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Flashcards in Other diuretic information Deck (11):
1

Common causes of diuretic resistance?

- Incorrect dx --> venoous or lymphatic edema

- Inappropriate NaCl or fluid intake

- Inadequate drug reaching tubule lumen in active form:
* nonadherence
* dose inadequate or too infrequent
* poor absorption (uncompensated HF)
* ↓ RBF (HF, cirrhosis, elderly)
* ↓ functional renal mass (AKI, CKD, elderly)
* proteinuria

- Inadequate renal response
* low GFR (AKI, CKD)
* ↓ effective arterial volume (edematous conditions)
* Activation of RAAS ( edematous conditions)
* nephron adaptation (prolonged diuretic therapy)
*NSAIDs (indomethacin, ASA)

2

Herbal diuretics?

- chicory, dendelion leaves, fennel, etc.

- Some have been shown to cause diuresis, but the active ingredients and MOA are unk
* probably OK by themselves
* should not be miced with other conventional diuretics bc of potential adverse or suboptimal effects

3

How does licorice change your BP?

- Only real licorice

- Containes sweet glycyrrhizic acid, potentiates aldosterone effects in kidney and dose-dependently increases systolic BP (~3-14 mmHg)

4

Diuretic therapy algorithm for renal insufficiency?

- loop diuretic, determine effective dose, and administer as frequently necessary to maintain response --> ADD --> Thiazide according to creatinine clearance: < 20 mL/min = 100-200/day; 20-50mL/min = 20-50 mg/day; > 50 mL/min = 25-50 mg/day --> ADD distal diuretic drug

5

Diuretic therapy algorithm for nephrotic syndrome?

- loop diuretic, determine effective dose, and administer as frequently necessary to maintain response --> ADD --> Thiazide according to creatinine clearance: < 20 mL/min = 100-200/day; 20-50mL/min = 20-50 mg/day; > 50 mL/min = 25-50 mg/day --> ADD distal diuretic drug

6

What is differs with treating cirrhosis or CHF vs RF or nephrotic syndrome?

Consider spironolactone as first line trx with cirrhosis --> HCTZ id creatinine clearance > 50

- Consider HCTZ if creatinine clearance is > 50 as first line of trx before adding a loop diuretic

7

What effect does hyperkalemia have on the heart?

- Tall T waves
- Prolonged PR interval
- Widened QRS interval
- Flattened P waves
- Arrhythmias including bradycardia, v-tach, or fibrillation
- Sinus arrest or nodal rhythm w/ possible asystole

8

What effect does hypokalemia have on the heart?

- Flattened T waves
-ST segment depression
- Prolonged QT interval
-Tall U waves
- Atrial arrhythmias
- V-tach or V-fib

9

Physiological mechanism of edema?

- Hydrostatic pressure pushing fluid out into the interstitium

- Decreased oncotic pressure (decreased proteins) not pushing fluid back into circulation

10

Edema formation is opposed by?

- Increased lymph flow
- Low compliance of interstitial space
- Washout of protein in interstitial space

11

Explain the countercurrent multiplier?

Water, but not sodium is reabsorbed in the descending limb of the loop --> sodium, but not water is reabsorbed at the ascending limb --> forms a concentration gradient in the interstitium