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