Diuretics, Nitrates, Chf Meds

Front 1

Diuretic effects

Back 1

increase rate of urine formation, net loss of electrolytes and water, mobilization of edema
"get the water off"

Front 2

Osmotic Diuretics

Back 2

Is a big fat starch molecule (use IV filter)
Increases osmotic pressure of tubular filtrate
inhibits renin (Na+ and H2O renention) release
fluid moves from ICF-->ECF, to kidneys for excretion
minimal electrolyte loss problem
Contraindicated in CHF, monitor for fluid overload
Ex) Mannitol (Osmitrol)

Front 3

Mannitol (Osmitrol)

Back 3

only osmotic diuretic (big starch molecule)
reduce CSF pressure with cerebral edema, neuro surgery uses, glaucoma, increases urine flow to prevent nephrotoxicity, dilute toxins

Front 4

Carbonic anhydrase inhibitors

Back 4

inhibit secretion of H+, increase excretion of HCO3 and Na+ (H2O follows).
Urine alkalizes, met. acidosis and renal calculus risks, contraindicated in COPD
high K+ excretion
Sulfonamide (watch for sulfa allergies)
Ex) Acetazolamide (Diamox)

Front 5

Acetazolamide (Diamox)

Back 5

Carbonic anhydrase inhibitor
Common in combo w/ antihypertensives
treat glaucoma, used in eye surgery, alkalizes urine for drug excretion, preventing altitude sickness
not so good at mobilizing edema

Front 6

Thiazide diuretics
"-thiazide"

Back 6

Increase excretion of Na+ (H2O), K+, other electrolytes
Ca++ retention (adjunct for osteoporosis Tx)
sulfa derivative, hyperglycemia in diabetics
Used for edema in mild/mod CHF, mild/mod HTN

Front 7

Hydrochlorothiazide (HCTZ, Hydrodiuril)

Back 7

Thiazide diuretic
sulfa derivative

Front 8

Loop diuretics

Back 8

Inhibit electrolyte reabsorption in ascending loop of Henle
Increase renal blood flow, loss of K+ and electrolytes
sulfa derivative
Rapid onset, short duration --> emergency uses
Use: edemas, HTN, renal failure
Monitor: I&Os, BP, K+, BG, daily weight, toxicity (tinitis)
give early in day, provide means to void!
Ex) Furosemide (Lasix)

Front 9

Furosemide (Lasix)

Back 9

Loop diuretic
very common, anyone w/ cardiac probs is on this

Front 10

Aldosterone antagonist

Back 10

competitive antagonist of aldosterone(Na+, H2O retention)
K+ sparing! Teach and watch for hyperkalemia
slow onset, long term managemnent
Use: HTN, edema, ascites w/ hepatic disease, CHF, adrenal tumors
Adverse: hyperkalemia, interactions w/ progesteone and androgen receptors
Ex) Spironalactone (Aldactone)

Front 11

Spironalactone (Aldactone)

Back 11

Aldosterone antagonsit
K+ sparing!

Front 12

Why are diuretics so often used in combination?

Back 12

Better diuresis w/ multiple sites of action, less problems w/ electrolyte imbalances (still monitor, esp. K+)
Common in therapies for cardiac probs

Front 13

Nitrates
Nitroglycerine
Nitric Oxide

Back 13

relaxation of vascular smooth muscle, decrease in myocardial O2 demand, dilate coronary vessels
No change in HR or force of contraction
Uses: coronary artery disease, angina, MI pain (may reduce size of MI), adjunct for CHF
Adverse: headache (common, dose dependent, decreases), flushing, dizziness, hypotension
Interactions: ETOH, ED drugs

Front 14

Routes and consideration of Nitro

Back 14

IV: for MI, unstable angina, rapid onset, short duration, maintain BP >100 systolic
Sublingual: tablets or spray, for angina, onset 1-2min, teach proper storage, 3 doses then call 911
Patch: for CHF, slow onset 24hr use, teach not to overdose
Paste: angina, less common since patch, measured in inches, cover with ceranwrap, gloves!
PO: for more than occasional angina, debate on effectiveness

Front 15

Nitroprusside (Nipride)

Back 15

short term use only - release of cyanide ion from smooth muscle
Use: hypertensive crisis like 220/140
titrate to effect, rapid onset short duration, minute to minute BP monitoring

Front 16

CHF management meds

Back 16

Inotropic meds (and remember ACE inhibitors as first line, beta-blockers too)

Front 17

Digitalis glycosides

Back 17

+ inotropic, -chronotropic, slows conduction thru AV node, increased CO, redistribution of blood flow to kidneys -->better diuresis
uses: slow vent. rate in A-fib and flutter, Tx CHF
adverse: high risk of toxicities (narrow therapeutic range), used only after ACE inhibitors and beta-blockers fail

Front 18

Digoxin (Lanoxin)

Back 18

digitalis glycoside
PO or IV for CHF, A-fib and flutter
Hallmark of toxicity is visual disturbances: blurred vision, halos around lights, seeing yellow/red spots
Use Digibind to treat toxicity

Front 19

Dopamine (Intropin)

Back 19

+chrono and inotropic
increases CO w/ min increase in myocardial O2 needs
Remember affects receptors in dose-dependent way: low doses for mild CHF, mod for CHF, high doses not great for cardiac pts due to alpha stimulation.
Uses: treat hypotension in shock, severe CHF in shock, short term, monitor close, in ICU setting

Front 20

Nesiritide (Natrecor)
new drug

Back 20

human B-type natriurietic peptide part of homeostasis
this drug enhances hBNP function to vasodilate, diruesis, suppress renin-angiotensis system, cholinergic effects (derese norepi)
Uses: IV for acute CHF treatment, can be used in combos