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Pre-reg Exam 2021 > Oedema And Vascular Disease > Flashcards

Oedema And Vascular Disease Flashcards

1
Q

When do you take diuretics?

A

In the morning to avoid sleep disruption

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2
Q

What are the loop diuretics?

A

Bumetanide - most potent

Furosemide - gout

Torasemide - MSK pain

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3
Q

What are the thiazide diuretics?

A

Bendroflumethiazide

Cyclopenthiazide

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4
Q

What are the thiazide like diuretics?

A

Chlortalidone - long half life
Indapamide- less aggravation of diabetes
Metolazone - still works in severe renal failure
Xipamide

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5
Q

What are the potassium sparing diuretics?

A

Amiloride

Triamterene - blue urine

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6
Q

What are the aldosterone antagonists?

A

Spironolactone - ascites liver failure

Eplerenone - post MI

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7
Q

What are the osmotic diuretics?

A

Mannitol - cerebral oedema

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8
Q

What are the carbonic anhydrase inhibitors?

A

Acetazolamide - glaucoma

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9
Q

What is the mechanism of action of diuretics?

A

Increase ursine output by the kidneys

Promotes diuresis by inhibiting sodium reabsorption at different parts of the renal tubular system (nephron)

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10
Q

How do the loop diuretics work?

A

Inhibits the Na+/K+/Cl- co-transporter in ascending limb of loop of henle

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11
Q

How long does it take for loop diuretics to work?

A

1 hour onset

6 hour duration

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12
Q

What are the side effects of loop diuretics?

A

Ototoxicity
Acute urinary retention - too rapid diuresis, caution in BPH

Hyperglycaemia in diabetes
Hyperuricaemia in gout

Hypo K+, Na+, Cl-, Mg2+
Hypo Ca2+

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13
Q

What is the heart failure dose for loop diuretics?

A

BD, last dose at 4pm

20-40mg OM - furosemide doses

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14
Q

What loop diuretics are used for resistant hypertension?

A

Bumetanide - most potent
Torasemide
Furosemide

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15
Q

How do thiazides and thiazide like diuretics work?

A

Inhibits Na+/Cl- transporter in distal convoluted tubule

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16
Q

How long does it take for thiazides and thiazide-like diuretics to work?

A

1-2 hour onset

12-24 hour duration

17
Q

What are the side effects of thiazide and thiazide like diuretics?

A

GI disturbances
Impotence
High LDL/triglycerides

Hyperglycaemia
Hyperuricaemia
Hypo K+, Na+, Cl-, Mg2+
Hyper Ca2+

Ineffective if eGFR <30 ml/min except metolazone

18
Q

What is the dose of thiazide and thiazide like diuretics in heart failure?

A

5mg OM

19
Q

What is the dose of thiazide and thiazide like diuretics in hypertension?

A

2.5mg OM

20
Q

What is the mechanism of action of potassium sparing diuretics?

A

Promotes urination without the loss of potassium by inhibiting sodium channels in the distal convoluted tubule

Weak diuretics used as adjunct to loop and thiazides

21
Q

When are triamterene and amiloride used?

A

Preferred over potassium supplements in counteracting hypokalaemia

22
Q

What are the side effects of potassium sparing diuretics?

A

Hyperkalaemia

23
Q

What causes hyperkalaemia when used concomitantly with potassium sparing diuretics?

A

ACEi/ARB, K+ supplements, aldosterone antagonists

24
Q

What is the mechanism of action of aldosterone antagonists?

A

Inihibits aldosterone which causes sodium reabsorption via the Na+/K+/H+ co-transporter

Less potassium and hydrogen ions are exchanged for sodium and therefore less lost to the urine

25
Q

What are the side effects of spironolactone?

A

Gynaecomastasia
Hypertrichosis
Change in libido
Hyperkalaemia, hyperuraemia, hyponatraemia

26
Q

What causes severe hyperkalaemia when used with aldosterone antagonists?

A

Potassium sparing diuretics, potassium supplements, ACEi/ARBs

27
Q

What is the MHRA warning for aldosterone antagonists and ACEi/ARBs?

A

In heart failure - risk of fatal severe hyperkalaemia

Monitoring of blood electrolytes is essential

28
Q

What is the mechanism of action of osmotic diuretics?

A

Inhibits sodium and water reabsorption by increasing the osmolarity (solute concentration) of blood and renal filtrate

Act on parts of nephron that are water permeable

29
Q

When is mannitol used?

A

Cerebral oedema

High intracranial pressure

30
Q

What is used for simple gravitational oedema in the elderly?

A

Low dose diuretic

Not for long term use

31
Q

What is peripheral vascular disease?

A

Occlusive - peripheral and arterial disease

Aspirin 75mg daily and statin as secondary prevention or cardiovascular events

Vasospastic - reynauds

Nifedipine used to treat Reynauds

Pre-reg Exam 2021 (79 decks)

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