CH 24: Diuretic drugs

Question 1

examines urine for the presence of blood cells, proteins, pH, specific gravity,
ketones, glucose, and microorganisms.

Answer 1

urinalysis

Question 2

primary measures of structural kidney damage.

Answer 2

proteinuria and albuminuria

Question 3

important laboratory tests for detecting
the buildup of nitrogen waste products in the blood.

Answer 3

Serum creatinine and blood urea nitrogen (BUN)

Question 4

The best marker for estimating kidney function

Answer 4

glomerular filtration rate (GFR),

Question 5

volume of filtrate passing through the glomerular capsules per minute. T

Answer 5

glomerular filtration rate (GFR),

Question 6

GFR can be used to predict the:

Answer 6

onset and progression of kidney failure and provides an indication of the kidney’s
ability to excrete drugs from the body.

Question 7

Kidneys are unable to synthesize
enough erythropoietin for red blood
cell production.

Answer 7

Anemia

Question 8

treatment for anemia

Answer 8

Epoetin alfa (Epogen, Procrit) or
darbepoetin alfa (Aranesp)

Question 9

Kidneys are unable to adequately
excrete potassium.

Answer 9

hyperkalemia

Question 10

treatment for hyperkalemia

Answer 10

Dietary restriction of potassium;
patiromer (Veltassa) or polystyrene
sulfate (Kayexalate) with sorbitol

Question 11

Kidneys are unable to adequately
excrete phosphate.

Answer 11

Hyperphosphatemia

Question 12

Hyperphosphatemia treatment

Answer 12

Dietary restriction of phosphate

phosphate binders such as calcium
carbonate (Os-Cal 500, others),
calcium acetate (Calphron, PhosLo),
lanthanum carbonate (Fosrenol),
sucroferric oxyhydroxide (Velphoro)
or sevelamer (Renagel)

Question 13

Kidneys are unable to excrete
sufficient sodium and water, leading
to water retention.

Answer 13

Hypervolemia

Question 14

treatment for hypervolemia

Answer 14

Dietary restriction of sodium
loop diuretics in acute conditions
thiazide diuretics in mild conditions

Question 15

Hyperphosphatemia leads to loss of
calcium.

Answer 15

Hypocalcemia

Question 16

treatment for hypocalcemia

Answer 16

Usually corrected by reversing the
hyperphosphatemia, but additional
calcium supplements may be
necessary

Question 17

Kidneys are unable to adequately
excrete metabolic acids.

Answer 17

Metabolic acidosis

Question 18

treatment for metabolic acidosis

Answer 18

Sodium bicarbonate or sodium citrate

Question 19

goal of diuretics

Answer 19

trigger the excretion of water and electrolytes from the kidneys, making these drugs a primary
choice in the treatment of renal disease, edema, hypertension, and heart failure.

Question 20

uses of diuretics

Answer 20

 HTN
 Heart failure
 AKI and CKD
 Liver failure or cirrhosis
 Pulmonary edema.

Question 21

Inhibits sodium and chloride reabsorption, excretes potassium

Answer 21

Loop Diuretics

Question 22

therapeutic uses of loop diuretics

Answer 22

Block reabsorption of Na and Cl
in the nephron loop

Question 23

adverse effects of loop diuretics

Answer 23

hypokalemia
orthostatic hypotension
tinnitus
nausea
diarrhea
dizziness
fatigue

Question 24

what to monitor for with loop diuretics

Answer 24

Monitor BP,
pulse rate,
I and 0
Check potassium
Contain sulfa!
Check for allergies

Question 25

therapeutic effects of furosemide

Answer 25

Can cause large amounts of fluid to be excreted from the kidney quickly Lower bp

Question 26

adverse effects of furosemide

Answer 26

Significant hypokalemia blood dyscrasias dehydration ototoxicity electrolyte imbalances circulatory collapse

Question 27

what to monitor for with furosemide

Answer 27

Monitor potassium Give IV dose over 1-2 minutes-+ diuresis in 5-10 min After PO dose diuresis in about 30 min Weigh the client daily Don't give at hs Encourage potassium-containing foods Ototoxicity with aminoglycocides Increase chance of lithium toxicity Monitor for arrythmias digoxin toxicity

Question 28

Hydrochlorothiazide: thiazide diuretic therapeutic effects

Answer 28

Interferes with sodium transport Decrease edema Prevent renal calculi Lower bp

Question 29

hydrochlorothiazide adverse effects

Answer 29

Hypokalemia Hyperglycemia Blurred vision Loss of Na+ ·Dry mouth Hypotension Significant hypokalemia electrolyte depletion dehydration hypotension hyponatremia hyperglycemia coma blood dyscrasias

Question 30

monitor for safety with hydrochlorothiazide

Answer 30

Monitor electrolytes, especially potassium I and 0 Monitor BUN and creatinine Don't give at hs Weigh client daily Encourage potassium-containing foods Combined with other antihypertensives have additive or synergistic effects with hydrochlorothiazide on blood pressure. Increased risk with NSAIDS nephrotoxicity Lithium toxicity possible Digitoxin additive effect

Question 31

Absorbed in the GI tract Spare potassium excretion

Answer 31

potassium-sparing diuretics

Question 32

adverse effects of potassium sparing diuretics

Answer 32

Hyperkalemia Hyponatremia Hepatic and renal damage

Question 33

safety monitoring for potassium sparing diuretics

Answer 33

Used with other diuretics Watch with potassium supplements

Question 34

Spironolactone therapeutic uses

Answer 34

Reduce edema Lower bp

Question 35

adverse effects of spironolactone

Answer 35

Tinnitus Rash Significant Dysrhythmias (from hyperkalemia) dehydration hyponatremia agranulocytosis other blood dyscrasias

Question 36

spironolactone safety monitoring

Answer 36

Give with meals Avoid salt substitutes containing potassium Monitor I and 0 ACE inhibitors increased risk of hyperkalemia Digoxin toxicity risk Lithium toxicity risk ASA can increase levels

Question 37

therapeutic effects of mannitol: osmotic diuretic

Answer 37

Inhibits reabsorption of sodium and water and draws fluid from the intracellular to to vascular Decrease ICP Maintain urine flow pt with AKI

Question 38

adverse effects of mannitol

Answer 38

thirst and dry mouth

Question 39

safety monitoring of mannitol

Answer 39

I and O must be measured Monitor vital signs Monitor for electrolyte imbalance I and O a must! Very Potent! Can worsen edema

Question 40

important reminders of implementing diuretics

Answer 40

 Teach the patient or caregiver how to monitor pulse and BP. Ensure the proper use and functioning of any home equipment obtained  Daily Weights!  Daily weights should remain at or close to baseline weight. (An increase in weight over 1 kg (2 lb) per day may indicate excessive fluid gain. A decrease of over 1 kg (2 lb) per day may indicate excessive diuresis and dehydration.)  Caution with older adult and hypotension!  Rise slowly  Do not take if BP below 90/60  Need regular labwork!  Report tinnitus  Encourage fluids unless contraindicated

Question 41

educate diuretic pts on SS of:

Answer 41

o hypokalemia o hyperkalemia o digoxin toxicity o hyperglycemia o gout

Question 42

take diuretics early in the day to avoid:

Answer 42

nocturia

Question 43

most frequent cause of AKI

Answer 43

hypoperfusion