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CHAPTER 25 AND 26
DIURETIC AND ANTIHYPERTENSIVE
| Question | Answer |
|---|---|
| Renal Function | kidneys remove waste from the blood and reabsorb water and sodium ions (Na) b/4 final excretion into d urine. Along d renal tubules, sodium ions are reabsorbed into d cells and blood by exchange for hydrogen (H) and potassium (K) ions. |
| Renal Function CONT: | water follows NA back into the blood (osmotic gradient) |
| Clinical Indication | Mangt. of anuria, hypertension, and edema of any cause including chronic congestive heart failure or renal disease, Mangt. of glaucoma. Mangt. of primary hyperaldosteronism. |
| Renal Mechanisms | Renal tubules produce hydrogen ions (H) and bicarbonate ion (HCO3) through d enzyem carbonic anhydrase, H exchange into d renal tubule filtrate acidified d fluid., HCO2 absorbed into d blood neutralzes waste products from d cells. |
| Understand how these are related RAAS Mechanism | Liver release Angiotensingen into the kidney, kidney then release Renin into the bloodstream, it will activate angiotensin 1 then ACE is release than adrenal gland now release Aldosterone the end result will make Increase in B/P, Na+ and decrease in k+ |
| Strongest to weakest diuietic | Organic acids(loop diuretic), Thiazide/thiazide-like (also unknown as Sulfonamide diuretic), Potassium-sparing, Carbonic Anhydrase Inhibitors and lastly Osmotice diuretic. |
| Organic Acids (Loop Diuretic) | Inhibit sodium and chloride in the tubule loop of Henle.Potent, loss of large volume of water in urine, loss of Na+ and Cl- in unrine, loss of K+(hypokalemia), hyopchloremic (Low chloride) alkalosis, Non refractory- diuresis continues when alkalosis devel |
| Thiazide and Thiazide-like diuretics | Inhibit sodium ion reabsorption by multiple mechanisms along the renal tubules. ACTION IS SAME AS THE ABOVE ORGANIC ACIDS. |
| Thiazide-like | Is sulfonamide diuretic same as the thiazide, but lack BENZOTHIADIAZINE chemical properties of a thiazide. They are the largest group of diuretic and widely used in treating edema, they combine with loop diuretic they have same pharmacological action in t |
| Thiazide drugs are;: | Chlorthalidone, Hydrochlorothiazide, polythiazide, and quinethazone. |
| Potassium-sparing | Inhibit k+ exchange for Na+ in the distal renal tubules. Spironolactone inhibits aldosteron receptors that control K+ exchange. Amilioride and triamterene inhibit other mechanisms to block k+ exchange |
| Potassium-sparing CONT: | Is a mild diureis, no significant effect on Na+, H+, Cl- or HCO3, No effect on acid/bases bal. but cause gynecomastia. |
| Carbomic Anhydrase Inhibitors | Reduce d production of hydrogen ions to exchange 4 sodium ion so water stays with sodium ions. Loss of Na+, Loss of K+ (hypokalemia), refuction in H+ and HCO3, metabolic acidosis, refractory- diuresis stops when acidosis develops. |
| Osmotic Diuretics | Enter d tubules but cannot be reabsorbed so water stays with d concentration of diuretic molecules. Ion exchange are not affected. Mild diuresis, diuresis continue as long as intravenou infusion is maintained. |
| Beta Blockers Names | Atenolol, Metoprolol, Nadolol and propranolol.D effect on d B/P; lower B/P by decreasing heart rate and cardiac output, affect body immune systems. For treating: hpyertension, cardiac arythmias, chf, glaucoma, migraines, and angina pectoris. |
| Beta Blockers CONT: | function of beta blockers are: d effect of norepinephrine and epinephrine, reduces heart rate and b/p by dilating blood vessels. |
| Beta blockers CONT: | Side effects of beta blockers are:- nausea, diarrhea, hypotension, bradycardia, symptoms of chf, drowsiness and depression. |
| Verapamil and diltiazem | Class 4 antiarrhythmias drug by blocking calcium ions, effect: decrease d heart rate and AV conduction, increase the PR interval. is used to treat supraventricular arrhythmias. cause cardiac depression at higher doses. |
| Time to take diuretic | In the morning immediately after b/fast 4 d first dose and the last dose b4 4.00pm. |
| How d heart has d ability to initiate its own beat? | By Authorhythmicity, because this property enable d heart to initiate its own electrical stimulation. SA node fire-excitation spreads through atrial myocardium-AV node fires - excitation spreads down AV bundle -Purkinje fibers distribute excitation throug |
| Diuretic cab used to treat d following conditions | Magt. of primary hyperaldosteronism, Magt. of glaucoma, Magt. of anuria, hypertension, and edema of any cause including chronic congestive heart failure of renal disease. |
| Hypertension | is the leading cause of cardiovascular disease and mortality. |
| Causes of hypertension | Most people have essential hypertension where d exact cause is not known, increase sympathetic activity and sodium overload increase B/P, renal disease increase renin-angiotensin-aldosterone activity raise B/p |
| Causes of hypertension CONT: | and cause sodium and fluid retention and smoking, body overweight and increased sodium consumption contribute to hypertension. |
| Classes of drugs to treat HTN | They are: diuretics, sympatholytic drugs, vasodilator drugs, calcium antagonist drugs, angiotensin-converting enzyme inhibitor, and angiotensin receptor blocking drugs, beta blocker decrease d B/P. |
| CHF (digitalization doses are administered to rapidly attain effective therapeutic) | Is due to weakening of d contractile function of d heart.Symptoms: fatigue, swelling(Edema) in legs, ankle, feet, rapid or irregular heartbeat, elevated B/P and increase urinate @ night contractile function of d heart. |
| How do cardiac glycosides work? | Inhibit Na/K adenosine triposphatase, d sodium pump which cause more Na to remain inside myocardial cells, stimulate d vagus nerve which decreases heart rate and atrioventricular conduction. |
| Digoxin and Digitoxin (digitalis is loading dose) | Digoxin is water soluble and eliminated mostly metabolized by the urinary tract,Digtoxin is more lipid soluble, requires metabolism, and has a longer half-life. |
| Ectopic beat | Means: strange beats, |
| Vital signs prior to cardiac glycoside administering | |
| Electrolyte and cardiac glycoside interaction | low serum K+ hypokalemia increase drug toxicity and can cause cardiac arrhythmias, High serum K+ level hyperkalemia decrease d actions of d cardiac glycosides and increase serum Ca+ level hypercalcemia can increase d action and toxicity of d cardia gylco |
| Why a vasodilator lower B/P | Act directly on vascular smooth muscle to cause relaxation.This results in vasodilation's and a reduction of B/P, and they are often used in combination with diuretic and beta blocker, this is necessary because vasodilators ofter cause fluid retention and |
| where are mast celss found in the body? | Are found predominately in the lungs, gastrointestinal tract, circulatory system. |
| Histamine | Histamine is naturally found in the body within mast cells or basophils. Env., bacterial or virla proteins (Allergens) attach to mast cells membranes and cause histamine release. d greater d allergen challenge, d greater d histamine release. |
| Triamterene and Spironolactone | Potassium sparing diuretic |
| Furosemide and bumetanide | Organic Acid |
| Enalapril and captopril | Angiotension converting enzyme inhibitor |
| Nifedipine and verapamil is Class IV | Calcium channel blocker |
| Propanolol and antenolol | Beta blocker |
| Hydrocholothizade | thiazide and thiazide diuretic |
| Acetazolamide | Carbonic anhydrase inhibitor |
| Mannitor | Osmotic diuretic |
| Minoxidil | peripheral vasodilator (causes hirsutism) |
| Hydralazine | Vasodilator, decrease heart failurem high b/p and is use in ER for hypertensive. |
| Albuterol | also known as Proventil, is a beta blocker, bronochodilator. |
| ACE inhibitors (Ends in pril) | Action: decrease peripheral vascular resistance w/o increase the following cardiac output, cardiac rate, cardiac contractility.Effect: dizzines, Gl distress, headache, nonproductive cough, hypotension |
| Calciun Antagonists | Very nice durg, Action: blocks Ca+ access to cells cause the decrease in contractility, decrease in conductivity of the heart and decrease in demand fro oxygen. |
| Side effect of Ca+ anatagonists | Decrease in b/p, bradycardia, may precipitate A-V block, headache, abdominal discomfort, perihpheral edema. |
| Treatment of hypertensive crisi | Administering of antihypertensive drugs can avoid serve complication and irreversible damage, Diazoxide and nitroprusside are potent vasodilator used in hypertension crisis. |
| 4C's compications | CAD (Coronary Artery Disease) CRF, CHF, CVA |
| Common diseases affecting d respiratory tract | Chronic bronichitis, emphysema, asthmas |
| Eosinophilic chemotactic factor of anaphylaxis | |
| Epinephrine and isoproterenol | are nonselective beta 1 and beta 2 agonists. ephinephrine(come from adrenal glad) stimulate beta 2 in the lung |
| Theophylline | is a bronchodilator |
| steroid | decrease the immune responseand in decrease information in the lung and cause infection. bronchodilator dialator first b/4 given any steroid inhalers. |
| Common leukotriene inhibitors | Singulair and accolate |
| Mucolytics | are intended to break apart the liquefy thick respiratory secretion to facilitate easier removal |
| PVCs | is d only kind of ventricular arrjythmias that is not fatal |
| SA node | is a peacemaker (Excitaility) |
| EKG | measure electrical conduction in the heart |
| Quinidine and procainamide | classified as number 1 antiarrhythmic durg, used for both suraventricular and ventricular arrhythmias |
| idocaine | slow down and epinephrine speed up |
| Lidocain | used only 4 ventricular arrhythmic |
| Amiodarone | class 3 antirrhythmic drug |
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