Ch. 20- Volume Regulation Flashcards
(23 cards)
Renin Inhibitor: inhibits renin–> decreses conversion of Angiotensinogen to angiotensin I–> decreased ACE & decreased NaCl reabsorption
Aliskiren
ACE Inhibitors- inhibits conversion of AT I to AT II
Captopril (active drug), Enalapril (prodrug), Ramipril (prodrug), Benazepril, Fosinopril, Moexipril, Perindopril, Quinapril, Trandolapril, Lisinopril (excreted unchanged)
AR & Contraindication of ACE inhbitors
angioedema, cough, hyperkalemia, Pregnancy
Angiotensin II Receptor Antagonist- Antag. Angiotensin II at AT1 receptor
Candesartan, Irbesartan, Losartan, Telmisartan, Valsartan
B-Type Natriuretic Peptide (BNP)- increases intracellular concentrations of cGMP by binding Guanylyl cyclase receptor NPR-A of vascular smooth muscle–>sm. Muscle relaxation
Nesiritide (BNP)
Use of BNP
Acute decompensated Heart failure
Vasopressin Receptor 2 (V2) antagonists (@ collecting duct)- prevents vasopressin-stimulated water reabsorption via V2-aquaporin channels in CD
Convaptan (IV), Tolvaptan (Oral)
Use of V2 antagonist
SIADH, cirrhotic asciteds, ADPKD
Carbonic Anhydrase Inhbitors- Inhib. Na & HCO3- reabsorption by inhib. Prox.-tubule carbonic anhydrase II and luminal IV
Acetazolamide
Use for Carbonic Anhydrase Inhibitors
High altitude sickness, Heart Failure, Glaucoma, Epilepsy
considerations of Acetazolamide
Metabolic Acidosis; ASA increases Acetazolamide= CNS toxicity
Osmotic Diuretics- filters and NOT reabsorbed= osmotic force pulling H2O out
Mannitol
Uses for osmotic diuretics
Cerebral Edema,
consideration for mannitol
careful monitoring of volume status
Loop Diuretics- Inhbit Na reabsorption by inhbiiting NKCC2 in luminal membrane of cells in TAL of loop of henle
Furosemide, Bumetanide, Torsemide, Ethacrynic Acid (use for allergy to sulfa; Toxic: cuase hyperuricemia)
Considerations for Loop Diuretics
Bumetanide- 40x more potent, Loops are first line for acute relief of pulm. Edema in CHF
Uses for loops
HTN, Acute pulm. Edema, CHF associated edema, Hypercalcemia, Hyperkalemia
AR of loops
Ototoxicity, hypokalemia, dehydration, allergy (sulfa), Nephritis, Gout, Hypocalcemia, met. alkalosis, arrhythmias, low K+
Inhib. NaCl reabsorption by acting as antagonist at NCC co-transport in distal convoluted tubule; promotes increased Ca reabsorption
HCTZ, Bendroflumethiazide, Hydroflumethiazide, Polythiazide, Chlorthalidone, Metolazone, Indapamide
Uses/considerations/AR for thiazides
HTN, CHF edema; can unmask DM; hypokalemic met. alkalosis, hyperglycemia, hyperlipidemia, hyperuricemia, hypercalcemia, sulfa allergy
Collecting duct (K+ sparing)- inhib. Aldosterone by binding to and preventing translocation of mineralcorticoid receptor; competitively inhib. Principal cell apical membrane on ENaC sodium channel
Spironolactone, Eplerenone, Amiloride, Triamterene
Use for K+ sparing diuretics
HTN, CHF edema, liver cirrhosis; HTN, Liddle’s syndrome (mendelian form of HTN)
AR of K+ sparing
Hyperkalemia (lead to arrhythmia), gynecomastia (antiandrogen effects)
