Diuretics and Renal Function Quiz

Study Notes

Metolazone retains activity in patients with impaired renal function, unlike thiazides.
Loop diuretics are effective despite renal impairment, but may require increased doses.
Potassium-sparing diuretics are weak antihypertensives when used alone; they are typically combined with other diuretics to prevent potassium loss.
Diuretics are unnecessary for heart failure patients without fluid retention, as they do not modify disease progression or enhance survival.
Chlortalidone has a longer action duration than thiazides and can be administered on alternate days for edema control.
Metolazone, effective with loop diuretics, still works in renal failure cases.
Xipamide and indapamide relate to chlortalidone and can lower blood pressure with minimal metabolic disturbance, especially in diabetic patients.
Spironolactone treats edema and ascites from liver cirrhosis; when combined with furosemide, it enhances effectiveness in heart failure.
Mannitol is an osmotic diuretic used for cerebral edema and elevated intra-ocular pressure.
Furosemide must be administered intravenously at doses over 50 mg, using sodium chloride 0.9% as infusion solution.
Thiazide and loop diuretics may lead to hypokalemia; potassium-sparing diuretics can cause hyperkalemia.
Spironolactone is taken with food due to its anti-androgenic effects, which can cause gynecomastia and impotence.
Colestyramine Powder should be mixed with at least 150 mL of liquid for proper administration.

Ezetimibe inhibits intestinal cholesterol absorption, resulting in modest LDL-cholesterol reduction; it is more effective when combined with statins, enhancing LDL lowering by about 25%.
Ezetimibe can be taken without regard to meals, suitable for improving cholesterol profiles.

Nicotinic acid and its derivatives decrease triglycerides and raise HDL cholesterol, with a modest reduction in LDL cholesterol as well.
Indicated for patients with high triglycerides, low HDL, and high LDL cholesterol levels.
Adverse effects like flushing and pruritus can limit niacin use, mitigated by pre-medication with aspirin or NSAIDs, food intake, avoidance of hot liquids, and slow dose titration.

Nitrates serve as vasodilators for managing angina, heart failure, myocardial infarction, anal fissures, and phlebitis.
Sublingual Glyceryl Trinitrate (GTN) offers rapid relief for angina symptoms, with the aerosol spray as an alternative.
Patients should sit or lie down when using GTN, placing the dose under the tongue, and calling for help if pain persists after 5 minutes.
GTN spray should not be swallowed or inhaled, and education about proper usage is vital.
Transdermal GTN patches, isosorbide dinitrate (ISDN), and isosorbide mononitrate (ISMN) are used for long-term angina prevention.
ISMN should be taken twice daily to avoid nitrate tolerance; modified-release formulations can be taken once daily.
Side effects from nitrates include hypotension and headaches, which often resolve with continued therapy and may be alleviated with acetaminophen.

Ambrisentan, bosentan, iloprost, macitentan, sildenafil, and tadalafil are approved treatments for pulmonary arterial hypertension.
Bosentan additionally reduces new digital ulcers in patients with systemic sclerosis.
Riociguat is prescribed for pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension.