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Flashcards in Diuretics DSA II Deck (23):
1

osmotic agent pharmacy

given IV
-excreted in filtrate (30-60 mins)
-promotes water retention - proximal tubule and descending loop
-oppose ADH in collecting tubule

2

osmotic agent toxicity

extracellular volume expansion
-extracts water from cells prior to diuresis, leads to expansion of extracellular volume and hyponatremia

3

osmotic agent contraindication

renal disease, dehyration, pulmonary edema

4

osmotic agent clinical use

urinary excretion of toxic substance
-reduces intracranial and IOP
-use for prevention of ARF not reccommended

5

ADH agonists

increased water reabsorption
-vasopressin and desmopressin
-mediate vasoconstriction of vasc. smooth m and increase water permeability in collecting tubule

6

clinical use ADH agonists

diabetes insipidus, polyuria, polydipsia, hypernatremia, nocturnal uresis

7

ADH antagonists

SIADH, heart failure
-conivaptan and tolvaptan

8

demeclocycline

ADH antagonist
-not used - high renal failure incidence

9

tolvaptan

V2 receptor selectivity

10

conivaptan

antagonist at V1a and V2 receptors

11

toxicity of ADH antagonists

hypernatremia
nephrogenic diabetes insipidus

12

loop and thiazide combo

when acting alone doesn't work
-more than an additive diuretic response
-thiazides mild natriuresis, blocked in increased thick ascending absorption - combo blocks Na reabsorption
>all three segments - PCT, ascending loop, DCT

13

metolazone

thiazide diuretic
-often used in COMBO

14

combination use

not recommended for outpatient
-severe diuresis

15

K-sparing combo

with loop and thiazide agents
-to control hypokalemia

16

heart failure

edematous state - treated with diuretics
-decreased blood flow to kidney > salt and water retention
-pulmonary or interstitial edema can occur

Tx - diuretics decrease this

17

kidney disease

edematous state - treated with diuretics
-kidney diseases - result in Na and water retention
-severe loss of renal function - diuretic agents not worth much

18

early stage renal disease

hyperkalemia - loop and thiazide diuretics

19

hepatic cirrhosis

edema and ascites become severe due to liver diseas
aggressive use of diuretics - disaster in liver patient

20

HTN

non-edematous state- Tx diuretics
-thiazide - mild vasodilator
-loop - renal insufficiency or heart failure

21

nephrolithiasis

non-edematous state - Tx diuretics
-2/3 stone calcium based
-thiazide increase Ca reabsorption and decreased urine Ca

22

hypercalcemia

non-edematous - Tx diuretics
-loop reduce Ca reabsorption and promote Ca diuresis

administer saline simultaneously

23

diabetes insipidus

non-edematous - Tx diuretics
-nephrogenic or neurogenic

-vasopressin/desmopressin - only central diabetes insipidus
-thiazide - reduce polyuria and polydipsia in both types