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Pharm Exam 2 > Topic 8 > Flashcards

Topic 8 Flashcards

1
Q

Carbonic anhydrase inhibitors and adenosine antagonists work on what part of the kidney

A

proximal convoluted tublule

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2
Q

Loop diuretics work on what part of the kidney

A

Thick ascending limb of Henle’s Loop

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3
Q

Thiazides work on what part of the kidney

A

cortical region of the Ascending Loop of Henle

Distal convoluted tubule

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4
Q

K+ sparing and adenosine antagonists work on what part of the kidney

A

Cortical collecting tubule

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5
Q

Vasopressin antagonists work on what part of the kidney

A

Medullary collecting tubule

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6
Q

Common uses for diuretics include

A

Congestive heart failure
Hepatic Ascites
Nephrotic Syndrome
HTN

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7
Q

Diuretic categories include

A

1) Carbonic Anhydrase Inhibitors
2) “Loop” Diuretics
3) Thiazides
4) Potassium-Sparing Diuretics

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8
Q

1: Carbonic Anhydrase (CA) Inhibitors Work by

A

inhibiting carbonic anhydrase in the proximal tubule epithelium
-With CA blocked, the reaction shifts to the right and bicarbonate accumulates in the urine

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9
Q

Carbonic Anhydrase (CA) Inhibitors: Sodium is less able to be exchanged for H⁺ in the tubules so H⁺ is

A

retained while Na⁺ is lost (with the bicarbonate).
*Sooo…urine becomes more alkaline, water follows the bicarbonate into the tubules (causing diuresis) and the patient experiences a metabolic acidosis

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10
Q

Carbonic Anhydrase (CA) Inhibitors: increase urinary excretion of

A

Na+ (small)
K+ (a lot)
Bicarb (a lot)
volume of urine increases (medium)

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11
Q

Carbonic Anhydrase (CA) Inhibitors: drug name

A

Acetazolamide (Diamox)

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12
Q 
Carbonic Anhydrase (CA) Inhibitors: Rarely used in \_\_\_\_\_ but You may see patients on acetazolamide who
have
A

cardiovascular surgery

glaucoma or high-elevation sicknes

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13
Q

Carbonic Anhydrase (CA) Inhibitors: Theoretically useful for

A

“trapping” chemicals in alkalinized urine

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14
Q

Acetazolamide

A

(Diamox)

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15
Q

2: Loop Diuretics act on the

A

ascending Loop of Henle

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16
Q

Loop Diuretics are also called

A
  • “High Ceiling” diuretics because the dose-response curve is close to linear
  • Non-Potassium-Sparing
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17
Q

Loop Diuretics work by

A
  • blocking the co-transport of Na⁺/K⁺/2Cl ̄ from the tubular lumen back into circulation.
  • increase renal blood flow by inducing the expression of COX-2
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18
Q

Loop Diuretics are the most

A

efficacious of all diuretics and work incredibly fast

within minutes when given IV

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19
Q

Loop Diuretics increase urinary excretion of

A

Na+ (a lot)
K+ (medium)
Ca++ (a lot)
Increases volume of urine (a lot)

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20
Q

COX-2 is referred to as the

A

“ungood” cyclooxygenase NSAIDS-preferentially block in inflamed tissues

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21
Q

Cyclooxygenases help produce

A

prostaglandins which are powerful vasodilators of renal arteries

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22
Q 
\_\_\_\_\_\_\_\_ may interfere with loop diuretic function in
compromised patients (hepatic cirrhosis, nephrotic syndrome)
A

NSAID’s

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23
Q

Loop diuretics are generally the diuretic of choice even in patients with

A

compromised renal function.

Also useful for hypercalcemia and hyperkalemia.

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24
Q

Loop Diuretics: *Because they are fast-acting and

incredibly efficacious, Loop Diuretics are the #1 choice for

A

edema in emergency situations (such as pulmonary edema from decompensated congestive heart failure)

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25
Q

Loop Diuretics: Perfusion Uses

A

1) Get rid of extra fluid on bypass (*Chemical hemoconcentrators)
2) Get rid of excess K⁺
3) Help maintain urine production/renal function in low output states on bypass

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26
Q

Loop Diuretics ***Recent evidence suggests giving loop diuretics simply to keep urine flowing and thus ‘help’ the kidneys is

A

NOT appropriate and may be deleterious in the long run!

*This is still, however, a common practice

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27
Q

Loop diuretics side effect

A

Ototoxicity particularly when used with aminoglycoside antibiotics

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28
Q

Loop diuretic: drug names

A

Furosemide (Lasix)
Ethacrynic acid (Edecrin)
Bumetanide (Bumex)
Torsemide (Demadex)

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29
Q

Furosemide

A

(Lasix)

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30
Q

Ethacrynic acid

A

(Edecrin)

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31
Q

Furosemide Very commonly used during and

A

peri-bypass

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32
Q

Furosemide has a _________ therefore the potential for “We always put some lasix in the pump” mentality

A

Wide margin of safety/therapeutic window

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33
Q

Furosemide duration of action when given IV (on

pump)

A

~2 hours

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34
Q

Furosemide Typical adult pump dose is

A

2.5-5.0 mg (20-40 mg bolus if the patient’s receiving chronic diuretic therapy)

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35
Q

Ethacrynic Acid (Edecrin) : ____ commonly used than furosemide

A

less

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36
Q

What is Like furosemide but greater potential for oxotoxicity

A

Ethacrynic Acid (Edecrin)

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37
Q

Bumetanide

A

(Bumex)

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38
Q

Torsemide

A

(Demadex)

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39
Q

what is like furosemide and ethacrynic acid -Much less frequently used

A

Bumetanide (Bumex)

Torsemide (Demadex)

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40
Q

what is Generally utilized as “physician’s preference” or when desired response is not achieved by furosemide

A

Bumetanide (Bumex)

Torsemide (Demadex)

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41
Q

3: Thiazide Diuretics: Act on the

A

cortical region of the Ascending Loop of Henle and the distal convoluted tubule

42
Q

Thiazide Diuretics are also called

A

“Ceiling Diuretics” because of their “flattening” dose/response curve

43
Q

Thiazide Diuretics work by

A

Na⁺/Cl- transport/reabsorption on the luminal side of the thick part of the Ascending Loop of Henle and the Distal Convoluted Tubule.

44
Q

Thiazide Diuretics causes NaCl to concentrate in the

A

tubular fluid (and H₂O obediently follows = increased urine production)

45
Q

Thiazide Diuretics have to actually get into the

A

tubular lumens via renal excretion…so thiazides lose

efficacy in patients with decreased renal function.

46
Q

Like “Loops”, thiazides increases renal blood flow through

A

COX-2 inducement of prostaglandin synthesis

47
Q

what is structurally related to Acetazolamide, but

cause much more diuresis

A

thiazide diuretics

48
Q

what was the original diuretic used for edema

A

Chlorothiazide (Thiazide diuretic)

49
Q

what is the only thiazide available for parenteral use

A

Chlorothiazide

50
Q

Chlorothiazide adult pump dose

A

500 mg

51
Q

Thiazide diuretics are not

A

potassium sparing

52
Q

thiazide diuretics increase urinary excretion of… and decrease urinary excretion of…

A

Increase: Na+, K+, Volume of urine (all same amount)
Decrease: Ca++ (small amount)

53
Q

Thiazide Diuretics: Perfusion Uses

A

-Like the “Loops” thiazides get rid of extra (edema) fluid and potassium.
- decrease SVR due to relaxation of arteriolar smooth
muscle
-HTN

54
Q

Thiazides promote the reabsorption of

A

calcuim

55
Q

Compared to “Loops”, long-term use results in significantly less decrease in

A

bone density (hip fractures are decreased by 1/3rd)

56
Q

Since thiazides can (uniquely) cause the production of

hyperosmolar urine it’s used in

A

diabetes insipidus

57
Q

what are the “second-line” treatments (after “Loops” for the edema of heart failure).

A

thiazide diuretics

58
Q

Thiazide Diuretics: drug names

A

Chlorothiazide (Diuril)

Hydrochlorothiazide (HCTZ) (Microzide)

59
Q

Chlorothiazide

A

(Diuril)

60
Q

Hydrochlorothiazide

A

(HCTZ) (Microzide)

61
Q

what is Like chlorothiazide except it’s MORE potent but has the SAME efficacy and is NOT given parenterally

A

Hydrochlorothiazide

62
Q

Use in fixed combinations for Rx of HTN:

Hyzaar=

A

HCTZ + Losartan

63
Q

Thiazide-like Diuretics: drug names

A

Chlorthalidone (Hygroton)
Indapamide (Lozol)
Metolazone (Zaroxolyn)

64
Q

Chlorthalidone

A

(Hygroton)

65
Q

Chlorthalidone (Hygroton) is commonly used to treat

A

HTN

66
Q

Indapamide

A

(Lozol)

67
Q

Indapamide (Lozol) is Partially excreted by the

A

GI tract, so useful in advanced renal failure

68
Q

Metolazone

A

(Zaroxolyn)

69
Q

4: Potassium-Sparing Diuretics Function in the

A

collecting tubules (ducts) to prevent Na⁺ reabsorption and K⁺ excretion

70
Q

Potassium-Sparing Diuretics Antagonize

A

aldosterone

71
Q

GFR stands for

A 
“G” = mineralocorticoids (aldosterone)
“F” = glucocorticoids (cortisol)
“R” = androgens (testosterone precursors)
72
Q

Potassium-Sparing Diuretics Used to treat

A

HTN, often in combination with chlorothiazide or hydrochlorothiazide

73
Q

Potassium -Sparing Diuretics are Significantly less _____ than its non-potassium-sparing alternatives

A

efficacious

74
Q

Potassium-Sparing Diuretics increase urine production of… and decrease urine production of…

A

increase: Na+ (small), volume of urine (medium)
decrease: K+ (medium)

75
Q

Potassium-Sparing Diuretics Problematic in patients with

A

hyperkalemia

76
Q

Potassium-Sparing Diuretics (Direct Aldosterone Antagonists) drug names

A

Spironolactone (Aldactone)

Eplerenone (Inspra)

77
Q

Spironolactone

A

(Aldactone)

78
Q

Eplerenone

A

(Inspra)

79
Q

Potassium-Sparing Diuretics (Direct Aldosterone Antagonists): Used as adjunctive therapy in

A

heart failure
–Statistically decreases mortality and helps
prevent pathological “remodeling” of the heart

80
Q

Spironolactone is the diuretic of choice for

A

liver failure patients with edema

81
Q

Potassium-Sparing Diuretics (Direct Aldosterone Antagonists): Ineffective when used on patients with

A

Addison’s Disease

82
Q

Potassium-Sparing Diuretics (Indirect-Acting Aldosterone Antagonists): work by

A

Blocking the Na⁺ transport channels affected by

aldosterone rather than aldosterone itself.

83
Q

Potassium-Sparing Diuretics (Indirect-Acting Aldosterone Antagonists): VERY similar to direct aldosterone
antagonists except they

A

can be used in Addison’s Disease patients

84
Q

Potassium-Sparing Diuretics (Indirect-Acting Aldosterone Antagonists): drug names

A

Triamterene (Dyrenium)

Amiloride

85
Q

Triamterene

A

(Dyrenium)

86
Q

5 Osmotic diuretics works by

A

Small non-metabolized molecules filtered through the glomerulus that osmotically carry water with them

87
Q

Osmotic Diuretics are given parenterally as they cause

A

severe diarrhea when given orally

88
Q

Mannitol very commonly given on bypass or added to the

A

prime solution

89
Q

Osmotic diuretics work in the

A

proximal tubule and the descending Loop of Henle

which permit the free passage of H₂O

90
Q

Osmotic diuretics are Commonly used to “draw” fluid into the

A

intravascular space and decrease interstitial edema but… its controversial

91
Q

Osmotic diuretics are used to maintain urine flow following

A

acute renal injury

92
Q

Osmotic diuretics are used to decrease

A

cerebral edema

93
Q

Osmotic diuretics are Problematic in patients with

A

oliguric/anuric renal failure

94
Q

Osmotic diuretics: When in doubt a “test dose” is given prior to administration. -If urine output is

A

<50ml/hour for three hours after a 12.5 gram IV dose, AVOID.

95
Q

Osmotic diuretic drug name

A

Mannitol (Osmitrol)

96
Q

Mannitol

A

(Osmitrol)

97
Q

Mannitol (Osmitrol) is a

A

small molecule categorized as a “sugar alcohol”

98
Q

Mannitol is usually supplied as a

A

20% solution

99
Q

RULE #1 when giving mannitol:

A

Check the bag/bottle for precipitated crystals!!!!

100
Q

Mannitol is excreted (not metabolized) within

A

one hour, so repeat doses can be given

101
Q

Mannitol MUST be given slow IV or what will occur

A

profound transient hypotension will occur due to skeletal muscle vasodilation

102
Q

Mannitol Typical adult CPB priming and/or intraoperative dose is

A

12.5-25 grams

Pharm Exam 2 (9 decks)

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