DIURETICS

Question 1

picture of electorlyte diuretics

Answer 1

Question 2

Drug samples of Carbonic Anhydrase Inhibitors

What is MOA?

Answer 2

• Acetazolamide
• Methazolamide

USED TO HELP METABOLIC ALKALOSIS

Question 3

What is the max dose for pushing on Acetazolamide

Answer 3

Administration (Inj)

• IV push (max rate: 500 mg/min); infusion
• NOT as great of a diuretic

Question 4

What are the SE of acetazolaminde

Answer 4

• Metabolic acidosis
• Hyperchloremia
• Hypokalemia
• Hyponatremia (mild)
• Hyponatremia
  Not as common as other diuretics Hypophosphatemia

Question 6

MOA and samples of Loop Diuretics

Answer 6

• Ethacrynic acid • Furosemide • Bumetanide • Torsemide

used for: heart failure, liver failure, renal failure

all sort of edema, hyperkalemia..

Question 7

How do you get delivery to the loop of henle for patients that has bad kidney functions?

Answer 7

for pts with Cr<10 you probably need to give large doses of loop diuretics.

Question 8

Loop diuretic only available PO

Answer 8

Torsamide

Question 9

Adverse SE of Loop diuretics:

higher with Ethacrynic Acid

Answer 9

Ototoxicity and Nausea

Question 10

Adverse SE of loop diuretics

Answer 10

Question 11

How to manage loop diuretic tolerance?

Answer 11

Loop diuretic tolerance
• “Braking phenomenon”

• Possible mechanism
– Low dose/secretion into tubule lumen
– Pronounced reabsorption at distal nephron sites
– Compensatory hypertrophy of renal tubules
– Pronounced post diuretic effect
• Greater amount of sodium may be reabsorbed once the
diuretic wears off
– Activation of renin angiotensin system

Question 12

Patients that have higher chance of ototoxicity when loop diuretics is administered fast

Answer 12

Question 13

Loop diuretic comparison:

Loop diuretic: Equivalent dosing

Answer 13

Question 14

What are samples of Thiazide diuretics?

what is the MOA?

IS IT AS GOOD as loops when it comes to removing volume?

Answer 14

Thiazide diuretics
• Chlorothiazide

• Metolazone
• Hydrochlorothiazide
• Chlorthalidone
• Indapamide

–> works on the covulated tubules. NOT as effective as loops in volume management

Question 15

Only IV thiazide available in the US

Answer 15

IV: Chlorothiazide

Question 16

Thiazide that is more effective in patients with renal injury but has a good gut function

Answer 16

Metolazone

Question 17

What are the SE of thiazide diuretics

Answer 17

Question 18

Thiazide diuretic comparison

Equivalent dosing

Answer 18

Question 19

Osmotic Diureses: Mannitol

MOA

Answer 19

Question 20

What do you need to have to use Mannitol?

Answer 20

filter

dont use it with crystals

you can use warmers

Question 21

Adverse SE of Mannitol

Answer 21

Pulmonary Edema and Volume overload is unique.

It has a nephrotoxicity SE. It can cause structural damage to the kidneys

know osmolar gap** if you are giving a lot of mannitol or your AKI is worsening.

*tissue injury and extravasation

Question 22

Clinical Implication of osmotic diuretics

Answer 22

Question 23

Samples of Potassium -sparing diuretics

Pteridine analogs

Aldosterone receptor blockers

Answer 23

Question 24

MOA of potassium sparing diuretics

Answer 24

1. Adjunct diuretic if you will start it – optimization of diuretic regimen

Question 25

SE: of potassium sparing what is greater in eplerenone?

Answer 25

boobies with spironolactone \*\* Rhabdo patients have higher chance of hyperkalemia \*watch out for hyperK dyrhythmias

Question 26

Samples of Dopamine receptor agonist whats the MOA? what is more potent?

Answer 26

Dopamine Fenoldopam -- **Fenoldopam 6x** more potent than dopamine

Question 27

Adverse effects of **Dopamine**

Answer 27

Hypertension Tachycardia Arrhythmias

Question 28

If your patient has nausea and vomiting will Tolvaptan be effective to use?

Answer 28

NO.

Question 29

What is the **MOA of Vasopressin receptor antagonists** **What is the SE?**

Answer 29

Vasopressin receptor antagonists * **Indications** * Hypervolemic hyponatremia * Euvolemic hyponatremia * **Side effects** of vasopressin antagonists * Hypovolemia * **Hypotension (more with conivaptan)** * Muscle weakness * Liver dysfunction

Question 30

What should you **monitor** for the patient on Vasopressin antagonist

Answer 30

**Monitor Na** more frequently as compared to other patient

Question 31

When should you avoid the use of diuretics?

Answer 31

* Avoid diuretic use in patients with **hypovolemia**

Question 32

What are the **indication for vasopressin**

Answer 32

Hypervolemic Hyponatremia Euvolemic hyponatremia -- if you do not have this you probably do not need vasopressin antagonist

Question 33

**Side effects of Vasopressin antagonist**

Answer 33

* Hypovolemia * Hypotension * Muscle weakness * Liver dysfunction

Question 34

**Drug** interactions with diuretics **concurrent nephrotoxins**

Answer 34

Question 35

Drug interactions **Digoxin + Diuretics**

Answer 35

leads to hypokalemia may increase **digoxin toxicity**

Question 36

Diuretic + Lithium leads to

Answer 36

Hyponatremia --\> increased lithium toxicity

Question 37

**Diuretic + Corticosteroids**

Answer 37

leads to **Hypokalemia**

Question 38

Drug interactions **Aminoglycoside + Diuretics**

Answer 38

**Ototoxicity**

Question 39

Drug Interactions **ARB/ ACE-I + Diuretics**

Answer 39

**Hyperkalemia** (potassium sparing diuretic)

Question 40

General considerations for diuretics in anesthesiology

Answer 40