule/reabsorbs what was blocked

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20
Q

Management of loop diuretic tolerance

A
  • thiazide diuretics
  • continuous infusion (vs. IVpush)
  • increased dose
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21
Q

Loop Diuretic Equivalent dosing: Bumex 1mg IV = Furosemide _____IV

A

20mg

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22
Q

Loop Diuretic Equivalent dosing: Bumex 1mg IV = Ethacrynic Acid _____IV

A

50mg

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23
Q

Loop Diuretic Equivalent dosing: Bumex 1mg IV = Bumex _____PO

A

1mg

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24
Q

Loop Diuretic Equivalent dosing: Bumex 1mg IV = Torsemide _____PO

A

20mg

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25
Q

Loop Diuretic Equivalent dosing: Furosemide 20mg IV = Furosemide _____PO

26
Q

Loop Diuretic Equivalent dosing: Ethacrynic Acid 50 mg IV = Ethacrynic Acid _____PO

27
Q

Loop/thiazide diuretics effect on anesthesia

A

Electrolyte imbalance (esp hypokalemia/hypocalcemia) may prolong NMB

28
Q

Thiazide Diuretics

A

Chlorothiazide
Metolazone
Hydrochlorothiazide

29
Q

Best diuretic to use for targeting volume

A

Loop Diuretics

30
Q

Hypernatremic Hypervolemic - in addition to loop diuretics, what tx should be added?

A

Thiazide diuretics

31
Q

Best diuretic for sodium spilling

A

Thiazide diuretic

32
Q

Clinical uses - Thiazide diuretics

A 
HTN
Edema
Hypernatremia
Diuresis
Adjunct to loop diuretics
33
Q

Loop diuretic + thiazide, order of administration

A

Thiazide diuretic, wait 30-60min, loop diuretic

34
Q

Chlorothiazide - careful in which pts?

A

Renal injury - avoid in CrCl <30mL/min

35
Q

Chlorothiazide P/O/D?

A

O: 15min
P: 30min
D: 6-12h

36
Q

Good thiazide diuretic in renal injury patients

A

Metolazone - PO only

37
Q

Hydrochlorothiazide - caution

A

PO only, long DOA (6-12h)

38
Q

All diuretics will cause what?

A

Metabolic alkalosis

*except for carbonic anhydrase inhibitors

39
Q

Osmotic diuretics

40
Q

Osmotic diuretics clinical uses

A

increased ICP

Toxin excretion enhancement (rhabdo)

41
Q

Avoid what type of mannitol?

A

PO - poor bioavailability, avoid

42
Q

Mannitol Peak Effect

43
Q

Important aspects of mannitol administration

A
  • inspect vials for crystals (if + must heat)

- administer thru < 5 micron filter

44
Q

Adverse effects of mannitol

A
  • Hypovolemia
  • Nephrotoxicity – highly osmotic Rx (higher osmotic gap = higher risk of renal injury)
  • extravasation
45
Q

Caution using Mannitol in which patients

A

Patients without intact blood-brain barrier–> fluid may go into brain, increasing ICP/brain blood volume (OPPOSITE effect of goal)

46
Q

Potassium sparing diuretics are different from all other diuretics in that _____

A

may cause HYPERkalemia, not hypo

47
Q

AE amiloride

A

hyperkalemia

*along with all other K-sparing diuretic

48
Q

Potassium sparing diuretics Duration

49
Q

Advantage of Fenoldopam over Dopamine

A

Does not cause tachyarrythmia

50
Q

Persistent hypervolemic hyponatremia or euvolemic hyponatremia Tx

A

Free water excretion:

Vasopressin Receptor Antagonists (Conivaptan, Tolvaptan)

51
Q

Vasopressin receptor antagonists

A

Conivaptan (IV)

Tolvaptan (PO)

52
Q

MOA vasopressin receptor antagonists

A

block v1 (and v2) receptors –> vasodilation

53
Q

Patient population targeted by vasopressin receptor antagonists

A

Chronic liver/heart failure patients (increased ADH)

54
Q

Conivaptan blocks

A

V1 + V2 receptors

55
Q

Tolvaptan blocks

A

V2 receptors

56
Q

vasopressin antagonists AEs

A

hypovolemia
hypotension
muscle weakness
liver dysfunction

57
Q

vasopressin antagonists - clinical implications in anesthesia

A
  • Rx intxns (metabolized via CYP3A)

- Fast correction of serum sodium (permanent nerve injury –> osmotic demyelination syndrome)

58
Q

Avoid diuretic use in patients with

A

hypovolemia

59
Q

Drug intxns with diuretics

A
  • concurrent nephrotoxins (NSAIDs, IV contrast, aminoglycosides, amphotericin, IV acyclovir)
  • digoxin (hypokalemia –> increased digoxin toxicity)
  • lithium (hyponatremia –> increased lithium toxicity)
  • corticosteroids (hypok)
  • aminoglycosides (ototoxicity)
  • ARB/ACE-I (hyperK)
60
Q

Should diuretics be held before surgery?

A
  • hold the A.M. of procedure if used for management of HTN

- do NOT hold if used for management of severe liver/heart failure

Pharm Fall 2019 (33 decks)

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