Diuretics and Vasodilators

Question 1

Name a carbonic anhydrase inhibitor diuretic

Answer 1

acetazolamide

Question 2

Name 2 thiazide diuretics

Answer 2

• hydrochlorothiazide

- metozalone

Question 3

Name 3 loop diuretics

Answer 3

furosemide
bumetanide
ethacrynic acid

Question 4

Name 2 potassium sparing diuretics

Answer 4

spironolactone

eplerenone

Question 5

Name an ADH antagonist

Answer 5

conivaptan

Question 6

Name a sodium glucose transport inhibitor

Answer 6

dapaglifozin

Question 7

Name 2 osmotic diuretics

Answer 7

Mannitol

Glucose

Question 8

What are the classes of diuretics?

What type of diuretics are in each class?

Answer 8

1. Minor
   - osmotic
   - CA inhibitor
2. Major
   - loop
   - thiazides
   - potassium sparing
3. Other
   - ADH antagonists
   - glycosuric agents

Question 9

Where and how to CA inhibitors work?

Uses?

Answer 9

• work in the proximal tubule
• inhibit CA
• decrease bicarbonate reabsorption
• used in severe alkalosis
• alkilinization of filtrate ionizes acidic drugs –> promotes drugs excretion because ionized drugs can’t cross barriers
• glaucoma –> decreases humor production

Question 10

Where and how do thiazides work?

Uses?

Answer 10

• work in the distal tubule (some proximal activity but only important if combined with a loop diuretic)
• inhibit the reabsorption of Na/Cl
• increases reabsorption of Ca2+ (loop diuretics do opposite)
• decreases BP without a huge volume loss

Question 11

What are the risks of thiazide diuretics?

Answer 11

• hyperglycemia (reduced insulin release)
• increased LDLs
• increased chance of ED
• plasma volume contraction (due to excessive urine loss)

Question 12

What are the advantages of thiazide?

Answer 12

• taken orally
• low toxicity
• no postural hypotension
• work with other anti-hypertension drugs

Question 13

Why are loop diuretics dangerous?

Answer 13

because they can cause a patient to excrete 20% of filtered load

Question 14

Loop diuretics help increase prostaglandin production. How do that help edema?

Answer 14

• causes vasodilation

Question 15

How do loop diuretics work?

Answer 15

• increase Na/K/Cl excretion (Mg and Ca follow)

- inhibits dilution and concentrating functions of the kidney

Question 16

Why would a patient use etharynic acid instead of furosemide or bumetanide?

Answer 16

They’re allergic to sulfonamides

Question 17

What problems do loop diuretic cause?

Answer 17

• electrolytes imbalances
• deafness (with aminoglycoside antibiotics)
• hyponatremia

Question 18

What are the uses of loop diuretics?

Answer 18

• renal insufficiency
• edema
• hypertensioln
• hypercalcemia
• heart failure

Question 19

What do you do if a patient is not responding to the loop diuretic (refractory)?

Answer 19

• add a thiazide diuretic
• thiazide has proximal tubule effect –> keeps Na in the nephron
• now the loop diuretic has something to prevent from leaving

Question 20

Loop and thiazides cause potassium depletion. What are the 2 causes of this?

Answer 20

1. secondary hyperaldosteronism
   - less plasma volume, more renin, AII, aldosterone
   - causes more Na reabsorption at expense of K
2. Increased distal delivery
   - more Na is reaching distal tubule because the loop is blocking reabsorption
   - when all that Na get to the collecting tubule, Na gets absorbed at expense of K

Question 21

What are the treatments for potassium depletion

Answer 21

1. Food
2. KCl tablets
3. K+ tablets
4. Emergencies (IV)
5. K+ sparing diuretics

Question 22

How do potassium sparing diuretics work?

Answer 22

• they block aldosterone receptors (interstitium)

- triamterene reduces Na permeability (lumen)

Question 23

What are the 3 major compensatory mechanisms when BP is decreased?

Answer 23

1. sodium retention
2. increased SNA
3. increased renin –> increased aldosterone

Question 24

What are the clinical applications of ARBs and ACEIs?

Answer 24

1. Hypertension
2. Congestive heart failure
3. Post MI therapy
4. Diabetic nephropathy

Question 25

What happens when you have ARB/ACEI toxicity?

Answer 25

- hypotension - hyperkalemia - proteinuria - dry cough (ACEIs) - angioedema (

Question 26

Name the 2 types of CCB, where they're active and 2 example of each.

Answer 26

1. Dihydropyridines - arterial - amlodipine, nifedipine 2. Non-dihydropyridines - cardiac - verapamil, diltiazem

Question 27

How do CCBs help with angina pectoris?

Answer 27

Decrease oxygen demand - decreases HR, contractility and BP Increases oxygen supply - dilates coronary artery

Question 28

Why are CCBs so beneficial?

Answer 28

- They can be used when beta blockers are contraindicated - They don't cause problems in airways or diabetes - They are metabolically neutral

Question 29

What are the side effects of CBBs related to vasodilation?

Answer 29

- headache - flushing - edema - constipation - decreased BP

Question 30

What is hydralazine? | Mechanism?

Answer 30

- vasodilator - given with a beta blockers and diuretic to help hypertension - dilates ARTERIES

Question 31

What is minoxidil? | Mechanism

Answer 31

It is a vasodilator like hydralazine, but it is used in refractory (severe) hypertension. Also given with a beta blockers and diuretic Activation of SNS could be problematic

Question 32

What type of drug is sodium nitroprusside? | Mechanism?

Answer 32

- venous and artery dilator - used in severe congestive heart failure - decreases preload, afterload --> decreases oxygen demand and increases CO

Question 33

What do nitrates do? | Mechanism?

Answer 33

- Relax veins and larger arteries (higher doses) - decreases preload - decreases pulmonary artery resistance - prevents coronary steal (smaller arteries aren't as effected, good because it prevents blood flow to the healthier areas - decreases demand (not increased supply)