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pharm exam 2 > Topic 8 Diuretics > Flashcards

Topic 8 Diuretics Flashcards

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1
Q

Diuretics Common uses?

A

Congestive Heart Failure
Hepatic Ascites
Nephrotic Syndrome
HTN

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2
Q

Diuretic Categories (4)

A

1) Carbonic Anhydrase Inhibitors
2) “Loop” Diuretics
3) Thiazides
4) Potassium-Sparing Diuretics

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3
Q

Carbonic Anhydrase Inhibitors work how?

A

Work by inhibiting carbonic anhydrase in the proximal tubule epithelium

CA is a catalyst for the reaction CO2 + H2O = H3CO2 + H. With CA blocked, the reaction shifts to the right and bicarbonate accumulates in the urine

Na is less able to be exchanged for H⁺ in the tubules so H⁺ is retained while Na⁺ is lost (with the bicarb)
*Sooo…urine becomes more alkaline (explain), water follows the bicarbonate into the tubules (causing diuresis) and the patient
experiences a metabolic acidosis (explain again)

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4
Q

Acetazolamide

A

Diamox

Carbonic Anhydrase Inhibitor

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5
Q

Acetazolamide (Diamox) typically seen in patients with what?

A

glaucoma and high elevation sickness

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6
Q

Carbonic Anhydrase Inhibitors used on bypass?

A

RARELY

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7
Q

Loop Diuretics act on what?

A

Act on the ascending Loop of Henle

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8
Q

Loop Diuretics are also called what?

A

“High Ceiling” diuretics because the dose-response curve is close to linear (that is, there’s no “ceiling”)

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9
Q

How do Loop Diuretics work?

A

Loop diuretics work by blocking the co-transport of Na⁺/K⁺/2Cl ̄ from the tubular lumen back into circulation.
So much NaCl is not reabsorbed that downstream nephron sites can not compensate for that loss

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10
Q

MOST efficacious of all diuretics?1

A

Loop Diuretics

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11
Q

Loop Diuretics are also called what?

A

“yellow zipper” “Non-Potassium-Sparing”

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12
Q

Loop Diuretics do what to RBF?

A

increase renal blood flow by inducing the expression of COX-2

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13
Q

COX-2?

A

COX-2 is referred to as the “ungood” cyclooxygenase NSAIDS preferentially block in inflamed tissues

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14
Q

NSAID

A

Nonsteroidal anti-inflammatory drugs

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15
Q

Cyclooxygenases help produce

A

prostaglandins which are powerful vasodilators of renal arteries

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16
Q

generally the diuretic of choice even in patients with compromised renal function

A

Loop Diuretics

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17
Q

1 choice for edema in emergency situations (such as pulmonary edema from decompensated congestive heart failure)

A

Loop Diuretics

Because they are fast-acting and incredibly efficacious
KNOW

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18
Q

Loop Diuretics are also used with what to elevated levels?

A

for hypercalcemia and hyperkalemia

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19
Q

Loop Diuretics Perfusion use (3)?

A

1)Get rid of extra fluid on bypass Chemical “ hemoconcentrators”
2)Get rid of excess K⁺ (norm 3.5-5mEq/l)
3) Help maintain urine production/renal
function (**!!!) in low output states on bypass

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20
Q

Recent evidence suggests giving
loop diuretics simply to keep urine
flowing and thus ‘help’ the kidneys
is what?

A

NOT appropriate and may be deleterious in the long run!

but still used

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21
Q

Loop Diuretics Side effects?

A

Ototoxitcity, Hypotension, Hypomagnesemia, hyperuricemia, hypokalemia

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22
Q

Ototoxicity caused by Loop Diuretics seen particularly when ?

A

when used with aminoglycoside antibiotics

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23
Q

Furosemide

A

Lasix

Loop Diuretic

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24
Q

Ethacrynic acid

A

Edecrin

Loop Diuretic

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25
Furosemide (lasix) Positives? (4)
Very commonly used during and peri-bypass. Very inexpensive Has been used forever Wide margin of safety/therapeutic window therefore the potential for “We always put some lasix in the pump” mentality
26
Furosemide (lasix) duration of action
2 hours when given IV/on pump
27
Furosemide (lasix) Typical adult dose?
Typical adult pump dose is 2.5-5.0 mg (20-40 mg bolus if the patient’s receiving chronic diuretic therapy)
28
Ethacrynic acid (Edecrin)
Less commonly used than furosemide | Greater potential for oxotoxicity
29
Bumetanide
Bumex Loop Diuretic less frequently used
30
Torsemide
Demadex Loop Diuretic less frequently used
31
Thiazide Diuretics act where?
Act on the cortical region of the ascending loop of Henle
32
Thiazide Diuretics are also commonly called
“Ceiling Diuretics” because of their “flattening” dose/response curve
33
Thiazide Diuretics work how?
Thiazide diuretics work blocking Na⁺/Cl- transport/reabsorption on the luminal side of the thick part of the Ascending Loop of Henle and the Distal Convoluted Tubule. -Consequently, NaCl concentrates in the tubular fluid (and H₂O obediently follows = ⬆️urine production)
34
Thiazide Diuretics lose efficacy in what kind of patients ?
so thiazides lose efficacy in patients with decreased renal function (bc thiazides have to actually get into the tubular lumens via renal excretion)
35
Thiazide Diuretics do what to RBF?
increases renal blood flow through COX-2 inducement of prostaglandin synthesis
36
Chlorothiazide
The original diuretic used for edema. | *Chlorothiazide is the only thiazide available for parenteral use (of relevance to you!)
37
the only thiazide available for parenteral use
Chlorothiazide
38
Chlorothiazide typical adult dose
*Typical adult pump dose is 500mg
39
Are Thiazide Diuretics Potassium sparing?
not “Potassium sparing”
40
Thiazide Diuretics Perfusion Uses?
get rid of extra (edema) fluid and potassium. | ⬇️systemic vascular resistance due to relaxation of arteriolar smooth muscle
41
Thiazides promote the reabsorption of what?
calcium
42
Thiazide Diuretics long term use does what?
long-term use results in significantly less decrease in bone density (hip fractures are ⬇️ by 1/3rd)
43
Thiazide Diuretics can cause production of what?
Since thiazides can (uniquely) cause the production of hyperosmolar urine it’s used in diabetes insipidus
44
Chlorothiazide
Diuril Thiazide Diuretic
45
Hydrochlorothiazide
HCTZ, Microzide Thiazide Diuretic
46
Hydrochlorothiazide administration and effects
more potent but has the same efficacy and is not given parenterally -Use in fixed combinations for Rx of HTN
47
Hyzaar=
HCTZ + Losartan
48
Chlorthalidone
Hygroton Commonly used to treat HTN, Thiazide-like Diuretic
49
Indapamide
Lozol
50
Indapamide (Lozol) usefull in what patients ?
Partially excreted by the GI tract, so useful in advanced renal failure
51
Metolazone
Zaroxolyn Thiazide-like Diuretics
52
Potassium-Sparing Diuretics do what?
Function in the collecting tubules (ducts) to | prevent Na⁺ reabsorption and K⁺ excretion.
53
Potassium Sparing Diuretics antagonize what?
Antagonize aldosterone
54
G in GFR layer?
G = mineralocorticoids (aldosterone)
55
F in GFR layer
glucocorticoids (cortisol)
56
R in GFR layer?
androgens (testosterone precursors)
57
Potassium Sparing Diuretics used with? for?
Used to treat HTN, often in combination Diuril or hydrochlorothiazide
58
Potassium Sparing Diuretics efficacy compared to non-potassium sparing alt?
Significantly less efficacious than its non-potassium-sparing alternatives
59
Potassium Sparing Diuretics problematic with what patients ?
patients with hyperkalemia
60
Spironolactone
Aldactone Direct Aldosterone Antagonists/Potassium Sparing Diuretics
61
Eplerenone
Inspra Direct Aldosterone Antagonists/Potassium Sparing Diuretics
62
Direct Aldosterone Antagonists/Potassium Sparing Diuretics resemble what?
Resemble sex steroids chemically
63
Direct Aldosterone Antagonists/Potassium Sparing Diuretics used with what condition?
Used as adjunctive therapy in heart failure –Statistically decreases mortality and helps prevent pathological “remodeling” of the heart
64
Direct Aldosterone Antagonists/Potassium Sparing Diuretics Drug of choice for liver failure patients with edema?
Spironolactone is the diuretic of choice | for liver failure patients with edema
65
Direct Aldosterone Antagonists/Potassium Sparing Diuretics are ineffective in what patients?
Addison’s Disease
66
Potassium-Sparing Diuretics : | Indirect-Acting Aldosterone Antagonists how do they work?
Block the Na⁺ transport channels affected by | aldosterone rather than aldosterone itself.
67
What patients Indirect Acting Aldosterine Antagonists can work on that Direct can't?
Addison's Disease pt
68
Indirect Acting Aldosterone Antagonist Drugs? (2)
Triamterene (Dyrenium) | Amiloride
69
Triamterene
Dyrenium Potassium-Sparing Diuretics :Indirect-Acting Aldosterone Antagonist
70
Osmotic Diuretics what?
Small non-metabolized molecules filtered | through the glomerulus that osmotically carry water with them
71
Osmotic Diuretics - how to administer
Given parenterally as they cause severe diarrhea if given orally
72
Mannitol
Osmitrol | Osmotic Diuretic used often in prime
73
Osmotic Diuretics work where?
Work in the proximal tubule and the | descending Loop of Henle which permit the free passage of H₂O
74
Osmotic Diuretics Perfusion relevance ? (4)
Commonly used to “draw” fluid into the intravascular space and decrease interstitial edema but... Used to maintain urine flow following acute renal injury Used to decrease cerebral edema Problematic in patients with oliguric/anuric renal failure When in doubt a “test dose” is given prior to administration
75
Osmotic Diuretics dosages
If urine output is <50ml/hour for three | hours after a 12.5 gram IV dose, AVOID
76
Mannitol (Osmitrol)
is a small molecule categorized as a “sugar alcohol” | Osmotic Diuretic
77
Mannitol (Osmitrol) usually what solution
a 20% solution
78
Mannitol number 1 rule
Check the bag/bottle for precipitated crystals!!!!”
79
Mannitol administration ? excretion?
Mannitol is excreted (not metabolized) within one hour, so repeat doses can be given. -MUST be given slow IV or profound transient hypotension will occur due to skeletal muscle vasodilation
80
Mannitol (Osmitrol) typical adult CPB priming dose
Typical adult CPB priming and/or intraoperative dose is 12.5-25 grams.

pharm exam 2 (9 decks)

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