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NURS 575 (Pharm) > Wk 12: Diuretics > Flashcards

Wk 12: Diuretics Flashcards

1
Q

Carbonic anhydrase inhibitors

Receptors

A

Carbonic anhydrase

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2
Q

Carbonic anhydrase inhibitors

Main site of action

A

Proximal convoluted tubule

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3
Q

Carbonic anhydrase inhibitors

Clinical uses

A

Altitude sickness
Glaucoma

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4
Q

Carbonic anhydrase inhibitors

Notable side effects

A

Metabolic acidosis

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5
Q

Loop diuretics

Receptors

A

Na-K-2Cl cotransport

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6
Q

Loop diuretics

Main site of action

A

Medullary thick ascending loop of Henle

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7
Q

Loop diuretics

Clinical uses

A

First-line diuretics in renal impairment

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8
Q

Loop diuretics

Notable side effects

A

Ototoxicity
Alkalosis
Hypokalemia

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9
Q

Thiazides

Receptor

A

Na-Cl cotransport

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10
Q

Thiazides

Main site of action

A

Cortical ascending loop of Henle

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11
Q

Thiazides

Clinical uses

A

First-line therapy of hypertension

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12
Q

Thiazides

Notable side effects

A

Alkalosis
Hypokalemia
Diabetes and dyslipidemia
Hyperuricemia

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13
Q

Osmotic diuretics

Receptors

A

N/A

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14
Q

Osmotic diuretics

Main site of action

A

Proximal convoluted tubule and loop of Henle

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15
Q

Osmotic diuretics

Clinical uses

A

Increased ICP
Oxygen free radical scavenging

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16
Q

Osmotic diuretics

Notable side effects

A

Volume overload in CHF
Hypokalemia
Hyponatremia
Hypomagnesemia

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17
Q

Potassium-sparing diuretics

Receptors

A

Endothelial Na channel

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18
Q

Potassium-sparing diuretics

Main site of action

A

Collecting duct

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19
Q

Potassium-sparing diuretics

Clinical uses

A

Adjuncts to loop diuretics or thiazides

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20
Q

Potassium-sparing diuretics

Notable side effects

A

Hyperkalemia

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21
Q

Aldosterone blockers

Receptors

A

NA-K-ATPase

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22
Q

Aldosterone blockers

Main site of action

A

Collecting duct

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23
Q

Aldosterone blockers

Clinical uses

A

HF with low EF

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24
Q

Aldosterone blockers

Notable side effects

A

Hyperkalemia

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25
Q

Dopamine and fenoldopam

Receptors

A

D1

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26
Q

Dopamine and fenoldopam

Main site of action

A

Proximal tubule and loop of Henle

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27
Q

Dopamine and fenoldopam

Clinical uses

A

Renal protection and hypertension treatment in critically ill patients

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28
Q

Dopamine and fenoldopam

Notable side effects

A

Effectiveness not substantiated

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29
Q

Brain natriuretic peptide

Receptors

A

Na-K-ATPase

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30
Q

Brain natriuretic peptide

Main site of action

A

Collecting duct

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31
Q

Brain natriuretic peptide

Clinical uses

A

Management of decompensated HF

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32
Q

Vasopressin

Receptor

A

V2

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33
Q

Vasopressin

Main site of action

A

Collecting duct

34
Q

Vasopressin

Clinical uses

A

SIADH
CHF
Cirrhosis

35
Q

Aquaporins

Receptor

36
Q

Aquaporins

Main site of action

A

Collecting duct

37
Q

Loop diuretics are first-line therapy in patients with fluid retention resulting from _______ _______

A

Heart failure

38
Q

Furosemide is effective when administered _____ or _______

A

orally
intravenously

39
Q

Furosemide

Absorption varies between patients from ___% to ____ %, with an average bioavailability of ___%

40
Q

Furosemide has a rapid onset, producing diuresis within ___ to ___ minutes of administration, with a peak effect at ___ mins and DOA of ___ to___ hours

A

5 to 10
30
2 to 6

41
Q

In patients with normal renal function, ____mg of IV Furosemide will produce maximal natriuresis

42
Q

___________ are the first line of treatment of hypertension in patients with renal insufficiency

A

Loop diuretics

43
Q

The antihypertensive effect of loop diuretics is due to effect on fluid ____ and _____

A

volume
salt

44
Q

Loop diuretics are commonly used in patients admitted with acute exacerbation of ________ ________

A

heart failure

45
Q

Furosemide ___________ intracranial pressure by inducing systemic diuresis and decreasing _________ production

A

decreases
CSF

46
Q

Furosemide can be administered as single-drug therapy (____to_____mg/kg IV) or as a lower dose (_____to_____mg/kg IV) in combination with _______

A

0.5-1.0mg/kg IV

0.1-0.3mg/kg IV

mannitol

47
Q

Combination of _________ and _______ is more effective in decreasing ICP than either drug alone but severe __________ and _________ ________ are also more likely

A

Furosemide
Mannitol

dehydration
electrolyte imbalances

48
Q

Side effects of loop diuretics most often manifest as abnormalities of _______ and ______ balance

A

fluid
electrolyte

49
Q

Loop diuretics SE (4)

A

Hypokalemia
Tolerance
Hypotension
Exacerbation of renal ischemic injury

50
Q

Loop diuretics side effects

Potential increased renal tissue concentrations of ___________ and enhances possible _________ effects of these ___________

A

antibiotics
nephrotoxic
antibiotics

51
Q

Loop diuretics side effects

Loop diuretics potentiate __________ __________ _________

A

nondepolarizing neuromuscular blockade

52
Q

Loop diuretics side effects

The renal clearance of ______ is decreased

53
Q

Loop diuretics side effects

_________, either transient or permanent, is a rare, dose-dependent complication associated with the use of loop diuretics

A

Ototoxicity

54
Q

Thiazide diuretics are most often administered for long-term treatment of _________ _______ in which the combination of ________, __________, and _______ are synergistic

A

essential hypertension

diuresis
natriuresis
vasodilation

55
Q

Thiazides are usually administered in combination with ________ _______

A

other antihypertensives

56
Q

Thiazide diuretics are readily absorbed when administered ______

57
Q

Hydrochlorothiazide has a ___% to ____% bioavailability

58
Q

Thiazides’ effectiveness markedly decreases in patients with _______ ______

A

renal insufficiency

59
Q

Thiazide diuretics have a long half-life of ____ to___ hours, allowing for a convenient once-a-day dosing

60
Q

Thiazide diuretics are recommended as first-line therapy for ________ ___________

A

essential hypertension

61
Q

The antihypertensive effect of Thiazide diuretics is due initially to a decrease in _________ _______ ______, often with a decrease in cardiac output, which normalizes after ______ weeks

A

extracellular fluid volume

several

62
Q

The sustained hypertensive effect of Thiazide diuretics is due to _________ _________, which requires _______ weeks to develop

A

peripheral vasodilation

several

63
Q

Side effects of Thiazide diuretics (7)

A

Hypokalemic, hypochloremic, metabolic alkalosis

Orthostatic hypotension (hypovolemia)

Cardiac dysrhythmias (hypokalemia or hypomagnesemia)

Potentiate nondepolarizing muscle relaxants (hypokalemia)

Promote lithium reabsorption (risk of lithium toxicity)

Glucose intolerance (Aggravate glucose control especially in combination with beta blockers)

Decrease efficacy in presence of NSAIDs

64
Q

Osmotic diuretics are _______ substances that do not undergo ______ and are filtered freely at the _______

A

inert
metabolism
glomerulus

65
Q

Osmotic diuretic examples (4)

A

Mannitol
Urea
Isosorbide
Glycerin

66
Q

Osmotic diuretic administration causes increased _______ and ________ ________ fluid osmolality, with resulting osmotic diuresis

A

plasma
renal tubular

67
Q

_________ is the only Osmotic diuretic in current use

68
Q

Structurally, mannitol is a ____-carbon sugar alcohol that does not undergo ________

A

six
metabolism

69
Q

After administration, mannitol is completely filtered at the _______, and none of the filtered drug is subsequently ________ from the renal tubules

A

glomeruli
reabsorbed

70
Q

By increasing tubular fluid osmolality, mannitol _______ water reabsorption and promotes _______ _______

A

decreases
water diuresis

71
Q

Mannitol is used primarily in the acute management of ______ _______ and in the treatment of _______

A

elevated ICP
glaucoma

72
Q

Mannitol decreases ICP by ________ plasma osmolarity, which draws water from tissues

A

increasing

73
Q

Mannitol begins to exert an effect within ___ to ___ minutes, with a peak effect at ___ to ___ minutes, and a duration of ____ hours

A

10 to 15 minutes
30 to 45 minutes
6 hours

74
Q

What is necessary for the cerebral effects of mannitol?

A

An intact blood-brain barrier

75
Q

If the blood-brain barrier is not intact, mannitol may enter the brain, drawing fluid with it and causing worsening of _______ ______

A

cerebral edema

76
Q

Increase in _______ may occur following mannitol use

A

ICP

(If BBB not intact)

77
Q

Mannitol has been used to prevent perioperative _____ _______ in the setting of ______ _______ ______

A

kidney failure
acute tubular necrosis

78
Q

Mannitol has free radical scavenging properties, which may protect ______ _______ following reperfusion

A

transplanted kidneys

79
Q

Despite its common use during cardiac and major vascular surgery for renal protection, mannitol has not been shown to prevent perioperative ______ _______ _______

A

acute renal failure

80
Q

The initial increase in intravascular volume associated with the administration of mannitol may be poorly tolerated in patients with _____ _______ ______, leading to _____ ______

A

left ventricular dysfunction
pulmonary edema

81
Q

________ may be the preferred drug for treatment of increased ICP in patients with left ventricular dysfunction

A

Furosemide

82
Q

Prolonged use of mannitol may cause (3)

A

Hypovolemia

Electrolyte imbalances with
hypokalemic hypochloremic
alkalosis

Plasma hyperosmolarity d/t
excessive secretion of water
and sodium

NURS 575 (Pharm) (20 decks)

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