CVD- OEDEMA + VASCULAR DISEASE Flashcards
(90 cards)
1
Q
What is oedema?
A
Condition causing fluid buildup
2
Q
When to use diuretics?
A
In the morning
2
Q
What are 6 drug classes used to treat oedema?
A
- Loop diuretics
- Thiazide
- Aldosterone antagonist
- Potassium sparing
5.Osmotic
- Carbonic anhydrase inhibitor
3
Q
List 3 loop diuretics?
A
Bumetanide
Furosemide
Torasemide
4
Q
What is most potent loop diuretic?
A
Bumetanide
5
Q
Which loop diuretic increases risk of gout?
A
furosemide
6
Q
which loop diuretic can cause musculoskeletal pain?
A
Torasemide
7
Q
List 6 thiazide diuretics?
A
Bendroflumethiazide
Hydrochlorothiazide
Chlortalidone
Indapamide
Metolazone
Xipamide
8
Q
What thiazide diuretic can cause risk of skin cancer?
A
Hydrochlorothiazide
9
Q
What thiazide diuretic is used in severe renal impairment?
A
Metolazone
9
Q
Which thiazide diuretic has a long half life?
A
Chlortalidone
10
Q
What is a risk of using Metolazone?
A
Be careful switching brands - different bioavailabilities
11
Q
What thiazide diuretic has less aggravation of diabetes?
A
Indapamide
12
Q
What is gravitational oedema?
A
Fluid pools in the lower parts of the body
13
Q
Who does gravitational oedema occur more in?
A
Elderly
14
Q
What to give if gravitational oedema?
A
Low dose diuretic (short term)
15
Q
What are 2 aldosterone antagonists?
A
Spironolactone
Eplerenone
16
Q
What is spironolactone also used in?
A
Liver ascites
17
Q
When is eplerenone also used for?
A
Post acute MI
18
Q
What are 2 potassium sparing diuretics?
A
Amloride
Triamterene
19
Q
What diuretic causes blue urine?
A
Triamterene
20
Q
What is 1 osmotic diuretic?
A
Mannitol
21
Q
What other 2 indications is mannitol used in?
A
Cerebral oedema
Raised Intra-ocular pressure
22
Q
Name 3 carbonic anhydrase inhibitors?
A
Acetazolamide
Brinzolamide
Dorzolamide
23
Name an oral carbonic anhydrase inhibitor?
Acetazolamide
24
What are carbonic anhydrase inhibitors also used for?
Glaucoma
25
What is MOA of diuretic?
Increase urine output by kidneys by blocking sodium reabsorption at different segments of the nephron.
26
What can excess diuresis cause?
HypOtension
HypOvolemia
27
What to do with diuretic on sick days?
STOP meds
28
What is MOA of loop diuretic?
Blocks the Na+/K+/CL- co-transporter on ascending limb of lop of henle
29
What is onset of loop diuretics?
act in 1 hr of administration
30
Which cases do we need to separate the doses of loop diuretics from other drug? (ALOUD)
Amino-glycosides- separate both
Low Na+/K+/CL-/Mg2+/Ca2+
Ototoxicity
Urinary retention
Diabetes + gout (increases this)
31
What is 2 indications of loop diuretics?
Heart failure
Resistant hypertension
32
What is a caution of loop diuretics?
Exacerbates diabetes(less likely compared to thiazides) + gout
33
What are 2 SE of loop diuretics?
Ototoxicity
Acute urinary retention
34
What class drug does loop diuretics interact with to increase ototoxicity?
Aminoglycosides e.g. gentamicin
35
How to overcome ototoxicity between loop diuretics + aminoglycosides?
Separate doses by long period
36
What is an MOA of thiazides?
Blocks Na+/CL- transporter on proximal distal convouted tubule.
37
What is onset of thiazides?
1-2 hrs
38
What is duration of thiazides?
12-14 hrs
39
What are 2 indications of Thiazide diuretics?
HF
Hypertension
40
Can thiazides be used in renal impairment?
Ineffective if severe
Except metolazone
41
What is the ONLY diuretic that can be used in RI?
Metolazone
42
What is a caution of thiazide diuretics?
exacerbates diabetes + gout
43
What are 4 side effects of thiazide diuretics? (SIGH)
Skin reactions
Impotences
GI disturbances
High LDL cholesterol
44
What is an MHRA warning regarding thiazide diuretics?
Risk of non-melanoma skin cancer in long term use of hydrochlorothiazide
45
What is the thiazide drug with skin cancer MHRA warning?
hydrochlorothiazide
46
How to counsel patient taking hydrochlorothiazide on MHRA warning on skin cancer risk?
Report new/ changed skin lesions.
Regular checks- limit sun + UV exposure.
Use enough sun protection
47
What drug interacts with loop + thiazide diuretics to cause hypOkalaemia?
Digoxin = toxicity
48
What happens when digoxin + loop/thiazide diuretics taken?
Increase risk of hypOkalaemia
49
What drug causes hypOnatraemia with loop/ thiazide diuretics?
Lithium
50
What 8 drug classes interact with loop/ thiazide diuretic to cause hypotension?
Anti-hypertensives
Anti-depressants
Anti-parkinson drug
Antipsychotics
Other diuretics
Nitrates
Phosphodiesterase type 5 inhibitors
SGL-2 inhibitors
51
What diabetic drug can cause hypotension when given with diuretics?
SGL-2 inhibitors E.G. CANAGLIFLOZIN
52
What drug can cause AKI with thiazides?
NSAIDS
53
What is MOA of K+ sparing diuretics?
Keeps K+
Blocks Sodium channels in late distal convoluted tubule to collecting duct.
54
What is indication of K+ sparing diuretics?
Potassium conservation with loop/ thiazides
55
Why is K+ sparing diuretics used?
Preferred over supplements
56
What is 2 big SE of K+ sparing diuretics?
HypERkalaemia
HypOnatraemia
57
What K+ sparing diuretics causes blue urine?
Triameterene
58
What is an interaction of K+ sparing diuretics?
Increase risk of HypERkalaemia
59
What 6 drug classes increase K+ risk?
ACEi/ ARB
Aldosterone antagonist
Heparin
NSAID
potassium supplement
Trimethoprim
60
What is MOA of aldosterone antagonist?
Blocks aldosterone
Acts on Na+ channels from late convoluted tubule to collecting duct.
61
What is indication of aldosterone antagonist?
Adjunct HF
Resistant HTN, Liver ascites
62
What specific aldosterone antagonist is used for liver ascites?
Spironolactone
63
What are 2 big SE of aldosterone antagonists?
HypERkalaemia
HypOnataemia
64
What 3 hormonal SE is associated with Aldosterone antagonist use?
Gynaecomastia
Libido changes
Menstrual disturbances
65
What 2 SE is linked to spironolactone use?
Benign breast tumours, hypertrichosis.
66
What 5 drug classes increase hyperkalaemia with aldosterone antagonists?
ACEi/ARB, K+, NSAID, trimethoprim
67
What is vascular disease?
Peripheral vascular disease is either occlusive or vasospastic
68
2 categories of vascular disease?
Occlusive
Vasospastic
69
What is the 1st line drug treatment of peripheral arterial disease?
If exercise does not work.
Naftidrofuryl
70
What is 2nd line drug treatment of peripheral arterial disease?
cilostazol OR pentoxifylline.
71
What is cilostazol used for?
intermittent claudication (calf pain)
72
What 2 drugs are used as secondary prevention of PAD?
High intensity statin
Low dose asprin
73
What is treatment if patient is vasospastic e.g. raynauds syndrome?
Nifedipine
74
What are 2 lifestyle things to stop PAD?
Stop smoking
Avoid cold + stress
75
What is occlusive PAD?
blockage of peripheral arteries is caused by atherosclerosis
76
What is Vasospastic PAD?
small blood vessels near the surface of the skin have spasms that limit blood flow
77
What condition is an example of Vasospastic PAD?
Raynaud's syndrome
78
What 3 drugs are licensed in management of Raynaud's syndrome?
Naftidrofuryl + prazosin
Nifedipine - prophylaxis
79
List 3 thiazide like diuretics?
Chlortalidone
Indapamide
Metolazone
80
When to give thiazide diuretics in the day?
Given early to prevent sleep disturbances- lasts 24 hrs
81
MOA of loop diuretics?
Inhibit reabsorption from ascending loop of henle.
82
Indication of loop diuretics?
pulmonary oedema due to left ventricular failure + Chronic HF
83
Loop diuretic duration of action?
lasts 6 hrs -= given 2 times day
84
What diuretic class to stop if person dehydrated due to vomiting + diarrhoea?
Aldosterone antagonists
85
What 2 electrolyte imbalances do all diuretics cause?
Hyponatremia
hypomagnesia
86
What condition does loop diuretics increase?
gout
87
spironolactone + lithium?
increases lithium toxicity
88
What 2 things does loop diuretics + aminoglycosides cause?
nephrotoxicity
ototoxicity
