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Pharm 2 > Class 12 Deck 1 > Flashcards

Class 12 Deck 1 Flashcards

1
Q

What are the 4 uses for thiazide diuretics?

A
  • HTN
  • Edema
  • Diabetes incipidus
  • hypercalcemia
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2
Q

How does thiazides help HTN?

A
  • Diuresis, naturesis
  • Vasodilate
  • Allows for a decrease in other more potent anti-hypertensives, decreasing side effects
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3
Q

What is the MOA of thiazides? and where does it work?

A
  • Inhibit reabsorption of Na and Cl

- CORTICAL Ascending loop

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4
Q

Thiazides increase urinary excretion of what?

A
  • Na
  • Cl
  • Bicarb
  • K
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5
Q

What is the INITIAL anti-hypertensive effect of thiazides?

A
  • Decrease extracellular volume

- Decrease CO

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6
Q

What is the SUSTAINED anti-hypertensive effect of thiazides?

A
  • peripheral vasodilation

- Takes weeks to develop

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7
Q

What are the electrolyte side effects of thiazides?

A
  • hypokalemia, hypochloemic metabolic alkalosis
  • Hyperglycemia
  • Hyperurecemia
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8
Q

What is the cardiac side effect of thiazides?

A

-Dysrhythmias due to hypokalemia and hypomag

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9
Q

What are the other side-effects of thiazide induced hypokalemia?

A
  • Muscle weakness
  • Ileus
  • Nephropathy
  • Dig toxicity
  • potentiation of non-depolarizing muscle relaxants
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10
Q

When would you suspect decreased intravascular fluid volume?

A
  • Othostatic hypotension
  • Hemoconcentration (↑ crit and BUN)
  • Decreased filing pressures
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11
Q

What causes the decrease in renal and hepatic function with thiazides?

A

-Decreases in blood flow to these organs

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12
Q

What is the MOA of loop and where does it work?

A
  • Inhibit reabsorption of Na and Cl

- MEDULLARY Ascending loop

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13
Q

What is the onset of action with Lasix or ethacrynic acid?

A

-2-10 minutes IV

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14
Q

How is lasix related to GFR?

A

-Higher the GFR, greater the effect of lasix

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15
Q

Furosemide-induced increases in RBF are inhibited by what?

A

NSAIDS

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16
Q

Furosemide induced production of _______ results in renal ___________ and ________ RBF

A
  • Prostaglandins
  • vasodilation
  • Increased
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17
Q

Ethacrynic Acid information?

A
  • Higher GI reactions w/ PO
  • Protein bound
  • Excreted by kidneys
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18
Q

Furosemide information?

A
  • 90% protein bound to albumin

- Elimination half life is <1hr (short duration of action)

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19
Q

Loop clinical uses?

A
  • Edema
  • ICP
  • Inhibit calcium uptake for hypercalcemia
  • Diagnosis of oliguria
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20
Q

When are loops non-effective?

A
  • HTN
  • Will not accelerate elimination of other drugs
  • No increase in GFR or tubbular secretion
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21
Q

With loops, what precedes diuresis?

A

-vasodilation (may drop BP)

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22
Q

With loops, _______ _______ ______ provides prompt effects in the management of acute pulmonary edema.

A

Decreased venous return

23
Q

Loops, _______ _________ flow through the throacic duct.

A

-Increases lymph

24
Q

How do loops decrease ICP?

A
  • Systemic diuresis
  • Decrease in CSF production
  • Resolve cerebral edema by improving cellular water transport
25
Q

How does lasix compare to mannitol compare in decreasing ICP?

A
  • Lasix is not as effective

- Mannitol will cross BBB if damaged( causing rebound ↑ in ICP), lasix will not

26
Q

What is the most effect treatment of increased ICP? What is the concern?

A
  • Lasix and mannitol together

- dehydration and electrolyte balance

27
Q

What electrolyte disturbances are seen with loops?

A
  • HypoK
  • Hypochloremia
  • Hyponatremia
  • Hypomag
  • Metabolic alkalosis
28
Q

Loop diuretics can cause acute tolerance aka ______ ______. This is due to activation of __________ _______. And does what? and is treated how? How to reestablish diuretic effect?

A
  • Braking phenomenon
  • Renin-angiotension
  • Na and H2O retention w/ loops
  • Replenish ECF volume
  • Thiazide diuretics
29
Q

How does loop induced hypoK effect the body?

A
  • Dig toxicity
  • ventricular irritability
  • Enhance NDMB
30
Q

What other effects does loops have?

A
  • Hyperuricemia
  • Hyperglycemia (less likely than thiazides)
  • Defmess
31
Q

How does lasix effect antibiotics?

A
  • Aminoglycosides and cephlasporins = Increased risk of nephrotoxicity
  • PCN = allergic interstitial nephritis
32
Q

How does Loops effect lithium?

A

-Renal clearance is decreased (due to ↓ Na reabsorption)

33
Q

There can be a cross sensitivity between lasix and what type of drug?

A

-Sulfonamide nucleus (Sulfas & thiazides)

34
Q

How does osmotics work?

A

-Alters the osmolarity of plasma, renal tubular fluid and glomerular filtrate.

35
Q

What is the site of action of osmotics?

A

-Proximal renal tubules and loops of henle (both highly permeable to water)

36
Q

Mannitol information

A
  • Only IV
  • Does not enter cells
  • Can only be cleared by glomerular filtration
37
Q

What is the net diuretic effect of osmotics?

A

-Urinary excretion of Water, Na, Chloride, and Bicarb

38
Q

What is the effect of osmotics on the renal tubules?

A
  • Increases osmolarity and prevents reabsorption of water

- Urinary excretion of water, Na, Chloride and Bicarb

39
Q

How does osmotic effect the plasma?

A
  • increases osmolarity, draws fluis from intra cellular to extracellular.
  • Expands intravascular volume
40
Q

How do osmotics redistribute fluid through the plasma?

A
  • Decrease brain bulk

- Increase renal blood flow

41
Q

What is the negative effect of osmotic’s plasma redistribution?

A

-CHF in patient w/ poor myocardial function

42
Q

Mannitol is a scavenger of what? leading to what?

A
  • Oxygen free radicals

- prevention of cellular swelling, and reduction in renal obstruction

43
Q

What are the 4 clinical uses of mannitol?

A
  • Prophylaxis against renal failure
  • Diagnose oliguria
  • Decrease ICP and IOP
44
Q

What is the only procedure in which mannitol has been proven renal protective?

A

-Renal transplant surgery

45
Q

How does mannitol diagnose acute oliguria?

A
  • If UO is increased, there is decreased volume

- If UO is unchanged, there is glomerular or tubular problems

46
Q

How does mannitol effect ICP?

A

-Will lower ICP by drawing water from the brain and by decreasing CSF

47
Q

What does mannitol require to reduce ICP?

A

-Intact BBB

48
Q

Mannitol is not associated with ______ _______ in ICP, and the brain will eventually _____ to increases in ______ _______. (later doses less effective)

A
  • Rebound increases
  • Adapt
  • Plasma osmolarity
49
Q

What need to be done with mannitol administration because of the initial increase in ICP?

A
  • Slow administration

- give with treatment that decrease intracranial volume (Corticosteroids or hyperventilate)

50
Q

Mannitol can cause vasodilation of vascular smooth muscle, what two things can this cause?

A
  • Increase in cerebral blood volume / ICP

- Decrease BP

51
Q

What are the side effects of mannitol?

A

-Precipitate pulmonary edema in CHF patients
-Hypovolemia / electrolyte disturbances
-

52
Q

How does mannitol effect NMBDs?

A

Unlike loops and thiazides, mannitol does not effect NMBD

53
Q

What differentiates urea from mannitol?

A
  • Smaller size
  • venous thrombosis and tissue necrosis after extravasation
  • Increases in BUN
  • Greater rebound ICP

Pharm 2 (23 decks)

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