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Diuretics

Pharm (Final)

QuestionAnswer
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