Exam 4: Diuretics Flashcards Preview

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Flashcards in Exam 4: Diuretics Deck (35)
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1
Q

Prototype thiazide diuretic:

A

Hydrochlorothiazide

2
Q

Site of action of thiazides:

A

Distal convoluted tubule

3
Q

MoA of thiazides:

A

Impairs Na+/Cl+ reabsorption, drawing water into the filtrate to be excreted

4
Q

Precaution with thiazides:

A

K+ depleting

5
Q

HTN mechanism of thiazides:

A

Peripheral vasodilation

6
Q

Anesthesia concerns with thiazides:

A
Electrolytes: hypokalemia, hypochloremia, hypomagnesemia
Muscle weakness that potentiates NMBs
Nephropathy
Increased risk of dig toxicity
Fluid volume depletion
7
Q

Dose effects of thiazides:

A

Increased dose has little extra effect

8
Q

Prototype loop diuretic:

A

Furosemide

9
Q

Site of action of loop diuretics:

A

Thick ascending loop of Henle

10
Q

MoA of furosemide:

A

Inhibit the passive transport of K+/Na+/Cl- from the lumen, keeping them + water in the filtrate

11
Q

PK of furosemide:

A

Onset: 2 - 10min (IV)
Extensively protein bound
Renal secretion!

12
Q

Indications for furosemide:

A

Mobilization of edema
Reduction of ICP
Hypercalcemia
Differential dx of oliguria

13
Q

Dosage of furosemide:

A

0.1 - 1.0 mg/kg (titrate)

14
Q

Electrolyte changes with loop diuretics:

A

Hypokalemia

Hypochloremia

15
Q

A/E of loop diuretics:

A

Potentiation of NMBs

Presynaptic cAMP inhibition, ACh release

16
Q

Drug interactions with loop diuretics:

A

Nephrotoxicity when administered with aminoglycosides and cephalosporins

Possible cross reactivity to sulfonamide allergy

Decreases renal clearance of lithium

17
Q

Prototype drug for osmotic diuretics:

A

Mannitol

18
Q

Site of action of osmotic diuretics:

A

Tubules

19
Q

MoA of osmotic diuretics:

A

Increased osmolarity in tubule → Na+, Cl-, HCO3- excreted along with water

20
Q

Concern with osmotic diuretics:

A

Increases plasma osmolarity and intravascular volume; can cause pulmonary edema in poor LV function

21
Q

PK of osmotic diuretics:

A

Do not enter cells; must be given IV
Onset: 10 - 15min
Duration: 2 hrs
100% renally excreted

22
Q

Indications for mannitol:

A

Differential dx of oliguria (after furosemide)
Prophylaxis for ARF
↓ ICP
↓ IOP

23
Q

Dose of mannitol:

A

0.25 - 1 g/kg IV

24
Q

Anesthesia concerns with mannitol:

A

Pulmonary edema
Hypovolemia
Electrolyte changes

25
Q

Two classes of potassium sparing diuretics:

A

Epithelial Na+ channel blockers

Aldosterone antagonists

26
Q

Prototype epithelial Na+ channel blocker:

A

Triamterene

27
Q

Site of action of triamterene:

A

Collecting duct

28
Q

MoA of triamterene:

A

Na+ channel blockade in the luminal membrane; non-competitive antagonism of aldosterone

29
Q

A/E of triamterene:

A

Can cause hypERkalemia

30
Q

Prototype aldosterone antagonist:

A

Spironolactone

31
Q

MoA of spironolactone:

A

Competitive aldosterone antagonist; weak and usually combined with other diuretics

32
Q

Indications for spironolactone:

A
HF
Ascites
Low-renin hypertension
Hypokalemia
Conn's syndrome
33
Q

Prototype carbonic anhydrase inhibitor:

A

Acetazolamide

34
Q

MoA of acetazolamide:

A

Blocks the action of carbonic anhydrase, increasing HCO3-, Na+, and H2O in urine

35
Q

Indications for acetazolamide:

A

Glaucoma
Altitude sickness
ICP