Non-traditional Uses of Diuretics

Question 1

Nontraditional Uses

Answer 1

Ascites
Acute Mountain Sickness
AKI
Cerebral Edema
Diabetes Insipidus

Question 2

Nontraditional Uses

Answer 2

Glaucoma
Hypercalcemia
Osteoporosis
PCOS
Resistant hypertension secondary to hyperaldosteronism

Question 3

Cerebral Edema

Answer 3

Mannitol, immediate response then creates osmotic concentration, quick Onset, osmolality goal: 300-320, avoid in renal failure

Question 4

Ascites

Answer 4

from cirrhosis/heart failure causing: portal HTN, NO release, RAAS, hypoalbuminemia

Question 5

RAAS

Answer 5

ANG II: increases sympathetic activity, Na/Cl/H20 retention, aldosterone secretion, vasoconstriction… all lead to water and salt retention to increase circulating volume

Question 6

Ascites Treatment

Answer 6

Spironolactone and Lasix at ratio of 100:40, goal is to lose 0.5kg/day of water weight, monitor potassium, urine output

Question 7

Furosemide ADE

Answer 7

orthostatic hypotension, dizziness, photosensitivity, GI

Question 8

Primary Hyperaldosteronism

Answer 8

Treatment: sprionolactone/ inspra (eplerenone), goal to decrease BP and maintain K conc.

Question 9

Hypercalcemia

Answer 9

pee it off, inhibit release from bone, reduce intestinal absorption, treatment with 0.9%NS and loops (indirectly work on Ca)

Question 10

Acute Mountain Sickness

Answer 10

related to hypoxia and respiratory alkalosis, treat w/ acetazolamide: increases excretion of HCO3, shortens time to acclimatization, improves ventilation and O2

Question 11

Acetazolamide Dosing

Answer 11

prevention 125mg BID, 2 days before ascent and for 2 days after descent, treatment is 250mg BID, causes metallic taste and hyperglycemia in diabetics

Question 12

Glaucoma

Answer 12

CAI to reduce intraocular pressure, oral cause greater reduction in IOP but have more ADE, Eye drops: Trusopt (dorzolamide) Azopt (brinzolamide)

Question 13

PCOS

Answer 13

hirsutism and acne present b/c of androgens, reduce androgen production with spironolactone up to 200mg/day

Question 14

AKI

Answer 14

no ACI b/c of acidosis
no K sparing b/c of poor renal function
no diuretic if GFR is less than 5
use thiazides to decrease amount of loops used (ex:metolazone and furosemide)

Question 15

Diabetes Insipidus

Answer 15

deficiency in production of ADH, NDI can be cause by lithium, treat with Thiazides: pee of Na, pee more, decrease EC volume, increase proximal Na reabsorption, decrease distal Na = peeing less

Question 16

Osteoporosis

Answer 16

Thiazides: lower calcium excretion, loops are BAD