CV-Diuretics Flashcards
How much is reabsorbed into circulation at PCT?
65% Na, K, Cl, Mg, 85% NaHCO3, 100% Glucose and AA (aa-charged, membrane - repels). WATER passively resorbs
What DM medication is a diuretic but not studied for CHF?
SGLT-flozin. PCT inhib filter of glucose and Na
What other substance diuresis in PCT?
Peniclin, Creatine, uric acid, ABX, NSAIDs
What reduces NA reabosorbtion in the thick ascending loop of henle and reduces ADH aquaporins, which promotes what?
LOOPS-PG5 prostaglandins have additive effect with loop diruetics
This drug will block H+ and Na exchange, thus, Na will be reabsorbed, HCO3 will be excreted?
Carbonic anhydrase inhibotors-BLOCK carbonic anhydrase transporters. Na stays in lumen, H20 follows= Diuresis and Natriuesis
What two carbonic anhydrase inhib are used topically for glaucoma?
Dorzolamide, Brinzolamide
What two carbonic anhydrase inhib are used for glaucoma and mountain sickness?
Acetazolamide, Methazolamide- D/T effects of bicarb secretion from blood into aqueus humor, reduces IO pressure
Why are potent CAI not used as diuretics, unless emergency?
Quick diurectic effect d/t Na/H block, but overtime becomes hyperchloremic metabolic acidosis b/c of bicarb loss in lumen. Body then corrects itself several days and diuresis becomes less effective. less bicarb/Na is lost. Urine becomes akaline
How else is CAI used other than eye and renal?
Remove bicarb from blood, reduces CSF volume= anticonvulsant effect. Edema- CHF, Mountain sickness,
How are all Diruretics eliminated?
Tubule excretion, that where they work
What are Renal affects of CAI
Hypokalemia, Hyperchloric metabolic acidiosis, Hyperglycemia,
What are CNS ADE of CAI?
Drowsiness, Parathesia
What are contraindications of CAI
Sufla allergy. Hematologic dz. Inc NH4
Which agent works at thick ascending limb of Henle Loop, TAL, where 25% Na, K, 2CL is resorbed, water is not permeable?
LOOP Diurectics
If Loops block Na/K ATPase pump, then K diffuses back in lumen creating a + charger. What happens to Mg and Ca w/ loops?
K+ charge in lumen normally pushes Mg and Ca to be resorbed. BUT if blocked, Mg and Ca stay in lumen= excretion= Hypomagesium and Hypocalcemia (rare)
Why are loops most efficacious?
- No llimitatiOn of acidosis 2. Induce PG syntheis via COX2 3. INC renal BF 4. Inhibtis Na/K/CL transport 5. DEC CHF 6. Nephrotic syndrome. 7 Cirrhoisis hepatic 8. HTN 9. ARF- flush casts out
What occurs first in resolving volume overload w/ loops?
Release blood flow thru vascular beds first, thus DEC pulmonary congestion sx prior to diuretic via PGs
When during the day should pts take Furosemide?
AM, and 4pm d/t polyuria. Dose 20-80mg/d BID- sulfa allergy alert
What is dose for Bumetanide?
Potent, 0.5-2mg/QD
What is does for Torsemide?
5-20mg QD
How do loops help with hypercalcemia, hyperkalemia?
LOOP cause hyopcalcemia. But must be given w/ saline to avoid dehydration 2. Loops cause hypokalemia at DCT d/t Na concentration
Overtime the diruectic effects of loops cause?
- DEC blood volume to Renal, so GFR is dec 2. Fluid and electrolyte depletion- orthostatic hypotension 3. Gout- d/t dehydration 4. Hearing dfx w/ rapid IV ONLY
Which drug interaction affect the following with loops? 1. Diruresis 2. Hypokalemia 3. Hear loss 4. Anitdiureisis
- Diruresis inc- Thiazides, HTN meds 2. Hypokalemia- Digoxin, amphotercine, steroids 3. Hear loss- aminoglycosides, erythromycin 4. Anitdiuresis- Indomethcin, NSAIDs d/t block of PGs. Bile acid sequetrants- cholestyramin, colesitpol
This agent keeps NaCl in the lumen thus inhibits resorbtion to blood stream at the Distal convulted tubule, and INC Ca resorbtion to treat osteoporosis?
Thiazides
