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pharm exam 2 > Topic 8 Diuretics > Flashcards

Topic 8 Diuretics Flashcards

1
Q

Diuretics Common uses?

A

Congestive Heart Failure
Hepatic Ascites
Nephrotic Syndrome
HTN

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2
Q

Diuretic Categories (4)

A

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

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3
Q

Carbonic Anhydrase Inhibitors work how?

A

Work by inhibiting carbonic anhydrase in the proximal tubule epithelium

CA is a catalyst for the reaction CO2 + H2O = H3CO2 + H. With CA blocked, the reaction shifts to the right and bicarbonate accumulates in the urine

Na is less able to be exchanged for H⁺ in the tubules so H⁺ is retained while Na⁺ is lost (with the bicarb)
*Sooo…urine becomes more alkaline (explain), water follows the bicarbonate into the tubules (causing diuresis) and the patient
experiences a metabolic acidosis (explain again)

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4
Q

Acetazolamide

A

Diamox

Carbonic Anhydrase Inhibitor

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5
Q

Acetazolamide (Diamox) typically seen in patients with what?

A

glaucoma and high elevation sickness

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6
Q

Carbonic Anhydrase Inhibitors used on bypass?

A

RARELY

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7
Q

Loop Diuretics act on what?

A

Act on the ascending Loop of Henle

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8
Q

Loop Diuretics are also called what?

A

“High Ceiling” diuretics because the dose-response curve is close to linear (that is, there’s no “ceiling”)

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9
Q

How do Loop Diuretics work?

A

Loop diuretics work by blocking the co-transport of Na⁺/K⁺/2Cl ̄ from the tubular lumen back into circulation.
So much NaCl is not reabsorbed that downstream nephron sites can not compensate for that loss

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10
Q

MOST efficacious of all diuretics?1

A

Loop Diuretics

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11
Q

Loop Diuretics are also called what?

A

“yellow zipper” “Non-Potassium-Sparing”

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12
Q

Loop Diuretics do what to RBF?

A

increase renal blood flow by inducing the expression of COX-2

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13
Q

COX-2?

A

COX-2 is referred to as the “ungood” cyclooxygenase NSAIDS preferentially block in inflamed tissues

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14
Q

NSAID

A

Nonsteroidal anti-inflammatory drugs

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15
Q

Cyclooxygenases help produce

A

prostaglandins which are powerful vasodilators of renal arteries

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16
Q

generally the diuretic of choice even in patients with compromised renal function

A

Loop Diuretics

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17
Q

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

A

Loop Diuretics

Because they are fast-acting and incredibly efficacious
KNOW

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18
Q

Loop Diuretics are also used with what to elevated levels?

A

for hypercalcemia and hyperkalemia

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19
Q

Loop Diuretics Perfusion use (3)?

A

1)Get rid of extra fluid on bypass Chemical “ hemoconcentrators”
2)Get rid of excess K⁺ (norm 3.5-5mEq/l)
3) Help maintain urine production/renal
function (**!!!) in low output states on bypass

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20
Q

Recent evidence suggests giving
loop diuretics simply to keep urine
flowing and thus ‘help’ the kidneys
is what?

A

NOT appropriate and may be deleterious in the long run!

but still used

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21
Q

Loop Diuretics Side effects?

A

Ototoxitcity, Hypotension, Hypomagnesemia, hyperuricemia, hypokalemia

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22
Q

Ototoxicity caused by Loop Diuretics seen particularly when ?

A

when used with aminoglycoside antibiotics

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23
Q

Furosemide

A

Lasix

Loop Diuretic

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24
Q

Ethacrynic acid

A

Edecrin

Loop Diuretic

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25
Q

Furosemide (lasix) Positives? (4)

A

Very commonly used during and peri-bypass.
Very inexpensive
Has been used forever
Wide margin of safety/therapeutic window
therefore the potential for “We always put some lasix in the pump” mentality

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26
Q

Furosemide (lasix) duration of action

A

2 hours when given IV/on pump

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27
Q

Furosemide (lasix) Typical adult dose?

A

Typical adult pump dose is 2.5-5.0 mg (20-40 mg bolus if the patient’s receiving chronic diuretic therapy)

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28
Q

Ethacrynic acid (Edecrin)

A

Less commonly used than furosemide

Greater potential for oxotoxicity

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29
Q

Bumetanide

A

Bumex

Loop Diuretic less frequently used

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30
Q

Torsemide

A

Demadex

Loop Diuretic less frequently used

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31
Q

Thiazide Diuretics act where?

A

Act on the cortical region of the ascending loop of Henle

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32
Q

Thiazide Diuretics are also commonly called

A

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

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33
Q

Thiazide Diuretics work how?

A

Thiazide diuretics work blocking Na⁺/Cl- transport/reabsorption on the luminal side of the thick part of the Ascending Loop of Henle and the Distal Convoluted Tubule.
-Consequently, NaCl concentrates in the tubular fluid (and H₂O obediently follows = ⬆️urine production)

34
Q

Thiazide Diuretics lose efficacy in what kind of patients ?

A

so thiazides lose efficacy in patients with decreased renal function
(bc thiazides have to actually get into the tubular lumens via renal excretion)

35
Q

Thiazide Diuretics do what to RBF?

A

increases renal blood flow through COX-2 inducement of prostaglandin synthesis

36
Q

Chlorothiazide

A

The original diuretic used for edema.

*Chlorothiazide is the only thiazide available for parenteral use (of relevance to you!)

37
Q

the only thiazide available for parenteral use

A

Chlorothiazide

38
Q

Chlorothiazide typical adult dose

A

*Typical adult pump dose is 500mg

39
Q

Are Thiazide Diuretics Potassium sparing?

A

not “Potassium sparing”

40
Q

Thiazide Diuretics Perfusion Uses?

A

get rid of extra (edema) fluid and potassium.

⬇️systemic vascular resistance due to relaxation of arteriolar smooth muscle

41
Q

Thiazides promote the reabsorption of what?

A

calcium

42
Q

Thiazide Diuretics long term use does what?

A

long-term use results in significantly less decrease in bone density (hip fractures are ⬇️ by 1/3rd)

43
Q

Thiazide Diuretics can cause production of what?

A

Since thiazides can (uniquely) cause the production of hyperosmolar urine it’s used in diabetes insipidus

44
Q

Chlorothiazide

A

Diuril

Thiazide Diuretic

45
Q

Hydrochlorothiazide

A

HCTZ, Microzide

Thiazide Diuretic

46
Q

Hydrochlorothiazide administration and effects

A

more potent but has the same efficacy and is not given parenterally
-Use in fixed combinations for Rx of HTN

47
Q

Hyzaar=

A

HCTZ + Losartan

48
Q

Chlorthalidone

A

Hygroton

Commonly used to treat HTN, Thiazide-like Diuretic

49
Q

Indapamide

A

Lozol

50
Q

Indapamide (Lozol) usefull in what patients ?

A

Partially excreted by the GI tract, so useful in advanced renal failure

51
Q

Metolazone

A

Zaroxolyn

Thiazide-like Diuretics

52
Q

Potassium-Sparing Diuretics do what?

A

Function in the collecting tubules (ducts) to

prevent Na⁺ reabsorption and K⁺ excretion.

53
Q

Potassium Sparing Diuretics antagonize what?

A

Antagonize aldosterone

54
Q

G in GFR layer?

A

G = mineralocorticoids (aldosterone)

55
Q

F in GFR layer

A

glucocorticoids (cortisol)

56
Q

R in GFR layer?

A

androgens (testosterone precursors)

57
Q

Potassium Sparing Diuretics used with? for?

A

Used to treat HTN, often in combination Diuril or hydrochlorothiazide

58
Q

Potassium Sparing Diuretics efficacy compared to non-potassium sparing alt?

A

Significantly less efficacious than its non-potassium-sparing alternatives

59
Q

Potassium Sparing Diuretics problematic with what patients ?

A

patients with hyperkalemia

60
Q

Spironolactone

A

Aldactone

Direct Aldosterone Antagonists/Potassium Sparing Diuretics

61
Q

Eplerenone

A

Inspra

Direct Aldosterone Antagonists/Potassium Sparing Diuretics

62
Q

Direct Aldosterone Antagonists/Potassium Sparing Diuretics resemble what?

A

Resemble sex steroids chemically

63
Q

Direct Aldosterone Antagonists/Potassium Sparing Diuretics used with what condition?

A

Used as adjunctive therapy in heart failure
–Statistically decreases mortality and helps
prevent pathological “remodeling” of the heart

64
Q

Direct Aldosterone Antagonists/Potassium Sparing Diuretics Drug of choice for liver failure patients with edema?

A

Spironolactone is the diuretic of choice

for liver failure patients with edema

65
Q

Direct Aldosterone Antagonists/Potassium Sparing Diuretics are ineffective in what patients?

A

Addison’s Disease

66
Q

Potassium-Sparing Diuretics :

Indirect-Acting Aldosterone Antagonists how do they work?

A

Block the Na⁺ transport channels affected by

aldosterone rather than aldosterone itself.

67
Q

What patients Indirect Acting Aldosterine Antagonists can work on that Direct can’t?

A

Addison’s Disease pt

68
Q

Indirect Acting Aldosterone Antagonist Drugs? (2)

A

Triamterene (Dyrenium)

Amiloride

69
Q

Triamterene

A

Dyrenium

Potassium-Sparing Diuretics :Indirect-Acting Aldosterone Antagonist

70
Q

Osmotic Diuretics what?

A

Small non-metabolized molecules filtered

through the glomerulus that osmotically carry water with them

71
Q

Osmotic Diuretics - how to administer

A

Given parenterally as they cause severe diarrhea if given orally

72
Q

Mannitol

A

Osmitrol

Osmotic Diuretic used often in prime

73
Q

Osmotic Diuretics work where?

A

Work in the proximal tubule and the

descending Loop of Henle which permit the free passage of H₂O

74
Q

Osmotic Diuretics Perfusion relevance ? (4)

A

Commonly used to “draw” fluid into the
intravascular space and decrease interstitial
edema but…
Used to maintain urine flow following acute
renal injury
Used to decrease cerebral edema
Problematic in patients with oliguric/anuric renal failure
When in doubt a “test dose” is given prior to
administration

75
Q

Osmotic Diuretics dosages

A

If urine output is <50ml/hour for three

hours after a 12.5 gram IV dose, AVOID

76
Q

Mannitol (Osmitrol)

A

is a small molecule categorized as a “sugar alcohol”

Osmotic Diuretic

77
Q

Mannitol (Osmitrol) usually what solution

A

a 20% solution

78
Q

Mannitol number 1 rule

A

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

79
Q

Mannitol administration ? excretion?

A

Mannitol is excreted (not metabolized) within
one hour, so repeat doses can be given.
-MUST be given slow IV or profound transient
hypotension will occur due to skeletal muscle vasodilation

80
Q

Mannitol (Osmitrol) typical adult CPB priming dose

A

Typical adult CPB priming and/or intraoperative dose is 12.5-25 grams.

pharm exam 2 (9 decks)

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