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NUR 326 > ADH > Flashcards

ADH Flashcards

1
Q

antidiuretic hormone disorders

A

SIADH, diabetes insipidus

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2
Q

what does SIADH stand for

A

syndrome of inappropriate anti diuretic hormone

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3
Q

what is SIADH

A

abnormal production or sustained secretion of ADH

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4
Q

what is SIADH characterized by

A

fluid retention
serum hypoosmolality and hyponatremia
concentrated urine

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5
Q

cause of SIADH

A

malignant tumors like small cell carcinoma of lung
central nervous disorders like head trauma, stroke
drug therapy like morphine, SSRI, some chemo
miscellaneous conditions like hypothyroidism, infection

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6
Q

pathogenesis of SIADH

A

inc ADH
inc water reabsorption in the renal tubules (inc permeability of distal tubule–>reabsorb water)
inc intravascular fluid volume
causes dilutional hyponatremia and dec serum osmolality

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7
Q

SIADH osmolality

A

urine osmolality and specific gravity: high
serum osmolality: low
serum sodium: low
urine output: low
wt: gained
pt gaining wt by gaining water without salt

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8
Q

SIADH clinical manifestations

A

depend on severity and rate of onset of hyponatremia
- dyspnea, fatigue
- water shifts from blood to cells
- neuro: dulled sensorium, confusion, lethargic, muscle twitching, convulsions
- GI: impaired taste, anorexia, vomiting, cramps
- severe: unrepairable neurological damage

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9
Q

is SIADH be lethal

A

yes from water intoxication
- serum Na level lower than in the cells, water shifts into cells causing cells to swell
- swelled cells in the brain can lead to herniate

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10
Q

pharm for SIADH

A

drugs not used rather treat underlying cause
- discontinue meds that inc ADH
- chronic SIADH: demecyclocline–> counteracts
- can be give loop diuretics to dec water but must monitor Na frequently so it doesnt drop too low

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11
Q

demeclocyline classification

A

tetracycline broad spectrum anb

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12
Q

demeclocycline indications

A

abx
chronic SIADH

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13
Q

demeclocycline moa

A

interferes with renal response to ADH
- kidneys don’t respond to ADH so water wont be reabsorbed

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14
Q

demeclocycline adverse effects

A

photosensitivity
teeth staining
nephrotoxic

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15
Q

what is diabetes insipidus

A

deficiency of ADH (from posterior pituitary) or
a dec renal response to ADH

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16
Q

what is diabetes insipidus characterized by

A

excessive water loss in the urine
inc plasma osmolality

17
Q

what are the two forms of DI

A

neurogenic (aka central, lesion of part of brain that interferes with release, most common)
nephrogenic (kidneys dont response to ADH)

18
Q

what is the cause of neurogenic DI

A

damage to the hypothalamus
damage to the pituitary gland

19
Q

what is neurogenic DI associated with

A

stroke
tramuatic brain injuries
cerebral infections
brain surgery

20
Q

what is the onset of neurogenic DI? permanent?

A

sudden and typically permanent

21
Q

what is the cause of nephrogenic DI

A

loss of kidney function
often drug related (lithium)

22
Q

what are the associated disorders with nephrogenic DI

A

chronic kidney disease

23
Q

what is the onset/course of nephrogenic DI

A

slow onset and progressive disease

24
Q

pathogenesis of DI

A

dec ADH
dec water reabsorption in renal tubules
dec intravascular volume leading to
- inc serum osmolality (hypernatremia)
- excessive urine output

25
Q

DI osmolality trends

A

urine osmolality and specific gravity: low
serum osmolality, serum Na, urine out put: high
wt: loss

26
Q

DI clinical manifestations

A

polyuria
polydipsia
dehydration
others based on severity:
- electrolyte imbalances, hypovolemic shock –> death

27
Q

pharm for neurogenic DI

A

synthetic ADH replacement

28
Q

pharm for nephrogenic DI

A

treat with diuretic (thiazide)
- dec polyuria, inc urine osmolality

29
Q

desmopressin moa

A

ADH replacement therapy
antidiuretic effects

30
Q

desmopressin routes

A

nasal spray, PO, IV, SQ

31
Q

desmopressin adverse effects

A

small doses: none
nasal spray can cause nasal irritation
large doses: hyponatremia, water intoxication
works very quickly

32
Q

DI DILUTE

A

dry
I and O, daily wt
low specific gravity
urinates lots
treat = vasopressin (desmopressin)
rehydrate

NUR 326 (20 decks)

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