Pharm #6 - Diuretics Flashcards Preview

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Flashcards in Pharm #6 - Diuretics Deck (55):
1

What drugs are CA inhibitors? (4)

1. Acetozolamide
2. dorzolamide
3. methazolamide
4. dichlorophenamide

2

MOA of CA inhibitors

inhibit CA in luminal membrane of PROXIMAL TUBULE
- reduce proximal HCO3- reabsorption

3

Indications (main 3) of CA inhibitors

1. Acetozolamide
2. dorzolamide
3. methazolamide
4. dichlorophenamide

1. reduce intraocular pressure in glaucoma
2. lower HCO3- in mountain sickness
3. raise urine pH in cystinuria

OTHER:
- hypokalemic periodic paralysis
-adjunctive therapy in epilepsy
- solid hypoxic tumors

Used as a backup diuretic (weak);

Glaucoma (reduction of aqueous humor),

urinary alkalinization (to treat overdose or some kidney stones),

high-altitude sickness (dec serum pH lowers Hb affinity for O2 increasing O2 delivery to tissues)

4

Side effects of CA inhibitors (2 main, 4 others)

1. Acetozolamide
2. dorzolamide
3. methazolamide
4. dichlorophenamide

1. Metabolic acidosis
- due to HCO3- depletion with prolonged treatment

2. Hypokalemia (acute)

3. Drowsiness, fatigue, CNS depression, parasthesia

5

What is the only osmotic diuretic

MOA

mannitol

- freely filterable, non-reabsorable osmotic agents like mannitol, glycerol & urea

- act primarily on the PT to reduce the reabsorption of H20 and solutes including NaCl

6

Indication for mannitol

2 other uses?

Treat or prevent ACUTE RENAL FAILURE
(ARF)

other:
- reduce intracranial or intraocular pressure
- enhance urinary excretion of chemical toxins

7

name the 4 loop diuretic

which is not a sulfa drug?

-furosemide
-bumetanide
-torsemide
-ethacrynic acid (not a sulfa drug)

8

MOA of LOOP DIURETICS (where and what does it inhibit)

-furosemide
-bumetanide
-torsemide
-ethacrynic acid (not a sulfa drug)

Inhibit the Na/K/Cl cotransport system in THICK ASCENDING LIMB

9

Side effects of mannitol (osmotic diuretic)

3 main (distinguish between normal and abnormal GFR changes)

- acute expansion of ECF volume and increased risk of pulmonary edema

-hyponatremia *with impaired renal function

- hypernatremia (prolonged use with normal GFR)

- nausea, vomiting, headache

10

Indications of LOOP diuretics (6)

-furosemide
-bumetanide
-torsemide
-ethacrynic acid (not a sulfa drug)

1. Acute Pulmonary edema
2. CHF in presence of renal insufficiency

3. ARF,
4. CRF
5. ascites
6. nephrotic syndrome

11

What drug can be used to treat hypercalcemia due to its inhibition of Calcium reabsorption?

LOOP DIURETICS

-furosemide
-bumetanide
-torsemide
-ethacrynic acid (not a sulfa drug)

12

Adverse effects of loop diuretics

1 main, 6 others

1. HYPOVOLEMIA

2. Hypokalemia
3. hypomanesemia
4. Hyponatremia

5. HYPERURICEMIA
6. metabolic alkalosis
7. ototoxicity & diarrhea (mainly with ethacrynic acid)

13

Which loop diuretic is mainly associated with ototoxicity and diarrhea?

ethacrynic acid

14

State the thiazide diuretics (5)

1. chlorothiazide
2. hydrochlorothiazide
3. chlorthalidone
4. metolazone
5. indapamide

15

1. chlorothiazide
2. hydrochlorothiazide
3. chlorthalidone
4. metolazone
5. indapamide

MOA of drug class

thiazide diuretics:

- inhibit NaCl cotransport in early DISTAL CONVOLUTED TUBULE (DCT)

16

Indications for thiazide diuretics (5)

1. chlorothiazide
2. hydrochlorothiazide
3. chlorthalidone
4. metolazone
5. indapamide

1. hypertension
2. EDEMA due to CHF
3. HEPATIC CIRRHOSIS*
4. Renal disease
5. Idiopathic Hypercalciuria

17

Which drug class can be used to treat idiopathic hypercalcuria? Renal caliculi

- state the drugs in this class

thiazide diuretics

1. chlorothiazide
2. hydrochlorothiazide
3. chlorthalidone
4. metolazone
5. indapamide

18

What drug class can be used for the following:

1. Nephrogenic Diabetes Insipidus

THIAZIDE diuretics

- prevent further urine dilution in DCT

19

Adverse affect of thiazide diuretics (6)


1. chlorothiazide
2. hydrochlorothiazide
3. chlorthalidone
4. metolazone
5. indapamide

1. Hypokalemia, hyonatremia, hypovolemia
2. Hyperuricemia due to increased rate reabsorption
3. hypercalcemia due to enhanced Ca reabsorption

4. metabolic alkalosis
5. hyperglycemia
6. hypersensitivity & interstitial nephritis

20

What drug is contraindicated for high plasma calcium levels of primary hyperparathyroidism?

THIAZIDE!!!
- increase Ca reabsorption!

- use LOOP DIURETICS for hypercalcemia

21

What are the 4 K+ sparing diuretics

1. spironolactone
2. eplerenone
3. amiloride
4. triamterene

22

MOA of spironolactone and eplerenone (K+ sparing)

MOA of Amiloride and triamterene (K+ sparing)

- comp. block action of aldosterone on CT

- reduce Na+ entry across luminal membrane of principal cells of CT

23

Indications for K+ sparing diuretics (3)

1. spironolactone
2. eplerenone
3. amiloride
4. triamterene

1. Chronic liver disease
- treat secondary hyperaldosteronism due to hepatic cirrhosis complicated by ascites (spironolactone and eplerenone)

2. prevent the hypokalemic effects of other diuretics

3. Primary hyperaldosteronism (Conn's syndrome -> spironolactone & eplerenone)

24

Which drugs are used for:

1. Chronic liver disease
- treat secondary hyperaldosteronism due to hepatic cirrhosis complicated by ascites (spironolactone and eplerenone)

spironolacton and eplerenone (K+ sparing and inhibit aldosterone in CT)

25

Which drug is responsible for the following adverse effects
What class of drugs do these belong to?

1. HYPERKALEMIA, gynecomastia, hirsutism, mentrual irregularities, testicular atrophy

2. HYPERKALEMIA, glucose intolerance in diabetics

3. HYPERKALEMIA, megaloblastic anemia in patients with liver cirrhosis

K+ SPARING!

1. spironolacton: HYPERKALEMIA, gynecomastia, hirsutism, mentrual irregularities, testicular atrophy

2. Amiloride: HYPERKALEMIA, glucose intolerance in diabetics

3. triamterene: HYPERKALEMIA, megaloblastic anemia in patients with liver cirrhosis

26

ADH antagonists, list the drugs (5)

which blocks V1 and V2 receptors

1. Doxycycline
2. Lithium
3. Tolvaptan
4. conivaptan (blocks both V1 and V2 receptors)
5. Mozavaptan

27

MOA of ADH antagonists

- state the drugs in this class

- doxycycline
-lithium
-conivaptan
-tolvaptan
-mozavaptan

MOA: prevent ADH induced water reabsorption in the prinicipal cells of the collecting tubule

28

What drugs are indicated for the following:

1. SIADH
2. Euvolemic/hypervolemic
3. hyponatremia

and CHF

ADH antagonists!

- doxycycline
-lithium
-conivaptan
-tolvaptan
-mozavaptan

29

Adverse effects of ADH antagonists:

1. lithium & doxycycline

2. tolvaptan, conivaptan, mozavaptan(5)

1. lithium & doxycycline: NEPHROTOXIC

2. tolvaptan, conivaptan, mozavaptan:
- hypernatremia
- thirst
-dry mouth
-hypotension*
-dizziness

30

Which ADH antagonists are nephrotoxic

lithium & doxycyline

31

Which two types of drugs decrease uric acid excretion and increase net uric acid reabsorption, causing hyperurecemia and possible gout?

1. THIAZIDE
2. Loop diuretics

32

What drugs interact with the following:

1. ACE inhibitors
2. AG's
3. Anticoagulants

1. ACE inhibitors - K+ sparing diuretics (increase hyperkalemia monitor serum K+)

2. AG's - LOOP diuretics (ototoxicity & nephrotoxicity)

3. Anticoagulants - THIAZIDE AND LOOP
- increased anticoagulant activity with loop
- decreased anticoagulant with THIAZIDE

33

Which drugs should not be used with ACE inhibitors?

K+ sparing diuretics!!

34

Drugs ending in -amide are what type of inhibitors?

CA inhibitors

- acetozolamide
- dischorphenamide
-methazolamide
-dorzolamide

35

What are the 2 main adverse effects of CA inhibitors?

1. metabolic acidosis
2. hypokalemia

36

Which drug is NOT orally absorbed and must be given via IV?

MANNITOL

- do not give for patients with CHF or renal failure
- worsens condition by pulling water out of cells into ECF!!! (also causes hyponatremia since Na follows H20 out of cells)

37

which 2 drug classes are used for reduced intracranial and intraocular pressure

MANNITOL
CA inhibitors

38

Which diuretic class is most efficacious?

LOOP diuretics

39

State which loop diuretic is described by the following:

1. 40x more potent than furosemide & shorter half life

2. better oral absorption & LONGER half life than furosemide?

3. last resort, only used when others exhibit hypersensitivity (since it is not a sulfa drug)
- nephrotoxic and ototoxic!

1. Bumetanide

2. Tosemide

3. ETHACRYNIC ACID

40

Which drug interacts with digoxin?

LOOP DIURETICS
-adverse effects more common in patients with hypokalemia since digoxin normally competes with K+ ions for the same binding site on Na/K ATPase

41

What drug is associated with the following adverse effects:

1. hyperglycemia
2. hyperlipidemia
3. metabolic alkalosis
4. hypokalemia

HYDROCHLOROTHIAZIDE

- thiazides make you THICK

42

Which drug is:

10X more potent than Hydrochlorothiazide; most EFFICACIOUS, only one for RENAL INSUFFICIENCY!!

Half-life of 4-5 hrs

1. Which thiazide has a half life of 10 -22 hrs
2. which has a half life of 44hrs? (longest)

METOLAZONE

1. indapamide

2. CHLORTHALIDONE is the longest

43

Which drug results in increased Ca reabsorption?

HYDROCHLOROTHIAZIDE

Hypertension
Congestive heart failure
Reduce Ca2+ excretion to prevent kidney stones


- LOOP DIURETICS = increase CA EXCRETION! (remember test)

44

Which distal nephron diuretic should be given for patients with renal insufficiency?

METOLAZONE

45

Loop and Thiazide diuretics cause metabolic alkalosis or acidosis? Why?

Metabolic Alkalosis

- incease Na and Cl- in tubule leads to increased lumen negative potential
- lumen negative potential enhances H+ efflux from intercalated cells!

46

What drug class is contraindicated for patients with the following:

diabetes mellitus,
multiple myeloma,
tubulointerstitial renal disease,
and renal insufficiency
on ACE inhibitors

Spironolactone, eplerenone and other K+ sparing diuretics should not be given for patients with hyperkalemia

NOOOOO

47

What drug can cause gynecomastia and amenorrhea?

What drug can be substituted for this?

SPIRONOLACTONE


EPLERANONE
-Eplerenone is considerably more expensive than spironolactone, but it does not inhibit testosterone binding and therefore it does not induce gynecomastia or other related anti-androgenic side effects.

48

How does spironolactone cause metabolic acidosis

***block aldosterone bindign to MR
decreased Na channels & Na/K atpase

= Decreased lumen negative potential (more K+ spared)

Reduced driving force for H+
Decreased expression of H+ pumps



49

WHAT IS THE DOC for liver cirrhosis?

SPIRONOLACTONE

- also used for Primary hyperaldosteronism
Secondary hyperaldosteronism
(Renin-AT system activated)

50

What drugs can exacerbate the hyperkalemia associated with AMloride?

NSAIDS

51

Demeclocycline & Lithium are both associated with what adverse effect

NEPHROTOXICITY

52

IV loop diuretics are used for (left/right HF)

Oral Loop diuretics are used for (left/right HF)

1. IV = LEFT (life threatening so needs quick IV!!!)

2. ORAL = RIGHT

53

Hypernatreamia is defined as serum sodium concentration less than ____

136 mEq/l

54

What drugs are approved for hyponatremia associated with euvolemia, hypervolemia or hypovolemia

AVP receptor antagonists have been shown to increase the serum [Na+] and urine output while decreasing urine osmolality.

do not use furosemide!
FUROSEMIDE  dramatically increases Na excretion

Na sparing diuretic = VAPTANS (treat hyponatremia)

55


For uncomplicated hypertension, _____ diuretic should be used in drug treatment for most, either alone or combined with drugs from other classes.


This drug can also be used for what other condition?

thiazide

- for the following conditions associated with hypertension:


2. thiazide use to reduce polyuria and increase urine osmolality in Diabetes insidious