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