Class 12 Deck 1

Question 1

What are the 4 uses for thiazide diuretics?

Answer 1

• HTN
• Edema
• Diabetes incipidus
• hypercalcemia

Question 2

How does thiazides help HTN?

Answer 2

• Diuresis, naturesis
• Vasodilate
• Allows for a decrease in other more potent anti-hypertensives, decreasing side effects

Question 3

What is the MOA of thiazides? and where does it work?

Answer 3

• Inhibit reabsorption of Na and Cl

- CORTICAL Ascending loop

Question 4

Thiazides increase urinary excretion of what?

Answer 4

• Na
• Cl
• Bicarb
• K

Question 5

What is the INITIAL anti-hypertensive effect of thiazides?

Answer 5

• Decrease extracellular volume

- Decrease CO

Question 6

What is the SUSTAINED anti-hypertensive effect of thiazides?

Answer 6

• peripheral vasodilation

- Takes weeks to develop

Question 7

What are the electrolyte side effects of thiazides?

Answer 7

• hypokalemia, hypochloemic metabolic alkalosis
• Hyperglycemia
• Hyperurecemia

Question 8

What is the cardiac side effect of thiazides?

Answer 8

-Dysrhythmias due to hypokalemia and hypomag

Question 9

What are the other side-effects of thiazide induced hypokalemia?

Answer 9

• Muscle weakness
• Ileus
• Nephropathy
• Dig toxicity
• potentiation of non-depolarizing muscle relaxants

Question 10

When would you suspect decreased intravascular fluid volume?

Answer 10

• Othostatic hypotension
• Hemoconcentration (↑ crit and BUN)
• Decreased filing pressures

Question 11

What causes the decrease in renal and hepatic function with thiazides?

Answer 11

-Decreases in blood flow to these organs

Question 12

What is the MOA of loop and where does it work?

Answer 12

• Inhibit reabsorption of Na and Cl

- MEDULLARY Ascending loop

Question 13

What is the onset of action with Lasix or ethacrynic acid?

Answer 13

-2-10 minutes IV

Question 14

How is lasix related to GFR?

Answer 14

-Higher the GFR, greater the effect of lasix

Question 15

Furosemide-induced increases in RBF are inhibited by what?

Answer 15

NSAIDS

Question 16

Furosemide induced production of _______ results in renal ___________ and ________ RBF

Answer 16

• Prostaglandins
• vasodilation
• Increased

Question 17

Ethacrynic Acid information?

Answer 17

• Higher GI reactions w/ PO
• Protein bound
• Excreted by kidneys

Question 18

Furosemide information?

Answer 18

• 90% protein bound to albumin

- Elimination half life is <1hr (short duration of action)

Question 19

Loop clinical uses?

Answer 19

• Edema
• ICP
• Inhibit calcium uptake for hypercalcemia
• Diagnosis of oliguria

Question 20

When are loops non-effective?

Answer 20

• HTN
• Will not accelerate elimination of other drugs
• No increase in GFR or tubbular secretion

Question 21

With loops, what precedes diuresis?

Answer 21

-vasodilation (may drop BP)

Question 22

With loops, _______ _______ ______ provides prompt effects in the management of acute pulmonary edema.

Answer 22

Decreased venous return

Question 23

Loops, _______ _________ flow through the throacic duct.

Answer 23

-Increases lymph

Question 24

How do loops decrease ICP?

Answer 24

• Systemic diuresis
• Decrease in CSF production
• Resolve cerebral edema by improving cellular water transport

Question 25

How does lasix compare to mannitol compare in decreasing ICP?

Answer 25

- Lasix is not as effective | - Mannitol will cross BBB if damaged( causing rebound ↑ in ICP), lasix will not

Question 26

What is the most effect treatment of increased ICP? What is the concern?

Answer 26

- Lasix and mannitol together | - dehydration and electrolyte balance

Question 27

What electrolyte disturbances are seen with loops?

Answer 27

- HypoK - Hypochloremia - Hyponatremia - Hypomag - Metabolic alkalosis

Question 28

Loop diuretics can cause acute tolerance aka ______ ______. This is due to activation of __________ _______. And does what? and is treated how? How to reestablish diuretic effect?

Answer 28

- Braking phenomenon - Renin-angiotension - Na and H2O retention w/ loops - Replenish ECF volume - Thiazide diuretics

Question 29

How does loop induced hypoK effect the body?

Answer 29

- Dig toxicity - ventricular irritability - Enhance NDMB

Question 30

What other effects does loops have?

Answer 30

- Hyperuricemia - Hyperglycemia (less likely than thiazides) - Defmess

Question 31

How does lasix effect antibiotics?

Answer 31

- Aminoglycosides and cephlasporins = Increased risk of nephrotoxicity - PCN = allergic interstitial nephritis

Question 32

How does Loops effect lithium?

Answer 32

-Renal clearance is decreased (due to ↓ Na reabsorption)

Question 33

There can be a cross sensitivity between lasix and what type of drug?

Answer 33

-Sulfonamide nucleus (Sulfas & thiazides)

Question 34

How does osmotics work?

Answer 34

-Alters the osmolarity of plasma, renal tubular fluid and glomerular filtrate.

Question 35

What is the site of action of osmotics?

Answer 35

-Proximal renal tubules and loops of henle (both highly permeable to water)

Question 36

Mannitol information

Answer 36

- Only IV - Does not enter cells - Can only be cleared by glomerular filtration

Question 37

What is the net diuretic effect of osmotics?

Answer 37

-Urinary excretion of Water, Na, Chloride, and Bicarb

Question 38

What is the effect of osmotics on the renal tubules?

Answer 38

- Increases osmolarity and prevents reabsorption of water | - Urinary excretion of water, Na, Chloride and Bicarb

Question 39

How does osmotic effect the plasma?

Answer 39

- increases osmolarity, draws fluis from intra cellular to extracellular. - Expands intravascular volume

Question 40

How do osmotics redistribute fluid through the plasma?

Answer 40

- Decrease brain bulk | - Increase renal blood flow

Question 41

What is the negative effect of osmotic's plasma redistribution?

Answer 41

-CHF in patient w/ poor myocardial function

Question 42

Mannitol is a scavenger of what? leading to what?

Answer 42

- Oxygen free radicals | - prevention of cellular swelling, and reduction in renal obstruction

Question 43

What are the 4 clinical uses of mannitol?

Answer 43

- Prophylaxis against renal failure - Diagnose oliguria - Decrease ICP and IOP

Question 44

What is the only procedure in which mannitol has been proven renal protective?

Answer 44

-Renal transplant surgery

Question 45

How does mannitol diagnose acute oliguria?

Answer 45

- If UO is increased, there is decreased volume | - If UO is unchanged, there is glomerular or tubular problems

Question 46

How does mannitol effect ICP?

Answer 46

-Will lower ICP by drawing water from the brain and by decreasing CSF

Question 47

What does mannitol require to reduce ICP?

Answer 47

-Intact BBB

Question 48

Mannitol is not associated with ______ _______ in ICP, and the brain will eventually _____ to increases in ______ _______. (later doses less effective)

Answer 48

- Rebound increases - Adapt - Plasma osmolarity

Question 49

What need to be done with mannitol administration because of the initial increase in ICP?

Answer 49

- Slow administration | - give with treatment that decrease intracranial volume (Corticosteroids or hyperventilate)

Question 50

Mannitol can cause vasodilation of vascular smooth muscle, what two things can this cause?

Answer 50

- Increase in cerebral blood volume / ICP | - Decrease BP

Question 51

What are the side effects of mannitol?

Answer 51

-Precipitate pulmonary edema in CHF patients -Hypovolemia / electrolyte disturbances -

Question 52

How does mannitol effect NMBDs?

Answer 52

Unlike loops and thiazides, mannitol does not effect NMBD

Question 53

What differentiates urea from mannitol?

Answer 53

- Smaller size - venous thrombosis and tissue necrosis after extravasation - Increases in BUN - Greater rebound ICP