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Cardio Exam 1 > Diuretics HTN > Flashcards

Diuretics HTN Flashcards

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1
Q

Arterial BP =

A

Cardiac output + peripheral vascular resistance

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2
Q

Cardiac output depends on?

A

Myocardial contractility

Ventricular filling pressure

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3
Q

Ventricular filling pressure is composed of?

A

Blood volume and venous tone

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4
Q

Vascular resistance depends on?

A

State of smooth muscle cells (contracted/relaxed)

Activity of the systems (controlling the diameter of resistance vessels)

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5
Q

Define Myocardial contractility

A

How the heart is contracting

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6
Q

Define ventricular filling pressure

A

How much blood if filling into the heart

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7
Q

What is the main function of the kidneys?

A

Maintain normal body fluid volume and electrolyte balance

- Filtration, reabsorption, secretion and excretion

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8
Q

Reabsorption of what?

A

Ions, amino acids, glucose, water,

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9
Q

Normal filtration rate?

A

120 mL/min

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10
Q

How much of fluid and electrolytes are reabsorbed?

A

99.9%

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11
Q

Rate if urine production?

A

1 mL/min

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12
Q

Nephron (urine forming unit) =

A

Glomerulus (filtration) + Tubule (reabsorption and conditioning)

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13
Q

What does the afferent arteriole do?

A

Brings the blood to the glomerulus

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14
Q

What does the efferent arteriole do?

A

Removes left over blood from the glomerulus

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15
Q

What is different about the glomerulus than other places in the body?

A

Endothelial cells are not tightly connected to each other leading to easier permeabilty

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16
Q

What holds filtered blood?

A

Bowman’s capsule

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17
Q

Where is reabsorption the greatest?

A

Proximal tubule and it declines distally towards the collecting ducts

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18
Q

Proximal tubules reabsorbs?

A

65% of sodium and highly permeable for water

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19
Q

Loop of Henle reabsorbs?

A

25% of sodium

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20
Q

Thin descending limb reabsorbs

A

Water but not sodium

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21
Q

Early distal tubule and distal convoluted tubules reabsorb?

A

5% of sodium

NO water or urea

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22
Q

Sodium reabsorption is controlled by?

A

Aldosterone

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23
Q

Water reabsorption is controlled by?

A

ADH

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24
Q

What is a major determinant of extracellular fluid volume?

A

NaCl

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25
What do diuretics do?
Increase the rate of urine flow and sodium and chloride excretion
26
Diuretics -->
Increase Na and Cl excretion --> Decreased ECF volume --> decreased venous return --> Decreased cardiac output --> Decreased BP
27
Continued administration of diuretics cause?
Sustained net deficit of sodium & decreased ECF volume and BP
28
Compensatory mechanisms mean what?
Balance between sodium intake and excretion
29
Chronic effects of diuretics -->
Increased excretion and decreased fluid --> compensatory mechanisms --> decreased excretion & extracellular volume returns to normal --> decreased peripheral resistance --> BP remains low
30
Initial BP lower effects of diuretics is due to?
Sodium excretion and ECF volume decrease
31
Chronic BP lowering effect of diuretics is due to?
Reduction of peripheral resistance
32
Loop diuretics drugs?
Bumetanide (Bumex) Furosemide (Lasix) Torsemide (Demadex)
33
Loop diuretics site of action
Thick ascending limb of the Henle Loop where 25% of sodium reabsorption occurs
34
Loop diuretics MOA
Inhibition of Na/K/Cl symporters | Inhibit the reabsorption of Na, K, Cl and indirectly inhibits reabsorption of Ca and Mg
35
Loop diuretics urinary and hemodynamic effects?
Increased urine flow: excretion of Na, K, Cl, Ca, and Mg | Volume depletion and decrease of BP via renin release and SNS activity
36
With acute use of loop diuretics what can you see that is lost during chronic use?
Increased excretion of uric acid
37
What are Loop Diuretics main therapeutic uses?
``` Acute pulmonary edema HTN and HF Edema and scites Drug overdose Hypercalcemia ```
38
Define ascites
Accumulation of fluid in the peritoneal cavity
39
What are the main adverse effects of loop diuretics due to fluid changes?
HYPOnaemia, hypotonia, circulatory collapse, thromboembolic episodes Hypochloremic Hypokalemia Hypomagnesemia and hypocalcemia
40
Hypokalmeia and hypomagnesmia are risk factors for?
Cardiac arrhythmias
41
What are other main adverse effects of loop diuretics NOT due to fluid changes?
Ototoxicity Hyperuricemia Increased LDL cholesterol and decreased HDL
42
What is the strongest diuretic?
Bumetanide
43
Thiazide Diuretics
Chlorthalidone (Hygroton) Hydrochlorithiazide (Microzide) Indapamide (Lozol) Metolazone (Zaroxolyn)
44
Thiazide Diuretics Site of Action
Distal convoluted tubule | where 5% of Na reabsorption occurs
45
Thiazide Diuretics MOA
Inhibition of Na/Cl symporters | No reabsorptions of Na or Cl
46
What are the main effects of thiazide diuretics?
Increased excretion of Na, Cl, K (indirectly) and water | Lower BP bc of increased Na excretion
47
What are the main effects of chronic thiazide diuretics uses?
Decreased excretion of Calcium and uric acid
48
Main therapeutic uses of Thiazide diuretics?
HTN Edema Nephrogenic diabetes insipidus Calcium nephrolithiasis & osteoporosis
49
Define Nephrogenic diabetes insipidus?
Kidney is unable to conserve water
50
What are other main adverse effects of thiazide diuretics due to fluid changes?
``` Extracellular volume depletion, HYPOtension HYPOnaemia, HYPOclemia HYPOkemia HYPERcaemia HYPERuricemia ```
51
Hyperuricemia leads to a risk of?
Gout
52
What are other main adverse effects of thiazide diuretics NOT due to fluid changes?
Reduction of glucose tolerance due to reduced insulin secretion or K depletion Increased risk for sexual impotency Increase levels of LDL, total cholesterol and TGs
53
Is chlorathalidone or hydrochlorthiazide more potent with a longer half life?
Chlorthalidone is 50% more potent and a MUCH longer halflife
54
What is THE most potent thiazide diuretic?
Indapamide
55
Inhibitors of renal epithelial Na Channels Potassium Sparing Diuretics
Amiloride (Midamor) | Triamterene (Dyrenium)
56
Potassium-Sparing Diuretics Site of Action
Late distal tubule and collecting duct where ~2% of Na reabsorption occurs
57
Inhibitors of renal epithelial Na Channels MOA
Inhibition of renal epithelial Na channels Decreased reabsorption of Na and increased reabsorption of K Involves principal cells collecting as much sodium as they can but not potassium
58
Inhibitors of renal epithelial Na Channels main adverse effects
HYPERkalemia N/V/D Headache
59
Triamterene can cause?
Glucose tolerance and photosensitization
60
Aldosterone Antagonists Potassium Sparing diuretics
Eplerenone (Inspra) | Spironolactone (Aldactone)
61
Aldosterone Antagonists site of action
Late distal tubule and collecting duct where ~2% of Na reabsorption occurs
62
Aldosterone cascade
Aldosterone binds to its receptors in the cytoplasm --> translocates into the nucleus and binds to DNA where is stimulates expression of aldosterone-induced proteins and causes the retention of Na and the excretion of potassium
63
Aldosterone antagonists bind?
At the receptor and block the effects of aldosterone causing the increased excretion of sodium and increased reabsorption of K
64
Potassium sparing diuretics main therapeutic uses?
Used with other diuretics to spare K | Heart failure
65
Spironolactone therapeutic uses are helpful in?
Primary (adrenal adenoma) and Secondary (overactivity of RAS) hyperaldosteronism In pts with hepatic cirrhosis
66
Potassium diuretics adverse effects?
HYPERkalemia | Spironolactone: gynecomastia, sexual impotency, decreased libido and altered clearance of digitalis glycosides

Cardio Exam 1 (7 decks)

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