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Pharm 2 > II. Diuretics > Flashcards

II. Diuretics Flashcards

1
Q

1.

Furosemide (Lasix®) IV & IVP Dose

A

IV: 0.1-1.0 mg/kg

IVP: 10-20 mg

Hint: Michael’s FUR coat cost $10-20 at Burlington Coat Factory; but one (.1) FUR coat was 1 too many.

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2
Q

Examples of Loop Diuretics

A
  1. Bumetanide (Bumex®)
  2. Furosemide (Lasix®)

(-ide)

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3
Q

Loop diuretics target what area of the kidneys?

A

Thick ascending Loop of Henle

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4
Q

Loop diuretics inhibit reabsorption of what?

A

Na, Cl, Mg, Ca

…and K later on at the DCT. This is caused by the elevated Na delivery to the DCT; this stimulates the Na-K exchange pump, which reabsorbs some of the increased Na content while pumping out K into the DCT lumen (on its way to excretion); this is how Loop Diuretics can cause hypokalemia.

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5
Q

What area do Thiazide diuretics target?

A

the DCT

Hint: Z is at the distal end of the alphabet

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6
Q

What do thiazide diuretics cause?

A

inhibition of Na and Cl reabsorption

Marked increase in excretion of Na, K, Cl, CO ions

Increased K is excreted which can lead to hypokalemia; this occurs because there is increased Na content that reaches the collecting duct. At the collecting duct, some Na may be reabsorbed in exchange for potassium, leading to decrease serum potassium

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7
Q

Thiazide diuretics are often administered concurrently with what?

A

ACE-I

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8
Q

What are some adverse S/E of Thiazide Diuretics?

A
  • Hypokalemia
  • Orthostatic HTN
  • Hyperglycemia
  • Decreased Placental Perfusion
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9
Q

Which diuretic is considered a first line anti-HTN Tx?

A

Thiazide diuretics

Hydrochlorothiazide (HCTZ or Hydrodiuril®)

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10
Q

Which diuretic:

  • decrease in ECF
  • Desensitization of vascular smooth muscle to Ca release stimulated by NE (less VC)
A

thiazide

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11
Q

Which diuretic:

  • increased production of prostaglandins resulting in renal VD and increased RBF
A

Loop Diuretics

this effect is inhibited if patient takes NSAIDS

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12
Q

T/F: Loop diuretics cause hypercalcemia.

A

FALSE

Loop diuretics cause a decrease in serum calcium, while thiazides cause an increase serum calcium.

Hint: “Loops LOSE calcium”

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13
Q

Indications for which diuretic:

  • Pulmonary Edema
  • CHF
  • Renal Insufficiency
  • Increased ICP
  • Hypercalcemia
A

Loop Diuretics

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14
Q

Which diuretic can potentiate NDMR?

A

Loop Diuretics

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15
Q

Which diuretic:

  • increases plasma osmolality and draws fluid from ICF
A

Osmotic Diuretic

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16
Q

Osmotic diuretics cause increased urinary excretion of what contents?

A
  • H2O
  • Na
  • Cl
  • CO2
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17
Q

Osmotic diuretics target what area of the nephron?

A

Loop of Henle

Thin Descending Loop of Henle

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18
Q

What is an example of an osmotic diuretic?

A

Mannitol

Mannitol is considered an aquaretic because mostly promotes H2O excretion and relatively small amount of Na.

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19
Q

How does Mannitol work on tubules?

A

By increasing water absorption into the PCT and Thin Descending LOH (Both of these portions are permeable to H2O), there is increased RBF through the tubules; this means there is less time for Na to be reabsorbed. Therefore, some Na is excreted along with a lot of H2O.

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20
Q

Mannitol is not typically prescribed for HTN, rather what is its main indications?

A
  • Increased IOP (glaucoma)
  • Increased ICP
  • ARF prophylaxis
  • Circuit prime for CPB
  • Dx of acute oliguria
  • Flush harmful stubstances out of kidneys (rhabdo induced myoglobin or hemolysis)
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21
Q

Which diuretic can worsen edematous states such as Pulmonary Edema?

A

Osmotic diuretics

Acute & transient increases in volume can lead to tissue injury from extravasation can lead to compartment syndrom

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22
Q

Which diuretic should be given centrally?

A

Osmotic

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23
Q

Mannitol dosage (weight based & IVP)

A

0.5-1 g/kg

IVP: 12.5-25 g

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24
Q

What is the MOA of K-sparing Diuretics?

A

Decreased Na reabsorption at the DCT

this inhibits the DCT Na-K pump from activating, therefore retaining serum K levels

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25
Q

Potassium-sparing diuretics may be prescribed alongside what other diuretics to prevent hypokalemia?

A
  1. Thiazide
  2. Loop
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26
Q

What are the two types of Potassium sparing diuretics?

A
  1. Spironolactone (Direct inhibition of Aldosterone receptor)
  2. Amiloride (Indirect inhibition of Aldosterone by blocking ENaC Channels)
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27
Q

What is the net result of potassium sparing diuretics?

A
  1. Increased excretion of Na & H2O loss through urine
  2. Decreased excretion of K & H+
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28
Q

Without a potassium sparing diuretic, what is the effect of Aldosterone?

A

it augments the renal tubular reabsorption of Na and Cl ions and increases the excretion of K

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29
Q

Which diuretic’s MOA targets the RAAS?

A

Potassium Sparing Diuretic (Spironolactone)

30
Q

Spironolactone is a ____ to aldosterone.

A

competitive antagonist

31
Q

Carbonic anhydrase inhibitors target what area of the tubule system?

A

Proximal Convoluted Tubule

32
Q

T/F: Carbonic anhydrase inhibitors competitively inhibit carbonic anhydrase.

A

False

non-competitively inhibit, reversing the Na/H pump thus inhibiting Na reabsorption = Na & H2O are excreted

33
Q

Bicarbonate binds with ____ to form carbonic acid.

A

Hydrogren

34
Q

____ splits carbonic acid into water and carbon dioxide.

A

Carbonic Anhydrase Type 4

35
Q

Carbonic anhydrase inhibitors end in ____.

A

-zolamide

36
Q

Clinical indications of Carbonic Anhydrase Inhibitors:

A
  • Altitude sickness
  • Glaucoma
  • Epilepsy
  • Benign increased ICP
  • HF
37
Q

Most common Carbonic Anhydrase Inhibitor

A

Acetazolamide (Diamox®)

38
Q

3 values we use to assess renal function:

A
  1. Cr
  2. GFR
  3. UO
39
Q

Normal GFR

A

> 90

40
Q

Normal Creatinine

A

0.8-1.2

41
Q

normal UO

A

> 0.5 mL/kg/hr

42
Q

Keep MAP between ____ mmHg to maintain autoregulation

A

80-160

43
Q

During an aneurysm clipping, your neurosurgeon asks you to diuresis the patient; what do you do?

A
  1. Mannitol 0.5 mg/kg
  2. Lasix 10-20 mg IVP
44
Q

What are three major general causes of fluid overload?

A
  1. CHF
  2. Renal Failure
  3. Cirrhosis
45
Q

2 main general treatments for fluid overload:

A
  1. Dialysis
  2. Diuresis
46
Q

Where is EPO produced?

A

kidneys

47
Q

what are three hormones secreted to control BP?

A
  1. Angiotensin II
  2. Prostaglandins
  3. Kinins
48
Q

Each kidney contains ____ nephrons.

A

1.2 Million

49
Q

What are the 4 major reasons diuretics are administered?

A
  1. CHF
  2. Liver Cirrhosis
  3. HTN
  4. Kidney Dz
50
Q

What are the 5 types of diuretics?

A
  1. Carbonic Anhydrase Inhibitors (“-zolamide”)
  2. Osmotic (mannitol)
  3. Loop (“-ide”)
  4. Thiazide (HCTZ)
  5. K-Sparing (spironolactone & amiloride)

Hint: COLT K

51
Q

Picture

A
52
Q

Picture

A
53
Q

Picture

A
54
Q

Picture

A
55
Q

Picture

A
56
Q

Which diuretic should pregnant patients NOT be on?

A

Thiazides, b/c they decrease placental perfusion

57
Q

What type of patients are best suited for thiazides?

A

patients with normal kidney function

58
Q

5 conditions that Loop Diuretics treat & how:

A
  1. Severe edema: increase Na excretion to 25% of filtered load
  2. Hypercalcemia: Increase Ca excretion
  3. Hyponatremia: Impair free H2O reabsorption
  4. Oliguric ARF: increase urine volume
  5. Pulmonary Edema: Increase Venous capacitance

Hint: SHHOP

59
Q

What will occur if a loop diuretic is administered to a hypovolemic patient?

A

Nephrotoxicity

60
Q

What 2 electrolyte abnormalities may occur with Loop Diuretics?

A
  1. Hypokalemia
  2. Hypochloremia

Loops do lose Calcium as well (tx for hypercalcemia)

61
Q

What happens to renal clearance of lithium if patient is on a loop diuretic?

A

it decreases

62
Q

T/F: the occurrence of ototoxicity from loop diuretics is rare.

A

TRUE

63
Q

Only loop diuretic we use?

A

Furosemide (Lasix®)

64
Q

Onset of Lasix

A

5 min

65
Q

Amount Lasix required to cause patient to begin making urine?

A

10 mg

66
Q

Mannitol preparation

A

250 mg/cc

67
Q

T/F: the onset of mannitol is faster than Lasix.

A

FALSE, slower

68
Q

Which diuretic is used as a sweetner for breath freshners?

A

Mannitol

69
Q

What value indicates oliguria?

A

<0.5 mL/kg/hr

70
Q

Stage 3 Renal Failure GFR range

A

30-59

71
Q

Stage 4 Renal Failure GFR range

A

15-29

Pharm 2 (6 decks)

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