Odema

Question 1

Water retention can cause ( lungs and legs)

Answer 1

Water retention in the system causing pulmonary(breathlessness) or peripheral oedema(swollen ankles and legs)

Question 2

Thiazides: have long? How do they work?? What do they inhibit?what are some of its indications? Higher doses are used for what? What is bendroflumethazide commonly used for?what is chlortalidone commonly used for?what is indapamide commonly used for?

Answer 2

bendroflumethazide and indapamide - BIT
- Long half life and given early in the day
- Inhibit sodium reabsorption at the beginning of the distal convoluted tubule
- Don’t want patient to be getting up in the night = more falls
- (Lasts up to 24hrs)
- If patient is prone to needed to go to the toilet in the night - give a loop diuretic

- Acts within 1-2 hours of oral admin and effects last 12-24hrs 
- Give in the morning to avoid diuresis at night which can interfere with sleep 
- Moderately potent 
- Indication - lower doses reduce blood pressure, with little biochemical disturbance 
- Higher doses are used for CHF, more effect on biochemical balance (potassium,sodium,Uric acid, glucose and lipids) - with little advantage on blood pressure 
- Bendroflumethazide- used for mild or moderate HF or hypertension(no longer 1st line)
- Chlortalidone - longer duration of action and may be given on alternate days Indapamide - lowers BP with less effects on electrolyte balance and less aggravation of diabetes

Question 3

Loop diuretic what is the moaaaaa, they last how long? So are taken how often is the day ? Without doing what?? Give 3 example

Answer 3

only last 6 hrs, can be given twice daily without interfering with sleep
- Inhibits reabsorption from the ascending limb of the loop of Henle
- Used in pulmonary oedema due to left ventricular failure
- Furosemide,bumetanide and torasemide

Question 4

-

Answer 4

-

Question 5

Which potassium sparing diuretics make you pee blue?? What is their mechanism of action??? What type of diuretics do we have within the group “potassium sparring” - potassium lets potassium live so we don’t do what?? What to others diuretics cause??

Answer 5

• Amiloride, triamterene (blue pee)
  
  • Prevents sodium reabsorption in the distal tubule collecting duct
  Within potassium sparring, we have aldosterone antagonists- eg. Sprinalactone, eplerenone
  - If someone becomes dehydrated because of vomiting of diarrhoea - stop the aldosterone antagonist!!- until cleared up
  Potassium sparring - (letting it live) so increased potassium so don’t take with potassium so the other types can cause hypokalaemia

Question 6

ALL DIURETICS CAUSE:

Answer 6

Hyponatraemia and hypomagnesaemia

LOOP AND THIAZIDE - HYPOKALAEMIA, GOUT, HYOTENSION AND DIABETES

Question 7

Potassium sparring diuretics can cause?

Answer 7

• Hyper kalemia
  
  • Change in libido
  • Breast pain or tenderness

Question 8

Interactions - diuretics
- loop and thiazide =
- loop and aminoglycosides =
- spricolactone/loop + lithium =

Answer 8

Loop and thiazide = hypokalemia inducing drugs
Potassium sparring = hyper kalemia meds
Loop diuretics and aminoglycosides = nephrotoxicity and ototoxicity
Sprinlactone/loop + lithium = reduce lithium secretion - increase levels of lithium = toxicity

Question 9

Vascular disease:- OCULSIVE PERIPHERAL VASCULAR DISEASE IS CAUSED BY ….. and how do we reduce it + what is given in terms of medication to do this

Answer 9

• Occlusive peripheral vascular disease
  
  • Normally caused by atherosclerosis
  • Reduce risk with healthier life style, statins and anti platelets

Question 10

Vasospastic peripheral vascular disease - Raynaud’s syndrome

Answer 10

• Avoid exposure to cold and smoking cessation
  
  • If further treatment needed, nifedipine

Question 11

Resistant hypertension:
- LOOP - what is the most potent, what is used for muscoskeletal pain? What is the last one?

Answer 11

• Bumetanide (most potent)
  
  • Torasemide(muscoskeletal pain)
  • Furosemide

Question 12

Thiazide diuretics: what do we monitor? What egfr value would mean it is ineffective? What is the dose in heart failure? What is the dose in hypertension is? And which one?

Answer 12

Monitor electrolytes, particularly at high doses.
Renal impairment: Ineffective is eGFR <30ml/in
Heart failure OM 5mg
Hypertension 2.5mg OM - bendroflumethazide doses

Question 13

Indapamide has less of an effect on what?

Answer 13

(less diabetes)

Question 14

Metolazone is used in what type of renal failure?

Answer 14

(use in less severe renal failure)

Question 15

Chlortalidone has a long .. so we can use it … if pts dislike

Answer 15

long half life given on alternate days if a cute retention is a problem or dislikes frequent ruination

Question 16

Hypertension- When you use a lower dose…

Answer 16

Low dose produces near maximal effect, higher doses of little
advantage

Question 17

Carbonic anahydrase inhibitors- ACETAZOLAMIDE

Answer 17

Carbonic Anhydrase inhibitors i.e. acetazolamide – weak diuretic for altitude
sickness prophylaxis

Question 18

Side effects OF K SPARRING

Answer 18

Side effects:
- Hyperkalemia
- Avid ACEi/ARB,K+ supplements, aldosterone antagonists

Question 19

Amiloride can be seen in a combined formulation with….. and is used to treat what?
Low and high strengths are what? (+ how many tablets are taken? - one other example with amiloride ?- hydrocholthiazide(+ amiloride too!!)

Answer 19

Amiloride + furosemide (Co-amilofruse – Frumil)
 Used to treat odema, hepatic cirrhosis with ascites
 Frumil 40mg/5mg Tablets
 Frumil Low Strength 20mg/2.5mg
 1-2 tablets in the morning
o Amiloride + hydrochlorothiazide (Co-amilozide)

Question 20

Aldosterone antagonists moA and example+ what is sprinolactone commonly used in?

Answer 20

inhibits aldosterone which causes sodium re absorption via NA+/k+/h+ co transporter. Less potassium and hydrogen ions are exchanged for sodium and therefore less lost to urine
- Eg. Sprinalactone (used in ascites)
- Eplererone

Question 21

Aldosterone antagonists side effects:

Answer 21

Side effects:
- Gynaecomastia(benign breast tumours),menstrual disturbance
- Hypertrichosis
- Change in libido
- Hyperkalaemia,hyperuraemia,hyponatraemia

Question 22

AA interactions

Answer 22

• Severe hyperkalaemia

Question 23

Osmotic diuretics can inhibit what? And examples of 2 and what they are used for?

Answer 23

Inhibits sodium and water re absorption by increasing the similarity (solute concentration)of blood and renal filtrate. Osmotic diuretics act on the parts of the nephron that are water permeable, proximal convoluted tubule and descending limb of the loop of Henle

Mannitol- (pharmacological inert sugar)
Used:Cerebral Odema
- High intracranial pressure

Simple gravitational oedema in the elderly:
- Low dose diuretic - not for long term use
- Try alternatives first eg, stockings,raising legs and movement

Question 24

VASCULAR DISEASES( peripheral disease, occlusive and vasospactic are caused by what and treated by what?)- what is raynauds syndrome?? Is an example of which one

Answer 24

Peripheral vascular disease (pvd)

Occlusive:
Eg, intermittent claudication caused by atherosclerosis
(Peripheral arterial disease)
- Aspirin 75mg daily and statins as secondary prevention of cardiovascular events

Vasospastic:
- Eg.Raynauds syndrome
- Stop smoking and avoid cold exposure
- Nifedipine - used to treat Raynauds syndrome