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CHAPTER 25 AND 26

DIURETIC AND ANTIHYPERTENSIVE

QuestionAnswer
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
Created by: 100000888879579