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P&T Block 5 Renal > L55 > Flashcards

Flashcards in L55 Deck (29)
1

4 reasons to use acetazolamide

1. Glaucoma
2. Metabolic alkalosis
3. Altitude sickness
4. Periodic paralysis - hypo + hyperK

2

4 SE of acetazolamide

Drowsiness
Dizziness
Headache
Fatigue

3

Is the diuresis from mannitol water or osmotic?

Large vol WATER - ↓U Na
Osmotically active - don't block specific ion transport channels

4

3 reasons to use IV mannitol

1. ↓ICP
2. Forced diuresis - lose water
3. Free radical scavenger (rhabdo)

5

SE of mannitol

Intravasc expansion - might increase ICP or worsen CHF/pulm edema before starts working... be careful

6

What disease state induces an osmotic diuresis?

Diabetes
Excess glucose in urine -> diuresis
Why diabetics so thirsty!!

7

Which diuretics are ceiling diuretics?

Loop: must achieve lower threshold [ ] to achieve diuresis
If increase drug dose above therapeutic window, no additional effects

8

Type of diuresis caused by loop diuretics

Isosthenuric

9

4 loop diuretics you need to know

Furosemide - variable oral availability, sulfa allergy, weak CA inhibitor (PCT), direct vasodilator
Torsemide - more avail but still sulfa allergy
Bumetanide " "
Ethacrynic acid - no allergy and good avail but no one makes it

10

4 uses for loop diuretics

1. Edema to due intravasc vol depletion: CHF, acute pulm cong, cirrhosis, nephrotic syndrome
2. HTN
3. ↑Ca
4. Forced diuresis

11

5 SE of loops

1. Lose too much vol = intravasc vol depletion: circulatory collapse, ↑BUN
2. ↓K - arrhythmia
3. ↓Ca
4. ↓Mg
5. Ototox - blocks 2Cl/K/Na in the ear!

12

U osm created by thiazides

Urine is either isotonic or hypertonic
Inhibits ability to produce a dilute urine

13

Added benefits of thiazides

Direct vasodilator

14

What drug do you use to treat nephrogenic diabetes insipidus (kidney doesn't respond to ADH)?

Volume depletion inhibits polyuria
You're wasting Na and thus water, as your body realizes your hypoNa, it starts to find ways to hold onto water in other ways

15

2 thiazides you need to know

HCTZ - limit to vasodilation and diuretic effects
Metolazone - larger diuresis b/c also has sign prox tubular effects

16

Which pts do you NEVER give thiazides to?

HypoNa
Also ineffective if GFR

17

4 indications to give thiazides

1. HTN - 1st choice!!!
2. Edema
3. Nephro DI
4. Hyper-Ca-URIA aka ↑risk kidney stones - works by ↑volume of urine, more dilute

18

SE of thiazides

HypoNa
HypoK
High cholesterol and diabetes - benefits out weigh risks
HyperCa
Hyper-uricemia
↑BUN

19

Indication + 2 SEs for amiloride and triamterene

ENAC blockers
Use = ascites due to cirrhosis
SE:
- Hyper K
- Hypotension

20

What do you add to HCTZ to prevent hypoK?

Triamterene = ENAC blocker

21

3 indications for spironolactone

1. Cirrhosis (ascites)
2. CHF - SURVIVAL benefit proven
3. Hyperaldo

22

SE spironolactone

HyperK
Hypotension
Gynecomastia + erectile dysfxn

23

What is the theory for synergistic use of diuretics?

No benefit by using 2 of the same type
Use those that sequentially block the nephron
Ex:
- Loop + thiazide
- Loop + K sparing

24

What organ is the primary target of toxicities due to diuretic therapy?

Kidney - b/c drugs really only build up in [ ] in the tubular fluid
Otherwise, vestibular fluid -> hearing SEs

25

Why not use loop or thiazides w/ digitalis?

HypoK -> dig tox

26

Why not use ACE inhibitors w/ K sparing?

HyperK -> arrhythmia

27

Why not use NSAIDs w/ loop or thiazide?

↓Diuretic effect

28

Why not use probenecid (gout) with loop or thiazide?

↓Diuretic effect

29

Which diuretics are hugely salt wasting?

Most = thiazide
Large salt waste from loop and K