Diuretics

Question 1

Thiazide Diuretic

Answer 1

hydrochlorothiazide

Question 2

Thiazide-like Diuretic

Answer 2

chlorthalidone

Question 3

Loop Diuretic

Answer 3

furosemide

Question 4

Potassium-sparing Diuretic

Answer 4

spironolactone

Question 5

Osmotic Diuretic

Answer 5

mannitol

Question 6

Where do loop diuretics works?

Answer 6

thick ascending limb

Question 7

Where do thiazide diuretics work?

Answer 7

distal convoluted tubule

Question 8

sodium reabsorption of thiazide diuretic

Answer 8

10%

Question 9

thiazide diuretic agents

Answer 9

chlorothiazide

hydrochlorothiazide

Question 10

only thiazide diuretic available in injectable form

Answer 10

chlorothiazide

Question 11

indications for hydrochlorothiazide

Answer 11

management of mild-to-moderate hypertension

treatment of edema in heart failure and nephrotic syndrome

Question 12

indications for chlorothiazide

Answer 12

management of hypertension

adjunctive treatment of edema

Question 13

indications for methylchlothiazide

Answer 13

management of hypertension

adjunctive therapy of edema

Question 14

Increasing the dose beyond the normal dose does not increase diuretic effect

Answer 14

“ceiling” diuretic

Question 15

ceiling number for hyrdochlorothiazide

Answer 15

50 mg/ day

Question 16

effects of thiazide diuretics

Answer 16

increased excretion of sodium and chloride

loss of potassium

loss of magnesium

decreased urinary calcium excretion

reduced peripheral vascular resistance

Question 17

How long does it take for thiazides to produce a stable reduction in blood pressure?

Answer 17

1 to 3 weeks

Question 18

Describe the kinetics of thiazide diuretics.

Answer 18

1 to 3 weeks to produce a stable reduction in blood pressure.

Question 19

ADRs of thiazide diuretics

Answer 19

Hyponatremia

Hyperuricemia

Volume depletion

Hypercalcemia

Hypersensitivity

Hyperglycemia

Hyperlipidemia

Hypokalemia

Question 20

Hydrochlorothiazide

Answer 20

Hydrochlorothiazide
25 mg
one tablet daily

Question 21

Cells in the distal convoluted tubule are ____________ to water.

Answer 21

impermeable

Question 22

thiazide like diuretics

Answer 22

chlorthalidone
metolazone
indapamide

Question 23

characteristics of chlorthalidone

Answer 23

cheap!

long duration of action

Question 24

These thiazide-like diuretics work well with other diuretic agents.

Answer 24

Metolazone

Indapamide

Question 25

characteristics of metolazone

Answer 25

more potent than the thiazides causes sodium excretion even in advanced renal failure

Question 26

characteristics of indapamide

Answer 26

low doses - significant antihypertensive effect with minimal effect gastrointestinal tract excretion - less likely to accumulate in patients with renal failure

Question 27

Chlorthalidone

Answer 27

Chlorthalidone 50 mg one tablet daily

Question 28

Where do loop diuretics work?

Answer 28

ascending loop of Henle

Question 29

Cells of the ascending loop of Henle are _________ to water.

Answer 29

impermeable

Question 30

sodium resorption of loop diuretics

Answer 30

25 - 30%

Question 31

loop diuretic agents

Answer 31

Bumetanide - Bumex Torsemide - Demadex Furosemide -Lasix Ethacrynic acid - Edecrin

Question 32

effects of loop diuretics

Answer 32

increased excretion of sodium and chloride loss of potassium loss of magnesium increased urinary calcium concentration reduced renal vascular resistance/increased renal blood flow

Question 33

"high-ceiling" diuretics

Answer 33

loop diuretics

Question 34

Furosemide

Answer 34

Furosemide 40 mg one tablet twice daily

Question 35

indications for furosemide

Answer 35

management of edema associated with heart failure and hepatic or renal disease acute pulmonary edema treatment of hypertension (alone or in combination with other antihypertensives)

Question 36

indications for bumetanide

Answer 36

management of edema secondary to heart failure or hepatic or renal disease (including nephrotic syndrome)

Question 37

indications for torsemide

Answer 37

management of edema associated with heart failure and hepatic or renal disease (including chronic renal failure) treatment of hypertension

Question 38

creatinine clearance indicating renal impairment in loop diuretics

Answer 38

<40 ml/min

Question 39

bioavailability of furosemide oral

Answer 39

~50%

Question 40

bioavailability of torsemide and torsemide oral

Answer 40

~70%

Question 41

The onset of loop diuretics allows for symptom relief...

Answer 41

...relatively rapidly - within hours to days.

Question 42

Loop diuretics are used for...

Answer 42

``` ... treatment of states of volume excess: heart failure nephrotic syndrome acute chronic renal insufficiency cirrhosis ```

Question 43

ADRs of loop diuretics

Answer 43

same as thiazides only electrolyte loss is more profound (sodium and magnesium depletion) Ototoxicity

Question 44

What may need to be supplemented with loop diuretics?

Answer 44

Potassium | Magnesium

Question 45

Where do potassium-sparing diuretics work?

Answer 45

collecting tubule

Question 46

sodium reabsorption of potassium-sparing diuretics

Answer 46

3-5%

Question 47

loop diuretic - sodium channel blocker agents

Answer 47

Triamterene | amiloride

Question 48

loop diuretic - aldosterone antagonists

Answer 48

Spironolactone | eplerenone

Question 49

How do loop diuretic aldosterone antagonists work?

Answer 49

blocks stimulation of sodium/potassium exchange sites in collecting tubule (1-3% net diuretic effect) sodium loss for diuretic effect but potassium retained spironolactone - hormonal effect works with high levels of aldosterone and vice versa

Question 50

ADRs of Triamterene/amiloride

Answer 50

leg cramps increased BUN potassium retention increased uric acid

Question 51

ADRs of aldosterone antagonists

Answer 51

gastric upset (spironolactone) gynecomastia (males) menstrual irregularities

Question 52

Amiloride

Answer 52

Amiloride 10 mg one tablet daily

Question 53

Spironolactone

Answer 53

Spironolactone 25 mg one table twice per day

Question 54

How is mannitol administered?

Answer 54

intravenoussly

Question 55

MOA of mannitol

Answer 55

inhibits sodium reabsorption in proximal convoluted tubule and Loop of Henle

Question 56

osmotic diuretic agent

Answer 56

Mannitol

Question 57

MOA of potassium supplementation

Answer 57

electrolyte replenishment

Question 58

ADRs of potassium supplementation

Answer 58

asymptomatic hyperkalemia ECG changes GI symptoms

Question 59

asymptomatic hyperkalemia occurs at

Answer 59

6.5 - 8 mEq/L

Question 60

Watch for patients with renal insufficiency for...

Answer 60

potassium supplementation.

Question 61

Potassium Supplementation Agents

Answer 61

potassium chloride K-Dur Slow-K

Question 62

Mannitol

Answer 62

Get an intensivist involved!!!