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1 STEP UW Nephrology > Thiazides (amboss ir UW) > Flashcards

Thiazides (amboss ir UW) Flashcards

1
Q

Thiazides agents?

A

Hydrochlorothiazide (HCTZ)
Chlorthalidone
Chlorothiazide
Metolazone

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2
Q

Indications?

A

Hypertension

Chronic edema (secondary to congestive HF, cirrhosis, and kidney disease)

Prevention of calcium kidney stones, idiopathic hypercalciuria

Osteoporosis

Nephrogenic diabetes insipidus

Sequential nephron blockade

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3
Q

Why thiazides used for nephrogenic diabetes insipidus?

A

Paradoxically, thiazide diuretics are able to reduce the volume of urine in patients with diabetes insipidus. The mechanism of action is not yet fully understood.

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4
Q

Sequential nephron blockade. What medications?

A

Loops+thiazides

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5
Q

What do Na and Cl cotransporters in early DCT?

A

reabsorb Na and Cl

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6
Q

Mechanism of thiazides?

A

Inhibition of Na+-Cl- cotransporters in the early DCT → ↑ excretion of Na+ (saluresis) and Cl- → ↓ diluting capacity of nephron (CIA MAIN MECHANISM) and ↑ excretion of potassium (kaliuresis) and ↓ excretion of calcium → diuresis

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7
Q

Why in thiazides decr. calcium excretion?

A

Increased secretion of sodium into the lumen of the tubules leads to an increased exchange of sodium and potassium in the late distal tubule via the luminal ENaC and ROMK channels, resulting in increased potassium excretion

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8
Q

Thiazides effect on calcium?

A

increased reabsorption

Decreased intracellular Na levels increase the activity of the basolateral Na+/Ca2+ exchanger in the cells of the distal convoluted tubule. Sodium is transported into, and calcium out of, the cell, resulting in decreased intracellular calcium concentration that leads to increased reabsorption from the lumen via luminal Ca2+ channels. Calcium reabsorption may also be increased because of increased uptake of sodium and calcium in the proximal tubule as a result of sodium depletion.

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9
Q

Thiazides effect on smooth muscle cells?

A

vasodilation

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10
Q

Thiazides effect on pancreatic beta cells?

A

decreased insulin release

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11
Q

Side effects of thiazides?

A 
Hypokalemia and metabolic alkalosis
Hyponatremia
Hypomagnesemia
Hypercalcemia 
Hyperglycemia  [11]
Hyperlipidemia (↑ cholesterol, triglycerides) 
Hyperuricemia 
Allergic reactions (sulfonamide hypersensitivity)
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12
Q

To avoid hypokalemia, thiazide diuretics may be combined with………

A

potassium-sparing diuretics (e.g., aldosterone receptor antagonists).

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13
Q

Side effect of thiazides - hypercalcemia. For what patients is benefitial?

A

Beneficial in patients with osteoporosis

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14
Q

Thiazides how cause hyperglycemia?

A

The exact mechanism is not fully understood. It is suggested to involve decreased insulin release and glucose uptake, as well as increased insulin resistance. Therefore, thiazide diuretics should be avoided in patients with diabetes mellitus.

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15
Q

Avoid thiazide diuretics in patients with metabolic syndrome or hypercholesterolemia.

A

.

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16
Q

in osteoporosis what diuretics may be beneficial?

A

thiazides (causes hypercalcemia)

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17
Q

hyperGLUC meaning?

A

hyperGlycemia, hyperLipidemia, hyperUricemia, and hyperCalcemia.

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18
Q

contraindications of thiazides?

A

Hypersensitivity (including hypersensitivity to any sulfonamide medications)
Gout
Anuria
Severe hypokalemia

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19
Q

thiazides are sulfonamides

A

.

20
Q

thiazides use in what patients should be used with precaution?

A

Thiazides should be used with caution in patients with prediabetes and diabetes mellitus because they can cause hyperglycemia and changes in glucose concentration.

21
Q

Interactions. Thiazides + GK?

A

increased hypokalemia

22
Q

Interactions. Thiazides + carbamazerpine?

A

increased hyponatremia

23
Q

Interactions. Thiazides + lithium?

A

increased hyponatremia

24
Q

Interactions. Thiazides + ACEI?

A

hypotension (especially first-dose hypotension)

25
Q

Interactions. Thiazides + propranolol?

A

increased hyperlipidemia and hyperglycemia

26
Q

Interactions. Thiazides + NSAIDs?

A

decreased diuretic effect

27
Q

what NSAIDs effect in diuresis?

A

NSAIDs increase retention of sodium and water

28
Q

Interactions. Thiazides + digitalis/methotrexate, lithium?

A

increased effects of digitalis, methotrexate, and lithium

29
Q

main side effect of thiazides?

A

HYPOKALEMIA AND METABOLIC ALKALOSIS

HYPONATREMIA and HYPERCALCEMIA

30
Q

In which part is Na/Cl symporter?

A

early DCT cells apical membrane

31
Q

In which part is Na/K atp’ases and Cl channels?

A

early DCT cells basolateral side

32
Q

parasyti thiazides mechanizma ant kalcio

A

.

33
Q

Thiazides are not as efficacious as loops as only a small amount of filtered Na reaches distal tubules

A

.

34
Q

Most common thiazides side effects?

A

hypokalemia, hyponatremia, hypomagnesemia

35
Q

Less common thiazides side effects?

A

hypotension, volume depletion, hypercalcemia (blet kodel kalcis :()

36
Q

thiazide Na total body electrolyte?

A

moderate decr in Na (2 arrows down)

37
Q

thiazide K total body electrolyte?

A

decr in K (1 arrows down)

38
Q

thiazide HCO3 total body electrolyte?

A

incr (1 arrow up)

39
Q

thiazide Ca2 total body electrolyte?

A

incr (1 arrow up)

40
Q

thiazide uric acid total body electrolyte?

A

incr (1 arrow up)

41
Q

Which medications used in calcium nephrolithiasis propjhylaxis?

A

thiazides (because calcium is reabsorbed from tubules back to blood)

42
Q

Indications?

………….

Chronic edema (secondary to congestive HF, cirrhosis, and kidney disease)

Prevention of calcium kidney stones, idiopathic hypercalciuria

Osteoporosis

Nephrogenic diabetes insipidus

Sequential nephron blockade

A

Hypertension

43
Q

Indications?

Hypertension

…….

Prevention of calcium kidney stones, idiopathic hypercalciuria

Osteoporosis

Nephrogenic diabetes insipidus

Sequential nephron blockade

A

Chronic edema (secondary to congestive HF, cirrhosis, and kidney disease)

44
Q

Indications?

Hypertension

Chronic edema (secondary to congestive HF, cirrhosis, and kidney disease)

………

Osteoporosis

Nephrogenic diabetes insipidus

Sequential nephron blockade

A

Prevention of calcium kidney stones, idiopathic hypercalciuria

45
Q

Indications?

Hypertension

Chronic edema (secondary to congestive HF, cirrhosis, and kidney disease)

Prevention of calcium kidney stones, idiopathic hypercalciuria

………..

Nephrogenic diabetes insipidus

Sequential nephron blockade

A

Osteoporosis

46
Q

Indications?

Hypertension

Chronic edema (secondary to congestive HF, cirrhosis, and kidney disease)

Prevention of calcium kidney stones, idiopathic hypercalciuria

Osteoporosis

………

Sequential nephron blockade

A

Nephrogenic diabetes insipidus

47
Q

Indications?

Hypertension

Chronic edema (secondary to congestive HF, cirrhosis, and kidney disease)

Prevention of calcium kidney stones, idiopathic hypercalciuria

Osteoporosis

Nephrogenic diabetes insipidus

……….

A

Sequential nephron blockade

1 STEP UW Nephrology (14 decks)

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