Week 2: Midterm Study Guide
Friday, May 9, 2025 11:39 PM
Week 2:
Chapter 37: Diuretics
• Loop Diuretics: adverse effects
- Ex: Furosemide (Lasix)
- Adverse Effects:
Hyponatremia, hypochloremia, dehydration
□ Produce excessive loss of sodium, chloride, and water.
□ Severe dehydration can result.
⬥ s/s: dry mouth, unusual thirst, oliguria.
□ Risk can be minimized by initiating therapy with low doses, adjusting
dosing carefully, and monitoring weight loss everyday.
Hypokalemia
□ Potassium is lost through increased secretion in the distal nephron. If
serum potassium falls below 3.5, dysrhythmias may occur.
□ hypoKalemia can be minimized by consuming K+ rich foods (drieds fruits,
nuts, spinach, potatoes, bananas), taking potassium supplements, or using a
K+ sparring diuretic.
Hypotension
□ Loss of volume, relaxation of venous smooth muscle , which reduces
venous return to the heart.
□ Signs of HoTN
⬥ Dizziness, lightheadedness, fainting.
Ototoxicity
□ Rare: can cause hearing impairment.
⬥ Deafness is transient although can occur very rapidly with IV admin.
⬥ With another loop diuretic, irreversible hearing loss may occur.
• Thiazide diuretics: therapeutic effect
- Ex: Hydrochlotothiazide
All same adverse effects but not ototoxic.
Adverse effects of thiazides and loop diuretics are nearly identical.
Chapter 38: Drugs acting on the renin-angiotensin-aldosterone system
• ARB indications
- (ex: Losartan)
- Approved for HTN, heart failure, diabetic nephropathy, MI, prevention of MI, stroke,
and death in people at high risk for cardiovascular events.
Name Approved indication
Azilsartan (Edarbi) HTN
, Candesartan (Atacand) HTN
HF
Irebesartan (Avapro) HTN
Diabetic nephropathy
Losartan (Cozaar) HTN
Stroke Prevention
Diabetic Nephropathy
Olmesartan (Benicar) HTN
Telmisartan (Micardis) HTN
Prevention of MI, Stroke, and death in people at
high risk for CVD but who cannot take an ACE
inhibitor.
Valsartan (Diovan) HTN
HF
Post MI
• ACE inhibitors MOA
- (ex: Lisinopril)
- MOA:
1) Reducing levels of angiotensin II (through inhibition of ACE)
2) Increasing levels of bradykinin (through inhibition of Kinase II)
- By reducing levels of angiotensin II, ACE inhibitors can dilate blood vessels
(primarily arterioles and to a lesser extent veins), reduce blood volume (through
effects on the kidney), and prevent or reverse pathologic changes in the heart and
blood vessels mediated by angiotensin II and aldosterone.
- Inhibition of ACE can also cause hyperkalemia and fetal injury.
- Elevation of bradykinin causes vasodilation (secondary to increased production of
prostaglandins and nitric oxide) and can also promote cough and angioedema.
- Approved for HTN; takes several weeks to see max benefits.
• RAAS- Angiotensin II BP regulation
- RAAS, acting through angiotensin II, raises bp through two basic processes:
1. Vasoconstriction
□ Raises BP by increasing total peripheral resistance.
□ Occurs within minutes to hours of activating the system and can raise
BP quickly.
2. Renal retention of water and sodium
□ Increases blood volume
□ Days, weeks, or months are required for the kidney to raise BP by
increasing blood volume.
□ Angiotensin II acts in two ways to promote renal retantion of water.
1. Constricting renal blood vessels--> reduces renal blood flow and reduces
glomerular filtration.
2. Stimulates release of aldosterone from the adrenal cortex --> acts
on renal tubules to promote retention of sodium and water
excretion of potassium.
• ACE Inhibitors & heart failure
Friday, May 9, 2025 11:39 PM
Week 2:
Chapter 37: Diuretics
• Loop Diuretics: adverse effects
- Ex: Furosemide (Lasix)
- Adverse Effects:
Hyponatremia, hypochloremia, dehydration
□ Produce excessive loss of sodium, chloride, and water.
□ Severe dehydration can result.
⬥ s/s: dry mouth, unusual thirst, oliguria.
□ Risk can be minimized by initiating therapy with low doses, adjusting
dosing carefully, and monitoring weight loss everyday.
Hypokalemia
□ Potassium is lost through increased secretion in the distal nephron. If
serum potassium falls below 3.5, dysrhythmias may occur.
□ hypoKalemia can be minimized by consuming K+ rich foods (drieds fruits,
nuts, spinach, potatoes, bananas), taking potassium supplements, or using a
K+ sparring diuretic.
Hypotension
□ Loss of volume, relaxation of venous smooth muscle , which reduces
venous return to the heart.
□ Signs of HoTN
⬥ Dizziness, lightheadedness, fainting.
Ototoxicity
□ Rare: can cause hearing impairment.
⬥ Deafness is transient although can occur very rapidly with IV admin.
⬥ With another loop diuretic, irreversible hearing loss may occur.
• Thiazide diuretics: therapeutic effect
- Ex: Hydrochlotothiazide
All same adverse effects but not ototoxic.
Adverse effects of thiazides and loop diuretics are nearly identical.
Chapter 38: Drugs acting on the renin-angiotensin-aldosterone system
• ARB indications
- (ex: Losartan)
- Approved for HTN, heart failure, diabetic nephropathy, MI, prevention of MI, stroke,
and death in people at high risk for cardiovascular events.
Name Approved indication
Azilsartan (Edarbi) HTN
, Candesartan (Atacand) HTN
HF
Irebesartan (Avapro) HTN
Diabetic nephropathy
Losartan (Cozaar) HTN
Stroke Prevention
Diabetic Nephropathy
Olmesartan (Benicar) HTN
Telmisartan (Micardis) HTN
Prevention of MI, Stroke, and death in people at
high risk for CVD but who cannot take an ACE
inhibitor.
Valsartan (Diovan) HTN
HF
Post MI
• ACE inhibitors MOA
- (ex: Lisinopril)
- MOA:
1) Reducing levels of angiotensin II (through inhibition of ACE)
2) Increasing levels of bradykinin (through inhibition of Kinase II)
- By reducing levels of angiotensin II, ACE inhibitors can dilate blood vessels
(primarily arterioles and to a lesser extent veins), reduce blood volume (through
effects on the kidney), and prevent or reverse pathologic changes in the heart and
blood vessels mediated by angiotensin II and aldosterone.
- Inhibition of ACE can also cause hyperkalemia and fetal injury.
- Elevation of bradykinin causes vasodilation (secondary to increased production of
prostaglandins and nitric oxide) and can also promote cough and angioedema.
- Approved for HTN; takes several weeks to see max benefits.
• RAAS- Angiotensin II BP regulation
- RAAS, acting through angiotensin II, raises bp through two basic processes:
1. Vasoconstriction
□ Raises BP by increasing total peripheral resistance.
□ Occurs within minutes to hours of activating the system and can raise
BP quickly.
2. Renal retention of water and sodium
□ Increases blood volume
□ Days, weeks, or months are required for the kidney to raise BP by
increasing blood volume.
□ Angiotensin II acts in two ways to promote renal retantion of water.
1. Constricting renal blood vessels--> reduces renal blood flow and reduces
glomerular filtration.
2. Stimulates release of aldosterone from the adrenal cortex --> acts
on renal tubules to promote retention of sodium and water
excretion of potassium.
• ACE Inhibitors & heart failure
