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Pharmocology > CH 35 DIURETICS > Flashcards

CH 35 DIURETICS Flashcards

1
Q

basic functional unit of kidney

A

nephron

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2
Q

Three basic functions of kidney

A

Cleansing of extracellular fluid (ECF) and maintenance of ECF volume and composition
Maintenance of acid-base balance
Excretion of metabolic wastes and foreign substances

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3
Q

3 basic renal processes

A
  1. filtration- occurs at glomerulus
  2. reabsorption
  3. active tubular secretion
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4
Q

Processes of reabsorption that occur at specific sites along the nephron

A 
Proximal convoluted tubule
Loop of Henle
Distal convoluted tubule (early segment)
Late distal convoluted tubule and collecting duct (distal nephron)
Sodium-potassium exchange
Regulation of urine concentration
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5
Q

HOW DIURETICS WORK

A

BLOCKS NA AND CL REABSORPTION

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6
Q

Classifications of diuretics

A 
Loop: Furosemide
Thiazide: Hydrochlorothiazide
Osmotic: Mannitol--- NOT PAYING ATTENTION TO FOR TEST
Potassium-sparing: Two subcategories
Aldosterone antagonists (spironolactone)
Nonaldosterone antagonists (triamterene)
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7
Q

Lasix mechanism of action

A

acts on ascending loop of henle to block reabsorption

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8
Q

Lasix pharmacokinetics

A

rapid onset
po 60 min
IV 5 min

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9
Q

Lasix uses

A
  1. pulmonary edema
  2. edema
  3. HTN
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10
Q

Lasix AE

A 
Hyponatremia, hypochloremia, and dehydration
Hypotension
Loss of volume
Relaxation of venous smooth muscle
Hypokalemia
Ototoxicity
Hyperglycemia
Hyperuricemia
Use in pregnancy- AVOID, Category C
Impact on lipids, calcium, and magnesium
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11
Q

Lasix drug interactions

A

Digoxin- narrow TI- increases risk of arrhythmias
Ototoxic drugs
Potassium-sparing diuretics
Lithium- excretion is reduced in a low sodium environment- so you can have toxic lithium doses, narrow TI, all kinds of things can affect lithium
Antihypertensive agents
Nonsteroidal antiinflammatory drugs

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12
Q

loop diuretics

A 
Ethacrynic acid [Edecrin]
Bumetanide [Bumex]
Torsemide [Demadex]
All can cause: 
Ototoxicity, hypovolemia, hypotension, hypokalemia, hyperuricemia, hyperglycemia, and disruption of lipid metabolism
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13
Q

thiazides

A

Effects similar to those of loop diuretics (except not as efficiaoius- not as signficaint)
Increase renal excretion of sodium, chloride, potassium, and water
Elevate levels of uric acid and glucose
Maximum diuresis is considerably lower than with loop diuretics
Not effective when urine flow is scant (unlike with loop diuretics)

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14
Q

hctz

A

action- early segment distal convoluted tubule
peaks 4-6 hrs
uses- essential HTN, edema, DI

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15
Q

HCTZ AE

A

Hyponatremia, hypochloremia, and dehydration
Hypokalemia
Use in pregnancy and lactation- DO NOT USE
Hyperglycemia
Hyperuricemia
Impact on lipids, calcium, and magnesium

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16
Q

hctz drug interactions

A

Digoxin- increased potentional for arrhythmias
Augments effects of hypertensive medications
Can reduce renal excretion of lithium (leading to accumulation)
NSAIDs may blunt diuretic effect
Can be combined with ototoxic agents without increased risk of hearing loss
So if you need diuretic and pt is on another ototoxic drug (like atb) you can order HCTZ

17
Q

potassium-sparing diuretics

A

modest increase in UO
substantial decrease in K excretion
rarely monotherapy

18
Q

aldosterone antagonist

A

spironolactone

19
Q

nonaldersterone antagonist

A

triamterene

amiloride

20
Q

spironolactone mechanism of action

A

Blocks aldosterone in the distal nephron
Retention of potassium
Increased excretion of sodium

21
Q

spironolactone therapeutic uses

A 
Hypertension
Edematous states
Heart failure (decreases mortality in severe failure)
Primary hyperaldosteronism
Premenstrual syndrome
Polycystic ovary syndrome
Acne in young women
22
Q

spironolactone AE

A

hyperkalemia
benign and malignant tumors
endocrine effects

23
Q

spironolactone AE

A

thiazide and loop diuretics

agents that raise K levels

24
Q

triamterene

A 
Mechanism of action
Disrupts sodium-potassium exchange in the distal nephron
Direct inhibitor of the exchange mechanism
Decreases sodium reuptake
Inhibits ion transport
Therapeutic uses
Hypertension
Edema
Adverse effects
Hyperkalemia	 
Leg cramps
Nausea 
Vomiting 
Dizziness
Blood dyscrasias (rare)

Pharmocology (15 decks)

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