Lesson 4: Vasodilators and Diuretics

Question 1

What are the two types of pulmonary vasodilators?

Answer 1

Inhaled Nitric Oxide
Synthetic Prostacyclins

Question 2

What are the two FDA approved synthetic prostacyclins?

Answer 2

Illoprost (Ventavis)
Treprostinil (Tyvaso)

Question 3

What synthetic prostacyclin is not FDA approved for pulmonary hypertension

Answer 3

Epoprostenol (Flovan)

Question 4

What is the normal pulmonary artery pressure

Answer 4

10-15 mmHg

Question 5

What pressure level is considered pulmonary hypertension

Answer 5

> 20 mmHg

Question 6

What is nitric oxide and natural product of?

Answer 6

Endothelial cells because they cause vasodilation

Question 7

What disease states is nitric oxide used in ?

Answer 7

Persistant Pulmonary Hypertension of the Newborn(PPHN)

ARDS

Question 8

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

Answer 8

Hypoxic respiratory failure

Question 9

What is the recommended dosage of INO?

Answer 9

20 ppm

Question 10

What does INO stimulate

Answer 10

cGMP production, which decreases intracellular Ca++

Question 11

What does cGMP production result in

Answer 11

smooth muscle relaxation

Question 12

What is the therapeutic benefit of INO

Answer 12

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

Question 13

Nitric Oxide is quickly oxidized into what?

Answer 13

NO2, which is more toxic

Question 14

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

Answer 14

10 ppm, 5 ppm is safe

Question 15

Methemoglobin is a byproduct of INO binding to what?

Answer 15

Hemoglobin

Question 16

What is the normal methemoglobin level?

Answer 16

0-2%

Question 17

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

Answer 17

levels >30% and methylene blue

Question 18

Oxidation index formula (OI)

Answer 18

Mean airway pressure cmH20 x (FiO2/PaO2)

Question 19

What is a good OI

Answer 19

Closer to 0 the better

Question 20

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

Answer 20

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

Question 21

What device does Iloprost (Ventasvis) use?

Answer 21

I-neb AAD

Question 22

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

Answer 22

Tyvaso Inhalation system (ultrasonic neb)

Can be given as DPI and aerosol

Question 23

What percent of the cardiac output goes through the kidneys

Answer 23

22%

Question 24

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

Answer 24

Renal failure and damage

Question 25

What is the functional unit of the kidney?

Answer 25

Nephron

Question 26

What does the nephron do?

Answer 26

Maintains homeostasis of fluid volume and electrolyes

Question 27

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

Answer 27

Each kidney has 2 million nephrons Approx. 75% need to be compromised

Question 28

What is the goal of diuretics

Answer 28

Reduce the extracellular fluid volume to decrease blood pressure

Question 29

What are the 5 major groups of diuretics

Answer 29

Osmotic CAI Thiazides Loop Potassium Sparing

Question 30

What are the four types of Osmotic diuretics

Answer 30

Glycerin Isosorbide Mannitol (preferred) Urea

Question 31

The main indication for osmotic diuretics is what?

Answer 31

TBI with cerebral edema

Question 32

Mannitol DPI brand name is what

Answer 32

Aridol

Question 33

Mannitol is used for what test?

Answer 33

Bronchial challenge test to diagnose asthma

Question 34

What doe CAI s do

Answer 34

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

Question 35

What is the strength of CAIs

Answer 35

Weak diuretics

Question 36

What are CAIs used to treat

Answer 36

Aggressive management of hypervolemia Metabolic alkalosis Glaucoma Altitude sickness

Question 37

What are 3 types of CAIs

Answer 37

Acetazolamide Methazolamide Dicholarphenamide

Question 38

Loops diuretics are also called what?

Answer 38

High ceiling, because theyre so powerful

Question 39

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

Answer 39

20%

Question 40

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

Answer 40

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

Question 41

What are indications for loop diuretics

Answer 41

Hypertension CHF Acute renal failure Chronic renal failure Ascites Nephrotic syndrome

Question 42

Loop med names

Answer 42

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

Question 43

Thiazide diuretics is considered what potency

Answer 43

Moderate because 5-10% of NaCl is reabsorbed

Question 44

What is Thiazide diuretics a first line agent for?

Answer 44

Mild hypertension

Question 45

What is the limited dose response curve

Answer 45

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

Question 46

Thiazide meds include

Answer 46

Chlorothiazide Chlorthalidone Indapamide

Question 47

Potassium sparing diuretics block the exchange of what

Answer 47

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.

Question 48

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

Answer 48

Thiazide bc they cause hypokalemia

Question 49

What potassium sparing meds treat chronic liver disease

Answer 49

Spironolactone Eplerenone

Question 50

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

Answer 50

Amiloride Trimterene

Question 51

Glucose changes is most often seen with what diuretics

Answer 51

Thiazide

Question 52

Ototoxicity is most often seen with what diuretics

Answer 52

Loop