Week 5 Diuretics / Reproductive cont.

Question 1

Loop Diuretics (e.g. Furosemide. Bumetanide, Torsemide)

Answer 1

• work in ascending Loop of Henle - block reabsorption of sodium and chloride, preventing water reabsorption - promote rapid diuresis even in severe renal impairment

Question 2

Loop Diuretics - Uses

Answer 2

• pulmonary edema - edema due to cardiac, liver or renal disease - hypertension - hypercalcemia

Question 3

Loop Diuretics - Complications

Answer 3

• hyponatremia, hypochloremia - hypomagnesemia, hypokalemia - hypotension - ototoxicity - hyperglycemia, hyperuricemia, hypocalcemia, hypomagnesemia - decreased HDL - increased LDL & cholesterol levels

Question 4

Loop Diuretics - Contraindications

Answer 4

• Digoxin - Lithium - ototoxic meds - NSAIDs - antihypertensives - pregnancy - anuria - caution with diabetes, cardiac disease, gout, dehydration or electrolyte issues

Question 5

Thiazide Diuretics (HCTZ, end in thiazide, metolazone)

Answer 5

• promote diuresis when renal function is intact - block reabsorption of sodium & chloride and inhibits water reabsorption - work in distal tubule of kidney

Question 6

Thiazide Diuretics - Use

Answer 6

• first line tx for essential hypertension - edema from mild to moderate liver or kidney impairment - often used with other blood pressure meds - promote reabsorption of calcium & reduce risk for osteoporosis in menopause

Question 7

Thiazide Diuretics - Complications

Answer 7

• dehydration - hyponatremia, hypokalemia, hypochloremia, hypomagnesemia - hyperglycemia, hyperuricemia - increased LDL levels - NO ototoxicity risks

Question 8

Thiazide Diuretics - Contraindications

Answer 8

• NO during pregnancy or breastfeeding - not for renal impairment - caution with diabetes, cardiac disease, gout, dehydration or electrolyte issues - use caution if patient is also taking: Digoxin, Lithium, ototoxic meds, NSAIDs, antihypertensives

Question 9

Potassium Sparing Diuretics (e.g. Spironolactone, Triamterene, Amiloride)

Answer 9

• block aldosterone, resulting in potassium retention, but excretion of water & sodium

Question 10

Potassium Sparing Diuretics - Uses

Answer 10

• combined with other diuretics for hypertension - heart failure - hyperaldosteronism - given orally

Question 11

Potassium Sparing Diuretics - Complications

Answer 11

• hyperkalemia - endocrine: deep voice, impotence, irregular menses - drowsiness, metabolic acidosis

Question 12

Potassium Sparing Diuretics - Interactions

Answer 12

• ACEs increase risk for hyperkalemia , as well as potassium supplements and salt substitutes

Question 13

Osmotic Diuretics (Mannitol)

Answer 13

• intracranial emergency from edema -> increased intraocular pressures -> rapid shift of fluid into vessels promoting diuresis

Question 14

Osmotic Diuretics - Complications

Answer 14

• heart failure - fluid overload - pulmonary edema - rebound increased intracranial pressure - fluid & electrolyte imbalance - metabolic acidosis

Question 15

Osmotic Diuretics - Contraindications

Answer 15

• NOT for intracranial bleeds - anuria - severe pulmonary edema - dehydration - renal failure - pregnancy & lactation

Question 16

Osmotic Diuretics - Interactions

Answer 16

• Lithium - Digoxin

Question 17

Erythropoietic Drugs (e.g. Epoetin Alfa, Darbepoetin) - Use

Answer 17

• anemia due to CKD, anemia pre-surgery, HIV/AIDS anemia, anemia secondary to meds - stimulates bone marrow to produce red blood cell development

Question 18

Erythropoietic Drugs - Complications

Answer 18

• hypertension - blood clot risk / MI / stroke / DVT - headaches, bone pain, muscle aches - NOT for pregnancy, hypertension or history of blood clots

Question 19

Estrogens (Estradiol) - Use

Answer 19

• contraception - menopause - osteoporosis - abnormal bleeding - prostate cancer

Question 20

Estrogens - Complications

Answer 20

• increased cancer risk - blood clots, especially with smoking - cautious use in cardiac patients - NOT for pregnancy / breastfeeding

Question 21

Estrogens - Interactions

Answer 21

• decreases anticoagulants’ effectiveness - phenytoin decreases estrogen effects - decreases effectiveness of oral hypoglycemics and thyroid meds - increases steroid effectiveness

Question 22

Androgens (Testosterone) - Use

Answer 22

• sperm maturation - increases sex development, skeletal muscle and synthesis of erythropoietin

Question 23

Androgens (Testosterone) Use

Answer 23

• hypogonadism, delayed puberty - replacement for testicular failure - anemia unresponsive to other tx - breast cancer - muscle wasting during caner or AIDS

Question 24

Androgens (Testosterone) - Complications

Answer 24

• facial hair, acne - irregular menses - deep voice - baldness - priapism, penile enlargement - reduction of height (epiphyseal plate) - hepatitis / jaundice - high cholesterol - prostate cancer - polycythemia - high potential for abuse - edema - hypercalcemia - hypoglycemia

Question 25

Androgens (Testosterone) - Contraindications

Answer 25

• NOT for pregnancy - breast or prostate cancer - severe cardiac, liver or kidney disease - caution with CHF, hypercalcemia or hypertension

Question 26

Androgens (Testosterone) - Interactions

Answer 26

• alters anticoagulants - affects insulin & oral antidiabetic drugs - increased risk for hepatotoxicity

Question 27

SERMS (Selective Estrogen Receptor Modulators), e.g. Raloxifene

Answer 27

• used for osteoporosis & breast cancer - controls bone loss, high cholesterol and coagulation

Question 28

SERMS (Selective Estrogen Receptor Modulators), e.g. Raloxifene - Complications

Answer 28

• DVTs - hot flashes - not for pregnancy or history of DVTs - 3 days before risk of blood clot (travel, surgery) - do NOT use with other estrogens

Question 29

5-Alpha Reductase Inhibitors (e.g. Finesteride, Minoxidil)

Answer 29

• decreases testosterone, shrinks prostate and grows hair - used for BPH & male pattern baldness

Question 30

5-Alpha Reductase Inhibitors (e.g. Finesteride, Minoxidil) - Complications

Answer 30

• decreased libido - gynecomastia - not for pregnancy or liver disease - DO NOT handle if pregnant or planning to become pregnant

Question 31

Alpha Blockers

Answer 31

• end in osin or zosin - vasodilator - used for BPH, urinary retention or frequency - complications: hypotension, dizziness, nasal congestion - not for liver failure or renal impairment - interacts with GI meds, ED drugs & nitrates

Question 32

Biphosphonates (e.g. Aldendronate)

Answer 32

• decreases bone loss - treats osteoporosis, Paget’s disease - risks: esophageal erosion / ulcers, GI upset, bone pain, vision changes, osteonecrosis of the jaw, kidney toxicity - interacts with calcium, iron, antacids, orange juice and caffeine - special instructions: must sit upright at least 30 - 60 minutes - take on empty stomach - drink at least 8 oz of fluid after - wait 30 minutes to take other meds

Question 33

Calcitonin (Calcitonin Salmon)

Answer 33

• inhibits osteoclasts in osteoporosis - treats osteoporosis and Paget’s - complications: nausea, dry nose or nasal irritation - NOT for pregnancy, allergy to salmon or fish - interacts with lithium - eat high calcium diet - alternate nostrils, store in fridge

Question 34

Phosphate Binders (e.g. Reangle, Renville, Phoslo)

Answer 34

• Phosphorus Binders (also called phosphate binders) prevent the body from absorbing phosphorus and help to pass excess phosphorus out of the body in the stool, reducing the amount of phosphorus that gets into the blood - usually phosphate binders are taken within 5 - 10 minutes before or with meals - normal phosphorus level is 3.0 - 5.5