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pre reg afsha CV > other diuretics (MRAnt's, K-sparing, others, potassium) > Flashcards

other diuretics (MRAnt's, K-sparing, others, potassium) Flashcards

1
Q

mnemonic to remember the diuretics that spare potassium (including aldosterone antagonists)

A

SEAT
- spironolactone
- eplerenone
- amiloride
- triamterene

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2
Q

triamterene stains urine…

A

blue

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3
Q

should diuretics be stopped during intercurrent illness

A

yes - kidney sick day rules as they can cause AKI

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4
Q

excess diuresis can lead to

A

hypotension and hypovolaemia

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5
Q

explain why diuretics can worsen diabetes and gout

A

they cause hyperglycaemia and high uric acid levels

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6
Q

hyperglycaemia is more likely with which class of diuretics? and which one is preferred in DM?

A

more likely with loops , a bit less with thiazides
give indapamide as is has the lowest effect of hyperglycaemia

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7
Q

which thiazide diuretic can be used in severe RI

A

metolazone

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8
Q

MHRA warnings - hydrochlorothiazide

A
  • can increase risk of non-melanoma skin cancer, esp with long term use
  • report any new or changes skin lesions and check regularly
  • limit sunlight and UV exposure
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9
Q

which diuretic increases risk of non-melanoma skin cancer

A

hydrochlorothiazide

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10
Q

which thiazides can also raise LDL-C and triglyceride levels

A

thiazides

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11
Q

Loop and thiazides cause similar electrolyte imbalances. But, there is one different - what is it

A

thiazides can cause hypercalcaemia

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12
Q

A patient has been admitted into hospital due to symptoms caused by an electrolyte disturbance. This is the medication they are taking, what do you think has happened and why? Furosemide, bisoprolol, beclomethasone inhaler, salbutamol inhaler, prednisolone tabs

A

Hypokalaemia caused by concomitant diuretic use and steroid and B2A use

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13
Q

A patient has been admitted to hospital for with palpitations, weakness, blurred vision and lightheadedness. She is on aripirazole, furosemide, salbutamol and beclomethasone. what do you think she has.

A

Prolonged QT interval (caused by aripirazole) and the other drugs cause hypokalaemia. Significant risk factor for TDP

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14
Q

a patient has been admitted to hospital with vomiting, headache, drowsiness, seizures. He is taking furosemide, spironolactone, desmopression, ibuprofen, sertraline. what do you think he has

A

hyponatraemia

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15
Q

Hyponatreamia predisposes to ……. toxicity

A

lithium

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16
Q

What is the MOA of potassium sparing drugs

A

cause diuresis without losing potassium
block sodium channels in late distal convuluted tubule to to the collecting duct

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17
Q

use of potassium sparing diuretics

A

to weak to act alone, are used as adjuncts or add ons to counteract potassium loss with loop & thiazides

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18
Q

potassium sparing diuretic or potassium supplements?

A

potassium sparing diuretics are preferred

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19
Q

main side effects of potassium sparing diuretics

A

HYPERkalaemia
HYPOnatraemia

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20
Q

ACEI/ARBs, NSAIDs and trimethoprim, aldosterone antagonists, heparin, potassium supplements interaction with potassium sparing diuretics

A

increased risk of HYPERkalaemia

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21
Q

MOA of aldosterone antagonists

A

block aldosterone which acts on sodium channels in the last part of the distal convoluted tubule

22
Q

uses of aldosterone antagonists

A
  • used as adjunct or add on to other drugs in HF
  • spironolactone licensed to treat resistant hypertension (blocking aldosterone can lower BP)
  • spironolactone also treated ascites in liver cirrhosis
23
Q

hykokalaemia in hepatic impairment can lead to

A

hepatic encephalopahty

24
Q

SE of aldosterone antagonists

A

HYPERKalaemia
HYPOnatraemia
Spironolactone: benign breast tumours, hypertrichosis, gynaecomastia, libido changes, menstrual disturbances

25
Q

What is peripheral vascular disease

A

type of CVD where athercloserosis narrows the peripheral arteries, normally in the legs

26
Q

what are the two types of peripheral vascular disease

A
  • occlusive
  • vasospastic
27
Q

symptoms of peripheral vascular disease

A
  • leg pain or aches when walking as the leg muscles aren’t getting enough blood and oxygen
  • can disappear after a few mins of resting - this is known as intermittent claudication
28
Q

treatment of peripheral arterial disease

A
  • secondary prevention: high intensity statin + low dose aspirin
29
Q

what is vasospastic peripheral vascular disease and how do you treat it

A
  • like reynauds, blood vessels temporarily spasm which restricts blood supply, usually to fingers and toes
  • avoid triggers: smoking, cold temps, stress
  • more severe symptoms may need a vasodilator e.g. the CCB nifedipine
30
Q

name the aldosterone antagonists

A
  • spironolactone
  • eplerenone
31
Q

name the potassium sparing diuretics

A
  • amiloride
  • triamterene
32
Q

other types of diuretics include osmotic (mannitol) and carbonic anhydrase inhibits (acetazolmide, brinzolamide, dorzolamide) but they are

A

rarely used

33
Q

what is intermittent claudication

A

pain affecting cold, and less commonly the thigh and buttock, that is induced by exercise and relieved by rest

34
Q

can a patient taking SEAT be given potassium supplements

A

NO

35
Q

resistant oedema, except lymphoma and oedema due to peripheral venostatis or the use of CCBs, should be treated with

A

loop + thiazide/TLD (e.g. bendro or metolazone)

36
Q

when can spironolactone be used in treatment of hypertension

A

only if pt who are starting step 3 treatment for resistant hypertension and have blood potassium level of 4.5 or less

37
Q

monitoring spironolactone in hypertension treatment

A

renal function and sodium and potassium levels within 1 month of starting treatment

38
Q

what to do if a pt has hyperkalaemia on spironolactone

A

discontinue

39
Q

dose of spironolactone in resistant hypertension (adjunct)

A

25mg OD with food
(upward titration not recommended)

40
Q

spironolactone label

A

take with or just after food or a meal

41
Q

monitoring requirements of spironolactone

A
  • electrolytes: discontinue if hyperklaaemia
  • in severe HF: potassium, and creatinine 1 week after initiation and after any dose increase, monthly for 3 months, then every 3 months for a year, then every 6 months
42
Q

Interactions: ACEI/ARB & spironolactone

A
  • increased risk of severe hyperkalaemia
  • avoid concurrent use in pt with marked RI
  • prescribe lowest dose possible of both drugs and monitor RFTs closely
  • discontinue spironolactone if hyperkalaemia develops
43
Q

interactions: spironolactone and antihypertensives

A

potentiated hypotensive effect

44
Q

interactions: spironolactone and ciclosporin, heparins, other potassium sparing diuretics, potassium supplements, tacrolimus, trimethoprim/sulfamethazole (co-trimoxazole)

A

concomitant use may result in severe hyperkalaemia
if this happens stop spironolactone and treat to reduce serum K to normal

45
Q

interactions: aspirin and NSAIDs & spironolactone

A

increases diuretic effect
may also increase renal toxicity and hyperkalamia esp with indomethacin

46
Q

interactions: digoxin and spironolactone

A

may increase levels of digoxin and interfere with serum digoxin assays
if digoxin dose needs to be adjusted, monitor pt carefully for signs of enhances or reduced digoxin effect

47
Q

interactions: lithium and spironolactone

A

concurrent use can reduce lithium conc
if using together, monitor plasma lithium conc within first 5-7 days of adding or stopping spironolactone, and periodically thereafter

48
Q

eplerenone dose

A

Initially 25 mg daily, then increased to 50 mg daily, increased within 4 weeks of initial treatment.

49
Q

max dose eplerenone with amiodarone

A

25mg od

50
Q

which antifungals/abx to avoid/ change dose with eplerenone and why

A

inhibitors: clarithromycin (avoid) erythromycin, itraconazole, fluconazole, posoconazole
increase exposure to eplerenone, adjust dose of eplerenone

51
Q

eplerenone renal impairment

A

avoid if CrCl <30
Initially 25 mg on alternate days if creatinine clearance 30–60 mL/minute, adjust dose according to serum-potassium concentration

pre reg afsha CV (38 decks)

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