Wk 12: Diuretics Flashcards
(82 cards)
1
Q
Carbonic anhydrase inhibitors
Receptors
A
Carbonic anhydrase
2
Q
Carbonic anhydrase inhibitors
Main site of action
A
Proximal convoluted tubule
3
Q
Carbonic anhydrase inhibitors
Clinical uses
A
Altitude sickness
Glaucoma
4
Q
Carbonic anhydrase inhibitors
Notable side effects
A
Metabolic acidosis
5
Q
Loop diuretics
Receptors
A
Na-K-2Cl cotransport
6
Q
Loop diuretics
Main site of action
A
Medullary thick ascending loop of Henle
7
Q
Loop diuretics
Clinical uses
A
First-line diuretics in renal impairment
8
Q
Loop diuretics
Notable side effects
A
Ototoxicity
Alkalosis
Hypokalemia
9
Q
Thiazides
Receptor
A
Na-Cl cotransport
10
Q
Thiazides
Main site of action
A
Cortical ascending loop of Henle
11
Q
Thiazides
Clinical uses
A
First-line therapy of hypertension
12
Q
Thiazides
Notable side effects
A
Alkalosis
Hypokalemia
Diabetes and dyslipidemia
Hyperuricemia
13
Q
Osmotic diuretics
Receptors
A
N/A
14
Q
Osmotic diuretics
Main site of action
A
Proximal convoluted tubule and loop of Henle
15
Q
Osmotic diuretics
Clinical uses
A
Increased ICP
Oxygen free radical scavenging
16
Q
Osmotic diuretics
Notable side effects
A
Volume overload in CHF
Hypokalemia
Hyponatremia
Hypomagnesemia
17
Q
Potassium-sparing diuretics
Receptors
A
Endothelial Na channel
18
Q
Potassium-sparing diuretics
Main site of action
A
Collecting duct
19
Q
Potassium-sparing diuretics
Clinical uses
A
Adjuncts to loop diuretics or thiazides
20
Q
Potassium-sparing diuretics
Notable side effects
A
Hyperkalemia
21
Q
Aldosterone blockers
Receptors
A
NA-K-ATPase
22
Q
Aldosterone blockers
Main site of action
A
Collecting duct
23
Q
Aldosterone blockers
Clinical uses
A
HF with low EF
24
Q
Aldosterone blockers
Notable side effects
A
Hyperkalemia
25
Dopamine and fenoldopam
Receptors
D1
26
Dopamine and fenoldopam
Main site of action
Proximal tubule and loop of Henle
27
Dopamine and fenoldopam
Clinical uses
Renal protection and hypertension treatment in critically ill patients
28
Dopamine and fenoldopam
Notable side effects
Effectiveness not substantiated
29
Brain natriuretic peptide
Receptors
Na-K-ATPase
30
Brain natriuretic peptide
Main site of action
Collecting duct
31
Brain natriuretic peptide
Clinical uses
Management of decompensated HF
32
Vasopressin
Receptor
V2
33
Vasopressin
Main site of action
Collecting duct
34
Vasopressin
Clinical uses
SIADH
CHF
Cirrhosis
35
Aquaporins
Receptor
AQP
36
Aquaporins
Main site of action
Collecting duct
37
Loop diuretics are first-line therapy in patients with fluid retention resulting from _______ _______
Heart failure
38
Furosemide is effective when administered _____ or _______
orally
intravenously
39
Furosemide
Absorption varies between patients from ___% to ____ %, with an average bioavailability of ___%
10
100
50
40
Furosemide has a rapid onset, producing diuresis within ___ to ___ minutes of administration, with a peak effect at ___ mins and DOA of ___ to___ hours
5 to 10
30
2 to 6
41
In patients with normal renal function, ____mg of IV Furosemide will produce maximal natriuresis
40
42
___________ are the first line of treatment of hypertension in patients with renal insufficiency
Loop diuretics
43
The antihypertensive effect of loop diuretics is due to effect on fluid ____ and _____
volume
salt
44
Loop diuretics are commonly used in patients admitted with acute exacerbation of ________ ________
heart failure
45
Furosemide ___________ intracranial pressure by inducing systemic diuresis and decreasing _________ production
decreases
CSF
46
Furosemide can be administered as single-drug therapy (____to_____mg/kg IV) or as a lower dose (_____to_____mg/kg IV) in combination with _______
0.5-1.0mg/kg IV
0.1-0.3mg/kg IV
mannitol
47
Combination of _________ and _______ is more effective in decreasing ICP than either drug alone but severe __________ and _________ ________ are also more likely
Furosemide
Mannitol
dehydration
electrolyte imbalances
48
Side effects of loop diuretics most often manifest as abnormalities of _______ and ______ balance
fluid
electrolyte
49
Loop diuretics SE (4)
Hypokalemia
Tolerance
Hypotension
Exacerbation of renal ischemic injury
50
Loop diuretics side effects
Potential increased renal tissue concentrations of ___________ and enhances possible _________ effects of these ___________
antibiotics
nephrotoxic
antibiotics
51
Loop diuretics side effects
Loop diuretics potentiate __________ __________ _________
nondepolarizing neuromuscular blockade
52
Loop diuretics side effects
The renal clearance of ______ is decreased
lithium
53
Loop diuretics side effects
_________, either transient or permanent, is a rare, dose-dependent complication associated with the use of loop diuretics
Ototoxicity
54
Thiazide diuretics are most often administered for long-term treatment of _________ _______ in which the combination of ________, __________, and _______ are synergistic
essential hypertension
diuresis
natriuresis
vasodilation
55
Thiazides are usually administered in combination with ________ _______
other antihypertensives
56
Thiazide diuretics are readily absorbed when administered ______
orally
57
Hydrochlorothiazide has a ___% to ____% bioavailability
60%-70%
58
Thiazides' effectiveness markedly decreases in patients with _______ ______
renal insufficiency
59
Thiazide diuretics have a long half-life of ____ to___ hours, allowing for a convenient once-a-day dosing
8 to 12
60
Thiazide diuretics are recommended as first-line therapy for ________ ___________
essential hypertension
61
The antihypertensive effect of Thiazide diuretics is due initially to a decrease in _________ _______ ______, often with a decrease in cardiac output, which normalizes after ______ weeks
extracellular fluid volume
several
62
The sustained hypertensive effect of Thiazide diuretics is due to _________ _________, which requires _______ weeks to develop
peripheral vasodilation
several
63
Side effects of Thiazide diuretics (7)
Hypokalemic, hypochloremic, metabolic alkalosis
Orthostatic hypotension (hypovolemia)
Cardiac dysrhythmias (hypokalemia or hypomagnesemia)
Potentiate nondepolarizing muscle relaxants (hypokalemia)
Promote lithium reabsorption (risk of lithium toxicity)
Glucose intolerance (Aggravate glucose control especially in combination with beta blockers)
Decrease efficacy in presence of NSAIDs
64
Osmotic diuretics are _______ substances that do not undergo ______ and are filtered freely at the _______
inert
metabolism
glomerulus
65
Osmotic diuretic examples (4)
Mannitol
Urea
Isosorbide
Glycerin
66
Osmotic diuretic administration causes increased _______ and ________ ________ fluid osmolality, with resulting osmotic diuresis
plasma
renal tubular
67
_________ is the only Osmotic diuretic in current use
Mannitol
68
Structurally, mannitol is a ____-carbon sugar alcohol that does not undergo ________
six
metabolism
69
After administration, mannitol is completely filtered at the _______, and none of the filtered drug is subsequently ________ from the renal tubules
glomeruli
reabsorbed
70
By increasing tubular fluid osmolality, mannitol _______ water reabsorption and promotes _______ _______
decreases
water diuresis
71
Mannitol is used primarily in the acute management of ______ _______ and in the treatment of _______
elevated ICP
glaucoma
72
Mannitol decreases ICP by ________ plasma osmolarity, which draws water from tissues
increasing
73
Mannitol begins to exert an effect within ___ to ___ minutes, with a peak effect at ___ to ___ minutes, and a duration of ____ hours
10 to 15 minutes
30 to 45 minutes
6 hours
74
What is necessary for the cerebral effects of mannitol?
An intact blood-brain barrier
75
If the blood-brain barrier is not intact, mannitol may enter the brain, drawing fluid with it and causing worsening of _______ ______
cerebral edema
76
Increase in _______ may occur following mannitol use
ICP
(If BBB not intact)
77
Mannitol has been used to prevent perioperative _____ _______ in the setting of ______ _______ ______
kidney failure
acute tubular necrosis
78
Mannitol has free radical scavenging properties, which may protect ______ _______ following reperfusion
transplanted kidneys
79
Despite its common use during cardiac and major vascular surgery for renal protection, mannitol has not been shown to prevent perioperative ______ _______ _______
acute renal failure
80
The initial increase in intravascular volume associated with the administration of mannitol may be poorly tolerated in patients with _____ _______ ______, leading to _____ ______
left ventricular dysfunction
pulmonary edema
81
________ may be the preferred drug for treatment of increased ICP in patients with left ventricular dysfunction
Furosemide
82
Prolonged use of mannitol may cause (3)
Hypovolemia
Electrolyte imbalances with
hypokalemic hypochloremic
alkalosis
Plasma hyperosmolarity d/t
excessive secretion of water
and sodium
