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38 Cards in this Set
- Front
- Back
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carbonic anhydrase inhibitors
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acetazolamide (diamox)
brinzolamide (Azopt) dorzolamide (truspot) |
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loop diuretics
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furosemide (lasix)
bumetanide, torsimide ethacrynic acid (edecrin) |
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thiazide diuretics and related compounds
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hydrochlorothiazide (esidrix)
Metolazone (mykrox) Indapamide (lozol) |
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K+ sparing diuretics
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Amiloride (Midamor)
Triamterene (Dyrenium) Aldosterone Antagonists Spironolactone (Aldactone) Eplerenone (Inspra) |
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osmotic diuretics
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Mannitol (osmitrol)
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ADH agonists and antagonists
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Desmopressin
Demeclocycline (Declomycin) Lithium Conivaptan (Vaprisol) Tolvaptan (Samsca) |
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what is the mech of action for acetazolamide (Diamox), dorzolamide (Trusopt),and brinzolamide (Azopt)
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Inhibits CA
inc Na+ loss inc bicarb loss this dec H+ conc in the cell reducing the action of Na+/H+ antiporter and therefore Na+ absorption this also leads to K+ loss in the distal tubules due to the Na+/K+ antiporter there |
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what are the effects acetazolamide (Diamox), dorzolamide (Trusopt),and brinzolamide (Azopt)
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systemic acidosis
Loss of bicarb alkalinize the urine hyperchloremic metabolic acidosis diuretic effectiveness dec in days reduced production of aqueous humor and CSF (inhibition of bicarb xport) |
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what are some renal toxicities for acetazolamide (Diamox), dorzolamide (Trusopt),and brinzolamide (Azopt)
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stones and K+ wasting
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what are the contraindications for acetazolamide (Diamox), dorzolamide (Trusopt),and brinzolamide (Azopt)
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sulfonamide sensitivity
systemic acidosis hepatic cirrhosis |
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what are acetazolamide (Diamox), dorzolamide (Trusopt),and brinzolamide (Azopt) used for clinically
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glaucoma
urinary alkalinization metabolic alkalosis acute mountain sickness Epilepsy |
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~ how much Na+ can be excreted as a result of loop diuretics?
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20 - 25%
2-3x more than thiozides |
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what is the mechanism of action for loop diuretics like furosemide?
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they inhibit the Na+, K+, 2Cl transporter
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what are the effects of loop diuretics like furosemide
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inc Mg++ and Ca++ excretion
Hypokalemia and alkalosis induce PG synth (blocked by COX inhibitors) relieve pulmonary congestion |
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what toxicities are associated with loop diuretics like furosemide
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hypokalemic metabolic alkalosis
hypocalcemia/magnesemia hyperuricemia |
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what type of drug interactions accompany loop diuretics like furosemide
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Ototoxicity when given w/ aminoglycosides
inc Na+ loss and Li+ retention with Lithium administration (toxic) digoxin toxicity- loss of K+ |
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what are the clinical applications for loop diuretics like furosemide
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CHF
edema due to impaired renal fxn peripheral edema pulmonary congestion treatment of hypercalcemia treat hyperkalemia |
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contraindications for loop diuretics
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cross react with other sulfonomides
allergies to sulfas cirrhosis renal failure CHF (excessive use) |
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what are the benefits of bumetanide and torsemide as loop diuretics?
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used for edema caused by CHF, hepatic or renal disease
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why would you use ethacrynic acid as a loop diuretic?
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sulfa allergies (not a sulfa derivative)
does have a higher ototoxicity |
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what are the pharmacokinetics of loop diuretics
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90% bound to plasma protein
peak effect in 60 - 90 min t 1/2= 1.5 hrs 50% excreted in liver bumetanide is 40x more potent than furosemide |
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effects of thiazides
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inc K+ loss and H2O
dec insulin release inc lipid release hyperglycemia hyperuricemia (competition for the same secretory mech) |
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what is the benefit of indapamide as a thiazide
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biliary excretion
useful in pts with renal insufficiency least effect on lipids best vasodilator |
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what are the adverse effects of thaiazides
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hypokalemia
hyperglycemia and Carb intolerance hyperuricemia elev serum lipids blood dyscrasia necrotizing vasculitis Li+ toxicity jaundice in infants |
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what is the use of metolazone as a substitute for thiazides
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diuresis in pts with a reduced GFR
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why would you use indapamide as opposed to a thiazide
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does not inc serum lipids
hepatic metabolism vasodialation effects reduces LVH |
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what is the mech of action for spironolactone
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competitive inhibitor of aldosterone
K+ sparing drug binds glucocorticoid and sex hormone receptors at high doses |
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what are the clincal uses for spironolactone
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edema (CHF, cirrhosis, nephrotic synd)
hyperaldosteronism |
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Eplerenone =
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selective aldosterone receptor antagonist
K+ sparing lower incidence of endocrine side effects than spironolactone has many drug interactions that increase the risk of hyperkalemia reduces "all cause" mortality by 15% |
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what is the mech of action for triamterene and amiloride
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inhibit Na+/K+ antiporter in the distal tubule (independent of aldosterone)
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what are the toxicities associated with Triamterene and amiloride
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hyperkalemia
megaloblastic anemia in cirrhotic pts (poss inhibits DHF reductase) do not give with spironolactone (Hyperkalemia) |
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what is the main use of triamterene and amiloride
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used in combination with K+ loosing diuretics
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mech of action for mannitol
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osmotic diuretic
Given IV |
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toxicities assc with mannitol admin
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Pulmonary edema, CHF
angioedema cerebral bleeds poss |
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what is mannitol used for
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prophylaxis of acute renal failure
dec intraocular pressure prior to eye surg dec intracrainal pressure protect kidney from nephrotoxic substances |
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what is desmopressin
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a strong V2 agonist that is more potent and longer lasting than vasopressin (ADH)
inc plasma factor VIII and vWF effective in treating diabetes insipidus |
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demeclocycline =
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tetracycline antibiotic that uncouples V2 receptor from adenylyl cyclase
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what is the order of effectivness for the diuretics
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loop>>thiazides>> CA inhib> K+ sparing
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