Pharmacology of Diuretics and Digoxin
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Questions and Answers

What is a potential consequence of using beta blockers in combination with grapefruit juice?

  • Intensified effects of beta blockers (correct)
  • Increased heart rate
  • Reduced efficacy of beta blockers
  • Decreased blood pressure

    • Which of the following medications is suitable for use in infants?

  • Verapamil (correct)
  • Propranolol
  • Diltiazem
  • Nifedipine

    • What is the primary mechanism of action for verapamil?

  • Alpha-adrenergic receptor stimulation
  • Vasodilation
  • Beta-adrenergic receptor blockade
  • Calcium channel blockade (correct)

    • What is a common side effect of nifedipine, particularly with the immediate-release formulation?

    <p>Reflex effects</p> Signup and view all the answers

    Which of the following medications is available in both immediate-release and slow-release formulations?

    <p>Nifedipine</p> Signup and view all the answers

    What is the primary therapeutic effect of diltiazem?

    <p>Calcium channel blockade</p> Signup and view all the answers

    Which of the following conditions is a contraindication for the use of beta blockers?

    <p>Sick sinus syndrome</p> Signup and view all the answers

    What is the recommended dosage of nifedipine for immediate-release and slow-release formulations?

    <p>10-20 mg IR and 30-60 mg SR</p> Signup and view all the answers

    What is a common adverse effect of loop diuretics?

    <p>Hyponatremia</p> Signup and view all the answers

    What is a side effect of spironolactone that is not seen with loop diuretics?

    <p>Hirsutism</p> Signup and view all the answers

    Which of the following is a therapeutic effect of both loop diuretics and spironolactone?

    <p>Reducing blood pressure</p> Signup and view all the answers

    What is a common indication for the use of loop diuretics?

    <p>Heart failure</p> Signup and view all the answers

    What is a mechanism of action of spironolactone?

    <p>Blocking the action of aldosterone</p> Signup and view all the answers

    What is a common adverse effect of loop diuretics that can lead to hypotension?

    <p>Dehydration</p> Signup and view all the answers

    How would you monitor for ototoxicity as a side effect of loop diuretics?

    <p>Performing regular audiograms</p> Signup and view all the answers

    What is a comparative efficacy of spironolactone compared to loop diuretics?

    <p>Spironolactone is less effective in reducing fluid volume</p> Signup and view all the answers

    What is a side effect of loop diuretics that is not seen with spironolactone?

    <p>Ototoxicity</p> Signup and view all the answers

    How would you monitor for hyperkalemia as a side effect of spironolactone?

    <p>Regularly checking blood potassium levels</p> Signup and view all the answers

    What is the primary effect of calcium channel blockers on the heart?

    <p>Reduce heart contractile force</p> Signup and view all the answers

    Which of the following medications has a similar effect on the heart as beta blockers?

    <p>Calcium Channel Blockers</p> Signup and view all the answers

    What is the mechanism of vasodilation caused by calcium channel blockers?

    <p>Decrease in calcium ions</p> Signup and view all the answers

    Which of the following is a common effect of calcium channel blockers on blood vessels?

    <p>Vasodilation</p> Signup and view all the answers

    What is the primary effect of calcium channel blockers on vascular smooth muscle cells?

    <p>Decrease contraction</p> Signup and view all the answers

    What is the primary site of action of calcium channel blockers?

    <p>Vascular smooth muscle cells</p> Signup and view all the answers

    What is the primary effect of Angiotensin II on blood vessels?

    <p>Vasoconstriction</p> Signup and view all the answers

    What is the role of juxtaglomerular cells in the RAAS pathway?

    <p>Secretion of renin</p> Signup and view all the answers

    What is the effect of aldosterone on kidney tubules?

    <p>Increased Na and water reabsorption</p> Signup and view all the answers

    What is the site of conversion of Angiotensin I to Angiotensin II?

    <p>Lungs</p> Signup and view all the answers

    What is the effect of Angiotensin II on blood pressure?

    <p>Increased blood pressure</p> Signup and view all the answers

    What is the role of the adrenal cortex in the RAAS pathway?

    <p>Secretion of aldosterone</p> Signup and view all the answers

    What is the stimulus for renin secretion by juxtaglomerular cells?

    <p>Decreased perfusion pressure in the afferent arteriole</p> Signup and view all the answers

    What is the effect of Angiotensin II on aldosterone production?

    <p>Stimulation of aldosterone production</p> Signup and view all the answers

    What is the site of action of Angiotensin II in terms of blood pressure regulation?

    <p>Blood vessels</p> Signup and view all the answers

    What is the effect of aldosterone on blood volume?

    <p>Increased blood volume</p> Signup and view all the answers

    What is the effect of grapefruit juice on the action of beta blockers?

    <p>Intensifies the effect of beta blockers</p> Signup and view all the answers

    Which of the following calcium channel blockers can be used in infants?

    <p>Verapamil</p> Signup and view all the answers

    What is the primary mechanism of vasodilation of nifedipine?

    <p>Blockage of calcium channels</p> Signup and view all the answers

    What is the primary therapeutic effect of diltiazem?

    <p>Cardiac rate reduction</p> Signup and view all the answers

    What is the primary difference between the immediate-release and slow-release formulations of nifedipine?

    <p>Reflex effects</p> Signup and view all the answers

    What is the effect of verapamil on the heart rate?

    <p>Decreases heart rate</p> Signup and view all the answers

    What is the primary therapeutic effect of nifedipine?

    <p>Vasodilation</p> Signup and view all the answers

    What is the effect of reflex effects on the heart rate?

    <p>Increases heart rate</p> Signup and view all the answers

    What diuretic is commonly used in patients with low GFR (renal impairment)?

    <p>Furosemide (loop diuretic)</p> Signup and view all the answers

    Which electrolyte imbalance can occur when taking diuretics?

    <p>Hypokalemia</p> Signup and view all the answers

    What patient education should be provided when prescribing Furosemide?

    <p>Eat K-rich foods and monitor blood pressure</p> Signup and view all the answers

    Which of the following drugs should be avoided when taking Furosemide?

    <p>Digoxin</p> Signup and view all the answers

    What is the main difference between a loop diuretic and a thiazide diuretic?

    <p>Site of action in the kidney</p> Signup and view all the answers

    What is a contraindication for using Hydrochlorothiazide?

    <p>GFR below 30</p> Signup and view all the answers

    What is a common side effect of Furosemide?

    <p>Ototoxicity</p> Signup and view all the answers

    What type of diuretic is Spironolactone?

    <p>Potassium-sparing diuretic</p> Signup and view all the answers

    What is the main reason why Spironolactone (Aldactone) would be prescribed?

    <p>To counteract the loss of potassium</p> Signup and view all the answers

    What is a potential adverse effect of Spironolactone (Aldactone)?

    <p>Hyperkalemia</p> Signup and view all the answers

    What should be monitored when prescribing Spironolactone (Aldactone) to a patient?

    <p>Weight, Vital signs, Electrolytes, and testosterone levels</p> Signup and view all the answers

    Why would you instruct a patient taking Spironolactone (Aldactone) to restrict potassium-rich foods?

    <p>To decrease potassium levels</p> Signup and view all the answers

    What type of diuretic is Triamterene (Dyrenium)?

    <p>Potassium-Sparing Diuretic</p> Signup and view all the answers

    What is the mechanism of action of Triamterene (Dyrenium)?

    <p>Disrupting the sodium and potassium exchange</p> Signup and view all the answers

    When would you avoid prescribing Triamterene (Dyrenium)?

    <p>In patients with elevated potassium levels</p> Signup and view all the answers

    How long does it take for Triamterene (Dyrenium) to start working?

    <p>A few hours</p> Signup and view all the answers

    Which of the following medications is preferred for use due to its ability to decrease cardiovascular morbidity and mortality?

    <p>ACE Inhibitors</p> Signup and view all the answers

    What is a common adverse effect of Aliskiren (Tekturna) Direct Renin Inhibitors?

    <p>All of the above</p> Signup and view all the answers

    What is the mechanism of action of Eplerenone (Inspra), a potassium-sparing aldosterone antagonist?

    <p>Selective blockade of aldosterone receptors</p> Signup and view all the answers

    What is a contraindication for the use of Eplerenone (Inspra)?

    <p>Use with K supplements or K-sparing diuretics</p> Signup and view all the answers

    What should be avoided when taking Aliskiren (Tekturna) to maintain its effectiveness?

    <p>High-fat meals and grapefruit juice</p> Signup and view all the answers

    What is the current recommendation for prescribing Eplerenone (Inspra)?

    <p>Add to standard HF therapy only in patients with persistent symptoms despite adequate treatment with an ACEI and a β blocker</p> Signup and view all the answers

    What is the primary effect of Eplerenone (Inspra) on blood volume and blood pressure?

    <p>Decreases blood volume and blood pressure</p> Signup and view all the answers

    What is a common adverse effect of Losartan (Cozaar), an ARB?

    <p>All of the above</p> Signup and view all the answers

    Study Notes

    Adverse Effects of Loop and Thiazide Diuretics

    • Hyponatremia, hypochloremia, dehydration, hypotension, hypokalemia, and ototoxicity
    • Hyperglycemia, hyperuricemia, reduced HDL, and increased LDL

    Adverse Effects of Spironolactone

    • Hyperkalemia, deep voice, impotence, menstrual irregularities, and hirsutism

    Identifying Adverse Effects

    • Monitor patients for signs of ototoxicity, dehydration, hypo- or hyperkalemia, and hypotension

    Digoxin

    • MOA: treats CHF and dysrhythmias, increases myocardial contraction force, and alters eclectic activity of the heart
    • AE/CI: digoxin-induced dysrhythmias, narrow therapeutic window, hypokalemia, and many interactions

    Amiodarone

    • MOA: delays repolarization and prolongs action potential
    • Use: life-threatening dysrhythmias (a fib, v tach, v fib)
    • CI: 2nd and 3rd degree HB, sick sinus syndrome
    • AE: lung damage, visual impairment, thyroid toxicity, optic neuropathy, photosensitivity, bradycardia, and hypotension

    Beta-Blockers

    • CI: hypotension, sick sinus syndrome, 2nd or 3rd degree HB, and grapefruit juice
    • Note: grapefruit juice can intensify effects of beta blockers

    Calcium Channel Blockers

    • Verapamil can be used in infants
    • Diltiazem (Cardizem)
    • Nifedipine (Procardia) 10-20 mg IR and 30-60 mg ER
    • Reflex effects occur primarily with the immediate-release (IR) formulation, not with the slow-release (SR) formulation

    Renin-Angiotensin-Aldosterone System (RAAS)

    • Decreased perfusion pressure in the afferent arteriole stimulates the secretion of renin by juxtaglomerular cells.
    • Renin reacts with angiotensin in the liver to make Angiotensin I, which converts to Angiotensin II in the lungs.
    • Angiotensin II causes vasoconstriction in blood vessels and becomes Angiotensin III in the adrenal cortex, stimulating aldosterone release.
    • Aldosterone increases Na and water reabsorption by kidney tubules, leading to increased blood volume and blood pressure (BP).

    Calcium Channel Blockers (CCBs)

    • Prevent calcium ions from entering cells, affecting the heart, blood vessels, and vascular smooth muscle (VSM).
    • Prevent contraction and lead to vasodilation.
    • Similar effect on the heart as Beta blockers, reducing heart contractile force, heart rate (HR), and suppressing conduction through the AV node.

    Specific CCBs

    • Verapamil: can be used in infants.
    • Diltiazem (Cardizem): no specific notes.
    • Nifedipine (Procardia): 10-20 mg IR and 30-60 mg ER formulations available.
    • Reflex effects occur primarily with the immediate-release (IR) formulation, not with the slow-release (SR) formulation.

    Contraindications and Interactions

    • Hypotension, sick sinus syndrome, 2nd or 3rd degree HB, and grapefruit juice can intensify the effects of Beta blockers.

    Diuretics and Renal Impairment

    • Furosemide (loop diuretic) is the preferred diuretic in patients with low GFR (renal impairment).
    • Low potassium levels can increase the risk of heart arrhythmia when taking diuretics.

    Patient Education for Furosemide

    • Monitor blood pressure and watch for signs and symptoms of postural hypotension (stand slowly to avoid).
    • Eat potassium-rich foods (dried fruit, nuts, spinach, potatoes).

    Contraindications and Interactions with Furosemide

    • Avoid prescribing digoxin, NSAIDS, antihypertensive drugs, and lithium with furosemide.

    Loop Diuretics vs. Thiazide Diuretics

    • Loop diuretics (e.g., furosemide) work by inhibiting sodium and chloride reabsorption in the loop of Henle, leading to a significant increase in urine production.
    • Thiazide diuretics act on the distal convoluted tubule, inhibiting sodium reabsorption to a lesser extent, resulting in a moderate increase in urine output.

    Hydrochlorothiazide (Microzide)

    • Not suitable for patients with inadequate renal functioning (GFR below 30).
    • Diuresis starts in 2 hours and peaks 4-6 hours.
    • Monitor blood pressure, heart rate, weight, and signs and symptoms of hypokalemia and gout before prescribing.

    Spironolactone (Aldactone)

    • Potassium-sparing diuretic.
    • Produces a modest increase in urine and a substantial decrease in potassium excretion.
    • Often used alongside other diuretics to counteract potassium loss.
    • Main reason for prescription: to counteract potassium loss caused by thiazide and loop diuretics.
    • Adverse effects: hyperkalemia, gynecomastia, menstrual irregularities, impotence, hirsutism, and deep voice.
    • Can cause tumors in rats; avoid unnecessary use.

    Triamterene (Dyrenium)

    • Potassium-sparing diuretic.
    • Works by disrupting the sodium and potassium exchange, resulting in decreased sodium absorption and reduced potassium secretion.
    • Not suitable for patients with elevated potassium levels.
    • Starts working in a few hours.

    ACE Inhibitors and ARBs

    • ACE inhibitors (e.g., Lisinopril) are preferred over ARBs due to their proven ability to decrease cardiovascular morbidity and mortality.
    • Adverse effects: angioedema, renal failure, and fetal harm.
    • Losartan (Cozaar) is an example of an ARB.

    Aliskiren (Tekturna)

    • Direct renin inhibitor (DRI).
    • MOA: inhibits the conversion of angiotensinogen into angiotensin I, suppressing the entire RAAS.
    • Adverse effects: cough, hyperkalemia, diarrhea, and fetal injury and death.
    • Important education: high-fat meals and grapefruit juice decrease absorption and lower effect.

    Eplerenone (Inspra)

    • Potassium-sparing aldosterone antagonist.
    • MOA: selective blockade of aldosterone receptors, promoting retention of K and increased secretion of Na and water, reducing blood volume and BP.
    • Current recommendation guidelines: add to standard HF therapy only in patients with persistent symptoms despite adequate treatment with an ACEI and a β blocker.
    • Contraindications: K supplements, K-sparing diuretics, elevated K levels, and impaired renal function.

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    Description

    This quiz covers the adverse effects of loop and thiazide diuretics, spironolactone, and digoxin, including electrolyte imbalances and cardiovascular effects. It also touches on monitoring patients for signs of these adverse effects.

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