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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
How does lasix compare to mannitol compare in decreasing ICP?
- Lasix is not as effective | - Mannitol will cross BBB if damaged( causing rebound ↑ in ICP), lasix will not
26
What is the most effect treatment of increased ICP? What is the concern?
- Lasix and mannitol together | - dehydration and electrolyte balance
27
What electrolyte disturbances are seen with loops?
- HypoK - Hypochloremia - Hyponatremia - Hypomag - Metabolic alkalosis
28
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?
- Braking phenomenon - Renin-angiotension - Na and H2O retention w/ loops - Replenish ECF volume - Thiazide diuretics
29
How does loop induced hypoK effect the body?
- Dig toxicity - ventricular irritability - Enhance NDMB
30
What other effects does loops have?
- Hyperuricemia - Hyperglycemia (less likely than thiazides) - Defmess
31
How does lasix effect antibiotics?
- Aminoglycosides and cephlasporins = Increased risk of nephrotoxicity - PCN = allergic interstitial nephritis
32
How does Loops effect lithium?
-Renal clearance is decreased (due to ↓ Na reabsorption)
33
There can be a cross sensitivity between lasix and what type of drug?
-Sulfonamide nucleus (Sulfas & thiazides)
34
How does osmotics work?
-Alters the osmolarity of plasma, renal tubular fluid and glomerular filtrate.
35
What is the site of action of osmotics?
-Proximal renal tubules and loops of henle (both highly permeable to water)
36
Mannitol information
- Only IV - Does not enter cells - Can only be cleared by glomerular filtration
37
What is the net diuretic effect of osmotics?
-Urinary excretion of Water, Na, Chloride, and Bicarb
38
What is the effect of osmotics on the renal tubules?
- Increases osmolarity and prevents reabsorption of water | - Urinary excretion of water, Na, Chloride and Bicarb
39
How does osmotic effect the plasma?
- increases osmolarity, draws fluis from intra cellular to extracellular. - Expands intravascular volume
40
How do osmotics redistribute fluid through the plasma?
- Decrease brain bulk | - Increase renal blood flow
41
What is the negative effect of osmotic's plasma redistribution?
-CHF in patient w/ poor myocardial function
42
Mannitol is a scavenger of what? leading to what?
- Oxygen free radicals | - prevention of cellular swelling, and reduction in renal obstruction
43
What are the 4 clinical uses of mannitol?
- Prophylaxis against renal failure - Diagnose oliguria - Decrease ICP and IOP
44
What is the only procedure in which mannitol has been proven renal protective?
-Renal transplant surgery
45
How does mannitol diagnose acute oliguria?
- If UO is increased, there is decreased volume | - If UO is unchanged, there is glomerular or tubular problems
46
How does mannitol effect ICP?
-Will lower ICP by drawing water from the brain and by decreasing CSF
47
What does mannitol require to reduce ICP?
-Intact BBB
48
Mannitol is not associated with ______ _______ in ICP, and the brain will eventually _____ to increases in ______ _______. (later doses less effective)
- Rebound increases - Adapt - Plasma osmolarity
49
What need to be done with mannitol administration because of the initial increase in ICP?
- Slow administration | - give with treatment that decrease intracranial volume (Corticosteroids or hyperventilate)
50
Mannitol can cause vasodilation of vascular smooth muscle, what two things can this cause?
- Increase in cerebral blood volume / ICP | - Decrease BP
51
What are the side effects of mannitol?
-Precipitate pulmonary edema in CHF patients -Hypovolemia / electrolyte disturbances -
52
How does mannitol effect NMBDs?
Unlike loops and thiazides, mannitol does not effect NMBD
53
What differentiates urea from mannitol?
- Smaller size - venous thrombosis and tissue necrosis after extravasation - Increases in BUN - Greater rebound ICP

Pharm 2 (23 decks)

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