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Diuretics
Pharm (Final)
| Question | Answer |
|---|---|
| Which 2 GFR forces favor filtration? | 1)glomerular hydrostatic pressure (60mmHg), 2)Bowman's capsule colloid osmotic pressure (0mmHg) |
| Which 2 GFR forces oppose filtration? | 1)Bowman's capsule hydrostatic pressure (18mmHg), 2)Glomerular capillary colloid osmotic pressure (32mmHg) |
| What is the net filtration pressure? | 10mmHg |
| What is the "autoregulation" range in MAP? | 50-150mmHg |
| GFR is normally preserved by maintaining a constant _____________ over a range of systemic blood pressures. | renal blood flow |
| How does HTN affect GFR and RBF? | hypertensive pts have a higher GFR when RBF is constant |
| What are the 2 types of autoregulation of RBF and GFR? | 1)myogenic, 2)tubuloglomerular |
| Describe myogenic autoregulation of RBF and GFR. | inc. arterial pressure stretches afferent arteriole wall then a reflex constriction occurs; dec. arterial pressure causes arteriole dilation |
| Describe tubuloglomerular autoregulation of RBF and GFR. | dec. RBF --> dec. GFR which results in afferent arteriolar dilation which inc. GFR and RBF and restores filatration; renin release --> angiotensin II --> inc. GFR |
| Where does the term "diuretic" originate? | dioure'tos: Greek word meaning to urinate |
| What are 3 solutes found in urine? | 1) electrolytes (Na+, K+, Cl-, HCO3), 2)waste products (creatinine), 3)pharmacologic metabolites |
| What are 6 indications for diuretic use? | 1)reduce HTN, 2)treat pulmonary and peripheral edema, 3)electrolyte and pH corrections (hyperkalemia), 4)reduce ICP/brain bulk, 5)prevent ARF due to ischemic insult, 6)drug clearance |
| Urine excretion=? | filtration rate - reabsorption rate + secretion rate |
| What 2 things determine classifications of diuretics? | 1)site of action on renal tubules, 2)how they excrete solute |
| What are the 5 main classifications of diuretics? | 1)thiazide, 2)loop, 3)osmotic, 4)potassium-sparing, 5)carbonic-anhydrase inhibitors |
| What are 4 examples of loop diuretics? | 1)Lasix, 2)torsemide, 3)bumex, 4)edecrin |
| What is the mechanism of action of loop diuretics? | inhibit reabsorption of NaCl in ascending loop |
| How do loop diuretics decrease BP? | decreases intravascular fluid volume; stimulates production of prostaglandins (vasodilation) |
| Which is the most effective diuretic class? | loop diuretics |
| True or False: Thiazide diuretics work faster than loop diuretics. | False: Loop diuretics work faster than thiazide diuretics |
| Loop diuretics (increase or don't increase?) RBF, and (increase or don't increase?) GFR. | increase RBF, don't increase GFR |
| What are some indications of loop diuretics? | 1)rapid intravascular fluid removal, 2)hyperkalemia treatment, 3)acute pulmonary edema, 3)kidney stone extraction, lithotripsy, 4)reduce ICP |
| In what 2 ways do loop diuretics decrease ICP? | 1)systemic diuresis and dec. CSF production, 2)can be used in combination with mannitol |
| What are 9 disadvantages to loop diuretics? | 1)hypokalemia, 2)depletes myocardial K+ stores, 3)potential digitalis toxicity, 4)enhanced NMB effects, 5)ototoxicity, 6)cardiac dysrhythmias, 7)mild hyperglycemia, 8)orthostatic hypotension, 9)hemoconcentration |
| What are some examples of thiazide diuretics? | 1)diuril, 2)chlorthalidone, 3)indapamide, 4)hydrochlorothiazide, 5)benzthiazide, 6)cyclothiazide, 7)metolazone |
| What is the mechanism of action of thiazide diuretics? | inhibits reabsorption of NaCl in loop, proximal and distal tubules |
| What are some indications for thiazide diuretics? | 1)reduces edema, 2)reduces intravascular fluid volume, 3)treatment for HTN, 4)treatment for CHF edema, 5)treatment for renal failure |
| How do thiazide diuretics decrease BP? | diuresis, vasodilation (dec. SNS in peripheral vascular smooth muscle d/t dec. total body Na+ stores) |
| Which electrolytes are excreted by thiazide diuretics? | Na+, Cl-, bicarb, Mg+, K+ |
| What are some adverse effects of thiazide diuretics? | hypokalemia, hypomagnesemia, hypochloremia, hyperglycemia, hyperuricemia, orthostatic hypotension, hemoconcentration, gouty arthritis |
| What are some potential complications of hypokalemia? | digitalis toxicity, cardiac dysrhythmias, muscle weakness, neuropathy, potentiation of NMB |
| What are 2 examples of osmotic diuretics? | mannitol, urea |
| What is the site of action of osmotic diuretics? | proximal convoluted tubule, loop of henle |
| Osmotic diuretics (do or don't?) affect GFR. | don't |
| What is the mechanism of action of osmotic diuretics? | large molecular weight molecule; filtered but too large to be reabsorbed; acute expansion of intravascular fluid volume |
| What is the most typical use for osmotic diuretics? | in craniotomies to reduce brain bulk |
| What are some side effects of osmotic diuretics? | increased intravascular volume until filtered; rebound HTN in non-intact BBB, pulmonary edema, can exacerbate CHF, electrolyte disturbances |
| What are some indications for mannitol? | 1)reduction of ICP and brain mass, 2)reduction of high IOP when unable to lower pressure by any other mechanism, 3)urinary excretion of toxic materials |
| What is an example of an aldosterone antagonist? | aldactone (spironolactone) |
| What is the mechanism of action of aldosterone antagonists? | competes with aldosterone; allows secretion of Na+ and Cl- |
| What are 2 indications for use of aldosterone antagonists? | edema reduction r/t: 1)CHF, 2)liver cirrhosis |
| What is a side effect of aldosterone antagonists? | hyperkalemia |
| Aldosterone antagonists are often given with... | thiazide diuretics |
| What are 2 examples of potassium-sparing diuretics? | 1)triamaterene, 2)amiloride |
| What is the mechanism of action of potassium-sparing diuretics? | spares K+ independent of aldosterone; increased excretion of Na+, Cl-, bicarb |
| What is the site of action of potassium-sparing diuretics? | distal tubules and collecting ducts |
| What is a common use of potassium-sparing diuretics? | used in combination with loop diuretics to limit potassium losses in the distal tubule |
| True or False: Potassium-sparing diuretics are used alone as anti-HTN or for edema. | False (used in combo.) |
| What is a side-effect of potassium-sparing diuretics? | hyperkalemia |
| Which pts should use potassium-sparing diuretics cautiously? | pts prone to hyperkalemia, pts using ACEi, NSAIDS |
| What are 2 examples of carbonic anhydrase inhibitors? | Diamox, neptazane |
| What is the site of action of carbonic anhydrase inhibitors? | proximal tubules |
| What is the mechanism of action of carbonic anhydrase inhibitors? | inhibits Ca+, blocks Nabicarb and causes diuresis |
| What is a common indication for carbonic anhydrase inhibitors? | used in glaucoma to reduce IOP by decreasing aqueous humor |
| What are 4 side effects of carbonic anhydrase inhibitors? | 1)hyperchloremic metabolic acidosis, 2)drowsiness, 3)paresthesia, 4)renal caliculi |
| Aldactazide is a combo drug of __________ + __________. | spironolactone + HCTZ |
| Dyaside is a combo drug of __________ + __________. | triamterene + HCTZ |
| Hydra-zide is a combo drug of __________ + __________. | hydralazine + HCTZ |
| Clopress is a combo drug of ___________ + _________. | clonidine + chlothalidone |
| Which diuretic class is known to cause gouty arthritis? | thiazide diuretics |
| Which diuretic class is a treatment for glaucoma? | carbonic anhydrase inhibitors |
| Which diuretic class can cause rebound HTN in pts w/ non-intact BBB? | osmotic diuretics |
| Which diuretic class can cause mild hyperglycemia? | loop, thiazide diuretics |
| Which diuretic class should be taken cautiously in pts taking ACE inhibitors and NSAIDs? | potassium sparing diuretics |
| Which diuretic class can cause temporary or permanent deafness? | loop diuretics |
| Which diuretic class can cause pulmonary edema? | osmotic diuretics |
| Which diuretic class dec. ICP? | loop, osmotic diuretics |
| Which diuretic class dec. IOP? | osmotic diuretics, carbonic anhydrase inhibitors |
| Which diuretic class is used for urinary excretion of toxic materials? | osmotic diuretics |
| Which diuretic class is used for lithotripsy? | loop diuretics |
| Which diuretics class can cause drowsiness, paresthesia, and renal caliculi? | carbonic anhydrase inhibitors |
| Which diuretic class can cause hypochloremic metabolic acidosis? | thiazide diuretics, carbonic anhydrase inihibitors |
Created by:
lindseymontgomery
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