Heart Failure And Diuretics - Pharm

Front 1

Loop diuretics can cause ____ which may precipitate ___?

Back 1

hyperuricemia; gout

Front 2

The drug class that is least helpful in heart failure?

Back 2

Calcium channel blockers (Verapimil, diltiazem, nifedipine)

Front 3

An increase in systolic cytoplasmic calcium levels is characteristic of what drug?

Back 3

Digoxin

Front 4

Pts been taking Digoxin for years for CHF and is about to receive atropine. A common effect of digoxin that can be blocked by atropine is?

Back 4

increased PR interval (ie any parasympathetic effect)

Front 5

If patient with MI develops acute severe HF with pulmonary edema, what drug is most useful?

Back 5

Furosemide (loop diuretic) is used in acute pulmonary edema

Front 6

what is the most likely cause of Dig contributing to arrhythmogenic effects?

Back 6

increased intracellular calcium

Front 7

What situation is risky for dig toxicity even if serum potassium is maintained?

Back 7

quinidine reduces dig clearance

Front 8

What does DIG do to the AV refractory period, QT interval, Twave?

Back 8

Increased, decreased, inverted

Front 9

What drug has important positive intotropic effects in acute heart failure?

Back 9

dobutamine - beta agonist

Front 10

What is the main effect of Dig in heart failure?

Back 10

decreased heart rate

Front 11

what monovalent cation will decrease or reverse mild/moderate digitalis induced arrhythmia?

Back 11

potassium

Front 12

What drug prolongs life in patients with CHF but has a negative inotropic effect?

Back 12

carvedilol - as do most beta blockers

Front 13

what is the DOC for treating DIG overdose?

Back 13

Digoxin antibodies

Front 14

Given IV for acute heart failure. Significant renal toxicity

Back 14

nesiritide (VD)

Front 15

Does DIG prolong life?

Back 15

no

Front 16

Digitalis effects is INHIBITED by extracellular ___ and ___ and FACILITATED by extracellular ___

Back 16

potassium; magnesium

calcium

Front 17

What does DIG act on?

Back 17

Na/K ATPase pump inhibitor

Front 18

The pressure that must be overcome for heart to pump?

The volume of blood the heart must pump?

Back 18

Afterload

Preload

Front 19

Decreased renal blood flow d/t low CO triggers ___ secretion? That in turn activates ___ which increases BP. It also activates ___ which also leads to Na retention and increased BP

Back 19

Renin

AGII

Aldosterone

Front 20

what are 2 HUGE reasons to use beta blockers in heart failure?

Back 20

Reduce cardiac remodeling; slow HR compensation by inhibiting SA node

Front 21

About __ of ppl with HF die within 1 year?

About ___ die within 5 years

Back 21

1/5

1/2

Front 22

The first DOC for mild heart failure?

Back 22

ACE (pril) inhibitors or ARBS (sartan)

Front 23

ACEI reduce preload by ?
Reduce afterload by?
and finally reduce ___?

Back 23

inhibiting aldosterone
inhibiting AT1 receptor (not directly)
Reduce remodeling

Front 24

Captoprils most common SE's (2)

Back 24

dry cough (d/t bradykinin)

angioedema

Front 25

All ACEI (prils) are prodrugs except ____

Back 25

captopril

Front 26

You would never give ___ to a pregnant lady d/t preeclampsia?

Back 26

ACEI

Front 27

The drug you add after ACEI/ARB?

Back 27

diuretic

Front 28

Beta blockers and ACE inhibitors both inhibit cardiac ___?

Back 28

remodeling

Front 29

why are diuretics useful in HF?

Back 29

Reduce PRELOAD

Front 30

Name the (2) loop diuretics?
(3) K sparing
(2) Thiazide?

Back 30

furosemide/ethacrynic acid

spironolactone/amiloride/triamterence

HCTZ/Nedroflumethiazide

Front 31

What drug is a slow acting diuretic with gynomastia as SE?

Back 31

spironolactone - K sparing diuretic

Front 32

What drug's main SE is kidney stone formation?

Back 32

Trimterene (K sparing) - Try to pass a kidney stone if you use trimterene

Front 33

What diuretic would you use with liver cirrhoisis?

Back 33

spironolactone

Front 34

What diuretic is super fast acting (like a fast ride)

Back 34

amiloride

Front 35

what the difference between the 2 loop diuretics?

Back 35

Furosemide is sulfa drug so can have ADR whereas ethacrynic acid is not

Front 36

DOC for HTN crisis or pheochromocytoma?

Back 36

Carvedilol (prototype beta blocker)

racemic mix of alpha1/beta1 blocker

Front 37

what drug is beta1 selective antagonist and produce NO and decreased TPR?

Back 37

nebivolol

Front 38

IV only, SHORT duration. increases inotropic activity of heart; also activates beta2 for VD; it is a beta agonist?

Back 38

dobutamine

Front 39

What 2 drug can be used for HTN in pregnancy?

Back 39

Hydralazine and Methyldopa (most important)

Front 40

Vasodilators cause __ influx and __ efflux which leads to VSM relaxation

Back 40

decrease; increase

Front 41

what preexisting electrolyte defect could precipitate DIG arryhtmias?

Back 41

potassium - K

Front 42

hx of HF and acute LVMI with severe pulmonary edema. Which drug to use?

Back 42

Furosemide

Front 43

Hx of frequent renal colic with high calcium renal stones. Most useful diuretic for renal stones?

Back 43

HCTZ - they inhibit renal excrection of Ca

Front 44

Chronic thiazide use does NOT cause what SE that Loops do?

Back 44

Ototoxicity

Front 45

elevated plasma uric acid, elevated blood glucose, elevated blod cholesterol, and decreased urinary Ca excretion would be expect in Chronic ___ use?

Back 45

thiazide diuretic use

Front 46

Where does Acetazolamide, Furosemide, Metolazone, Thiazide, and Spiros work in the tubules?

Back 46

Proximal convoluted tubule (carbonic anhydrase inhibitor)

Thick ascending limb - Loop (20%)

Metolazone/Thiazide so TAL

Collecting tubule

Front 47

pt with long hx of diabetic renal disease and hyperkalemia and recent onset of heart failure needs a diuretic. which is safest with severe hyperkalemia?

Back 47

HCTZ b/c it will not reduce rapidly but won't increase it

Front 48

which drugs interfere with aldosterone production or collecting tubule potassium excretion which are all capable of increased serum potassium?

Back 48

ARBs, amiloride, spiro, triamterene

Front 49

what diuretic would be used in coma patient with cerebral edema?

Back 49

mannitol (direct osmotic agent used to reduce ICP and glaucoma)

Front 50

what is a common SE of thiazide diuretics?

Back 50

Hypocalciuria - so also used to reduce kidney stones (the K sparing trimterene causes them though)

Front 51

how should I manage severe hypercalcemia besides saline infusion?

Back 51

Loop diuretic (furosemide)

Front 52

60 y/o c/o paresthesias and nausea with her drug. She is hyperchloremic metabolic acidosis so she's taking?

Back 52

acetazolamide (SE = GI upset and paresthesia) especially in glaucoma use

Front 53

which class of diuretic can create hyperchloremic metabolic acidosis?

Back 53

carbonic anhydrase inhibitors like acetazolamide

Front 54

potassium sparing diuretics are ___ antagonists in the collecting tubules?

Back 54

aldosterone

Front 55

which diuretic can cause hyperkalemic metabolic acidosis?

Back 55

potassium sparing (spiro, eplerenone, amiloride, triamterene)

Front 56

what diuretic most likely to cause syncope?

Back 56

loop diuretic b/c loosing potassium (furosemide) - would consider thiazide b/c they don't spare potassium but they don't reduce blood volume enough to cause syncope

Front 57

what drugs act in the DCT?

Back 57

HCTZ. metolazone,

Front 58

Reabsorption of Ca from the urine is ___ and urine Ca is ___ in thiazide diuretic use, which is opposite to what class?

Back 58

increased; decreased
Loops

Front 59

what 2 diuretic classes work synergistically to produce extremem diuresis?

Back 59

Loop + thiazide

Front 60

The drug that increased dilute urine formation and treats SIADH?

Back 60

conivaptan (ADH agonists) - these increase aquaporins via V2 receptors

Front 61

what 2 drugs would be used to create super dilute urine due to ADH oversecretion?

Back 61

conivaptan and demeclocycline

Front 62

What is the prototypical ADH agonist?

Back 62

desmopressin

Front 63

drug used for acute mountain sickness

Back 63

acetazolamide

Front 64

For stage 1 HTN, what diuretic is the go to? when would you not use a diuretic (2)?

Back 64

Thiazide

Post MI or chornic renal disease

Front 65

The most efficacious diuretics used for acute pulmonary edema?

Back 65

Loops (furosemide mainly)
and ethyacrynic acid

Front 66

3 Carbonic anhydrase inhibtors?
2 osmotic diuretics?
3 loop diuretics?

Back 66

acetazolamide/dorzolamide/brinzolamide

mannitol/urea

furosemide
ethyacrinic acid
torasemide

Front 67

3 K sparing diuretics?
5 Thiazide diuretics?

Back 67

Sprio/amiloride/triamterene

HCTZ/Bendroflumethiazide/Chlorthalidone/metalozone/indapamide

Front 68

Drug class used in Hypercalcemia and Osteoporosis?

Back 68

Diuretics (thiazide for osteoporosis b/c promotes Ca reabsorption)

Front 69

HTN + edema are the primary indications for ___ use

Back 69

diuretic use

Front 70

Most of the bicarb and sodium chloride get reabsorped in the ?

Back 70

PCT (that's where carbonic anhydrase inhibitors act)

Front 71

Which part of the Tubule is indicated and CI for cirrhosis?

Back 71

PCT is CI'd for cirrhosis (CAIs)
DCT is indicated (Thiaizde)

Front 72

Most commonly used in Glaucoma, mountain sickness, and metabolic ALKALOSIS

Back 72

acetazolamide

Front 73

Dorzolamide and Brinzolamide are ___ diuretics used to treat ___ b/c they are given ____; Therefore they have no metabolic SEs

Back 73

Carbonic Anhydrase Inhibitors
glaucoma
topically

Front 74

indicated in Hypercalcemia, acute renal failure, CHF, pulmonary edema?

Back 74

Loop diuretic (most efficacious available)

Front 75

What symporter do Loop diuretics inhibit?

Back 75

NaK-2CL

Front 76

main SE include hypokalemia, hyperuricemia (may cause gout), allergic rxn, reversible ototoxicity?

Back 76

Furosemide/Ethacrynic acid

Eth won't cause allergic b/c not sulfa derivative

Front 77

The main diuretic used to treat hypercalcemia?

Back 77

loops (furosemide or ethacrynic acid)

Front 78

Block Na/CL transporter, blocking NaCL reabsorption which means no water reabsorption?

Back 78

Thiazide

Front 79

Where do the thiazide diuretics act?

Back 79

DCT

Front 80

A diuretic used in diabetes Insipidus and CHF?

Back 80

thiazide

Front 81

what are the 3 MAIN SE's of thiazide diuretics?

Back 81

Hyponatremia (d/t increased ADH)
Hyperlipidemia (increases LDL)
Allergic Rxn (sulfa derivative)

Front 82

When a pt has high Ca in urine use ___ diuretics? What about low?

Back 82

Loop; thiazide

Front 83

The most potent thiazide diuretic?

Back 83

Metolazone

Front 84

The DOC in hepatic cirrhoisis?

Back 84

spiro - CCT K sparing diuretic

Front 85

DOC in hyperaldosteronism (Conn's syndrome) b/c it effectiely inhibits aldosterone receptors in the CCT?

Back 85

Spiro

Front 86

the 2 main SEs of spiro?

Back 86

gynecomastia; hyperkalemia

Front 87

diuretic that is insoluble and can cause Kidney stones?

Back 87

Triamterene - trying to pass kindey stone b/c it causes them

Front 88

mainstay for treatment of patients with acute renal failure b/c it helps preserve them during dialysis; also good in decreasing ICP and glaucoma

Back 88

mannitol (osmotic drug) - ALWAYS IV

Front 89

SEs of mannitol?

Back 89

dehydration and HYPERnatremia