Diuretics, ACEs, ARBs, CCBs Flashcards Preview

NU 607 Pharm Quiz 2 > Diuretics, ACEs, ARBs, CCBs > Flashcards

Flashcards in Diuretics, ACEs, ARBs, CCBs Deck (93)
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1

hydrochlorothiazide, indapamide, chlorothiazide, chlorthalidone, methylclothiazide

thiazide diuretics

2

furosemide, bumetanide, ethacrynic acid, torsemide

loop diuretics

3

amiloride, spironolactone, triamterene

potassium-sparing diuretics

4

prototype: thiazide

hydrochlorothiazide

5

prototype: loop

furosemide

6

prototype: potassium-sparing (2)

spironolactone & triamterene

7

which diuretic acts in the ascending loop of Henle to inhibit sodium and chloride reabsorption?

loop diuretics

8

indications for loop diuretics (4)

1. edema r/t HF
2. edema r/t renal disease or liver failure
3. hypertension that cannot be control with thiazide or potassium sparing diuretics
4. patients who need diuretic therapy but have low renal blood flow

9

ototoxicity is a side effect in which diuretic class?

loop diuretics

10

electrolytes excreted with the majority of diuretics

sodium, chloride, potassium, hydrogen, calcium, magnesium

11

most powerful diuretic class?

loop diuretics

12

diuretic class most commonly used in HF

loop diuretics (furosemide)

13

which diuretic class is effective in treating pulmonary edema & mod./severe CHF

loop diuretics

14

adverse effects with loop diuretics include (5)

- electrolyte imbalances (hypokalemia, hyponatremia, hypochloremia, hypomagnesemia, hypocalcemia)
- dehydration
- hypovolemia/hypotension
- hyperuricemia
- ototoxicity

15

drug interactions with loop diuretics (6)
(which one is a positive interaction?)

- potassium sparing diuretics (positive, helps counterbalance K+ loss)
- NSAIDs
- digoxin
- ototoxic drugs
- lithium
- antihypertensive drugs (hypotension)

16

which class of medications can blunt loop diuretic effects?

NSAIDs

17

monitoring for loop diuretics

- monitor BP & pulse
- daily weights
- intake and output
- monitor for decreased edema

18

which diuretic acts in the distal convoluted tubule, decreasing reabsorption of sodium and increasing sodium & water excretion into the urine?

thiazides

19

which diuretic class is associated with HYPERcalcemia?

thiazides

20

indications for thiazide diuretics (2)

- essential HTN
- edema in mild HF

21

which diuretic class is ineffective in patients with eGFR < 30-40?

thiazide

22

if eGFR < 30-40, which diuretic class should be used?

furosemide

23

thiazides should be used in caution with patients suffering what kind of impairments?

renal and liver

24

the eGFR in which thiazides have their best efficacy

when eGFR is normal (> 90 mL/min), thiazides are most effective
- These drugs are ineffective when GFR is < 15-20 mL/min

25

the ability of thiazides to promote diuresis is dependent on what?

adequate kidney fx

26

adverse effects for thiazide diuretcs (6)

- hypokalemia
- hypomagnesemia
- HYPERcalcemia
- HYPERglycemia
- HYPERuricemia
- HYPERlipidemia

27

which diuretic should be used cautiously with gout?

thiazide

28

which diuretic should be used cautiously with diabetes?

thiazide

29

drug interactions with thiazide diuretics (5)
(which one is a positive interaction?)

- potassium sparing diuretics (positive, helps counterbalance K+ loss)
- NSAIDs
- digoxin
- lithium
- antihypertensive drugs (hypotension)

30

drug interaction differences between loop & thiazide diuretics?

thiazides CAN be combined with ototoxic agents without increasing risk of hearing loss

31

In treatment of hypertension, what determines the use of a loop diuretic vs thiazide diuretic?

Loop diuretic will only be used in place of thiazide diuretic when HTN is uncontrolled with other diuretics

32

diuretic class most commonly used in HTN

thiazide

33

monitoring for thiazide diuretics

- monitor BP & pulse
- daily weights
- intake and output
- monitor for decreased edema

34

which diuretic acts on the late distal tubule and collecting duct?

potassium-sparing (triamterene)

35

which diuretic blocks the action of aldosterone?
what does this cause?

potassium-sparing (spironolactone)
--> causes retention of potassium & increased excretion of sodium

36

indications for potassium-sparing diuretics (3)

HTN, edema, HF

37

adverse effects of potassium-sparing diuretics (2)

- hyperkalemia
- endocrine effects (gynecomastia & impotence)

38

which diuretic is associated with hyperkalemia

potassium-sparing diuretics

39

are potassium-sparing diuretics used as monotherapy?

no - generally combined with thiazide or loop

40

drug interaction of potassium-sparing diuretics with thiazides and loop diuretics

counteracts the potassium-wasting effects of the more powerful diuretic

41

agents that raise potassium levels must be used with caution in which diuretic class? what are these agents?

potassium-sparing (salt substitutes, potassium supplements, or another K+ sparing diuretic) in addition to ACEs, ARBs, and DRIs

42

monitoring for potassium-sparing diuretics

- monitor K+ level

43

contraindications for potassium-sparing diuretics

those with hyperkalemia

44

caution should be used in potassium-sparing diuretics for patients taking what?

ACEs, ARBs, or DRIs

45

caution should be used with thiazides for patients with what conditions (4) or taking what meds (3)?

- cardiac disease
- renal impairment
- diabetes
- history of gout
- dig, lithium, anti hypertensives

46

caution should be used with loop diuretics for patients with what conditions (4) or taking what meds (5)?

- cardiac disease
- renal impairment
- diabetes
- history of gout
- dig, lithium, ototoxic drugs, NSAIDs, anti hypertensives

47

3 determinants of BP

1. mean arterial pressure
2. cardiac output
3. peripheral vascular resistance

48

most commonly used diuretic for HTN

thiazide

49

most cost effective diuretic used for HTN

thiazides

50

ACE inhibitor prototype

captopril

51

-prils belong to what drug class?

ACE inhibitors

52

benazepril, captopril, enalapril, enalaprilat, fosinopril, lisinopril, moexipril, perindopril, quinapril, ramipril, trandolapril

ACE inhibitors

53

which drug class reduces levels of angiotensin II and increases levels of bradykinin

ACE inhibitors

54

main difference between mechanism of actions between ACEs and ARBs

ARBs block the actions of angiotensin II, whereas ACE inhibitors block the formation of angiotensin II

55

contraindications for ACE inhibitors (3)

1. Pregnancy
2. Bilateral renal artery stenosis (or stenosis in artery to single remaining kidney)
3. History of hypersensitivity reactions (especially angioedema) to ACE inhibitors

56

caution should be used when prescribing ACEs to which patients (3) or taking which meds (4)?

- salt/volume depletion
- renal impairment
- collagen vascular disease
OR
- K+ supplements, salt substitutes, K+ sparing diuretics
- ARBs
- aliskiren
- lithium

57

indications for ACE inhibitors (6)

- HTN
- HF
- MI
- diabetic & non-diabetic nephropathy
- prevention of MI, stroke and death in pt. with high CV risk
- diabetic retinopathy

58

adverse effects with ACEs (what's the big one?) (7)

COUGH
- hypotension** first dose hypotension
- rash
- angioedema
- hyperkalemia
- renal failure
-neutropenia

59

drug interactions for ACE inhibitors(5)

- diuretics
- antihypertensive agents
- drugs the elevate potassium levels
- lithium
- NSAIDs

60

first line hypertensive medication classes (4)

- thiazides
- ACEs
- ARBs
- CCBs

61

which drug class is good for patients with HTN & DM or HTN & CHF?

ACEs

62

which drug class can slow the progression of neuropathy?

ACEs

63

monitoring for ACEs (5)

- monitor BP closely
- obtain CBC
- monitor for reduced BP (140/90)
- monitor for reduced s/s HF
- monitor for protienuria & GFR

64

which drug class blocks the angiotensin II receptor, inhibiting the action of angiotensin II

ARBs

65

-sartan belongs to which drug class?

ARBs

66

ARB prototype

losartan

67

azilsartan, candesartan, eprosartan, irbesartan, losartan, olmesartan, telmisartan, valsartan

ARBs

68

which drug class is an alternative to ACE inhibitors if cough is a problem?

ARBs

69

indications for ARBs (7)

- HTN
- HF
- diabetic nephropathy
- MI
- Stroke prevention
- prevention of MI, stroke, and death in those with high CV risk
- diabetic retinopathy

70

adverse effects for ARBs (8)

- hyperkalemia
- fatigue, headache, dizziness
- insomnia
- sinus congestion
- angioedema
- renal failure
*lower incidence of cough bc ARBs don't affect bradykinin*

71

contraindications for ARBs (3)

1. Pregnancy
2. Bilateral renal artery stenosis (or stenosis in artery to single remaining kidney)
3. History of hypersensitivity reactions (especially angioedema) to ARBs

72

monitoring for ARBs (3)

- monitor for reduced BP (140/90)
- monitor for reduced s/s HF
- monitor for protienuria & GFR

73

important drug interaction for ARBs

hypotensive effects of ARBs are additive with those of other antihypertensive drugs...when ARB is added, other drugs may require reduction

74

use cautiously in patients with HF, liver impairment or patients taking digoxin or beta blockers (2)

verapamil & diltizem

75

3 classes of CCBs

1. diphenyalkylamines
2. benzothiazipines
3. dihydropyridine

76

diphenyalkylamines

verapamil

77

benzothiazipines

diltiazem

78

dihydropyridines

nifedipine

79

agent that affects the heart & blood Vessels

verapamil

80

agent that act maiNly on blood vessels

nifedipine

81

prototype CCBs (2)

verapamil & nifedipine

82

therapeutic uses for verapamil (3)

- angina
- essential HTN (2nd line)
- cardiac dysrhythmias

83

contraindications for verapamil & diltiazem (3)

- severe hypotension
- sick sinus syndrom
- second or third degree AV block

84

adverse effects include: cardiosuppression (brady, AV block, & HF), peripheral edema, and constipation*

verapamil (and diltiazem)

85

drug interactions include: digoxin, beta blockers, and grapefruit juice

verapamil (and diltiazem)

86

which medication class should be used cautiously with hypotension, sick sinus syndrome, second/third degree AV block, angina (d/t RT), and HF?

nifedipine
(dihydropyridines)

87

which drug can treat angina and essential HTN?

nifedipine

88

reflex tachycardia, gingival hyperplasia, eczema, & peripheral edema are adverse reactions of what drug?

nifedipine

89

positive drug interaction associated with nifedipine

beta blockers (to prevent reflex tachycardia)

90

how do beta blockers interact with nifedipine?
how they interact with verapamil & diltiazem?

nifed = decreases cardiac affects
verapamil = intensify adverse effects

91

which CCBs can worsen HF & cause bradycardia?

verapamil & diltiazem

92

which CCB is associated with constipation

verapamil

93

which CCB has an increased risk of MI when used for HTN?

nifedipine