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Cardio-Renal I Midterm > Pharmacology - Diuretics > Flashcards

Pharmacology - Diuretics Flashcards

1
Q

how can endothelial cell damage lead to high blood pressure

A

endothelial cells (healthy) would normally release nitric oxide - a vasodilator. if the endothelial cells are damaged, there will be no nitric oxide release and the arteries will become stiff and blood flow hindered - INCREASED RESISTANCE

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2
Q

increased load on the heart due to high BP can cause…

A

CHF

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3
Q

true or false

if HTN is asymptomatic, it does not need to be treated

A

FALSE i it does

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4
Q

name 3 classes of diuretics

A

thiazides
loop diuretics (high ceiling)
potassium sparing

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5
Q

MOA diuretics

A

act on the kidneys to increase excretion of sodium and water

this decrease in blood volume causes decreased blood pressure

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6
Q

name 2 thiazide diuretics

A

hydrochlorothiazide
chlorthalidone

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7
Q

name 2 high ceiling loop diuretics

A

furosemide and torsemide

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8
Q

name 3 potassium sparing diuretics

A

spironolactone
triamterene
amiloride

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9
Q

MOA ACE inhibitors

how to recognize them?

A

anything ending in “pril”

inhibits conversion angiotensin 1 to angiotensin 2 by inhibiting ACE enzyme

this causes decrease in vasoconstriction, reduces peripheral resistance, and lowers BP

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10
Q

what are AT1 blockers and what is their MOA

A

inhibit angiotension 2 binding to its receptor (AT1)
called “ARBS”
all end in “artan”

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11
Q

name 2 centrally acting antihypertensives and their MOA

A

clonidine, methyldopa

act (agonists) on CENTRAL alpha 2 receptors to decrease sympathetic outflow, and thus cause a fall in bp

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12
Q

true or false

a2 causes vasodilation so clonidine and methyldopa are agonists to it

A

true

a1 causes constriction

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13
Q

nonselective beta blocker

what is MOA

A

propranolol

binds beta adrenergic receptors and BLOCKS activity

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14
Q

explain how labetolol and carvedilol work

A

bind B1 receptor in heart and BLOCK IT — blocks firing of SA node and reduces heart rate

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15
Q

cardioselective beta blocker

A

metoprolol

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16
Q

verapamil class

A

calcium channel blocker (NON dihydro pyridine)

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17
Q

name 3 alpha adrenergic blockers and their MOA

A

prazosin, terasozin, doxasozin

block alpha adrenergic receptors in smooth muscle to cause vasodilation

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18
Q

explain MOA calcium channel blockers

A

block influx of calcium into smooth muscle cells —- reduced contraction – decreased BP

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19
Q

**name 4 thiazide diuretics

A

chlorthalidone
hydrochlorothiazide
indapamide
metolazone

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20
Q

thiazide diuretics can also be called…

A

naturetics

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21
Q

___ are also called water pills. why?

A

diuretics

bc they remove more water through the urine

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22
Q

some things diuretics can treat

A

hypertension
edema
heart failure

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23
Q

***where do thiazides work within the nephron?

A

DCT - distal convoluted tubule

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24
Q

***EXPLAIN the full mechanism of thiazide diuretics

A

directly block the reabsorption of sodium and chloride into the body at the 1st portion of the DCT

they do this by inhibiting a sodium/chloride symport cotransporter

by inhibiting sodium entry, calcium reabsorption is ENHANCED

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25
Q

diuretics will _____:

-sodium levels
-potassium levels
-calcium lvels

A

decreased sodium and potassium

increased calcium levels

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26
Q

true or false

thiazide diuretics enhance the excretion of sodium and chloride in the urine

A

true

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27
Q

thiazide diuretics DECREASE the urinary excretion of _______

A

calcium

28
Q

true or false

thiazide diuretics work in the collecting duct

A

FALSE - DCT

29
Q

true or false

thiazide diuretics increase calcium reabsorption

A

TRUE

30
Q

thiazide diuretics cause ___ metabolic ____

A

hypokalemic metabolic alkalosis

31
Q

molecular target of thiazide diuretics

A

the sodium/chloride symport cotransporter

32
Q

true or false

the sodium and potassium lost in the urine due to thiazide diuretics is a passive loss

A

true

33
Q

*****5 contraindications for HCTZ and explain

A

-gout (bc uric acid levels will be elevated)

-diabetes (elevates glucose)
bc potassium needed to convert proinsulin to insulin, and diuretics deplete potassium

-hypokalemia

-sulfonamide allergy

-renal failure

34
Q

***_______ can occur when taking diuretics because diuretics cause sodium depletion, which increases _____ reabsorption

A

LITHIUM TOXICITY

INCREASED LITHIUM REABSORPTION

35
Q

**thiazide diuretics cause ____ kalemia

what are the symptoms?

A

hypo

muscle pain and fatigue

36
Q

**thiazide diuretics cause ____ glycemia

why

A

hyperglycemia

potassium depletion – no conversion of proinsulin to insulin

37
Q

** thiazide diuretics cause _____ lipidemia

A

hyperlipidemia

rise in LDL —- risk of stroke

38
Q

**thiazide diuretics cause _____ uricemia

A

hyperuricemia

bc urate excretion is inhibited

39
Q

**thiazide diuretics can cause sudden cardiac ____

A

DEATH

bc of hypokalemia – heart rate affected

40
Q

all of the AE of thiazide diuretics listed are really only relevant when?

what is conclusion that the JNC made**

A

at HIGH DOSES – very minimal AE with low doses of 12.5-25

start low dose thiazide therapy in HTN. if this therapy fails, try another antihypertensive along with it. DO NOT INCREASE THE THIAZIDE DOSE!!!!!!!

41
Q

___diuretics are to be given when there is severe hypertension with retention of body fludis

A

loop diuretics

42
Q

*** thiazides can cause metabolic ________

A

ALKALOSIS

43
Q

____ is thiazide like diuretic

A

chlorthalidone

44
Q

true or false**

chlorthalidone has a different MOA than thiazides

A

FALSE - same

even tho thiazide like
inhibits Na/Cl symporter at DCT

45
Q

CV reaction to chlorthalidone

A

orthostatic hypotension

46
Q

indapamide class

A

thiazide-like diuretic

47
Q

metolazone class

A

thiazide-like diuretic

48
Q

true or false

potassium sparing diuretics and thiazide/thiazide-like diuretics cannot be used together

A

FALSE

they can be used together to replenish potassium lost by thiazides

49
Q

other than _____, potassium sparing diuretics are primarily used with thiazide diuretics

A

other than spironolactone

50
Q

“a class of drugs that helps the body to get rid of excess sodium and water without losing potassium in the urine”

A

potassium sparing diuretics

51
Q

true or false

k+ sparing diuretics have a different MOA than thiazide and thiazide-like diuretics

A

TRUE

52
Q

name 4 potassium sparing diuretics

A

amiloride
eplerenone
spironolactone
triamterene

53
Q

amiloride inhibits ____

A

enac

blocks epithelial sodium channel in the DCT

54
Q

besides amiloride, what other drug inhibits enac

A

triamterene

55
Q

____ is the metabolite of spironolactone and has the same MOA

A

eplerenone

56
Q

potassium sparing diuretics work where in the nephron?

A

the collecting duct

57
Q

explain how aldosterone antagonists like spironolactone and eplerenone work

A

normally, aldosterone would bind its receptor and work to retain water

however, aldosterone antagonists bind the aldosterone receptor instead

58
Q

the expression of enac channels is regulated by what?

A

aldosterone

59
Q

potassium sparing diuretics can cause ___ kalemia and ____osis

A

hyperkalemia and acidosis

60
Q

true or false

aldosterone increase enac expression

A

TRUE

more enac expression = more sodium influx and more water retained

61
Q

true or false

aldosterone antagonists cause a loss of sodium and water

A

true

62
Q

3 major advantages of spironolactone over HCTZ

A

no hypokalemia, hyperglycemia, hyperuricemia

63
Q

**2 major AE of potassium sparing diuretics like spironolactone

A

hyperkalemia
metabolic acidosis

64
Q

*****metabolite of spironolactone

when is its use beneficial?

A

eplerenone

in liver failure! it bypasses hepatic metabolism

65
Q
A

Cardio-Renal I Midterm (8 decks)

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