Diuretics

Question 1

4 types of diuretics

Answer 1

loop diuretics
thiazides
potassium sparing
aldosterone antagonist

Question 2

Where do diuretics act

Answer 2

Loop = LOH
thiazides = DCT
K+ sparing = CD
Aldosterone antagonist = CD

Question 3

Thiazide/thiazide like diuretics

Answer 3

Bendroflumethiazide
Indapamide

Question 4

Loop diuretics

Answer 4

Bumetanide, furosemide

Question 5

K+ sparing

Answer 5

Amiloride

Question 6

Aldosterone antagonist (also K+ sparing)

Answer 6

Spironolactone, eplerenone

Question 7

4 other forms of diuretics

Answer 7

CA inhibitors
Osmotic agents (mannitol)
SGLT2 inhibitors
ADH antagonists

Question 8

2 ADH antagonists/aquaretics

Answer 8

Tolvaptan
Lithium

Question 9

Drinks that cause diuresis

Answer 9

Alcohol - inhibits ADH release

Caffeine- Increased GFR and decrease tubular Na+ reaborption

Question 10

Management of chronic heart failure

Answer 10

Diuretics (furosemide)
With HfRf = ACEi or if not tolerated can give ARB
With HfPf = manage comorbidities and exercise

MRA if symptoms continue (spironolactone)

Question 11

Symptoms persist after first line treatments in chronic heart failure

Answer 11

Digoxin with heart failure with sinus rhythm

Hydralazine and nitrate if African-Caribbean descent

Ivabradine for sinus rhythm with HR >75 with ejection fraction <35%

Replace ACEi or ARB with sacubitril valsartan if ejection fraction <35%

Question 12

Acute heart failure treatment

Answer 12

IV nitrates, sympathomimetic inotropes

Question 13

How does neurohormonal activation make heart failure worse

Answer 13

-Compromised cardiac function
-Decreased MAP
-Baroreceptor reflex
-Increased sympathetic outflow
-Vasoconstriction
-Increased after load
-Increased myocardial O2 demand
-Worsening HF