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Pharm - Ch. 40


At what site of action would a diuretic produce the greatest diuresis? Proximal tubule
Most diruetics block sodium and chloride _______ Reabsorption
True or false: diuretics directly remove fluid from the nephrons False. Creates osmotic pressure within nephron to prevent passive reabsorption of water, which is then excreted
List the adverse effects of diuretics Hypovolemia, acid-base imbalance, electrolyte imbalances, hypotension and ototoxicity
List the four classes of diuretics High ceiling/loop, thiazide, potassium sparing, osmotic
Match each drug with its diuretic class: spironolactone, hydrochlorothiazide, mannitol, furosemide Spironolactone -> potassium sparing Hydrochlorothiazide -> thiazide diuretic Mannitol -> osmotic diuretic Furosemide -> high ceiling (loop) diuretic
For furosemide, list the following: site of action, onset, and uses Site of action = ascending part of loop of Henle; profound diuresis Rapid onset Uses in priority: CHF, HTN, edema unresponsive to other drugs
List the adverse effects of furosemide/high-ceiling diuretics Hypotension, ototoxicity, electrolyte imbalance, hyper(glycemia, uricemia, lipidemia), dehydration, multiple DDIs, danger in pregnancy
True or false: high-ceiling diuretics are effective even when GFR is low True
For patients taking digoxin, ______ caused by diuretics is a special problem Hypokalemia
True or false: thiazide diuretics are effective even when GFR is low False. Thiazide diuretics depend on kidney function.
List the site, mechanism of action, and use for hydrochlorothiazide Site: distal convoluted tubule MoA: Blocks reabsoprtion of Na+/Cl- by priority: HTN, edematous states, diabetes
True or false: hydrochlorothiaizdes are ototoxic False
Can thiazide diuretics cross the placental barrier to produce direct fetal harm? Yes
List the site and mechanism of action for spironolactone Site: distal nephron MoA: blocks aldosterone actions, leading to retention of K and excretion of Na. Produces only modest increase in urine production and decrease in K execretion.
List the therapeutic uses of spironolactone Takes up to 48 hours to work. Used for HTN, edema, severe heart failure, and primary hyperaldosteronism. Commonly given c. TZD or loop diuretic.
List the adverse effects and DDIs of spironolactone Adverse: hyperkalemia, endocrine effects, TZDs and loop diuretics to counteract K loss. Don't use c. drugs that increase potassium (e.g., ACE inhibitors)
What is mannitol? An osmotic diuretic which is a 6-carbon sugar freely filtered at glomerulus. Minimal reabsorption and metabolism.
What is the site and mechanism of action of mannitol? Site: lumen of nephron MoA: osmotic force prevents passive H2O reabsorption and increases urine output
What are the therapeutic uses of mannitol? IV rapid (30-60 min); prophylaxis of renal failure, reduction of intracranial/intraocular pressure by removing H2O from CNS.
What are the adverse effects of osmotic diuretics? Can leave vascular system at capillary beds (except CNS), lead to edema. Be cautious c. heart disease patients.
Created by: choel



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