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Farmacologie > CURS 10 PART 1 DIURETICE/ANTIDIURETICE > Flashcards

CURS 10 PART 1 DIURETICE/ANTIDIURETICE Flashcards

1
Q

Diuretice inhibitore de anhidraza carbonica

  • Care sunt?
  • Mecanism?
A
  • Acetazolamida, Metazolamida, Diclorfenamida, Dorzolamida, Brinzolamida
  • inhiba anhidraza carbonica, blocarea formarii de bicarbonat si H+
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2
Q

Diuretice inhibitore de anhidraza carbonica

  • Efecte?
  • indicatii?
A
  • inhiba schimbul de H+, favorizeaza ramanerea Na in lumen, creste diureaza si eliminarea de bicarbonat, Na, apa
  • glaucom, hiperfosfatemie, alcaloza metabolica cronica, adjuvant in epilepsii, rau acut de inaltime, paralizie periodica hipokaliemica, boala peptica
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3
Q

Diuretice inhibitore de anhidraza carbonica

  • efecte adverse?
  • contraindicatii
A
  • toleranta rapida, deactii de hipersensibilitate, litiaza renala, eliminare renala de K, acidoza metabolica hiperkaliemica, (ameteli somn oboseala deprimare SNC)
  • ciroza hepatica
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4
Q

Diuretice de ansa

-clasificare

A
  • Furosemid + derivati : Bumetadina, Piretadina
  • Acid etacrinic + deriv: Indacrinona, Ticrinafen
  • deriv de sulfoniluree: Torsemid
  • diuretice mercuriale - nu se mai fol
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5
Q

Diuretice de ansa

-mecanism?

A
  • stimuleaza sinteza de prostaglandine vasodilatatoare: PGE1, PGE2, PGI2
  • inhiba contransportul de Na/K/2Cl
  • stimuleaza sinteza de renina
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6
Q

Diuretice de ansa

efecte?

A
  • rapide, intense, de scurta durata
  • vasodilatatie
  • creste filtrarea
  • diuretic, creste eliminarea de Na K Ca Cl Mg apa fosfati
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7
Q

Diuretice de ansa

indicatii?

A
  • Edeme de diverse etiologii ( macar 4 cauze)
  • HTA
  • Hipercalcemie
  • Tulburari hidroelectrolitice din intox cu bromuri ioduri fluoruri
  • Glaucom cine?
  • Guta cine?
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8
Q

Diuretice de ansa

-efecte adverse?

A
  • alcaloza metabolica
  • hiponatremie/kaliemie/calcemie etc
  • hiperglicemie si hiperuricemie
  • hipovolemie
  • greata/varsaturi
  • reactii imunologice
  • cresterea reninei
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9
Q

Diuretice de ansa

-contraindicatii

A
  • reactii de idiosincrazie si hipersensibilitate
  • deshidratari masive
  • neoplasm pulmonar
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10
Q

Diuretice cu structura tiazidica

-clasificare

A
  • benzotiadiazine: Hidroclorotiazida, Bendroflumetiazida, Clorotiazida, Benztiazida, Hidroflumetiazida, Ciclotiazida
  • analogi/variante: Indapamida, Metolazona, Clopamida, Xipamid, Clortalidona
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11
Q

Diuretice cu structura tiazidica

-mecanism?

A

inhiba cotransportul de Na/Cl, deci inhiba reabsorbtia de NaCl in segm proximale ale tubului contort distal, ascendent Henle, ultima parte a tubului proximal

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12
Q

Diuretice cu structura tiazidica

-farmacodinamie?

A
  • diuretic
  • retentie de acid uric, Ca
  • hiperglicemie, hiperlipidemie
  • Indapamida are si efect vasodilatator, prezinta efectul primului pasaj hepatic si are excretie primara biliara
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13
Q

Diuretice cu structura tiazidica

-indicatii?

A
  • HTA
  • insuficienta cardiaca
  • hipercalcemie idiopatica
  • nefrolitiaza prin hipercalcemie
  • insuf renala cu clearance peste 30
  • diabet nefrogen insipid indus de litiu
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14
Q

Diuretice cu structura tiazidica

-contraindicatii?

A
  • diabet zaharat
  • IC + insuf renala
  • ciroza + insuf renala
  • insuf renala: exceptie Indapamida
  • Guta, saroidoza
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15
Q

Diuretice cu structura tiazidica

-efecte adverse

A
  • alcaloza
  • astenie, parestezii
  • hiponatremie, hipokaliemie
  • hipercalcemie, hiperfosfaturie
  • hiperuricemie
  • hiperglicemie, glicozurie, hiperlipidemie
  • creste rezistenta la insulina
  • litiaza urinara
  • impotenta sexuala
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16
Q

Diuretica care “economisesc” potasiul

Clasificare?

A
  • antagonisti competitivi ai receptorilor pentru aldosteron:
    • neselectivi: Spironolactona si Prorenona
    • selectiv: Eplerenona
  • antagonisti fizologici ai aldosteronului: Amilorid si Triamteren
17
Q

Diuretica care “economisesc” potasiul

-mecanism?

A
  • cei competitivi: inhiba Na/K ATP-aza

- cei fiziologici: inhiba direct transportul de Na in tubii renali

18
Q

Diuretica care “economisesc” potasiul

-Efecte farmacodinamice

A

-stimularea reabsorbtiei de K si H
-cresterea eliminarii de Na, Cl, bicarbonat, apa
-efect antifibrozant
-efecte antiandrogenice
Spironolactona, Prorerona si Eplererona au efecte de durata lunga

19
Q

Diuretica care “economisesc” potasiul

-indicatii?

A
  • IC
  • hipokaliemie
  • ciroza
  • sindrom nefrotic
  • hiperaldosteronism
  • Spironolactona in IC congestiva
20
Q

Diuretica care “economisesc” potasiul

-efecte adverse?

A
  • hiperK si hipoNa
  • acidoza metabolica
  • Spironolactona: ginecomastie, tulburari menstruale, impotenta, hiperplazie benigna de prostata
  • Triamteren: anemie megaloblastica la pacientii cu ciroza
  • Amilorid: hiperamonemie, alterarea tolerantei la glucoza
21
Q

Diuretica care “economisesc” potasiul

-contraindicatii

A
  • acidoza metabolica
  • hiperpotasemie
  • IR
  • alaptare
  • sindrom hepato-renal
22
Q

Diuretice care influenteaza excretia apei

-care sunt?

A

Manitol ( cel mai eficient) , uree+glicerol ( mai putin eficiente deoarece pot strabate membranele celulare) , glucoza, zaharoza, sucroza
- Se administreaza numai intravenos

23
Q

Diuretice care influenteaza excretia apei

  • mecanism?
  • efecte?
A
  • cresterea presiunii osmotice in lumenul vascular si lumenul nefronului
  • creste filtrarea glumerulara si eliminarea apei K apa bicarbonat fosfat Ca Mg
24
Q

Diuretice care influenteaza excretia apei

- indicatii?

A
  • reducerea presiunii intracraniene si intraoculara
  • cresterea volumului urinar
  • in caz de hipersecretie de ADH
25
Q

Diuretice care influenteaza excretia apei

-efecte adverse?

A
  • cresterea volumului tranzitorie
  • hipernatremie tranzitorie
  • deshidratare celulara
26
Q

Ce determina interactiunea:

  • diuretice tiazidica + de ansa?
  • Diuretice de ansa?
A
  • creste toxicitatea digitalicelor

- risc de hemoragii + creste toxicitatea litiului

27
Q

Ce determina interactiunea:

  • beta-blocante + diuretice tiazidice?
  • Clorpropamida + diuretice tiazidice?
A
  • accentuarea unei dislipidemii

- hiponatremie

28
Q

Ce determina interactiunea:

  • Aminoglicozide - diuretice de ansa?
  • Fluorochinolone + diuretice de ansa?
A
  • risc de ototoxicitate

- risc de condrotoxicitate

29
Q

Medicamente care modifica pH-ul?

A

cresc: citrat de Na sau K si bicarbonat de Na
scad: clorura de amoniu

30
Q

Vasopresina

  • mecanism
  • efecte?
A
  • agonist al receptorilor V1 V2 V2-like

- vasopresor (V1), antidiuretic (V2), eliberare de factori VIIIc si von Willebrand (V2-like)

31
Q

Desmopresina

  • mecanism
  • efecte?
A
  • agonist selectiv V2

- antidiuretic

32
Q

Vasopresina si Desmopresina

-efecte adverse?

A

-greata, varsaturi, cresteri tensionale, dureri abdominale, alergii tip 1, cefalee, hiponatremii severe

33
Q

Vasopresina

  • indicatii
  • contraindicatii
A 
indicatii
-diabet insipid
-enurezis
-hemoragii digestive superioare
-refacerea capacitatii renale in terapie cu litiu
-hemofilie A, boala von Willebrand
contraindicatii
-HTA, leziuni coronariene, insuf renala avansata
34
Q

Desmopresina
indicatii?
contraindicatii?

A
  • diabet de cauza hipofizara/ enurezis

- leziuni coronariene, sarcina

Farmacologie (10 decks)

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