C- Diuretics & RAAS Antagonists Flashcards Preview

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Flashcards in C- Diuretics & RAAS Antagonists Deck (34):
1

CO=

HR*SV

2

Increase Cardiac Output by increasing

Intropy
Heart Rate
Preload

3

Decrease CO by

Inc. Afterload

4

Specific Goals of Heart Failure Management with Pharmacotherapy

Reduction of congestion
Modulate neurohormonal activation
Improve flow

5

Used first as needed to reduce congestion
Reverse Na+ and fluid retention
Relieve volume overload: dyspnea peripheral edema
Lowers preload (LVEDP)

Diuretics

6

resulting in long-term stabilization, positive remodeling, and increased survival with RAAS antagonists and β-blockers

Modulate neurohormonal activation

7

Loop diuretics preferred because of ______- can augment with a thiazide diuretic

efficacy

8

may be difficult to accomplish pharmacotherapeutically with vasodilators and requires mechanical devices or transplantation

improve flow

9

ALDO--> Na+ sparing is the _______ but can cause K+ wasting

Major action

10

ALDO antagonists are ____ sparing

K+ sparing

11

fluid optimization with diuretics is a major part of heart failure therapy

Reduction of congestion

12

ALDO--> Na+ sparing is the major action but can cause ______

K+ wasting

13

ACE-ARB are ____ sparing

K+ sparing

14

Furosemide ______diructic

most common

15

Loop and thiazide are both ____ wasting

K+

16

#11: Hydrochlorothiazide
#14: Furosemide (Lasix®)
#42: HCTZ-Triamterene (Dyazide)
#70: Spironolactone (Aldactone®)

Important diuretics

17

most common diuretic

Furosemide

18

Interactions with membrane transport proteins
• Interactions with enzymes (acetazolamide) or hormone receptors (spironolactone)
• Osmotic effects preventing water reabsorption (mannitol)

Mechanisms of diuretics

19

Important diructics from top 200 list

#11: Hydrochlorothiazide
#14: Furosemide (Lasix®)
#42: HCTZ-Triamterene (Dyazide)
#70: Spironolactone (Aldactone®)

20

Most diuretics exert effects at __________ surface of renal tubule cells

luminal (urine)

21

Inhibit NaCl transport (Na+-K+-2Cl--transporter) in TAL - greatest efficacy due to large capacity of this segmen

Associated with increase in Mg++, Ca++ excretion (diminish lumen-positive potential)

Loop Diuretics

22

_________ diuretics act via inhibition of Na+-K+-ATPase

No, None, Nada

23

Diuretic agents decrease _________ at various sites in the nephron

Na+ reabsorption

24

In loop diuretics:
Handled by glomerular filtration and renal secretion (same organic acid transporter as uric acid)
Is the mechanism for?

Mechanism for hyperuricemia

25

Loop Diuretics
Use in Heart Failure

Used in HF patients with volume overload
Efficacy is enhanced with salt restriction
Furosemide most commonly used

26

Loop diuretics most _________ in HF

efficacious

27

Loop Diuretics
Adverse Reactions

Hypokalemic metabolic alkalosis
Hyperuricemia

28

Inhibit the Na+/Cl- cotransporter --> increased urinary excretion of NaCl
Modest diuretic effect since only 5-10% of filtered Na+ is reabsorbed here

Thiazide Diuretics

29

Thiazides ________ of Ca++ ( NOTE: loop diuretics decrease serum Ca++ levels)

increase reabsorption

30

Competitive antagonist at aldosterone receptor

Spironolactone

31

Vasodilation Salt / Water Excretion

ACE INHIBITORS / ANGIOTENSIN RECEPTOR BLOCKER

Adrenergic and RAAS blockers- REDUCE MORBIDITY AND IMPROVE SURVIVAL

32

Decreased Contractility
(May worsen symptoms)

BETA BLOCKERS

Adrenergic and RAAS blockers- REDUCE MORBIDITY AND IMPROVE SURVIVAL

33

Thiazides increase reabsorption of Ca++ ( NOTE: loop diuretics _________ Ca++ levels)

decrease serum

34

Salt / Water Excretion Potassium retention

ALDOSTERONE RECEPTOR BLOCKADE

Adrenergic and RAAS blockers- REDUCE MORBIDITY AND IMPROVE SURVIVAL