Odema Flashcards
Water retention can cause ( lungs and legs)
Water retention in the system causing pulmonary(breathlessness) or peripheral oedema(swollen ankles and legs)
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?
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
Loop diuretic what is the moaaaaa, they last how long? So are taken how often is the day ? Without doing what?? Give 3 example
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
-
-
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??
- Amiloride, triamterene (blue pee)
- Prevents sodium reabsorption in the distal tubule collecting duct
- 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
ALL DIURETICS CAUSE:
Hyponatraemia and hypomagnesaemia
LOOP AND THIAZIDE - HYPOKALAEMIA, GOUT, HYOTENSION AND DIABETES
Potassium sparring diuretics can cause?
- Hyper kalemia
- Change in libido
- Breast pain or tenderness
Interactions - diuretics
- loop and thiazide =
- loop and aminoglycosides =
- spricolactone/loop + lithium =
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
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
- Occlusive peripheral vascular disease
- Normally caused by atherosclerosis
- Reduce risk with healthier life style, statins and anti platelets
Vasospastic peripheral vascular disease - Raynaud’s syndrome
- Avoid exposure to cold and smoking cessation
- If further treatment needed, nifedipine
Resistant hypertension:
- LOOP - what is the most potent, what is used for muscoskeletal pain? What is the last one?
- Bumetanide (most potent)
- Torasemide(muscoskeletal pain)
- Furosemide
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?
Monitor electrolytes, particularly at high doses.
Renal impairment: Ineffective is eGFR <30ml/in
Heart failure OM 5mg
Hypertension 2.5mg OM - bendroflumethazide doses
Indapamide has less of an effect on what?
(less diabetes)
Metolazone is used in what type of renal failure?
(use in less severe renal failure)
Chlortalidone has a long .. so we can use it … if pts dislike
long half life given on alternate days if a cute retention is a problem or dislikes frequent ruination
Hypertension- When you use a lower dose…
Low dose produces near maximal effect, higher doses of little
advantage
Carbonic anahydrase inhibitors- ACETAZOLAMIDE
Carbonic Anhydrase inhibitors i.e. acetazolamide – weak diuretic for altitude
sickness prophylaxis
Side effects OF K SPARRING
Side effects:
- Hyperkalemia
- Avid ACEi/ARB,K+ supplements, aldosterone antagonists
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!!)
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)
Aldosterone antagonists moA and example+ what is sprinolactone commonly used in?
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
Aldosterone antagonists side effects:
Side effects:
- Gynaecomastia(benign breast tumours),menstrual disturbance
- Hypertrichosis
- Change in libido
- Hyperkalaemia,hyperuraemia,hyponatraemia
AA interactions
- Severe hyperkalaemia
Osmotic diuretics can inhibit what? And examples of 2 and what they are used for?
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
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
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
