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Pharmacology-Diuretics Flashcards

1
Q

What is the primary therapeutic effect of diuretics

A

Inhibit Na+ reabsorption

(promotes loss of Na+ and H2O; reduces plasma volume and blood pressure)

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2
Q

What are the main uses for diuretics?

A

*HTN
*CHF
kidney/liver disease
ICP/IOP management

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3
Q

What two medications work in the glomerulus

A

NSAIDS and ACEI

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4
Q

Which medications work in the PCT?

A

Carbonic Anhydrase Inhibitors
Osmotic Diuretics

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5
Q

Which medication works in the Loop of Henle (thick ascending)

A

Loop Diuretics

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6
Q

Which diuretic works in the DCT?

A

Thiazides

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7
Q

Which medications work in the Collecting Duct?

A

Aldosterone Antagonists
ADH Antagonists

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8
Q

What medication is a carbonic anhydrase inhibitor

A

Acetazolamide

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9
Q

MOA of carbonic anhydrase inhibitor

A

block carbonic anhydrase activity

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10
Q

carbonic anhydrase inhibitor decrease the reabsorption of

A

Na+
HCO3-
H2O

(causing natriuresis, diuresis, alkaline urine)

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11
Q

carbonic anhydrase inhibitors increases the excretion of

A

K+

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12
Q

carbonic anhydrase inhibitors increase the reabsorption of

A

Cl-

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13
Q

carbonic anhydrase inhibitors cause the reabsorption of _________, causing metabolic acidosis

A

hydrogen (lose bicarb)

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14
Q

SIDE EFFECTS of carbonic anhydrase inhibitors

A

Metabolic Acidosis

HYPOkalemia

HYPERchloremia (excess chloride in the blood due to exchange of Cl- for bicarb

Kidney Stones

Fatigue

Paresthesias (tingling)

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15
Q

Which patients should not receive carbonic anhydrase inhibitors

A

renal insufficient patient

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16
Q

Can carbonic anhydrase inhibitors cause tolerance?

A

YES, after 2-3 days

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17
Q

Osmotic diuretics dont go under _______ and causes ________ in plasma & renal tubular fluid osmolarity

A

metabolism; increase

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18
Q

Osmotic diuretics decreases reabsorption of_______

A

water

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19
Q

What medications are osmotic diuretics

A

*Mannitol
Urea
Isosorbide
Glycerine

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20
Q

What diuretics do you give a patient with LV dysfunction?

A

Osmotic & Furosemide

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21
Q

What are the SIDE EFFECTS of osmotic diuretics?

A

Increased plasm volume
Caution w/LV dysfunction & pulmonary edema
HYPOVOLEMIA w/long-term use
HYPOkalemia/natremia
Thrombophlebitis

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22
Q

Mannitol not filtered with

A

renal insufficiency

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23
Q

What is the dose of mannitol

A

0.25-2g/kg

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24
Q

Mannitol is a ______ ______, meaning it does not _________cell membranes

A

sugar alcohol; cross

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25
What is the duration of mannitol
6-8 hours
26
How does mannitol prevent perioperative renal failure in ATN?
Vasodilates (improves RBF) Removes toxins & necrotic debris Scavenger of free O2 radicals (prevent cellular injury)
27
Which is the most potent diuretic
loops
28
MOA of loop diuretics
block Na/K/2Cl co-transporter, decreasing the reabsorption of EVERYTHING
29
Loops cause
natriuresis, diuresis, and hyppokalemia
30
Which diuretic is 1st line for HTN
Thiazide
31
Loops are less effective ini
lowering HTN
32
Loops cause an increase in _________ formation, leading to vasodilation
prostaglandin
33
Loop diuretic medications
*Furosemide (Lasix) Torsemide Ethacrynic Acid Bumetanide
34
Loops are used to treat
HTN Edema HYPERkalemia/calcemia
35
SIDE EFFECTS of Loops
HYPOkalemia/natremia/calcemia/magnesemia Metabolic alkalosis HOTN Renal ischemic injury Hyperuricemia Gout Ototoxicity Tinnitus Increased nephrotoxic effects of aminoglycosides & cephalosporins
36
Dose of Loop
20-40mg IV (200mg MAX) Onset 5-10min Duration 2-6 hrs
37
HF patients are often resistant to
Loops and may need thiazide
38
Loops can treat
pulmonary edema
39
Thiazide can treat
hypocalcemia
40
MOA of thiazides
block Na/Cl cotransporter and work in the DCT
41
Thiazides decrease the reabsorption of
Na/Cl/Water, causing natriuresis and diuresis
42
Thiazides increase the excretion of
K+
43
Thiazides increase the reabsorption of
Ca+
44
What medications are thiazide diuretics
*Hydrochlorothiazides Chlorothiazide Chlorthalidone Indapamide
45
SIDE EFFECTS of Thiazides
HYPOkalemia/natremia/chloremia/magnesia/phosphate/volemia Hypercalcemia/uricemia/glycemia glucose intolerance & insulin resistance Metabolic alkalosis Cross-reactivity in sulfa allergy
46
2 types of Potassium Sparing Diuretics
Epithelial Na+ channel (ENaC blockers Aldosterone receptor antagonist
47
Example of ENaC blockers
Triamterene Amiloride
48
Examples of Aldosterone receptor antagonists
Spironolactone Eplerenone
49
Where do potassium sparing drugs work
CD
50
Both ENaC and Aldosterone receptor antagonists decrease reabsorption of____________and decrease excretion of
Na+ and Water K+
51
Aldosterone receptor antagonists (potassium sparing) work to inhibit
Na/K ATPase
52
Na/K pump and the ENaC channel promotes_______
Na+ loss K+ reabsorption
53
SIDE EFFECTS of potassium sparing diuretics
HYPERkalemia Hyponatremia Metabolic Acidosis Dehydration HOTN Gynecomastia Decreased androgen levels Dry Skin Rash
54
Potassium Sparing is _____and usually given with a _______ to prevent________
weak;thiazide; hypokalemia
55
Medications of the Dopamine Receptor Agonist family
*Dopamine Fenoldopam
56
D1 receptor activation inhibits
Na/H+ exchange Na/K+/ATPase
57
D1 receptor activation increases
cAMP
58
D1 receptor activation causes_______ and maintains and increases ____and____
Natriuresis; RBF & GFR
59
Higher doses of D1 receptor activation can cause
Beta cardiac stimulation Alpha vasoconstriction
60
D1 med Fenoldopam is ________, increases_______and decreases______
selective;RBF;SVR (causes no vasoconstriction nor cardiostimulation due to moderate alpha-2 activity)
61
Fenoldopam is used for short term treatment of severe_____ and _____ ______
HTN: renal protection
62
Hypokalemia can ______muscle relaxant due to the cells being______
potentiate; hyperpolarized
63
renal ischemia may occur with
a normal MAP

Anesthesia-Diuretics (3 decks)

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