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diuretics Flashcards

1
Q

T of F

Diuretics are medications that inc urine formation and outut

A

T

**they inc renal excretion of water, sodium, and other electrolytes, thereby increasing urine formation and output. They are used in management of edematous and non-edematous conditions.

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2
Q

diuretics are used in management of what conitions?

A

**Edematous: HF, renal disease, hepatic disease

Non-edematous: HTN, ophthalmic surgery

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3
Q

what is the primary renal function? how much of CO do they receive

A

regulate vol, composition and pH of body fluids

kidneys receive ~25% of CO

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4
Q

what is the functional unit of the kidney?

A

nephron

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5
Q

the kidney (nephron) functions via 3 processes. what are these processes?

A

glomerular filtration, tubular reabsorption, and tubular secretion

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6
Q

what is the day min urine output?

A

400 ml. remove normal amounts of metabolic end products

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7
Q

diuretics act on kidneys to what?

A

**decrease reabsorption of sodium, chloride, water, and other substances

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8
Q

what are the major subclasses of diuretic drugs?

A

thiazides and related diuretics
ooo diuretics
potassium-sparing diuretics

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9
Q

major clinical indications of diuretics? and how for each?

A

edema- mobilize tissue fluids of decreasing plasma
heart failure
HTN- exact mechanism unknown, attributed to sodium depletion

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10
Q

which diuretic is preferred when rapid diuretic effect is needed?

A

loop diuretic ***

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11
Q

what diuretic is used to manage hypokalemia?

A

potassium sparing diuretic

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12
Q

examples of loop diuretics?

A

Bumetanide*
ethacrynic acid (rarely used clinically)
Furosemide* (Lasix®)

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13
Q

MOA of loop diuretics?

A

**acts directly on the loop of hence to block chloride and sedum resorption
inc kidney prostaglandins, resulting in the dilation of bleed vessels and reduced kidney, pulmonary, and systemic vascular resistance

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14
Q

what treatment are loop diuretics good for?

A

useful in treatment of edema

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15
Q

do loop diuretics have a slow or rapid onset? how long do they last?

A

rapid onset and last at least 2 hours

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16
Q

the decreased fluid vol causes a reduction in what for loop diuretics?

A 
BP
pulmonary vascular resistance
systemic vascular resistance
central venues pressure
left ventricular end-diastolic pressure
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17
Q

what do loop diuretics deplete someone of? what should you teach the patient?

A

**K and Na
small calcium loss

tell them to take K supplements or eat bananas

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18
Q

indications of loop diuretics?

A

deem associated with heart failure and liver or kidney dsease

HTN

kidney excretion of calcium in patients with hypercalcemia

heart failure resulting from diastolic dysfunction

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19
Q

adverse effects for loop diuretics? CNS GI, metabolic, and hematological

A

CNS: Dizziness, headache, tinnitus, blurred vision
GI: ausea, vomiting, diarrhea

hematological: Agranulocytosis, neutropenia, thrombocytopenia
metabolic: Hypokalemia, hyperglycemia***, hyperuricemia

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20
Q

where are loop diuretics toxic?

A

neurotoxic and nephrotoxic

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21
Q

loop diuretics inc serum levels of what?

A

uric acid, glucose, alanine aminotransferase, and aspartate aminotransferase

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22
Q

loop diuretics combined with thiazide (metolazone) cause what?

A

results in the blockade of sodium and water reabsorption at multiple sites in the nephone, a property referred to as sequential nephrite blockade

23
Q

what may dec the reduction of vascular resistance? in loop diuretics so what impedes the effects of loop diuretics?

A

NSAIDS ***

24
Q

what is the most commonly used loop diuretic?

A

furosemide (lasix)***

25
Q

what are the uses for furosemide ?

A

pulmonary edema and edema associated with HF,l over dx, nephrotic syndrome, ascites, htn

26
Q

how to administer furosemide?

why this way?

A

nurse gives IV injections of furosemide over 1-2 min and administers high-dose furosemide continuous IV infusions at a rate of 4mg/min or less

dec or avoids high peak serum levels, which inc risk of adverse effects, including ototoxicity

27
Q

When administering a loop diuretic to a patient, it is most important for the nurse to determine if the patient is also taking which drug?

lithium
acetaminophen (Tylenol®)
penicillin
theophylline

A

lithium bc

Correct answer: A
Rationale: Use of loop diuretics with lithium can increase the risk of lithium toxicity. Drug interactions with loop diuretic therapy can occur with concurrent use of nonsteroidal anti-inflammatory drugs, and vancomycin can cause increased neurotoxicity and ototoxicity when used with loop diuretics. There is no associated risk of drug interaction when acetaminophen, penicillin, or theophylline are taken with loop diuretics.

Because lithium is a salt so if youre taking lithium it will affect diuiretic and may eed to lower dose of lithium

28
Q

potassium-sparing diuretics are also known as what?

A

aldosterone-inhibiting diuretics

29
Q

examples of potassium spring diuretics?

A

Amiloride* (Midamor®)
Spironolactone* (Aldactone®)
triamterene
triamterene in combination with hydrochlorothiazide*

30
Q

MOA of K-sparing diuretic?

A

Work in collecting ducts and distal convoluted tubules

Interfere with sodium–potassium exchange

Competitively bind to aldosterone receptors

Block resorption of sodium and water usually induced by aldosterone secretion

31
Q

are K-sparing diuretics drug effects weak or strong compared with the thiazide and loop diuretics?

A

weak

32
Q

what are the indications of potassium-sparing diuretics?

A

spironolactone and triamterene

  • hyperaldosteroism
  • htn
  • reversing K loss caused by K-wasting diuretics
  • certain cases of heart failure: prevention of remodelling

amiloride
-similar to spironolactone and triamterene but less effective in the long term

33
Q

adverse effects of K sparing diuretics? CNS, GI, otehr

A

CNS: dizziness, headache
GI: cramps, n+V, diarrhea
other: urinary freq, weakness, hyperkalemia

34
Q

adverse effects of spironolactone?

A

gynecomastia
amenorrhea
irregular mensus
postmenopausal bleeding

bc it affects prolactin levels

35
Q

interactions for K-sparing diuretics?

A

lithium
ACE inhibitors
K supplements
NSAIDs

36
Q

what are some ways of preventing potassium imbalances? for hypokalemia?

A

low dose of diuretics
using supplemental potassium, use potassium-sparing along w potassium-losing medications

inc food of intake of K
restrict dietary sodium intake

37
Q

what are some of ways of preventing potassium imbalances? for hyperkalemia?

A

potassium- sparing diuretics and potassium supplements wit renal impairment

avoid excessive amounts of potassium supplments

avoid salt substitutes

maintain urine output

38
Q

example of thiazide diuretics

A

hydrochlorothiazide

39
Q

examples of thiazide-like diuretics?

A

metolazone
chlorthalidone
indapamide

40
Q

MOA of thiazide and thiazide-like diuretics?

A

inhibit tubular resoption of sodium, chloride, and K ions

action primarily in the distal convoluted tubule

result in osmotic water loss

dilate the arterioles by direct relaxation

dec preload and afterload

41
Q

when should thiazides not be used?

A

if creatinine clearance is less than 30-50 mil/min (normal is 125ml/min)

42
Q

which thiazide diuretic remains effective to a creatinine clearance of 10ml/min?

A

metolazone

43
Q

indications for thiazide and thiazide-like diuretics?

A 
htn
edematous states
idiopathic hypercalciuria
diabets insipidus
heart failure caused by diastolic dysfunction
44
Q

adverse effects of thiazide lie diuretics? CNS, GI, GU, hematological

A

CNS: dizziness, headache, blurred vision

GI: Anorexia, N+V, diarrhea

GU: erectile dysfunction

Hematological: jaundice, leukopenia, agranulocytosis

45
Q

adverse effects for thiazide-like diuretics (cont.) integumentary
metabolic

A

**integumentary: urticaria, photosensitivity

metabolic: hypokalemia, glycosuria, hyperglycaemia, hyperuricemia, hypochloremic, alkalosis

46
Q

when should patients take diuretics?

A

morning bc can’t sleep at night

47
Q

what foods are high in potassium?

A

bananas, oranges, dates, apricots, raisins, broccoli, green beans, potatoes, tomatoes, meats, fish, wheat bread, and legumes.

48
Q

what should you teach patients with diabetes if they’re taking diuretics?

A

** Patients with diabetes mellitus who are taking thiazide or loop diuretics should be told to monitor blood glucose and watch for elevated levels.

49
Q

teaching strategies for diuretics?

A

Teach patients to change positions slowly and to rise slowly after sitting or lying, to prevent dizziness and fainting related to orthostatic hypotension.
**Encourage patients to keep a log of their daily weight.
Remind patients to return for follow-up visits and laboratory work

50
Q

if a patient has an electrolyte imbalance d/t diuretic how might this present?

A

nausea, vomiting or diarrhea

51
Q

what are some signs and symptoms of hypokaemia? **

A

**anorexia, nausea, lethargy, muscle weakness, mental confusion, and hypotension

52
Q

how would hypotension or fluid loss present?

A

**Instruct patients to notify their primary care provider immediately if they experience rapid heart rates or syncope (reflects hypotension or fluid loss).

53
Q

excessive consumption of liquorice can lead to ____in patients taking thiazides?

A

hypokalemia

54
Q

what are some therapeutic effects?

A 
Reduction of edema
Reduction of fluid volume overload
Improvement in manifestations of heart failure
Reduction of hypertension
Return to normal intraocular pressures

Pharm (20 decks)

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