NURS8024: Module 4 Questions
and Answers (Graded A)
Diltiazem - ANSWER - CCB, nondihydropyridine
MOA: decreased HR, slows AV conduction
decreased cardiac contractility (negative inotrope) and O2 demand
also Rx for coronary artery spasm (vasospastic angina)
ADEs: peripheral edema, hypoT, bradyC, constipation
works less effectively than verapamil
Diuretics - ANSWER - agents that increase urine volume
numerous mechanisms of action
Thiazide Diuretics - ANSWER - MOA: inhibits Na reabsorption in distal tubules,
increases excretion of Na, K, and H2O
initially decreases BP via lowering plasma volume; with LT use, causes decreased
peripheral vascular resistance
Indications: mild to moderate HTN, HF
E.g. hydrochlorothiazide, chlorthalidone, metolazone
,ADEs: decreased K, Mg, Na; increased Ca, uric acid, glucose, LDL, triglycerides;
rash, photosensitivity, hypovolemia, weakness, fatigue, paresthesia
Contraindications: renal failure, hepatic cirrhosis
Notes: monitor RFTs, F&E, orthostatic hypoT, take in AM, daily wts
Loop Diuretics - ANSWER - MOA: selectively inhibit NaCl reabsorption in the
ascending loop of Henle
!!! most effective diuretic agent !!!
Indications: HF, acute pulmonary edema, acute hyperCa, hyperK
E.g. furosemide, torsemide, ethacrynic acid, bumetanide
ADEs: ototoxicity, hyperuricemia, hypoMg, severe hypovolemia, hypoK, hypoT,
allergic rxns (eosinophilia, interstitial nephritis, rash)
Contraindications: possible cross-reactivity in pts sensitivie or allergic to
sulfonamides
Notes: monitor BP, F&E, daily wts
Potassium Sparing Diuretics (Aldosterone Antagonists) - ANSWER - MOA: prevents K
secretion and Na absorption by antagonizing the effects of aldosterone in collecting
tubules
Indications: diuresis, HF, hepatic cirrhosis, nephrotic syndrome, hyperaldosteronism
E.g. spironolactone, eplerenone
, ADEs: hyperK, gynecomastia, kidney stones, acute renal failure, hyperchloremic
metabolic acidosis
Contraindications: chronic renal insufficiency, caution with use of ACEIs-ARBs-BBs
Notes: often used in combo with loop or thiazide diuretics to blunt K losses
Potassium Sparing Diuretics - ANSWER - MOA: inhibits Na reabsorption at the distal
convoluted tubule (not dependent on presence of aldosterone)
Indications: diuresis
E.g. triamterene, amiloride
ADEs: hyperK, weakness, fatigue, N/V/D, azotemia, muscle cramps
Notes: typically given with a loop or thiazide diuretic to blunt K losses
Carbonic Anhydrase Inhibitors - ANSWER - MOA: inhibition of carbonic anhydrase,
blunts HCO3 reabsorption, causes diuresis
Indications: glaucoma (most common indication), acute mountain sickness, urinary
alkalinization, metabolic alkalosis
E.g. acetazolamide (Diamox)
ADEs: hyperchloremic metabolic acidosis, renal stones, renal K wasting, drowsiness
and paresthesias, decreased excretion of NH4+ in liver failure
Notes: caution in hepatic cirrhosis (hyperammonemia)
and Answers (Graded A)
Diltiazem - ANSWER - CCB, nondihydropyridine
MOA: decreased HR, slows AV conduction
decreased cardiac contractility (negative inotrope) and O2 demand
also Rx for coronary artery spasm (vasospastic angina)
ADEs: peripheral edema, hypoT, bradyC, constipation
works less effectively than verapamil
Diuretics - ANSWER - agents that increase urine volume
numerous mechanisms of action
Thiazide Diuretics - ANSWER - MOA: inhibits Na reabsorption in distal tubules,
increases excretion of Na, K, and H2O
initially decreases BP via lowering plasma volume; with LT use, causes decreased
peripheral vascular resistance
Indications: mild to moderate HTN, HF
E.g. hydrochlorothiazide, chlorthalidone, metolazone
,ADEs: decreased K, Mg, Na; increased Ca, uric acid, glucose, LDL, triglycerides;
rash, photosensitivity, hypovolemia, weakness, fatigue, paresthesia
Contraindications: renal failure, hepatic cirrhosis
Notes: monitor RFTs, F&E, orthostatic hypoT, take in AM, daily wts
Loop Diuretics - ANSWER - MOA: selectively inhibit NaCl reabsorption in the
ascending loop of Henle
!!! most effective diuretic agent !!!
Indications: HF, acute pulmonary edema, acute hyperCa, hyperK
E.g. furosemide, torsemide, ethacrynic acid, bumetanide
ADEs: ototoxicity, hyperuricemia, hypoMg, severe hypovolemia, hypoK, hypoT,
allergic rxns (eosinophilia, interstitial nephritis, rash)
Contraindications: possible cross-reactivity in pts sensitivie or allergic to
sulfonamides
Notes: monitor BP, F&E, daily wts
Potassium Sparing Diuretics (Aldosterone Antagonists) - ANSWER - MOA: prevents K
secretion and Na absorption by antagonizing the effects of aldosterone in collecting
tubules
Indications: diuresis, HF, hepatic cirrhosis, nephrotic syndrome, hyperaldosteronism
E.g. spironolactone, eplerenone
, ADEs: hyperK, gynecomastia, kidney stones, acute renal failure, hyperchloremic
metabolic acidosis
Contraindications: chronic renal insufficiency, caution with use of ACEIs-ARBs-BBs
Notes: often used in combo with loop or thiazide diuretics to blunt K losses
Potassium Sparing Diuretics - ANSWER - MOA: inhibits Na reabsorption at the distal
convoluted tubule (not dependent on presence of aldosterone)
Indications: diuresis
E.g. triamterene, amiloride
ADEs: hyperK, weakness, fatigue, N/V/D, azotemia, muscle cramps
Notes: typically given with a loop or thiazide diuretic to blunt K losses
Carbonic Anhydrase Inhibitors - ANSWER - MOA: inhibition of carbonic anhydrase,
blunts HCO3 reabsorption, causes diuresis
Indications: glaucoma (most common indication), acute mountain sickness, urinary
alkalinization, metabolic alkalosis
E.g. acetazolamide (Diamox)
ADEs: hyperchloremic metabolic acidosis, renal stones, renal K wasting, drowsiness
and paresthesias, decreased excretion of NH4+ in liver failure
Notes: caution in hepatic cirrhosis (hyperammonemia)
