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๐Ÿ„ผ๐Ÿ’Š CARDIO PATH/RX > pharm: 10-12 Diuretics > Flashcards

pharm: 10-12 Diuretics Flashcards

1
Q

Carbonic Anhydrase Inhibitors

  • Indications (5)*
  • B: Main Example*
  • C: What renal Secretory pump does they use?*
A

โ€œCarbonic Anhyrase Inhibitors are Mega HUGE like Mountainsโ€

  1. To reduce intraocular pressure in Glaucoma.
  2. โ€œMountain Altitude sicknessโ€ (treats by DEC serum pHโ€“>DEC HgB affinity for O2โ€“> [INC Tissue O2 Delivery])
  3. [Urine pH] INCREASE in cystinuria
  4. HypOkalemic periodic paralysis (will require Dietary K+)
  5. Epilepsy adjunct tx

B: Acetazolamide

C: [Organic Acid (MATE) Transporter]

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2
Q

Osmotic Diuretics

Indications (3)

A
  1. Tx or Prevention for Acute Renal Failure
  2. DEC intra-cranial and intra-ocular pressure
  3. Enhance Urinary Excretion of Chemical Toxins
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3
Q

Loop Diuretics

  • Indications (6)*
  • B: Effect on Venous and Renal Vasculature*
  • C: How long post administration does it take to act?*
A

CANCHA

  1. Acute Pulmonary Edema.
  2. HTN
  3. (CHF)โ€”in the presence of renal insufficiency or for immediate effect.
  4. [ACA - ARF, CRF, Ascites],
  5. Nephrotic syndrome
  6. HyperCalcemia

B: Venous and Renal vasoDILATIONโ€”> LATER DEVELOPING DEC TPR

C: 20 min. to act but absorption rate is DEC in CHF pts

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4
Q

Thiazides

  • Indications (6)*
  • B: Site of Action (2)*
  • C: Condition that prevents* Thiazides from being used? Whatโ€™s the [Thiazide Family] Exception?
A

โ€œThiazide drink is a Happy CIDERโ€

  1. Hypertension.
  2. Edema 2ยบ to CHF,
  3. Cirrhosis,
  4. Renal disease.
  5. [Idiopathic Hypercalcuric Renal Calculi]
  6. [Diabetes Insipidus-nephrogenic] (prevent further urine dilution from taking place in the DCT).

B: [Early DCT] and [cortical thick aLOH]

C: [Severe Renal Insufficiency] โ€”> use [Metolazone Quinazoline] since it is the strongest of [Thiazide Family]

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5
Q

K+ Sparing Diuretics

  • A: 4 Main Drugs*
  • B: Indications (4)*
  • C: Which 2* K+ Sparing Diuretics can treat Hyperaldosteronism?

D:

*_____ and _____ have side effects = Hyperkalemia/ Gynecomastia/ [Testicular Atrophy]

  • _____ has sie effects= megaloblastic anemia in liver failure pts
  • ______ has side effects= cause Glucose Intolerance in Diabetics

E: MAJOR SIDE EFFECT FOR ALL

A

A: SEAT - Spironolactone/ Eplerenone/ Amiloride / Triamterene

B:

  1. [S**econdary HyperAldosteronism 2ยบ to Cirrhosis or CHF]
  2. [Connโ€™s Primary hyperaldosteronism syndrome]
  3. Prevents hypOkalemic effects of other diuretics.
  4. HTN adjunct tx

C: SPIRONOLACTONE AND EPLERENONE

D:

  • Spironolactone/Eplerenone SE = Hyperkalemia/ Gynecomastia/ [Testicular Atrophy]
  • Triamterene can cause megaloblastic anemia in liver failure pts
  • Amiloride can cause Glucose Intolerance in Diabetics

E: METABOLIC ACIDOSIS

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6
Q

ADH Blockers

  • Indications (3)*
  • Main Examples (3)*
A
  1. SIADH
  2. hypOnatremia (Euvolemic or Hypervolemic)
  3. CHF

B: Tolvaptan / Doxycycline / Lithium

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7
Q

Carbonic Anhydrase Inhibitors

  • Side Effects (4)*
  • B: Why are they contraindicated in Cirrhosis pts?*
A

โ€ CAMP is a Side Effect of Carbonic Anhydrase Inhibitors โ€œ

  • Metabolic acidosis 2ยบ to HCO3-
  • Acute hypokalemia
  • [CNS depression + Drowsiness and fatigue],
  • Paresthesia

B: increased urine pH DEC [NH3 secretion] โ€“> [INC serum NH3]โ€”โ€“> hyperammonemia in Cirrhosis pts โ€“> Encephalopathies

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8
Q

Loop Diuretics

Side Effects (8)

A

โ€œGoing in a Loop? DUNK and MOVMโ€

  • hypOKalemia (may be linked to hyperglycemia)
  • hypOMagnesemia;
  • hypONatremia;
  • Volume Contraction in serum***
  • HyperUricemia โ€“> Gout
  • Metabolic alkalosis
  • Ototoxicity (reversible)
  • Diarrhea (when using ethacrynic acid)
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9
Q

Thiazide

Side Effects ( 11 )

A

โ€œWanna know Thiazide Side Effects? Get a CAULKiiNG VoiceMail โ€œ

  1. hypOKalemia;
  2. hypONatremia;
  3. hypOVolemia;
  4. HyperUricemia due to INC urate ReAbsorption*
  5. HyperCalcemia due to INC Ca2+ ReAbsorption
  6. Metabolic alkalosis
  7. [HyperGlycemia 2ยบ to DEC in Insulin Secretion]
  8. HyperLipidemia (HIGH doseโ€“> INC LDL and TAG)
  9. Allergic rxn (fever, rash, purpura, anaphylaxis);
  10. Interstitial nephritis and Impotence

**Thiazides should be used in low doses**

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10
Q

The vaptan family (Tolvaptan / Conivaptan / Mozavaptan] are all ______ blockers in the Kidney.

Name their common Side Effects (5)

B: Which vaptan is effective orally

C: Which vaptan is a combined [V1a and V2 Receptor Blocker] which allows it to also treat _________ by ________

A

vaptan family (Tolvaptan / Conivaptan / Mozavaptan] are all ADH blockers in the Kidney.

SE:

  • Hypernatremia
  • Thirst
  • Dry Mouth
  • hypOtension
  • Dizziness

B: Tolvaptan

C: Conivaptan (IV ONLY) also treats [Euvolemic hypOnatremia] by vasoconstricting arterials + Diuresis

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11
Q

What Potential Interactions do the Rx below pose to the pt?

[ACEk2 Inhibitors]

+

[K+ Sparing Diuretics - SEAT]

B: How do you circumvent this

A

INC Hyperkalemia โ€”> Cardiac Arrhythmias

B: Monitor Serum K+

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12
Q

What Potential Interactions do the Rx below pose to the pt? (2)

Aminoglycosides

+

Loop Diuretics

B: How do you circumvent this (2)

A
  1. Ototoxicity
  2. Nephrotoxicity
    * B: Monitor hearing and Serum creatinine*
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13
Q

What Potential Interactions do the Rx below pose to the pt? (2)

Anticoagulants

+

[Loop Diuretics] vs. Thiazides

A

increased anti-coagulant activity with Loop diuretics;

vs.

decreased anti-coagulant activity with thiazide diuretics.

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14
Q

What Potential Interactions do the Rx below pose to the pt? (4)

Beta Blockers

+

[Loop Diuretics AND Thiazides]

A

INC PLUG in the plasma!

Propranolol

Lipid (HyperLipidemia)

Uric acid (Hyperuricemia)

Glucose (Hyperglycemia)

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15
Q

What Potential Interactions do the Rx below pose to the pt?

Thiazide

+

[Carbamazepine or Chlorpropamide]

A

hypOnatremia (monitor Na+!)

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16
Q

What Potential Interactions do the Rx below pose to the pt?

Digoxin

+

[Loop Diuretics AND Thiazide]

B: How do you circumvent this

A

hypOkalemia โ€“> INC Digoxin Toxicity

B: Monitor K+ and Cardiac Function

17
Q

What Potential Interactions do the Rx below pose to the pt? (3)

NSAIDs

+

[Loop / Thiazide / K+ Sparing DIURETICS]

A

๔ฐ„ 1. reduced diuretic effect,

  1. increased risk of salicylate toxicity with high doses of salicylates (thiazide & loop d.).
    ๔ฐ„
  2. increased risk of hyperkalemia with K+ sparing diuretics
18
Q

What Potential Interactions do the Rx below pose to the pt?

Quinidine

+

[Loop Diuretics or Thiazide]

A

Polymorphic VTach (Torsade De Pointes)

19
Q

What Potential Interactions do the Rx below pose to the pt?

Sulfonylureas

+

Loop Diuretics

A

Hyperglycemia

20
Q

What Potential Interactions do the Rx below pose to the pt?

Steroids

+

[Loop Diuretics or Thiazide]

A

hypOkalemia

(monitor serum K+)

21
Q

Renal Papillae

[Renal Papillae] form [Funnel-shaped ______], which then converge to form a ________

A

A Conjoined Apex of all the [Medullary pyramid] ducts

[Renal Papillae] form [Funnel-shaped Calyces], which then converge to form a Renal Pelvis

22
Q

A: Most diuretics are tightly ______ bound and undergo ______ glomerular filtration.

They reach renal tubule lumen via ______ across the ______ cell (______ or ______ secretory pathway)

A2: Which Diuretic works via Glomerular filtration?

B: 2 Drugs that inhibit acidic drugs secretory pump

C: Which Drug competes with Basic drugs secretory pump

A

A: Most diuretics are tightly protein bound and undergo little filtration. They reach renal tubule lumen via secretion across the PCT cell (organic acid or base secretory pathway)

A2: Mannitol

B: [probenecid and NSAIDs] compete with acidic

C: cimetidine

23
Q

Osmotic Diuretics (Mannitol)

A: Route of Administration

B: Parts of the Kidney it acts (3)

C: Contraindications (3)

C2: Rationale behind Contraindications

A

A: IV ONLY and initially causes [Intravascular volume expansion].

B: PCT / [thin descending LOH] / [Collecting Duct w/ADH around]

C:

  • CHF
  • Chronic Renal Failure
  • Acute Pulmonary Edema

C2: In pts with DEC GFR, [Osmotic Diuretics] distribute into the [Extracell Fluid] and then pull WATER AND Na+ Out of cells โ€”> Worsening condition

24
Q

Which Loop Diuretic has a ________ than Furosemide

A: GREATER POTENCY

B: Longer Half-Life and [Duration of Action]

C: Greater TOXICITY (nephro/ototoxic and is last resort)

D: Better PO absorption

A

A: Bumetanide

B: Torsemide

C: Ethacrynic Acid

D: Torsemide

25
Q

Contraindications for [K+ Sparing Diuretics - SEAT] (9)

A

*These conditions can cause HYPERkalemia*

โ€ Have a SEAT on our Hot TM BRANDSโ€

  1. DM
  2. Multiple Myeloma
  3. [Tubulointerstitial Renal Dz]
  4. Renal Insufficiency
  5. [ACEk2 inhibitors and ARBs]
  6. Supplemental K+
  7. NSAIDs
  8. Heparin
  9. Beta Blockers
26
Q

Differences between Spironolactone and Eplerenone (2)

A
  • Eplerenone is considerably more expensive
  • Eplerenone does not inhibit testosterone binding and therefore it does not induce gynecomastia or other related anti-androgenic side effects
27
Q

How is Diabetic Nephropathy and Diuretics related?

A

Diabetic nephropathyโ€”associated with HYPERkalemiaโ€”may be treated with [loop diuretics or thiazides]

28
Q

A: What is the most common electrolyte disorder in hospitalized patients?

B: What are the 3 Types

B2: Which types can NOT be treated with [saline infusion] (2), and what is the alternative tx (2)

B3: Which type is associated with SIADH

C: What specifically was Mozavaptan just approved for?

A

A: hypOnatremia, (less than 136 mEq/L)

B: hypOvelimic vs. Euvolemic vs. HYPERvolemic

B2: Euvolemic and HYPERvolemic] can NOT be treated w/saline infusion โ€”> use [Tolvaptan or Conivaptan]

B3: [Euvolemic hypOnatremia] <โ€”SIADH

C: hyponatremia caused by SIADH due to ADH producing tumors

29
Q

Current Recommendations for HTN tx with Diuretics

A: For uncomplicated HTN

B: Pts with DM and Chronic Renal Dz

C: Pt whose BP is more than [20 over Systolic goal] or [10 over diastolic goal]

A

A: a thiazide diuretic should be used in drug either alone or combined with drugs from other classes.

B: 2 or more antihypertensive medications will be required to achieve goal BP (140/90 mm Hg, or 130/80 mm Hg)

C: initiation of therapy using two agents, one of which is a thiazide diuretic

30
Q

Causes of Diuretic Resistance or Edema Refractory (4)

A

๔ฐ 1. NSAID co-administration (block prostaglandin-induced increase in RBF / [INC expression of Na+/K+/2Cl- in TAL], compete for organic acid transporter in PCT).

๔ฐ 2. (CHF) or renal failure DEC RBFโ€”> decreases delivery of diuretics to tubule / build-up of organic acids competes for secretory transport into tubule.

๔ฐ 3. Nephrotic syndrome (protein in tubule binds to diuretic drugs and limits their actions).

๔ฐ 4. [Hepatic cirrhosis / CHF / renal failure] (decreased GFR results in increased PCT absorption of Na+

31
Q

A: Which Blood Pressure medication is best for Pts with [Metabolic Syndrome X]?

B: Criteria for [Metabolic Syndrome X] (4)

A

DIURETICS

B: [Metabolic Syndrome X - DIVe] is when pt has
1. Dyslipidemia [TG over 150] or [HDL under 40]

  1. Insulin resistance [Fasting Glucose OVER 100]
  2. Visceral Obesity [Men Waist over 40] or [Women Waist over 35]
  3. HYP(e)RTENSION [BP over 135/80]

๐Ÿ„ผ๐Ÿ’Š CARDIO PATH/RX (22 decks)

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