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Flashcards in Diuretics Deck (46):
1

How do mercuric compounds work?

Inhibit sodium reabsorption in proximal tubules
(no longer used due to adverse effects)

2

How do osmotic diuretics work?

prevent reabsorption of sodium and water from proximal tubule

3

What is an adverse affect of an osmotic diuretic?

Can cause rapid shift of fluid from interstitial compartment to vascular compartment, causing pulmonary edema or increased cardiac workload

4

What is mannitol used to treat? How is it administered?

Cerebral edema and elevated ICP
Not absorbed in G.I. tract – must be given IV

5

Give the equation for central perfusion pressure

CPP = MAP - ICP

6

Who commonly uses glycerin as a diuretic?

Weightlifters swallow glycerin to decrease water weight due to osmotic diuretic effect

7

What are aquaretics? Give an example

ADH receptor blockers that increase urine production (Demeclocycline)

8

What kind of drug can be used to treat patients with SIADH?

Demeclocycline

9

Which patients commonly have SIADH?

Neuro patients with head trauma/increased ICP

10

What were the first diuretics used?

Mercury containing compounds

11

How do you carbonic anhydrase inhibitors work?

They inhibit reabsorption of bicarbonate, causing bicarb waste and water waste

12

What is a potentially serious adverse reaction of carbonic anhydrase inhibitors?

Hypokalemia due to additional waste of potassium

13

What are carbonic anhydrase inhibitors mainly used for?

Management of glaucoma – lower intraocular pressure by decreasing aqueous humor production

14

Why can carbonic anhydrase inhibitor's affect excretion of other drug products?

Changes in the blood and urine pH alter excretion of drugs

15

What drugs do carbonic anhydrase inhibitors cross react with?

Sulfonamides- can cause rash

16

Which diuretic can be used to treat altitude sickness?

Carbonic anhydrase inhibitors – hemoglobin discharges oxygen for increased consumption if blood becomes acidotic (potential effect of CAIs)

17

What is the only CAI on the market?

Acetazolamide (Diamox)

18

How do thiazides work?

Prevent reabsorption of sodium and water at the distal tubule

19

What is the minimum creatinine clearance at which thiazides can be used?

30 mL per minute

20

What diuretic should be used in cases of reduced CrCl?

Loop diuretics

21

List five electrolyte related side effects of thiazides

Hypokalemia, hypomagnesemia, hyperuricemia, hyperglycemia, hypercalcemia

22

Which patients should not take thiazides?

Patients with gout due to thiazide causing increased uric acid production

23

How quickly do thiazides take effect?

1 to 2 hours

24

Which type of diuretics cause photosensitivity?

Thiazide – patient should wear sunscreen with at least 15 SPF

25

Why are diuretics extra helpful in postmenopausal women?

They cause calcium retention, slowing osteoporosis

26

What time of day should thiazides be taken?

Best in morning, no later then 1700 (5:00)

27

What is the most common thiazide used?

HCTZ

28

Which diuretics are known as high ceiling diuretics and high efficacy diuretics?

Loop diuretics

29

Which type of loop diuretics are more potent and bioavailable?

Bumetanide (#1) and torsemide (#2) (2-4x more effective then furosemide)

30

How do Loop diuretics work?

They block sodium rehab sorption in the loop of Henle

31

How can ototoxicity be prevented in administration of Loop diuretics?

Administer slowly over 2 to 3 minutes to avoid ringing in ears

32

List the two potassium sparing diuretics

Aldosterone antagonists and nonsteroidal potassium sparing diuretics

33

How do aldosterone antagonists work?

They antagonize aldosterone's actions: aldosterone Binds to receptors in the distal tubules to stimulate reabsorption of sodium and water and potassium excretion

34

Must be present for Spironolactone to be effective?

Aldosterone – patient must have functional adrenal gland

35

List two potential side effects of aldosterone antagonists

Hyperkalemia and gynecomastia

36

List four uses of Spironolactone

Hypertension, hirtuism, primary aldosteronism, cirrhosis

37

Why should salt substitutes be avoided when taking aldosterone antagonists?

Salt substitutes often contain potassium rather than sodium and can contribute to hyperkalemia

38

Which diuretic is better for patients with gout?

Aldosterone antagonists

39

Name the Second generation aldosterone antagonist with reduced affinity for estrogen receptors

Eplerenone (Inspra)

40

How do nonsteroidal potassium sparing diuretics work?

Exact mechanism unknown, but affect reabsorption of sodium from the distal tubule

41

Which diuretics are considered low efficacy?

Potassium sparing

42

What are three electrolyte related side effects of nonsteroidal potassium sparing diuretics?

Hyperkalemia, hypercalcemia, hypomagnesemia

43

List two Nonsteroidal potassium sparing diuretics often found in combination with HCTZ

Triamterene and amiloride

44

List five treatments for hyperkalemia in order of ascending strength

Potassium wasting diuretic, SPS (Kayexalate), bicarbonate, insulin with D5W, calcium chloride

45

What is the fastest that potassium should be replaced?

No faster than 10 mEq per hour

46

Which osmotic diuretic is shown to reduce cerebral edema and manage elevated ICP?

Mannitol