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Flashcards in Diuretics and RAAS antagonists Deck (29):
1

3 goals of HF management with pharmacotherapy

• Reduction of congestion
• Modulate neurohormonal activation
• Improve flow

2

Which diuretics are the most efficacious, why?

Loop

3

Which classes of drugs are K+ sparing? Na + sparing? K+ wasting?

Na+ sparing = Aldosterone
K+ wasting = Loop and Thiazides
K+ sparing = Aldo-antagonists, ACE-I, and ARB

4

In HFrEF acute conditions, which drugs would you use?

IV diuresis!!!
Nitrates (if BP allows)
CPAP/BiPAP (if SOB)
Pressors (if ↓↓↓CO, shock

5

In HFpEF acute conditions, which drugs would you use?

IV diuresis!!!
Nitrates (if BP allows)
CPAP/BiPAP

6

Diuretics used to treat what?

Volume overload
(SV-Vntricular EDP grap gets moved to left)

Diuretics will:
↑ Salt (+Water) Excretion →
↓ Intravasc Fluid Vol →
↓ Venous congestion →
↓ Dyspnea, Edema

Lowers preload (LVEDP)

7

Are diuretics used chronically or acutely?

can be both

8

Most common diuretic

Furosemide

* Torsemide or bumetanide have more reliable absorption

9

Describe when/how you would initially use ACEIs

Started during or after optimization of diuretic therapy at low doses

10

What do ACEIs produce?

Produce vasodilation
↓ aldosterone activation
Plus antiremodeling effect

11

True/False, ARBs used in conjuction with ACEIs will benefit from the dual therapy

NO!

No apparent benefit from dual therapy

12

What drug is added to therapy for LVEF < 30-35%, optimized on ACEI/ARB and β-blocker therapy

Aldosterone Antagonists
- ACEI/ARB aldosterone block is incomplete

13

what type of aldosterone antagonist is preferred?

Spironolactone preferred if tolerated - if endocrine side effects (gynecomastia) can use eplerenone

14

Diuretic Agents you would be stupid not to know

#11: Hydrochlorothiazide
#14: Furosemide (Lasix®)
#70: Spironolactone (Aldactone®)

15

Nearly all diuretic agents exert their effects at______ surface of renal tubule cells.

luminal (urine)

16

Na+ is the major extracellular cation and its movement between compartments is controlled by regulated active transport via ________ activity at the _______ surface

Na+-K+-ATPase

interstitial (blood)

17

Compensatory changes in HF

↓ CO →

1. ↑ Sympathetic discharge
(baroreceptor response)
2. ↑ Renin release
(RAAS response)

3. Na+ reabsorption → ↑ fluid retention

(remodeling caused by AII can cause chronic harm)

18

Diuretic mechanism of:
(thiazides, furosemide, triamterene)

Interactions with membrane transport proteins

19

Diuretic mechanism of:
(acetazolamide)
or
(spironolactone)

Intxn of enzymes (acetazolamide)
or
hormone receptors (spironolactone)

20

Diuretic mechanism of:
Mannitol

Osmotic effects preventing water reabsorption

21

True / False, diuretics act via inhibition of Na+-K+-ATPase

False
Diuretic agents decrease Na+ reabsorption at various sites in the nephron

22

K+ sparing diuretics do what?
K+ wasting diuretics do what?
- examples

K+ sparing diuretics
- decrease K+ excretion in collecting duct
K+ wasting diuretics
- increase K+ excretion in ascending LOH

23

K+ sparing diuretics
- examples

Aldosterone antagonists

24

K+ wasting diuretics
- examples

Loop agents
Thiazides

25

Loop diuretic examples
- what do they do?
- examples

Inhibit NaCl transport (Na+-K+-2Cl--transporter)

Furosemide
Bumetanide
Torsemide

26

Loop diuretics Associated with increase in ____and ___ excretion (diminish lumen-positive potential)

Mg++, Ca++

27

If Loop diuretics such as Furosemide has a lack of response, what drugs can you switch to?
What about if there is a sulfa allergy?

Switch to bumetanide or torsemide --> more reliable bioavailability and longer duration of action


Ethacrynic acid can be used if sulfa allergy

28

Which aldosterone antagonist improves survival in some pts with systolic HF?

Spironolactone

29

What type of drug is most efficacious in HF?

Loop diuretics