Pharm Unit 9-2

Front 1

alleviate

cause

Back 1

1. Kidney may _________ acid-base balance if the cause is from another source.

Ex. alkalosis: hyperventilation, vomiting
acidosis: respiratory insufficiency, diarrhea, excess lactic acid

2. Kidney may ________ acid-base imbalance if malfunction or diuretic given.

Front 2

sodium bicarbonate

Back 2

What is the potential drug therapy for treating acidosis?

Front 3

ammonium chloride or weak acid

Back 3

What is the potential drug therapy for treating alkalosis?

Front 4

Cardiac edema (congestive heart failure

Acute pulmonary edema

Liver disease (cirrhosis or other portal obstruction can cause ascites; made worse by lack of plasma proteins.

Renal disease (as long as kidney still capable of functioning)

Pregnancy (caution: some diuretics may be teratogenic)

Special caution: Potassium depletion - especially if on digitalis

Back 4

What are the CAUSES of edema?

Front 5

What are the CAUSES of edema?

Back 5

Cardiac edema (congestive heart failure

Acute pulmonary edema

Liver disease (cirrhosis or other portal obstruction can cause ascites; made worse by lack of plasma proteins.

Renal disease (as long as kidney still capable of functioning)

Pregnancy (caution: some diuretics may be teratogenic)

Special caution: Potassium depletion - especially if on digitalis

Front 6

1. Osmotically hold water and increase urine volume.
2. Increase glomerular filtration rate (vasodilation)
3. Direct or indirect inhibition of ion reabsorption ** (Na+, H20, CI-, HCO3-)

Back 6

How do the diuretics work in the body?

Front 7

diuretics mech of action

Back 7

1. Osmotically hold water and increase urine volume.
2. Increase glomerular filtration rate (vasodilation)
3. Direct or indirect inhibition of ion reabsorption ** (Na+, H20, CI-, HCO3-)

Front 8

Direct or indirect inhibition of ion reabsorption ** (Na+, H20, CI-, HCO3-)

Back 8

What is the MAIN mechanism of action for all diuretics?

Front 9

Main mech of action for all diuretics.

Back 9

Direct or indirect inhibition of ion reabsorption ** (Na+, H20, CI-, HCO3-)

Front 10

carbonic anhydrase inhibitors
thiazides

Back 10

What are the drugs that act at the proximal convoluted tubule?

Front 11

Thiazide
Furosemide
Ethacrynic acid
Bumetanide
Torsemide

Back 11

What are the drugs that act at the ascending loop of Henle?

Front 12

proximal tubule

Back 12

inhibits reabsorption of HCO3-

where do these drugs act?

Front 13

carbonic anhydrase inhibitors
thiazides

Back 13

Na+ accompanies HCO3-

Extra Na+ entering distal tubule may cause K+ depletion

Not as much acid base upset as one might expect.

HCO3- loss may be balanced by tendency toward systemic alkalosis at the distal tubule.

Front 14

Thiazide
Furosemide
Ethacrynic acid
Bumetanide
Torsemide

Back 14

These drugs mechanism of action is to inhibit the reabsorption of Na+ and CI-. Very powerful. They work at the loop of henle. WHat are they?

Front 15

Thiazide
Furosemide
Ethacrynic acid
Bumetanide
Torsemide

Back 15

Na+ accompanies CI-

Extra Na+ at distal tubule may cause K+ depletion, H+ secretion may now be a problem.

WHat drugs?

Front 16

Spironolactone
Triamterene
Amiloride

Back 16

What are the drugs that act on the DCT?

Front 17

DCT

Back 17

potassium sparing diuretic drugs act here.

frequently cause hyperkalemia.

Front 18

Spironolactone

Back 18

need aldosterone to work

an aldosterone antagonist (only works well if aldosterone is high)

causes Na+ diuresis and K+ retention.

Front 19

Triamterene and amiloride

Back 19

Direct action on tubule

inhibits reabsorption of Na+

mimics effects of aldosterone antagonist, however, effectiveness DOES NOT depend upon aldosterone levels but still causes Na+ diuresis and K+ retention.

Which drugs?

Front 20

Thiazide

Back 20

most commonly used diuretics

inhibits HCO3- (and Na+)reabsorption from proximal tubule and CI- (and Na+) reabsorption from ascending limb of the loop of henle.

What drug?

Front 21

Thiazide

Back 21

Therapeutic uses

1. essential hypertension
2. fluid retention
3. acute pulmonary edema
4. sometimes used in pregnancy

What drug?

Front 22

Thiazides

Back 22

Side effects

potassium depletion

hyperglycemia

uric acid in blood (aggrevate gout)

Front 23

Furosemide

Back 23

A very powerful thiazide that retains it effect on blood vessels (vasodilation). Also, powerful inhibitor of Cl- reabsorption from ascending limb of loop of henle

Front 24

Furosemide

Back 24

8-10 times more powerful than thiazides

It can cause up to 4 liters of urine to be formed within the first few hours of administration.

Front 25

Furosemide

Back 25

Therapeutic uses

dangerous

emergency drug when rapid, effective diuretic needed

Congestive heart failure; often results in pulmonary edema
Acute pulmonary edema (works because of vasodilator effect)
Hypertension (not long term though, so use thiazide)
Chronic renal failure (very powerful)

**short duration of action (only 4 hours)

Front 26

Furosemide

Back 26

Cautions
serious electrolyte imbalance commonly occurs - especially K+ and H+ depletion and alkalosis

temporary or permanent deafness may occur

Front 27

ethacrynic acid
bumetanide
torsemide

Back 27

What are the other loop diuretics?

Front 28

ethacrynic acid
bumetanide
torsemide

Back 28

Inhibit Na+ reabsorption from proximal tubule

Inhibit CI- reabsorption from ascendinig limb of loop of henle

What drugs?

Front 29

ethacrynic acid
bumetanide
torsemide

Back 29

Hypokalemia and alkalosis

Deafness
Rapid onset (max effect in 2 hours, and can last 6-8 hours.)
Rare cases of myalgia reported.

What drugs?

Front 30

Carbonic anhydrase inhibitors

Back 30

No longer used as diuretics

we studied with glaucoma

Front 31

Aldosterone antagonist or spironolactone

Back 31

What is the drug that actually inhibits aldosterone, but you need aldosterone to be present to work?

Front 32

Aldosterone antagonist or spironolactone

Back 32

Used either:
1. in combo with thiazides or
2. when other diuretics are toxic or ineffective.

Front 33

potassium retention

males develop gynecomastia (enlarged breasts)

Back 33

What are the cautions with aldosterone antagonists or spironolactones?

Front 34

osmotic diuretics

Back 34

osmotically attracts water

Front 35

osmotic diuretics

Back 35

Therapeutic uses of what drug?

1. withdraw water from overhydrated cells (esp. brain and eye)

maintain high volume of urine
1. prevent renal failure after hemolytic reaction, shock, hemorrhage, or surgery
2. helps eliminate drug overdose such as barbiturates, salicylates, etc.
Does not extract abnormal amounts of fluid from body, ***NOT for EDEMA because doesn't eliminate Na+ ions.

Front 36

Triamterene and amiloride

Back 36

don't need aldosterone to work

works independently of amount in system

Front 37

osmotic diuretics

Back 37

***NOT for EDEMA because doesn't eliminate Na+ ions.