pharm: 10-12 Diuretics Flashcards
(31 cards)
Carbonic Anhydrase Inhibitors
- Indications (5)*
- B: Main Example*
- C: What renal Secretory pump does they use?*
“Carbonic Anhyrase Inhibitors are Mega HUGE like Mountains”
- To reduce intraocular pressure in Glaucoma.
- “Mountain Altitude sickness” (treats by DEC serum pH–>DEC HgB affinity for O2–> [INC Tissue O2 Delivery])
- [Urine pH] INCREASE in cystinuria
- HypOkalemic periodic paralysis (will require Dietary K+)
- Epilepsy adjunct tx
B: Acetazolamide
C: [Organic Acid (MATE) Transporter]
Osmotic Diuretics
Indications (3)
- Tx or Prevention for Acute Renal Failure
- DEC intra-cranial and intra-ocular pressure
- Enhance Urinary Excretion of Chemical Toxins
Loop Diuretics
- Indications (6)*
- B: Effect on Venous and Renal Vasculature*
- C: How long post administration does it take to act?*
CANCHA
- Acute Pulmonary Edema.
- HTN
- (CHF)—in the presence of renal insufficiency or for immediate effect.
- [ACA - ARF, CRF, Ascites],
- Nephrotic syndrome
- HyperCalcemia
B: Venous and Renal vasoDILATION—> LATER DEVELOPING DEC TPR
C: 20 min. to act but absorption rate is DEC in CHF pts
Thiazides
- Indications (6)*
- B: Site of Action (2)*
- C: Condition that prevents* Thiazides from being used? What’s the [Thiazide Family] Exception?
“Thiazide drink is a Happy CIDER”
- Hypertension.
- Edema 2º to CHF,
- Cirrhosis,
- Renal disease.
- [Idiopathic Hypercalcuric Renal Calculi]
- [Diabetes Insipidus-nephrogenic] (prevent further urine dilution from taking place in the DCT).
B: [Early DCT] and [cortical thick aLOH]
C: [Severe Renal Insufficiency] —> use [Metolazone Quinazoline] since it is the strongest of [Thiazide Family]
K+ Sparing Diuretics
- A: 4 Main Drugs*
- B: Indications (4)*
- C: Which 2* K+ Sparing Diuretics can treat Hyperaldosteronism?
D:
*_____ and _____ have side effects = Hyperkalemia/ Gynecomastia/ [Testicular Atrophy]
- _____ has sie effects= megaloblastic anemia in liver failure pts
- ______ has side effects= cause Glucose Intolerance in Diabetics
E: MAJOR SIDE EFFECT FOR ALL
A: SEAT - Spironolactone/ Eplerenone/ Amiloride / Triamterene
B:
- [S**econdary HyperAldosteronism 2º to Cirrhosis or CHF]
- [Conn’s Primary hyperaldosteronism syndrome]
- Prevents hypOkalemic effects of other diuretics.
- HTN adjunct tx
C: SPIRONOLACTONE AND EPLERENONE
D:
- Spironolactone/Eplerenone SE = Hyperkalemia/ Gynecomastia/ [Testicular Atrophy]
- Triamterene can cause megaloblastic anemia in liver failure pts
- Amiloride can cause Glucose Intolerance in Diabetics
E: METABOLIC ACIDOSIS
ADH Blockers
- Indications (3)*
- Main Examples (3)*
- SIADH
- hypOnatremia (Euvolemic or Hypervolemic)
- CHF
B: Tolvaptan / Doxycycline / Lithium
Carbonic Anhydrase Inhibitors
- Side Effects (4)*
- B: Why are they contraindicated in Cirrhosis pts?*
” CAMP is a Side Effect of Carbonic Anhydrase Inhibitors “
- Metabolic acidosis 2º to HCO3-
- Acute hypokalemia
- [CNS depression + Drowsiness and fatigue],
- Paresthesia
B: increased urine pH DEC [NH3 secretion] –> [INC serum NH3]—–> hyperammonemia in Cirrhosis pts –> Encephalopathies
Loop Diuretics
Side Effects (8)
“Going in a Loop? DUNK and MOVM”
- hypOKalemia (may be linked to hyperglycemia)
- hypOMagnesemia;
- hypONatremia;
- Volume Contraction in serum***
- HyperUricemia –> Gout
- Metabolic alkalosis
- Ototoxicity (reversible)
- Diarrhea (when using ethacrynic acid)
Thiazide
Side Effects ( 11 )
“Wanna know Thiazide Side Effects? Get a CAULKiiNG VoiceMail “
- hypOKalemia;
- hypONatremia;
- hypOVolemia;
- HyperUricemia due to INC urate ReAbsorption*
- HyperCalcemia due to INC Ca2+ ReAbsorption
- Metabolic alkalosis
- [HyperGlycemia 2º to DEC in Insulin Secretion]
- HyperLipidemia (HIGH dose–> INC LDL and TAG)
- Allergic rxn (fever, rash, purpura, anaphylaxis);
- Interstitial nephritis and Impotence
**Thiazides should be used in low doses**
The vaptan family (Tolvaptan / Conivaptan / Mozavaptan] are all ______ blockers in the Kidney.
Name their common Side Effects (5)
B: Which vaptan is effective orally
C: Which vaptan is a combined [V1a and V2 Receptor Blocker] which allows it to also treat _________ by ________
vaptan family (Tolvaptan / Conivaptan / Mozavaptan] are all ADH blockers in the Kidney.
SE:
- Hypernatremia
- Thirst
- Dry Mouth
- hypOtension
- Dizziness
B: Tolvaptan
C: Conivaptan (IV ONLY) also treats [Euvolemic hypOnatremia] by vasoconstricting arterials + Diuresis
What Potential Interactions do the Rx below pose to the pt?
[ACEk2 Inhibitors]
+
[K+ Sparing Diuretics - SEAT]
B: How do you circumvent this
INC Hyperkalemia —> Cardiac Arrhythmias
B: Monitor Serum K+
What Potential Interactions do the Rx below pose to the pt? (2)
Aminoglycosides
+
Loop Diuretics
B: How do you circumvent this (2)
- Ototoxicity
- Nephrotoxicity
* B: Monitor hearing and Serum creatinine*
What Potential Interactions do the Rx below pose to the pt? (2)
Anticoagulants
+
[Loop Diuretics] vs. Thiazides
increased anti-coagulant activity with Loop diuretics;
vs.
decreased anti-coagulant activity with thiazide diuretics.
What Potential Interactions do the Rx below pose to the pt? (4)
Beta Blockers
+
[Loop Diuretics AND Thiazides]
INC PLUG in the plasma!
Propranolol
Lipid (HyperLipidemia)
Uric acid (Hyperuricemia)
Glucose (Hyperglycemia)
What Potential Interactions do the Rx below pose to the pt?
Thiazide
+
[Carbamazepine or Chlorpropamide]
hypOnatremia (monitor Na+!)
What Potential Interactions do the Rx below pose to the pt?
Digoxin
+
[Loop Diuretics AND Thiazide]
B: How do you circumvent this
hypOkalemia –> INC Digoxin Toxicity
B: Monitor K+ and Cardiac Function
What Potential Interactions do the Rx below pose to the pt? (3)
NSAIDs
+
[Loop / Thiazide / K+ Sparing DIURETICS]
1. reduced diuretic effect,
- increased risk of salicylate toxicity with high doses of salicylates (thiazide & loop d.).
- increased risk of hyperkalemia with K+ sparing diuretics
What Potential Interactions do the Rx below pose to the pt?
Quinidine
+
[Loop Diuretics or Thiazide]
Polymorphic VTach (Torsade De Pointes)
What Potential Interactions do the Rx below pose to the pt?
Sulfonylureas
+
Loop Diuretics
Hyperglycemia
What Potential Interactions do the Rx below pose to the pt?
Steroids
+
[Loop Diuretics or Thiazide]
hypOkalemia
(monitor serum K+)
Renal Papillae
[Renal Papillae] form [Funnel-shaped ______], which then converge to form a ________
A Conjoined Apex of all the [Medullary pyramid] ducts
[Renal Papillae] form [Funnel-shaped Calyces], which then converge to form a Renal Pelvis
A: Most diuretics are tightly ______ bound and undergo ______ glomerular filtration.
They reach renal tubule lumen via ______ across the ______ cell (______ or ______ secretory pathway)
A2: Which Diuretic works via Glomerular filtration?
B: 2 Drugs that inhibit acidic drugs secretory pump
C: Which Drug competes with Basic drugs secretory pump
A: Most diuretics are tightly protein bound and undergo little filtration. They reach renal tubule lumen via secretion across the PCT cell (organic acid or base secretory pathway)
A2: Mannitol
B: [probenecid and NSAIDs] compete with acidic
C: cimetidine
Osmotic Diuretics (Mannitol)
A: Route of Administration
B: Parts of the Kidney it acts (3)
C: Contraindications (3)
C2: Rationale behind Contraindications
A: IV ONLY and initially causes [Intravascular volume expansion].
B: PCT / [thin descending LOH] / [Collecting Duct w/ADH around]
C:
- CHF
- Chronic Renal Failure
- Acute Pulmonary Edema
C2: In pts with DEC GFR, [Osmotic Diuretics] distribute into the [Extracell Fluid] and then pull WATER AND Na+ Out of cells —> Worsening condition
Which Loop Diuretic has a ________ than Furosemide
A: GREATER POTENCY
B: Longer Half-Life and [Duration of Action]
C: Greater TOXICITY (nephro/ototoxic and is last resort)
D: Better PO absorption
A: Bumetanide
B: Torsemide
C: Ethacrynic Acid
D: Torsemide
