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Flashcards in AntiHTN Deck (95)
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1

What are the main reasons that Diuretics are used:

to decrease HTN (lowers bld pressure), decreases edema (peripherally and pulmonary) in pts w/HF or renal/liver disorders.

2

Elevated blood pressure is defined as:

HTN

3

How do diuretics increase urine flow:

Diuresis occurs by the inhibition of Na and H2O reabsorption from the kidney tubules.

4

What drugs are considered to be the first-line meds for HTN:

diuretics (can be used alone or in combination w/other antiHTN)

5

Where does the reabsorption of Na and H2o occur throughout the renal tubular segments:

Na and H2o reabsorption typically occurs in the proximal tubule, Loop of Henle (both descending and ascending loops), and collecting tubules.

6

What diuretics act on the proximal tubule:

Osmotics (mannitol), mercurial, and carbonic anhydrase inhibitor diuretics act on the proximal tubule

7

What diuretics act on the loop of Henle:

High-ceiling (loop) diuretics act on the loop of Henle

8

What diuretics act on the distal convoluted tubule:

thiazide diuretics act on the distal tubule

9

What diuretics act on the collecting tubules:

k-sparing diuretics act on the collecting tubules

10

Every 1.5 hrs, the glomeruli filters out what from the ECF (extra cellular fluid)-process for beginning process of urine formation:

electrolytes, Na, H20, drugs, glucose, waste products from protein metabolism are filtered through the glomeruli

11

Where of the renal tubules can diuretics have the greatest effect (where the effects of diuretics are the fastest) in causing natriuresis (loss of Na in urine):

Greatest diuretic effect in natriuresis occurs at the tubules closest to the glomeruli: proximal tubule

12

Why do diuretics have an anti-HTN effect:

There's an anti-HTN effect when taking diuretics due to the blocking of Na and Cl reabsorption (thus promoting Na and water loss thru urine). This blockage decreases fluid volume=lower BP; decrease in fluid volume=decrease in edema

13

What are the most commonly used diuretics effective i the removal water and sodium:

thiazides (or thiazides-like diuretic), high-ceiling (loop), osmotic (mannitol), k-sparing, carbonic anhydrase inhibitors are all the diuretics commonly used for HTN (minus the last diuretic)

14

This type of diuretic should not be used on pts w/renal insufficiency or DM, can be combined with ace-inhibitors and beta-blockers; acts on the distal convoluted tubule to promote Na, Cl, K, H2O excretion

HydrochloroTHIAZIDE or HydroDiuril

15

What are some common effects of thiazides:

hyperglycemia, hypercalcemia, hypokalemia (potentiates digoxin), hyperuricemia, and hyponatremia, (should be given in the morning to avoid nocturia

16

What can the herbs: aloe, ginko, and licorice cause when taking diuretics:

aloe and licorice can cause hypokalemia and ginko can increase BP

17

This type of diuretic id considered extremely potent in the cause of rapid diuresis and rapid decrease in BP; its effects are dose dependent; should not be Rx if some other diuretic could alleviate bofy fluid excess; not an effective HTN med; used primarily on end-stage renal pts; acts on the ascending loop of Henle by inhibiting Cl transport of Na into the circulation

Furosemide (Lasix) and Bumetanide (Bumex-more potent then Lasix)

18

This "potassium wasting diuretic will cause hypokalemia (muscle weakness, abd distension, leg cramps, cardiac dysrhythmias), orthostatic hypotension, digoxin toxicity, should not be combined with another loop diuretic but can be combined with thiazide:

Furosemide (Lasix) and Bumetanide (Bumex)

19

Why is Furosemide (Lasix) and Bumetanide (Bumex), both of which are Loop or high-ceiling dieretics, considered to be potent in the cause of rapi diuresis and rapid decrease in BP:

Loop diuretics have a great saluretic (Na-Cl-losing) or natriuretic (Na-losing) effect that causes rapid diuresis, which decreases CO and BP

20

This diuretic increases the concentration and Na reabsorption in the proximal tubule and the loop of Henle by pulling fluid from the interstitial tissue spaces into vascular; used in emergency cases such as ICP (intracranial pressure) and IOP (intraocular pressure), to prevent kidney failure, and used often in cancer therapy; diuresis occurs w/in 1-3 hrs after IV

Mannitol osmotic (and Urea) diuretic

21

Mannitol should not be given to pts w/HF or renal failure. Some s/s of mannitol are:

Fluid and electrolyte imbalances (due to rapid fluid shifts), tachycardia, and pulmonary edema

22

What diuretic is usually given to pts tin the prevention of AKI, oliguria (low output of urine), IOP in glaucoma, and ICP:

Mannitol (osmotic diuretics) or Urea

23

What diuretic is typically used on pts with chronic (open-angle) glaucoma, management of epilepsy, pts w/metabolic alkalosis, and may cause metabolic acidosis w/prolonged use:

Carbonic anhydrase inhibitors

24

How do carbonic anhydrase inhibitors work:

This diuretic blocks the action of the carbonic anhydrase enzyme (needed to maintain H+ and bicarbonate ion-acid base balance-balance) to increase Na,K, and bicarbonate secretion

25

What diuretic is primarily Rx for pts w/chronic cardiac problems, blocks the action of aldosterone in the sodium-potassium pump, it's main side effect is hyperkalemia if taken w/and ACE or angiotensin II bc of increased K levels, acts primarily on the collecting duct of the renal tubules:

Spironolactone (Aldactone) potassium-sparing diuretics (can be use with a HCTZ or loop-potassium wasting diuretics-to enhance diuretic effect and prevents K-loss)

26

What are the S/S of hyperkalemia that can be caused when taking ACE inhibitors (or angiotensin II) along with Spironolactone (Aldactone):

tachycardia which could lead to bradycardia, EKG irregularities, numbness/tingling of hands and feet, N/V and abd cramps

27

Thiazides (hydrochlorothiazide or HydroDiuril ) is commonly combined w/what types of drugs:

Spironolactone (aldactone) potassium-sparing diuretic, BBs, ACE inhibitors, and Angiotensin II antagonists

28

A pt is taking hydrochlorothiazide 50 mg a day along w/digoxin 0.25 mg a day. What type of electrolyte imbalance would you expect to occur: A: hypocalcemia, B: hypokalemia, C: hyperkalemia, D: hypermagnesemia

B: digoxin and thiazides taken together can cause hypokalemia (same with loop diuretics and digoxin)

29

The nsg is teaching a pt who's has DM and is taking hydrochlorothiazide 50 mg/day. The teaching should include the importance of monitoring which levels: A: Hgb &HCT, B: BUN, C: arterial blood gases, D: Serum glucose

C: thiazides (hydrochlorothiazide or HydroDiuril) increase glucose levels

30

A pt has HF and is Rx Lasix. The nurse is aware that Lasix (furosemide) is what kind of drug: A: Thiazide diuretic, B: Osmotic diuretic, C: High-ceiling diuretic (loop), D: K-sparing diuretic

C: High-ceiling (loop) diuretic