Diuretics

Question 1

Osmotic diuretics are effective in what part of the nephron?

Answer 1

proximal tubule

Question 2

what are 2 adverse effects of the osmotic diuretics? why?

Answer 2

flash pulmonary edema, increased cardiac workload

-drugs pull fluid from interstitial spaces to the vasculature very quickly.

Question 3

What are 3 examples of an osmotic diuretics?

Answer 3

Mannitol (manages elevated ICP), glycerin and urea

Question 4

How do aquaretics work? What is the drug called? Where are the patients that need these?

Answer 4

decrease ADH
Demeclocycline
Neuro ICU

Question 5

Carbonic anhydrase inhibitors waste what?

Answer 5

bicarb and water follows it

Question 6

what do CAIs mainly treat? what ELSE can it treat?

Answer 6

Glaucoma (increased intraocular pressure)

altitude sickness

Question 7

What are 3 AEs of CAIs?

Answer 7

severe hypokalemia
rash
may affect excretion of other drugs

Question 8

what is an example of a CAI?

Answer 8

Acetazolamide

Question 9

Thiazides have what level efficacy?

Answer 9

medium

Question 10

Thiazides have an effect on what part of the nephron? what does this mean for those with CrCl

Answer 10

DISTAL.

If drug cannot get filtered at the distal tubule, then it will not work.

Question 11

What are AEs of thiazides?

Answer 11

HYPOkalemia, magnesemia
HYPERuricemia, glycemia, calcemia
photosensitivity
rash

Question 12

what is an example of a thiazide?

Answer 12

HCTZ

Question 13

Loop diuretics have what level efficacy?

Answer 13

HIGH

Question 14

Loops are also known as “high _____”. Also, as Vitamin ___.

Answer 14

ceiling (25-2500mg)

Vitamin P

Question 15

Loops have a ______onset and last _____hours.

Answer 15

rapid onset

last 6-8 hours

Question 16

Loops are commonly used in patients with what 2 conditions?

Answer 16

CHF and acute pulmonary edema

Question 17

What are the AEs of loops?

Answer 17

HYPOkalemia, calcemia
HYPERuricemia, glycemia
ototoxicty when pushed too fast
rash

Question 18

What are examples of loop diuretics? Which is more potent?

Answer 18

Ethacrynic acid
furosemide 40mg
torsemide 10-20mg
bumetanide (most potent–1mg)

Question 19

Which two diuretics are K sparing? this means that an AE of both of these drugs is….

Answer 19

aldosterone antagonists and Nonsteroidal drugs

hyperkalemia

Question 20

Aldosterone antagonists block Na and water reabsorption at the …….

Answer 20

distal tubule

Question 21

another AE of aldosterone antagonists is what? therefore, it is often used for what condition?

Answer 21

estrogenic effects –gynecomastia!

hirtuism

Question 22

AA have NO effect on what two things? what does this mean?

Answer 22

blood sugar and uric acid.

they are the diuretic of choice for those with gout

Question 23

What is the problem with using salt substitutes and potassium sparing diuretics?

Answer 23

salt substitutes are potassium based. so hyperkalemia is a problem

Question 24

What other conditions are AA beneficial for? Why?

Answer 24

cirrhosis – aldosterone is metabolized in the liver. antagonizing aldosterone lessons the impact on the liver.
primary aldosteronism

Question 25

what is an example of an AA? is it useful in patients who have been adrenalectomized?

Answer 25

spironolactone | no

Question 26

what is a second generation AA that is NOT anti-androgenic? is it helpful with hirtuism?

Answer 26

Eplerenone (Inspra) | no

Question 27

Nonsteroidal K sparing drugs have an effect on what part of the nephron?

Answer 27

distal

Question 28

AE of nonsteroidal KSD are...

Answer 28

HYPERkalemia, calcemia | HYPOmagnesemia

Question 29

What is an example of an NSKSD?

Answer 29

Triamterene

Question 30

Hypokalemia is an issue for what type of diuretics?

Answer 30

K wasting

Question 31

NSKSD are often added to what other therapy? why?

Answer 31

HCTZ, so that the therapy is K-neutral

Question 32

what foods are high in potassium?

Answer 32

bananas, apricots, figs, oranges, raisins

Question 33

how is K replaced in those who are on K wasting diuretics?

Answer 33

food PO replacement 10-20mEqs KCl IV formulations --never give >10mEq / hr

Question 34

How do you treat hyperkalemia?

Answer 34

``` K wasting diuretics Kayexalate (SPS) Bicarb D5W, Insulin Calcium Cl ```

Question 35

S/S of hyperkalemia:

Answer 35

muscle cramping, bradycardia, asystole | narrow QRS, peaked T waves

Question 36

When you prescribe acetozolamide, and the patient is also taking a acidic drug, what will happen? basic drug?

Answer 36

the acidic drug will appear in the urine. | basic drug will not appear in the urine

Question 37

which drug would you prescribe to someone with a CrCl

Answer 37

loop diuretic

Question 38

which diuretics cause hyperkalemia?

Answer 38

spironolactone (eplerenone), and Triamterene

Question 39

which diuretic is beneficial for a post-menopausal woman?

Answer 39

HCTZ (thiazide) because it retains calcium

Question 40

people with bad CHF are prescribed furosemide, but they are not getting enough diuresis. What can you do?

Answer 40

prescribe B or T, that is better absorbed. If CHF causes an edematous GI tract, you can use a more potent loop diuretic.

Question 41

what is the major difference between thiazides and loop diuretics?

Answer 41

thiazides cause hypercalcemia. | loops cause hypocalcemia. So patients with hypercalcemia are often prescribed a loop diuretic.