Lesson 4: Vasodilators and Diuretics Flashcards

1
Q

What are the two types of pulmonary vasodilators?

A

Inhaled Nitric Oxide
Synthetic Prostacyclins

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2
Q

What are the two FDA approved synthetic prostacyclins?

A

Illoprost (Ventavis)
Treprostinil (Tyvaso)

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3
Q

What synthetic prostacyclin is not FDA approved for pulmonary hypertension

A

Epoprostenol (Flovan)

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4
Q

What is the normal pulmonary artery pressure

A

10-15 mmHg

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5
Q

What pressure level is considered pulmonary hypertension

A

> 20 mmHg

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6
Q

What is nitric oxide and natural product of?

A

Endothelial cells because they cause vasodilation

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7
Q

What disease states is nitric oxide used in ?

A

Persistant Pulmonary Hypertension of the Newborn(PPHN)

ARDS

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8
Q

What is nitric oxide approved to be used for in regards to neonates?

A

Hypoxic respiratory failure

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9
Q

What is the recommended dosage of INO?

A

20 ppm

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10
Q

What does INO stimulate

A

cGMP production, which decreases intracellular Ca++

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11
Q

What does cGMP production result in

A

smooth muscle relaxation

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12
Q

What is the therapeutic benefit of INO

A

Improved blood flow to ventilated alveoli resulting in improved V/Q mismatch

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13
Q

Nitric Oxide is quickly oxidized into what?

A

NO2, which is more toxic

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14
Q

What level of NO2 is toxic, what is a safe level

A

10 ppm, 5 ppm is safe

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15
Q

Methemoglobin is a byproduct of INO binding to what?

A

Hemoglobin

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16
Q

What is the normal methemoglobin level?

A

0-2%

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17
Q

At what level do you treat high methemoglobin and what do you use to treat it

A

levels >30% and methylene blue

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18
Q

Oxidation index formula (OI)

A

Mean airway pressure cmH20 x (FiO2/PaO2)

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19
Q

What is a good OI

A

Closer to 0 the better

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20
Q

Iloprost (Ventavis) and Treprostinil (Tyvaso) both treat what? And are not approved for who?

A

Treat pulmonary hypertension and are not studied in asthmatics or peoples with COPD

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21
Q

What device does Iloprost (Ventasvis) use?

A

I-neb AAD

22
Q

What device does the Tyvaso use? What two forms can it be given as?

A

Tyvaso Inhalation system (ultrasonic neb)

Can be given as DPI and aerosol

23
Q

What percent of the cardiac output goes through the kidneys

A

22%

24
Q

The kidneys have a high oxygen consumption, so impaired circulation can cause what?

A

Renal failure and damage

25
Q

What is the functional unit of the kidney?

A

Nephron

26
Q

What does the nephron do?

A

Maintains homeostasis of fluid volume and electrolyes

27
Q

How many nephrons does each kidney have? How many nephrons have to be compromised before renal disease is apparent?

A

Each kidney has 2 million nephrons

Approx. 75% need to be compromised

28
Q

What is the goal of diuretics

A

Reduce the extracellular fluid volume to decrease blood pressure

29
Q

What are the 5 major groups of diuretics

A

Osmotic
CAI
Thiazides
Loop
Potassium Sparing

30
Q

What are the four types of Osmotic diuretics

A

Glycerin
Isosorbide
Mannitol (preferred)
Urea

31
Q

The main indication for osmotic diuretics is what?

A

TBI with cerebral edema

32
Q

Mannitol DPI brand name is what

A

Aridol

33
Q

Mannitol is used for what test?

A

Bronchial challenge test to diagnose asthma

34
Q

What doe CAI s do

A

Inhibit carbonic anhydrase, which keeps sodium in the proximal tubule, and thus water in the proximal tubule, where it will eventually continue through the system and get excreted as urine

35
Q

What is the strength of CAIs

A

Weak diuretics

36
Q

What are CAIs used to treat

A

Aggressive management of hypervolemia
Metabolic alkalosis
Glaucoma
Altitude sickness

37
Q

What are 3 types of CAIs

A

Acetazolamide
Methazolamide
Dicholarphenamide

38
Q

Loops diuretics are also called what?

A

High ceiling, because theyre so powerful

39
Q

Loop diuretics can cause up to how much NaCl and H2O loss?

A

20%

40
Q

Higher doses of loop diuretics may be needed because of what?

A

Patients with renal dysfunction have less meds reach the site of action within the nephron

41
Q

What are indications for loop diuretics

A

Hypertension
CHF
Acute renal failure
Chronic renal failure
Ascites
Nephrotic syndrome

42
Q

Loop med names

A

Furosemide (Lasix)
Bumetanide (Bumex)
Torsemide (Demadex)
Ethacrynic acid

43
Q

Thiazide diuretics is considered what potency

A

Moderate because 5-10% of NaCl is reabsorbed

44
Q

What is Thiazide diuretics a first line agent for?

A

Mild hypertension

45
Q

What is the limited dose response curve

A

Difference in therapeutic effect is small between minimal and max doses. Higher doses may not produce greater effects, but may increase risk of toxicity

46
Q

Thiazide meds include

A

Chlorothiazide
Chlorthalidone
Indapamide

47
Q

Potassium sparing diuretics block the exchange of what

A

Na and K / H in distal convoluted tubule, or by acting as an antagonist at the aldosterone receptor, more potassium stays in the blood, and can lead to hyperkalemia.

48
Q

If someone becomes hyperkalemic on potassium sparing diuretics what treats it?

A

Thiazide bc they cause hypokalemia

49
Q

What potassium sparing meds treat chronic liver disease

A

Spironolactone
Eplerenone

50
Q

What potassium sparing meds treat CHF with counteracting hypokaemic affect of other diuretics

A

Amiloride
Trimterene

51
Q

Glucose changes is most often seen with what diuretics

A

Thiazide

52
Q

Ototoxicity is most often seen with what diuretics

A

Loop