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31 Cards in this Set
- Front
- Back
In pharm, renal dispostion of ANY substance is generally dictated by the kidney's _____ ?
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rate of filtration, reabsorption, and secretion
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What are the two major indications for diuretics?
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HTN (for some diuretics) and edema
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Where do the diuretics act?
osmotics CA inhibitors thiazide loops K sparing |
Osmotic --> PCT and desc limb
CA --> PCT loop --> thick asc limb thiazide --> distal tubule K sparing --> CD |
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What is the MOA of mannitol?
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alter osmotic gradients (inc plasma osmolarity), extruding water OUT OF cells (brain, eye) --> good for reducing cerebral edema and intracular pressure
in urine: hold h20 in lumen |
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What are the volume expansion impacts of mannitol?
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dec blood viscosity, dec renin release, inc renal bF, dec NaCl in medulla..... dec H2O reabsorption in desc limb of henle
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When can mannitol be used as an antidote?
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lithium toxicity (pulls it with it in the urine)
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What are the AE's of mannitol and why (when kidney funciton is slow)?
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CHF and pulmonary edema..... if rapid infusion causes rapid volume expansion of ECF --> hyponatremia before diuresis (or anuria)
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What are three situations that can cause the pulmonary AE's of mannitol?
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1. too rapid of infusion
2. too high of dose 3. anuria (<100 ml/day) |
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When kidney function is normal, what are 2 AE's of mannitol?
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hypernatremia and dehydration
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What is a major contraindication for mannitol?
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active cranial bleeding
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What is the MOA of furosemide?
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Enter lumen via tubular secretion
inhibits NKCC symporter (binds to Cl site) Ca++/Mg++ reabsorption also inhibited indirectly |
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You want to give a loop diuretic to a pt, but they are allergic to sulfonamides..... what can you give them?
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ethacrynic acid
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How does furosemide get to its target cell?
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Rapid oral absorption --> extensively bound to plasma proteins --> secreted (not filtered) into lumen via organic acid transporters
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What is the most potent loop diuretic? Orally available?
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bumetanide is most potent, 80% oral availabilty
furosemide has variable (~60%) oral availability |
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What is the preferred loop diuretic for CHF?
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torsamide: fewer hospitalizations and increase quality of life
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What diuretic would you choose when you need rapid treatment of acute pulmonary edema?
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loop diuretics (furosemide)
can also use to Tx hypercalcemia |
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Which diuretics alleviate pulmonary edema.. which can cause?
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loops --> alleviate
mannitol --> aggrevate |
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Which diuretic is useful for chronic CHF?
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torsemide
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What diuretic should you avoid in a pt with osteoporosis? WILL BE ON THE TEST..?
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loop diuretics
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What is a common AE of loop diuretics?
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ototoxicity (deafness, hearing impairment, tinnitus, vertigo)
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What are a major drug interactions issue of loop diuretics?
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Digoxin
Diuretics --> hypokalemia --> increased digoxin-induced AR NSAIDS blunt diuretic response |
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What is the MOA of hydrochlorothiazide?
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Enter lumen via filtration/secretion and inhibit the apical Na-Cl co-trasnporter --> hyperosmolar urine
Also enhances calcium reabsorption indirectly |
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What influences efficacy of diuretics more? Site of action or MOA?
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site of action
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Which thiazide diuretics are sulfonamides, which are benzothiadiazines?
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Sulf: chlorothiazide, hydrochlorothiazide, chlorthalidone
Benzo: indapamide, metalozone |
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Which thiazides are useful whe GFR is low?
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Indapamide
Metolazone (met is a weak CA inhibitor) |
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What diauretic class is the 1st line therapy for uncomplicated HTN?
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thiazide diuretics
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What are 2 important AE's of thiazide diuretics?
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othrostatic hypotension
HYPERURICEMIA (urate crystals) |
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What is an important drug interaction of thiazide diuretics?
What do NSAIDS do to thiazide action? |
Quinidine!
hypokalemia --> torsade de pointes --> V fib --> death NSAIDS blunt diuretic response |
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What is the MOA of spironolactone?
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Enter cells via basolateral membrane and antagonize intracellular aldosterone receptors in the CD
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What are two important AE's of spironolactone?
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hyperkalemia
endocrine (anti-androgenic effects) |
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What is the advantage of eplerenone over aldosterone?
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eplerenone is more selective for the aldosterone receptor (less endocrine SE's)
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