Drugs to Treat Hypo/hypernatremia (Wolff) Flashcards

1
Q

1) Isotonic (0.9%) NaCl (normal saline) has what effect on volumes?
2) 0.45% NaCl has what effect?
3) 3% or 5% NaCl?
4) 5% albumin?
5) 5% dextrose (D5W)?

A

1) Increases ECF volume
2) Expands both ICF and ECF
3) Expands ECF while shrinking ICF
4) Expands plasma volume
5) Expands total body water

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2
Q

If the GFR falls due to ACE inhibition than what happens in all patients?

What effect does it have in diabetic patients?

A

1) Increases serum creatinine

2) Preserves kidney function

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3
Q

What effect does renal sympathetic nerve activity have on NaCl excretion?

Renin-Angiotensin-Aldosterone activity?

Atrial Natriuretic Peptide activity?

A

1) Decreases
2) Decreases
3) Increases

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4
Q

Hypernatremia is defined as plasma sodium concentration greater than?

Hyponatremia less than?

What is the normal value of plasma osmolality?

A

1) 145 mEq/L
2) 135 mEq/L
3) 285 – 295 mOsm/kg

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5
Q

What is the most common electrolyte abnormality encountered in clinical practice?

A

Hyponatremia

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6
Q

What should be done to treat hyponatremia if a patient presents with severe symptoms such as vomiting, seizure, obtundation, respiratory distress and coma?

A

Hypertonic NaCl first followed by fluid restriction or vaptan

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7
Q

What should be done to treat hyponatremia if a patient presents with moderate symptoms such as nausea, confusion, disorientation, and altered mental status?

A

Vaptan or hypertonic NaCl first followed by fluid restriction

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8
Q

What should be done to treat hyponatremia if a patient presents with no or minimal symptoms such as headache, irritability, inability to concentrate, altered mood, falls or unstable gait?

A

Fluid restriction

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9
Q

Overly rapid correction of hyponatremia can cause?

A

Osmotic demyelination syndrome

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10
Q

What is the overall MOA of vaptans?

A

Block the antidiuretic hormone receptor in the collecting duct

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11
Q

Which vaptan is a non-peptide arginine vasopressin receptor antagonist (AVP=ADH), with affinity for AVP receptor subtypes V1A and V2?

Which is a selective V2 receptor antagonist?

A

1) conivaptan

2) tolvaptan

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12
Q

How is conivaptan administered?

How is tolvaptan?

A

1) IV

2) Orally

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13
Q

What effect do the vaptans have?

What is its clinical application?

A

1) Increases free water clearance

2) Treatment of euvolemic and hypervolemic hyponatremia

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14
Q

Tolvaptan is used to slow progression of?

Why must you use tolvaptan less than 30 days for hyponatremia treatment?

A

1) Adult polycystic kidney disease

2) Hepatotoxicity

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15
Q

What effect do vaptans have on plasma volume and plasma osmolality primarily due to an increase in plasma sodium concentration?

A

1) Decreases plasma volume

2) Increases plasma osmolality

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16
Q

What are vaptans metabolized by which can cause drug interactions?

A

CYP3A4

17
Q

What do you use to treat hypernatremia if the patient is also hypovolemic?

In other patients you use?

A

1) Isotonic saline

2) Hypotonic IV solutions

18
Q

Overly rapid correction of hypernatremia can cause?

A

Brain edema

19
Q

What is a synthetic analogue of the antidiuretic hormone arginine vasopressin and is a V2 selective agonist?

A

Desmopressin (DDAVP)

20
Q

What effect does desmopressin have due to its V2 stimulation?

A

Increases cAMP in the collecting duct which increases water permeability

21
Q

What effect does desmopressin have on urine volume and urine osmolality?

A

1) Decreases urine volume

2) Increases urine osmolality

22
Q

What are the clinical applications for desmopressin?

A

1) Central diabetes insipidus

2) Primary nocturnal enuresis

23
Q

What black box warning does desmopressin have?

A

Life threatening hyponatremia

24
Q

How do you treat diabetes insipidus if the patient lacks ADH (central or neurogenic DI)?

A

Desmopressin

25
Q

How do you treat diabetes insipidus if the patient lacks ADH response (Nephrogenic DI)?

However this is contraindicated in what scenario?

A

1) Thiazide diuretics

2) Patient is undergoing Li+ therapy

26
Q

What is the treatment for Li-Induced Diabetes Insipidus?

A

Amiloride