First Aid: Cardiac & Hypertensive Drugs

Front 1

Mannitol

Back 1

mxn: osmotic diuretic, + urine osmolarity to + urine flow

C: shock, drug OD, - intracranial/intraocular pressure

tox: pulm edema, dehydration, CHF, don't use in anuria

Front 2

Acetazolamide

Back 2

mxn: carbonic anhydrase inhibitor, cause self-limited NaHCO3 diuresis, reduce body bicarb stores, act at proximal convoluted tubule

C: glaucoma, urinary alkalization, metabolic alkalosis, altitude sickness

tox: hyperchloremic metabolic acidosis, neuropathy, NH3 tox, sulfa allergy

Front 3

Furosemide

Back 3

mxn: sulfonamide loop diuretic, blocks cotransport of Na/K/2Cl of thick AL, abolish hypertonicity of medulla and prevents concentration of urine, increase Ca++ excretion

C: edema states (CHF, cirrhosis, nephrotic syndrome, pulm edema), hypertension, hypercalcemia

tox: OH DANG! (Ototoxicity, Hypokalemia, Dehydration, Allergy (sulfa), Nephritis (interstitial), Gout

Front 4

Ethacrynic acid

Back 4

mxn: phenoxyacetic acid derivative (NOT a sulfa), same action as furosemide

C: diuresis for pts allergic to sulfa

tox: similar to furosemide, can be used in hyperuricemia, acute gout (not used to treat gout)

Front 5

Hydrochlorothiazide

Back 5

mxn: thiazide diuretic, blocks NaCl reabsorption in early distal tubule, reduces diluting capacity of nephron, decrease Ca++ secretion

C: hypertension, CHF, idiopathic hypercalciuria, nephrogenic diabetes insipidus

Tox: hypokalemic metabolic alkalosis, hyponatremia, hyperGLUC (-Glycemia, -Lipidemia, Uricemia, -Calcemia), sulfa allergy

Front 6

What are the 3 big K+ sparing diuretics?

Back 6

"The K+ STAys"
- Spironolactone
- Triamterene
- Amiloride

Front 7

What are the mxn, clinical use, and tox of K+ sparing diuretics?

Back 7

mxn: Spironolactone is a competitive aldosterone receptor antagonist in the cortical collecting tubule. Triamterene and amiloride act in the same area by blocking the Na+ channels.

C: hyperaldosteronism, K+ depletion, CHF

tox: hyperkalemia, endocrine effects (eg. spironolactone causes gynecomastia, antiandrogen effects)

Front 8

What diuretics increase urine NaCl?

Back 8

all: carbonic anhydrase inhibitors, loop diuretics, thiazides, K+ sparing diuretics

Front 9

Which diuretics increase urine K+?

Back 9

All except the K+ sparing diuretics.

Front 10

Which diuretics lead to a decrease in blood pH (acidosis)?

Back 10

CA inhibitors, K+ sparing diuretics

Front 11

Which diuretics cause an increase in blood pH (alkalosis)?

Back 11

loop diuretics and thiazide diuretics

Front 12

How do diuretics affect urine Ca++?

Back 12

loop diuretics increase urine calcium, while thiazides decrease urine calcium

Front 13

Nifedipine, verapamil, diltiazem

Back 13

Mxn: calcium channel blockers; act on L-type voltage-dependent channels of smooth muscle and cardiac muscle; verapamil is most sensitive on heart tissue, followed by diltiazem

Clin: HTN, angina, arrhythmias (not nifedipine)

Tox: cardiac depression, peripheral edema, flushing, dizziness, constipation

Front 14

captopril, enalapril, lisinopril

Back 14

mxn: ACE inhibitor; lowers angiotensin II levels and prevents inactivation of bradykinin (vasodilator)

clin: HTN, CHF, diabetic renal disease

tox: CAPTOPRIL (Cough, Angioedema, Proteinuria, Taste changes, hypOtension, Pregancy problems, Rash, Increased renin, Lower angiotensin II) and hyperkalemia

Front 15

Losartan

Back 15

angiotensin II receptor blocker (ARB); does NOT cause cough

Front 16

nitroglycerine, isosorbide dinitrate

Back 16

mxn: vasodilate by releasing NO in smooth muscle, cause + in cGMP and smooth muscle relaxation; dilates veins >> arteries

clin: angina, pulm edema, aphrodisiac, erection enhancer

tox: tachycardia, hypotension, headache, "Monday disease"