HTN 3 Flashcards
Which 3 medications act on the Thick Ascending Limb of the Loop of Henle?
Loop diuretics:
- Furosemide
- bumetanide
- torsemide
What are 4 clinical applications of Loop diuretics (act on the TAL of the loop of henle)
- Heart Failure
- pulmonary edema
- severe HTN
- other forms of edema
The following describes the pharmacokinets of which group of meds?
Oral- decreased absorption with edema or bowel
IV
Loop diuretics (furosemide, bumetanide, torsemide)
The following are ADEs/interactions of which group of meds?
- Hypokalemia
- Hypomagnesemia
- Hypocalcemia
- Hypovolemia
- Hyperuricemia
- Ototoxicity
- Efficacy is reduced by NSAIDS
- Sulfonamide allergy (rare)
Loop diuretics (furosemide, bumetanide, torsemide)
Which loop diuretic?
–short duration of action
–poor antihypertensive
–use in patients with kidney disease or fluid retention
Furosemide
WHich loop diuretic is an effective BP med at low dosage
Torsemide
which 2 loop diuretics are used in tx of hypercalcemia
Furosemide and Torsemide
The following describes which part of the nephron
- actively pumps sodium and chloride out of the lumen of the nephron via the Na+/Cl− carrier (NCC)
- This cotransporter is the target of the thiazide diuretics.
- The distal convoluted tubule is responsible for approximately 5–8% of sodium reabsorption.
- Calcium is also reabsorbed in this segment under the control of parathyroid hormone (PTH).
Distal convoluted Tubule
Which cotransporter is the target of the thiazide diuretics?
The Na/Cl carrier in the Distal Convoluted Tubule
Mechanism of which group of medications?
–Blocks the reabsorption of sodium and chloride in the distal convoluted tubule via NCC
–Water follows due to the osmotic pressure within the nephron created by the ions
–**Initial diuresis-decreased plasma and stroke volume
–**provides the chronic antihypertensive action through sustained decrease in PVR and direct smooth muscle relaxation
Thiazide diuretics (HCTZ, Chlorthalidone, Metolazone, Indapamide)
What are the 2 clinical applictions of Thiazide diuretics (Hydrochlorothiazide)
- HTN
- Mild heart failure
The following are ADEs/interactions of which group of meds?
- Hypokalemic
- Hyponatremia
- Hypercalcemia
- Hyperglycemia
- Hyperlipidemia
- Hyperuricemia
- Efficacy is reduced by NSAIDS
- Sulfonamide allergy (rare)
Thiazide diuretics (hydrochlorothiazide)
****Which medication is not a thiazide, but effects are indistinguishable from those of thiazides. Longer duration of action*****
Chlorthalidone
What are the 2 main differences between Chlorthalidone vs HCTZ?
- Half life (Chlorthalidone= 45-60 hrs, HCTZ= 8-15 hours)
2. Duration of diuretic effect (Chlor=48-72hrs, HCTZ= 16-24 hrs)
The following is a limitation of which drug?
–**GFR < 30ml/min for HCTZ
–Sulfa allergy (?)
–**Unrestricted salt intake reduces efficacy
Thiazides
Efficacy for HCTZ: How much does HCTZ lower SBP and DBP by?
–Lower SBP 15 to 20 mmHg
–Lower DBP 8 to 15 mmHg
What 4 things are important to monitor for Thiazides?
- BUN
- creatinine
- uric acid level
- electrolytes: K+, Na+, Ca++, Mg+++
Which 2 meds (1 thiazide, the other acts like a thiazide) is special because a low dose is as effective?
HCTZ and Chlorthalidone
Which thiazide may be more effective w/ concurrent kidney disease?
Metolazone
(Better efficacy at lower GFR)
Which Thiazide does not alter serum lipid levels?
Indapramide
(So better for patients with hyperlipidemia)
Which group of diuretics increases the levels effect of the following meds:
- ACE/ARB
- carbamazepine
- lithium
- oxcarbazepine
- topiramate
- Vit D analog
Thiazides- HCTZ
**Which group of diuretics decreases the levels/effect of Antidiabetic agents?**
**Thiazides- HCTZ**
The following substances increase the effects of which diuretic?
- Alcohol
- opioid analgesics
- barbiturates
- Beta2-agonists
- corticosteroids
- licorice
HCTZ
(a Thiazide diuretic)
**Which group of meds decreases levels/effects of HCTZ?**
NSAIDS
Which part of the nephron is controlled by aldosterone?
Cortical Collecting Tubule (CCT)
Which part of the nephron is responsible for reabsorbing 2-5% of the total filtered sodium under normal circumstances
Cortical Collecting Tubule (CCT)
Which part of the nephron
***reabsorption of sodium occurs via channels (ENaC, not a transporter) and is accompanied by loss of potassium or hydrogen ions.***
**Cortical collecting Tubule (CCT)**
The ________ is the primary site of acidification of the urine and the last site of potassium excretion.***
Collecting tubule
The aldosterone receptor and the sodium channels are sites of action of the _______ diuretics.**
Which part of the nephron is this?
**potassium-sparing**
The Cortical Collecting Tubule (CCT)
•Reabsorption of water occurs in the medullary collecting tubule under the control of ________?
ADH
