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Pharmacology > Kidney chapter 51 > Flashcards

Kidney chapter 51 Flashcards

1
Q

What are functions of the kidney ?

A
  • Regulating fluid volume
  • Electrolyte control
  • Blood pressure
  • Red blood cells production
  • Acid-base balance
  • Excretion of medication
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2
Q

What do diuretic agents help with

A
  • Promote renal excretion of sodium, water and other
    electrolytes
    decreases overall fluid volume
  • Indicated for HF, HTN, pulm edema, renal disease

Glaucoma management
* Decreases fluid pressure in the eye [intraocular pressure (IOP)]

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3
Q

What are adverse affects of diruetics?

A

*General:
* Fluid imbalance
* Electrolyte imbalances
(potassium/ calcium)
* Hyperglycemia(Change the way glucose is metabolized)

GI:
* Upset/ decrease appetite due to fluid shift

CNS:
* Drowsiness
* Confusion

CV:
* Hypotension
* Arrhythmias

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4
Q

What are classes of diuretics?

A
  • Thiazide diuretics and thiazide-like diuretics
  • Loop diuretics
  • Carbonic anhydrase inhibitors
  • Potassium sparing diuretics
  • Osmotic diuretics
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5
Q

What is hydrochlorothiazide (HydroDiuril)?

A

Thiazide diuretics
Synthetic, related to sulfonamides*

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6
Q

What are therapeutic actions of hydrochlorothiazide (HydroDiuril)?

A

Thiazide diuretics

  • Block chloride pump –> Inhibit resorption of Na, Cl, and KCL –> Results in water loss
  • Also cause relaxation of arterioles
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7
Q

What are indications of hydrochlorothiazide (HydroDiuril)?

A

Thiazide diuretics

HF, HTN

Edema caused by renal dz, hf, liver

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8
Q

What are adverse effects of hydrochlorothiazide (HydroDiuril)?

A

Thiazide diuretics

  • Electrolyte changes
  • GI upset
  • Hypotension
  • Photosensitivity (HCTZ)
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9
Q

What are contra of hydrochlorothiazide (HydroDiuril)?

A

Thiazide diuretics

  • Allergy to sulfonamides
  • Severe renal disease
  • Hypotension
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10
Q

What are cautions of hydrochlorothiazide (HydroDiuril)? ?

A

Thiazide diuretics

  • Systemic lupus erythematosus (SLE)
  • Diabetes
  • Pregnancy – use only if necessary
  • Gout
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11
Q

What are drug to drug interactions with hydrochlorothiazide (HydroDiuril)?

A

Thiazide diuretics

  • Digoxin
  • Lithium
  • Diabetic agents
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12
Q

What are nursing considerations with hydrochlorothiazide (HydroDiuril)?

A

Thiazide diuretics

  • Monitor for electrolyte
    imbalance:
  • Hypokalemia
  • Hypercalcemia
  • Hyperuricemia
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13
Q

What is furosemide (Lasix)?

A

Loop diuretic

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14
Q

What are therapeutic actions of furosemide (Lasix)?

A

Loop diuretic
* Work in loop of Henle –> Block chloride and sodium resorption
* Also may have some vasodilating effect, reducing preload and afterload

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15
Q

What are indications of furosemide (Lasix)?

A

Loop diuretic
CHF, peripheral edema associated with HF, acute pulmonary edema, HTN

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16
Q

What are pharmacokinetics of furosemide (Lasix)?

A

Loop diuretic
Can be given IV (slow push) or PO

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17
Q

What are adverse effects of furosemide (Lasix)?

A

Loop diuretic
* Hypokalemia
* Hypocalcemia
* Hypotension, dizziness
* Monitor for ototoxicity
* May be reversed if drug stopped early

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18
Q

What are contras of furosemide (Lasix)?

A

Loop diuretic
* Severe renal failure
* Hypotension
* Pregnancy

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19
Q

What are cautions of furosemide (Lasix)?

A

Loop diuretic
* Systemic lupus erythematosis
(SLE)
* Gout
* Diabetes

20
Q

What are drug interactions with furosemide (Lasix)?

A

Loop diuretic
Monitor use with
aminoglycosides(Ototoxicity), NSAIDS,
diabetic agents

21
Q

What are nursing considerations with furosemide (Lasix)?

A

Loop diuretic
Nutrition consult – dietary
potassium needs

22
Q

Describe potassium sparing diruetics?

A

Slow acting, weak diuretic, often used in combo with other diuretics

23
Q

What is spironolactone (Aldactone)?

A

potassium sparing diruetics
Most frequently used, aldosterone antagonist – blocks action of aldosterone

24
Q

What are therapeutic actions of spironolactone (Aldactone)?

A

potassium sparing diruetics

Loss of sodium, retain potassium

25
Q

What are indications of spironolactone (Aldactone)?

A

potassium sparing diruetics

spironolactone –> used to treat hyperaldosteronism – often seen with liver cirrhosis and nephrotic syndrome

26
Q

What are adverse affects spironolactone (Aldactone)?

A

potassium sparing diruetics

Hyperkalemia

27
Q

What are contras of spironolactone (Aldactone)?

A

potassium sparing diruetics
Renal dz due to risk of hyperkalemia
* Pregnancy

28
Q

What are cautions of spironolactone (Aldactone)?

A

potassium sparing diruetics
* Use of other diuretics – dehydration
* Cardiac disease – arrhythmias with hypo/hyperkalemia

29
Q

What are nursing considerations of spironolactone (Aldactone)?

A

potassium sparing diruetics

  • Monitor for effects of hyperkalemia  lethargy confusion, muscle cramps, cardiac
    arrhythmias
  • Educate to avoid foods high in potassium
30
Q

What is mannitol (Osmitrol)?

A

Osmotic diuretic

31
Q

what are therapeutic actions of mannitol (Osmitrol)?

A

Osmotic diuretic
* Pulls fluid into vasculature from
extra vascular spaces – including
aqueous humor

32
Q

What are indications of mannitol (Osmitrol)?

A

Osmotic diuretic
* Used for rapid and/or emergent
diuresis
* Useful for ICP, intraocular pressure,
urinary excretion of toxic substances

33
Q

What are pharmacokinetics of mannitol (Osmitrol)?

A

Osmotic diuretic
IV only – rapid acting

34
Q

What are adverse effects of mannitol (Osmitrol)?

A

Osmotic diuretic
* r/t large, sudden volume loss 
hypotension, shock, fluid &
electrolyte imbalance

35
Q

What are contras of mannitol (Osmitrol)?

A

Osmotic diuretic
* Renal failure
* Dehydration
* Cranial bleeds

36
Q

What is acetazolamide (Diamox)?

A

Carbonic Anhydrase Inhibitors
Mild diuretic

37
Q

What are therapeutic actions of acetazolamide (Diamox)?

A

Carbonic Anhydrase Inhibitors

  • Inhibits enzyme needed for
    sodium, bicarbonate and water
    resorption.
    more sodium and bicarbonate being excreted
38
Q

What are indications of acetazolamide (Diamox)?

A

Carbonic Anhydrase Inhibitors
Glaucoma
* Process especially useful to reduce
aqueous humor in eye
* Used in conjunction with other
diuretic

39
Q

What are contras acetazolamide (Diamox)?

A

Carbonic Anhydrase Inhibitors

  • Pregnancy
  • Allergy to sulfa/thiazides
  • Some glaucoma
40
Q

What are cautions ofacetazolamide (Diamox)?

A

Carbonic Anhydrase Inhibitors

Electrolyte imbalance,
renal/hepatic disease

41
Q

What are drug interaction with acetazolamide (Diamox)?

A

Carbonic Anhydrase Inhibitors

Increases excretion of lithium

42
Q

What are nursing considerations with diuretics?
children

A

HCTZ, lasix, spironolactone used
in children
* Monitor for rapid metabolism and
effect
* Follow weights, assess for
ototoxicity

43
Q

What are nursing considerations with diuretics?
adults

A
  • Teach to monitor weights, activity
    levels, dietary guidelines
  • Careful assessment of renal
    function, syncope, drug-drug
    interactions
  • AM dosing!
44
Q

What to assess with diuretics?

A
  • VS, Allergies
  • Wt, I&O
  • Physical assessment
  • Past medical history
  • Labs
  • Electrolytes, Renal function
  • Pregnancy status
45
Q

What are nsg diagnosis with diuretics?

A

Risk for deficient fluid volume
r/t drug effect
* Impaired urinary elimination r/t
drug effect

46
Q

What are implementation of diuretics?

A
  • Monitor I&Os, weight, edema
  • Administer in am
  • Check potassium levels prior to administering each
    dose
  • Educate pt:
  • Adverse effects to monitor
  • s/s of dehydration
  • Daily weight  when to call PCP (3+ lbs in 1 day)
  • Dietary sources of potassium  encourage intake (or
    need to avoid with potassium-sparing)
  • Safety measures
47
Q

What to evaluate with a patient on diuretics?

A

Monitor patient response to medication (wt, urinary
output, edema changes, blood pressure)

Pharmacology (39 decks)

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