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PRE-REG-Thuri > CVD- OEDEMA + VASCULAR DISEASE > Flashcards

CVD- OEDEMA + VASCULAR DISEASE Flashcards

1
Q

What is oedema?

A

Condition causing fluid buildup

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2
Q

When to use diuretics?

A

In the morning

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2
Q

What are 6 drug classes used to treat oedema?

A
  1. Loop diuretics
  2. Thiazide
  3. Aldosterone antagonist
  4. Potassium sparing

5.Osmotic

  1. Carbonic anhydrase inhibitor
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3
Q

List 3 loop diuretics?

A

Bumetanide

Furosemide

Torasemide

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4
Q

What is most potent loop diuretic?

A

Bumetanide

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5
Q

Which loop diuretic increases risk of gout?

A

furosemide

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6
Q

which loop diuretic can cause musculoskeletal pain?

A

Torasemide

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7
Q

List 6 thiazide diuretics?

A

Bendroflumethiazide

Hydrochlorothiazide

Chlortalidone

Indapamide

Metolazone

Xipamide

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8
Q

What thiazide diuretic can cause risk of skin cancer?

A

Hydrochlorothiazide

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9
Q

What thiazide diuretic is used in severe renal impairment?

A

Metolazone

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9
Q

Which thiazide diuretic has a long half life?

A

Chlortalidone

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10
Q

What is a risk of using Metolazone?

A

Be careful switching brands - different bioavailabilities

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11
Q

What thiazide diuretic has less aggravation of diabetes?

A

Indapamide

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12
Q

What is gravitational oedema?

A

Fluid pools in the lower parts of the body

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13
Q

Who does gravitational oedema occur more in?

A

Elderly

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14
Q

What to give if gravitational oedema?

A

Low dose diuretic (short term)

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15
Q

What are 2 aldosterone antagonists?

A

Spironolactone

Eplerenone

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16
Q

What is spironolactone also used in?

A

Liver ascites

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17
Q

When is eplerenone also used for?

A

Post acute MI

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18
Q

What are 2 potassium sparing diuretics?

A

Amloride

Triamterene

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19
Q

What diuretic causes blue urine?

A

Triamterene

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20
Q

What is 1 osmotic diuretic?

A

Mannitol

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21
Q

What other 2 indications is mannitol used in?

A

Cerebral oedema

Raised Intra-ocular pressure

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22
Q

Name 3 carbonic anhydrase inhibitors?

A

Acetazolamide

Brinzolamide

Dorzolamide

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23
Q

Name an oral carbonic anhydrase inhibitor?

A

Acetazolamide

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24
Q

What are carbonic anhydrase inhibitors also used for?

A

Glaucoma

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25
Q

What is MOA of diuretic?

A

Increase urine output by kidneys by blocking sodium reabsorption at different segments of the nephron.

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26
Q

What can excess diuresis cause?

A

HypOtension

HypOvolemia

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27
Q

What to do with diuretic on sick days?

A

STOP meds

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28
Q

What is MOA of loop diuretic?

A

Blocks the Na+/K+/CL- co-transporter on ascending limb of lop of henle

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29
Q

What is onset of loop diuretics?

A

act in 1 hr of administration

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30
Q

Which cases do we need to separate the doses of loop diuretics from other drug? (ALOUD)

A

Amino-glycosides- separate both

Low Na+/K+/CL-/Mg2+/Ca2+

Ototoxicity

Urinary retention

Diabetes + gout (increases this)

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31
Q

What is 2 indications of loop diuretics?

A

Heart failure

Resistant hypertension

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32
Q

What is a caution of loop diuretics?

A

Exacerbates diabetes(less likely compared to thiazides) + gout

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33
Q

What are 2 SE of loop diuretics?

A

Ototoxicity

Acute urinary retention

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34
Q

What class drug does loop diuretics interact with to increase ototoxicity?

A

Aminoglycosides e.g. gentamicin

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35
Q

How to overcome ototoxicity between loop diuretics + aminoglycosides?

A

Separate doses by long period

36
Q

What is an MOA of thiazides?

A

Blocks Na+/CL- transporter on proximal distal convouted tubule.

37
Q

What is onset of thiazides?

A

1-2 hrs

38
Q

What is duration of thiazides?

A

12-14 hrs

39
Q

What are 2 indications of Thiazide diuretics?

A

HF

Hypertension

40
Q

Can thiazides be used in renal impairment?

A

Ineffective if severe

Except metolazone

41
Q

What is the ONLY diuretic that can be used in RI?

A

Metolazone

42
Q

What is a caution of thiazide diuretics?

A

exacerbates diabetes + gout

43
Q

What are 4 side effects of thiazide diuretics? (SIGH)

A

Skin reactions

Impotences

GI disturbances

High LDL cholesterol

44
Q

What is an MHRA warning regarding thiazide diuretics?

A

Risk of non-melanoma skin cancer in long term use of hydrochlorothiazide

45
Q

What is the thiazide drug with skin cancer MHRA warning?

A

hydrochlorothiazide

46
Q

How to counsel patient taking hydrochlorothiazide on MHRA warning on skin cancer risk?

A

Report new/ changed skin lesions.

Regular checks- limit sun + UV exposure.

Use enough sun protection

47
Q

What drug interacts with loop + thiazide diuretics to cause hypOkalaemia?

A

Digoxin = toxicity

48
Q

What happens when digoxin + loop/thiazide diuretics taken?

A

Increase risk of hypOkalaemia

49
Q

What drug causes hypOnatraemia with loop/ thiazide diuretics?

A

Lithium

50
Q

What 8 drug classes interact with loop/ thiazide diuretic to cause hypotension?

A

Anti-hypertensives

Anti-depressants

Anti-parkinson drug

Antipsychotics

Other diuretics

Nitrates

Phosphodiesterase type 5 inhibitors

SGL-2 inhibitors

51
Q

What diabetic drug can cause hypotension when given with diuretics?

A

SGL-2 inhibitors E.G. CANAGLIFLOZIN

52
Q

What drug can cause AKI with thiazides?

A

NSAIDS

53
Q

What is MOA of K+ sparing diuretics?

A

Keeps K+
Blocks Sodium channels in late distal convoluted tubule to collecting duct.

54
Q

What is indication of K+ sparing diuretics?

A

Potassium conservation with loop/ thiazides

55
Q

Why is K+ sparing diuretics used?

A

Preferred over supplements

56
Q

What is 2 big SE of K+ sparing diuretics?

A

HypERkalaemia

HypOnatraemia

57
Q

What K+ sparing diuretics causes blue urine?

A

Triameterene

58
Q

What is an interaction of K+ sparing diuretics?

A

Increase risk of HypERkalaemia

59
Q

What 6 drug classes increase K+ risk?

A

ACEi/ ARB

Aldosterone antagonist

Heparin

NSAID

potassium supplement

Trimethoprim

60
Q

What is MOA of aldosterone antagonist?

A

Blocks aldosterone
Acts on Na+ channels from late convoluted tubule to collecting duct.

61
Q

What is indication of aldosterone antagonist?

A

Adjunct HF

Resistant HTN, Liver ascites

62
Q

What specific aldosterone antagonist is used for liver ascites?

A

Spironolactone

63
Q

What are 2 big SE of aldosterone antagonists?

A

HypERkalaemia

HypOnataemia

64
Q

What 3 hormonal SE is associated with Aldosterone antagonist use?

A

Gynaecomastia

Libido changes

Menstrual disturbances

65
Q

What 2 SE is linked to spironolactone use?

A

Benign breast tumours, hypertrichosis.

66
Q

What 5 drug classes increase hyperkalaemia with aldosterone antagonists?

A

ACEi/ARB, K+, NSAID, trimethoprim

67
Q

What is vascular disease?

A

Peripheral vascular disease is either occlusive or vasospastic

68
Q

2 categories of vascular disease?

A

Occlusive

Vasospastic

69
Q

What is the 1st line drug treatment of peripheral arterial disease?

A

If exercise does not work.

Naftidrofuryl

70
Q

What is 2nd line drug treatment of peripheral arterial disease?

A

cilostazol OR pentoxifylline.

71
Q

What is cilostazol used for?

A

intermittent claudication (calf pain)

72
Q

What 2 drugs are used as secondary prevention of PAD?

A

High intensity statin

Low dose asprin

73
Q

What is treatment if patient is vasospastic e.g. raynauds syndrome?

A

Nifedipine

74
Q

What are 2 lifestyle things to stop PAD?

A

Stop smoking

Avoid cold + stress

75
Q

What is occlusive PAD?

A

blockage of peripheral arteries is caused by atherosclerosis

76
Q

What is Vasospastic PAD?

A

small blood vessels near the surface of the skin have spasms that limit blood flow

77
Q

What condition is an example of Vasospastic PAD?

A

Raynaud’s syndrome

78
Q

What 3 drugs are licensed in management of Raynaud’s syndrome?

A

Naftidrofuryl + prazosin

Nifedipine - prophylaxis

79
Q

List 3 thiazide like diuretics?

A

Chlortalidone

Indapamide

Metolazone

80
Q

When to give thiazide diuretics in the day?

A

Given early to prevent sleep disturbances- lasts 24 hrs

81
Q

MOA of loop diuretics?

A

Inhibit reabsorption from ascending loop of henle.

82
Q

Indication of loop diuretics?

A

pulmonary oedema due to left ventricular failure + Chronic HF

83
Q

Loop diuretic duration of action?

A

lasts 6 hrs -= given 2 times day

84
Q

What diuretic class to stop if person dehydrated due to vomiting + diarrhoea?

A

Aldosterone antagonists

85
Q

What 2 electrolyte imbalances do all diuretics cause?

A

Hyponatremia

hypomagnesia

86
Q

What condition does loop diuretics increase?

A

gout

87
Q

spironolactone + lithium?

A

increases lithium toxicity

88
Q

What 2 things does loop diuretics + aminoglycosides cause?

A

nephrotoxicity

ototoxicity

PRE-REG-Thuri (44 decks)

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