Diuretics

Question 1

medication? is it a good diuretc?

• causes net loss of bicarb & sodium; reversible inhibition of carbonic anhydrase at the PCT
• used for altitude sickness/functional metabolic alkalosis, removing acidic drugs, cerebral edema and glaucoma
• SE: dizziness, polyuria, confusion, tachypnea, tachycardia, N/V

Answer 1

Acetazolamide (diamox)
- not really used in diuresis & HTN because it acts on PCT and after that there is so many opportunities after that for sodium reabsorption especially at the loop of henle!

Question 2

which med has the C/I of h.o anaphylaxis to sulfonamides, severe renal/hepatic dysfunction

Answer 2

acetazolamide

Question 3

which medication has drug interxns of amphetamines, lithium, salicylates

Answer 3

acetazolamide

Question 4

• acts in late DCT and collecting duct through gene transcription to reduce # of transporters; only group that doesn’t act thru tubular secretion
• Uses: CHF, HTN, cirrhosis,primary aldosteronism
• specific ADR: steroid SE, gynecomastia

Answer 4

spironolactone

Question 5

3 shared ADR of the two K+ sparing diuretics

Answer 5

hyperkalemia
metabolic acidosis
dizziness

Question 6

3 drug interactions & 2 C/I of K+ sparing diuretics

Answer 6

• Interactions: ACE-i, K+ supplements, NSAIDs
• C/I: hyperkalemia, acute renal/hepatic failure

Question 7

• blocks Na channel in late DCT; creates depolarization of luminal side of cell, results in K+ secretion into tubular lumen
• Uses: HTN
• specific ADR: flatulence, rash, nephrolithiasis

Answer 7

triamterene (dyrenium)

Question 8

can be used in patients w/ severe allergies to other loop diuretics but is more $$ and has more SE including otoxicity

Answer 8

ethacrynic acid

Question 9

• MOA: blocks Na, K, Cl transporters in ascending loop of henle→ More Na+ in filtrate, more total volume removed in urine!!
• Uses: CHF, nephrotic syndrome/cirrhosis, edema, HTN, hyperkalemia/hypercalcemia
• C/I: h.o sulfonamide anaphylaxis, kidney failure (soft C/I), pregnancy
• Se: hypo-K+,Na,Cl,Mg, ototoxicity, gout exacerbation, allergic interstitial nephritis, hyperglycemia, dyslipidemia, orthostatic hypotension
• drug interxns: NSAID, aminoglycosides, digoxin/QT prolong.

Answer 9

loop diuretics– furosemide & bumetanide

Question 10

how is furosemide converted from IV to PO

Answer 10

IV:PO is 1:2

Question 11

• MOA: inhibition of Na/Cl cotransporter (aka symporter) at the DCT→ More Na+ in filtrate, more total volume removed in urine!!
• Uses: edema/fluid retention, CHF, HTN
• ADR: hypokalemia, hyperuricemia, impotence, glucose intolerance, hypercholesterolemia
• drug interxns: ACE-i (first dose hypotension if added), NSAIDs, lithium, digoxin
• C/I: h.o sulfonamides anaphylaxis, anuria

Answer 11

thiazide diuretics– HCTZ & metolazone

Question 12

high T wave on ECG..

Answer 12

K+ of 7

Question 13

prolonged P-R
high T wave
depressed S-T segment

Answer 13

K+ of 8

Question 14

auricular standstill
Intraventricular block

Answer 14

K+ of 9

Question 15

v fib on ECG

Answer 15

K+ of 10

Question 16

low T wave or S-T segment
high U wave

Answer 16

K+ 2.5

Question 17

low T wave only

Answer 17

K+ 3.5

Question 18

what condition is this? how is it treated?

• Worsen hepatic encephalopathy
• Increased risk of arrhythmias
• HTN, muscle cramps, myalgias, weakness

Answer 18

hypokalemia
if under 3– replacement
if above 3.5– diet changes

Question 19

which class of medication from this lecture does NOT have C/I of sulfonamide anaphylaxis

Answer 19

thiazide diuretics

Question 20

which class of meds in this lecture is C/I in pregnancy

Answer 20

loop diuretics

Question 21

which class does NOT interact with NSAIDs?

Answer 21

carbonic anhydrase inhibitors– acetazolamide