Pharm 20 - Diuretics Flashcards Preview

PBL Pharm Block 3 > Pharm 20 - Diuretics > Flashcards

Flashcards in Pharm 20 - Diuretics Deck (56)
Loading flashcards...
31

Mannitol clinical applications

Cerebral edema, increased intraocular pressure, prophylaxis of oliguria in acute renal failure

32

Mannitol adverse effects

Thrombophlebitis, acidosis, seizure, urinary retention, pulmonary edema; also hypotension, palpitations, fluid/electrolyte imbalance, N, D, rhinitis

33

Mannitol contraindications

Anuria, severe dehydration, After administration of mannitol: heart failure, pulmonary congestion, renal dysfunction

34

Mannitol therapeutic considerations

Promotes vigorous natriuresis so monitor pt's volume status; if water loss exceeds sodium excretion -> causes hyponatremia; used mostly for emergent reduction of ICP in head trauma, brain hemorrhage, etc; sometimes used to Tx compartment syndrome

35

Loop Diuretics MOA

Reversibly/competitively inhibits NKCC2 (Na/K/Cl co-transported) in luminal thick ascending limb; reduces lumen-positive transepithelial potential difference

36

Loop Diuretics Names (4)

Furosemide, Bumetanide, Torsemide, Ethacrynic acid

37

Loop Diuretics clinical applications

HTN; acute pulmonary edema; edema due to heart failure, cirrhosis, or renal dysfunction; hypercalcemia; hyperkalemia

38

Loop Diuretics adverse effects

Hypotension, erythema multiforme, Stevens-Johnson syndrome, pancreatitis, aplastic/hemolytic anemia, leukemia, thrombocytopenia; also volume contraction alkalosis, dose-related OTOTOXICITY, hypokalemia, hypomagnesemia, hyperglycemia, rash, cramps, spasticity, HA, blurred vision, dyspepsia, glycosuria

39

Loop Diuretics contraindications

Hypersensitivity to sulfonamides (but can still use Ethacrynic acid); Anuria

40

Loop Diuretics therapeutic considerations

Bumetanide is most potent; co-administration with aminoglycosides increases ototoxicity and nephrotoxicity; edema due to hypoalbuminemia can be Tx w/ low dose loop diuretics

41

Thiazide Diuretics MOA

Acts as competitive antagonist at NCC Na/Cl co-transporter in luminal membrane of distal convoluted tubule -> inhibits NaCl resporption; promotes increased transcellular calcium resorption in distal convoluted tubule

42

Thiazide Diuretics names (7)

HydrochloroTHIAZIDE, BendroflumeTHIAZIDE, HydrolumeTHIAZIDE, PolyTHIAZIDE, Chlorthalidone, Metolazone, Indapamide

43

Thiazide clinical applications

HTN, edema associated w/ heart failure, cirrhosis, renal dysfunction, corticosteroid Tx, and estrogen Tx

44

Thiazide adverse effects

Cardiac arrhythmia, Stevens-Johnson syndrome, toxic epidermal necrolysis, pancreatitis, hepatotoxicity, SLE; also hypotension, vasculitis, photosensitivity, electrolyte abnormalities, hypokalemic metabolic alkalosis, hyperglycemia, hyperuricemia, dyspepsia, HA, blurred vision, impotence, restlessness

45

Thiazide contraindications

Anuria, hypersensitivity to sulfonamides, co-administration with drugs that prolong QT interval (quinidine, stall) b/c it predisposes to torsades de pointes

46

Thiazide therapeutic considerations

Can used to diminish hypercalciuria for pts at risk for nephrolithiasis and osteoporosis; HYDROCHLOROTHIAZIDE DECREASES GLUCOSE TOLERANCE (may unmask diabetes); in pts w/nephrogenic diabetes insipidus, may DECREASE urine flow

47

Spironolactone & Eplerenone Class & MOA

Potassium-Sparing Diuretics: Binds to, and prevents, nuclear translocation of the mineralocorticoid receptor -> inhibits aldosterone action

48

Spironolactone & Eplerenone clinical applications

HTN (especially obesity-related HTN); Edema b/c of heart failure, cirrhosis, or nephrotic syndrome; Hypokalemia; Primary aldosteronism; Spironolactone only: acne, female hirsutism

49

Spironolactone & Eplerenone adverse effects

Hyperkalemic metabolic acidosis, GI hemorrhage, agranulocytosis, SLE; also gynecomastia, dyspepsia, lethargy, abnormal menstruation, impotence, rash

50

Potassium-Sparing Diuretics contraindications

Anuria, Hyperkalemia, Acute renal insufficiency

51

Amiloride & Triamterene Class & MOA

Potassium-Sparing Diuretics: competitive inhibitor of principal cell apical membrane ENaC sodium channel

52

Amiloride & Triamterene clinical applications

HTN, Liddle's syndrome

53

Amiloride & Triamterene adverse effects

Hematopoietic diseases, nephrotoxicity (triamterene), hyperkalemic metabolic acidosis; also orthostatic hypotension, hyperkalemia, dyspepsia, HA

54

Spironolactone & Eplerenone therapeutic considerations

Mild diuretics when used in isolation (but potentiates loop diuretics); can be used in combination with thiazides to reduce potassium-wasting; can reduce mortality in heart failure from inhibition of cardiac fibrosis resulting from a paracrine aldosterone-signaling pathway

55

Amiloride & Triamterene therapeutic considerations

Drug of choice for Liddle's syndrome (genetic HTN from gain-of-function mutations in beta/gamma subunits of ENaC sodium channel

56

[-PRIL] Types

1) Captopril: active when administered, processed to active metabolite
2) Enalapril, Ramipril: ester prodrug converted in plasma to active metabolite (Enalaprilat, Ramiprilat)
3) Lisinopril: active when administered, excreted unchanged