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Pharmacology Exam #1 > Diuretics > Flashcards

Diuretics Flashcards

1
Q

What are the main actions of diuretics?

A
  • Increase urine volume
  • Increase sodium excretion
  • Prevent fluid retention
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2
Q

What are the main indications of diuretics?

A
  • edema r/t congestive heart failure
  • acute pulmonary edema
  • liver disease
  • renal disease
  • hypertension
  • hyperkalemia
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3
Q

What are the 5 classes of diuretics?

A
  • Thiazide/Thiazide like diuretics
  • Loop Diuretics
  • Carbonic Anhydrase Inhibitors
  • Potassium Sparing Diuretics
  • Osmotic Diuretics
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4
Q

Considerations for Diuretics in Children

A
  • Thiazides, Loop, and spironolactone can be used
  • Rapid drug effect and adverse effects
  • Monitor closely: Fluid and electrolyte imbalances
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5
Q

Considerations for Diuretics in Adults

A
  • Patient education
  • Daily weights to check for fluid imbalance
  • Adequate fluid intake
  • Awareness of fluid loss situations
  • DO NOT use in lactation
  • Only when benefits outweigh risks in pregnancy
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6
Q

Considerations for Diuretics in Older Adults

A
  • Underlying renal and hepatic impairment
  • Monitor fluid and electrolyte imbalance closely
  • maintain oral fluid intake
  • maintain same activity levels
  • avoid excessive salt (causes fluid retention)
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7
Q

Thiazide and Thiazide like Diuretics
Drug Names

A
  • Hydrochlorothiazide
  • Chlorothiazide
  • Chlorathalidone
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8
Q

Thiazide and Thiazide like Diuretics
MOA

A

Action is to BLOCK the chloride pump in the DCT (distal convoluted tubule)

Keeps chloride and sodiium IN the tubule to be excreted in the urine, preventing the reabsorption of both into the vascular system

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9
Q

Thiazide and Thiazide like Diuretics
Indications

A
  • Hypertension
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10
Q

Thiazide and Thiazide like Diuretics
Contraindications

A

Absolute: Allergy

Relative:
* Allergy to sulfonamides
* Hypovolemia
* Severe renal disease

Cautions:
* Lupus (causes kidney issues)
* Liver Disease (altered metabolism => toxicity)
* Diabetes or glucose tolerance abnormalities (may cause increase in glucose)

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11
Q

Thiazide and Thiazide like Diuretics
Adverse Effects

A

Electrolyte and glucose imbalances:
* HYPOkalemia
* HYPERcalcemia
* HYPERglycemia (with long term use)

Fluid Loss:
* dizziness, weakness, fatigue

Alkalinized Urine:
* bladder infections

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12
Q

Thiazide and Thiazide like Diuretics
Drug Interactions

A
  • Digoxin => increased risk of digoxin toxicity r/t potassium changes
  • Antidiabetic agents => may need to adjust
  • Lithium => increased risk of lithium toxicity - measure lithium and sodium levels closely
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13
Q

Loop Diuretics
MOA

A
  • Blocks the chloride pump in the LOOP of Henle
  • This keeps sodium and chloride in the loop, prevents reabsorption into circulation
  • Large amount of sodium and chloride rich urine is excreted
  • Works quickly
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14
Q

Loop Diuretics
Indications

A
  • Heart failure
  • Pulmonary edema
  • Edema r/t heart failure, renal failure, or liver disease
  • Hypertension
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15
Q

Loop Diuretics
Drug Names

A
  • Furosemide (tends to be safest. Brand: Lasix)
  • Bumetanide
  • Torsemide
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16
Q

Loop Diuretics
Contraindications

A

Absolute: Allergy

Relative:
* Electrolyte depletion
* Severe renal disease
* liver failure

Cautions:
* Lupus
* Hyperglycemia

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17
Q

Loop Diuretics
Adverse Effects

A
  • HYPOkalemia
  • HYPOcalcemia
  • HYPERglycemia
  • Ototoxicity (otic nerve - could cause deafness - reversible)
  • Hypotension and dizziness
18
Q

Loop Diuretics
Drug Interactions

A
  • Aminoglycosides or cisplatin (Inc. risk of ototoxicity)
  • Anticoagulants (effects of anticoagulants are increased)
  • Digoxin (increased risk of digoxin toxicity r/t potassium changes)
  • Antidiabetic Agents (may need to adjust)
  • Lithium (Inc. risk of lithium toxicity)
  • Indomethacin, ibuprofen, salicylates, or NSAIDs (decreased therapeutic effect of diuretic)
19
Q

Carbonic AnHYdrase Inhibitors
MOA

A
  • Blocks the affect of carbonic anhydrase; slows down the movement of hydrogen ions
  • more sodium and bicarbonate are lost in the urine
20
Q

Carbonic AnHYdrase Inhibitors
Drug Name

A

“-amide”

  • Acetazolamide
21
Q

Carbonic AnHYdrase Inhibitors
Indications

A
  • Adjuncts to other diuretics
  • Glaucoma
22
Q

Carbonic AnHYdrase Inhibitors
Contraindications

A

Absolute: Allergy

Relative: allergy to sulfonamides or thiazides

Cautions (can make these worse):
* Renal or hepatic disease
* Adrenocortical insufficiency
* Respiratory acidosis/COPD

23
Q

Carbonic AnHYdrase Inhibitors
Adverse Effects

A
  • Metabolic acidosis (d/t acid-base imbalance)
  • HYPOkalemia
  • CNS effects: paresthesia of extremities, confusion, drowsiness (r/t fluid imbalance)
24
Q

Carbonic AnHYdrase Inhibitors
Drug Interaction

25
**Potassium Sparing Diuretics** MOA
Loss of sodium WITH the retention of potassium Spironolactone: * Aldosterone antagonist: blocks aldosterone in the distal tubule which results in the secretion of sodium Triamterene: * Blocks potassium secretion through the tubule (excreting sodium)
26
**Potassium Sparing Diuretics** Indications
* Adjuncts with thiazide or loop diuretics * Those who need a diuretic but are at risk for hypokalemia * Hyperaldosteronism
27
**Potassium Sparing Diuretics** Contraindications
**Absolute**: Allergy **Relative**: Hyperkalemia, Severe Renal Disease
28
**Potassium Sparing Diuretics** Drug Interactions
Aspirin (decreased diuretic effect)
29
**Potassium Sparing Diuretics** Drug Names
Spironolactone Triamterene
30
**Potassium Sparing Diuretics** Adverse Effects
***Hyper**kalemia *Androgen effects: gynecomastia (enlargement of breast tissue in men) Irregular menses Hirsutism (increase in body hair) Deepening of the voice
31
**Osmotic Diuretics** MOA
* Pulls water** INTO the renal tubule** *without sodium loss* * ONLY adminsitered by IV * Pulls fluid from extravascular space into the intravascular space
32
**Osmotic Diuretics** Indications
* Increased Intracranial Pressure (ICP) * ACUTE renal failure due to shock, drug overdose, or trauma * Decrease Intraocular Pressure (IOP) before eye surgery or in ACUTE glaucoma attacks
33
**Osmotic Diuretics** Drug Name
Mannitol
34
**Osmotic Diuretics** Contraindications
**Relative**: * Pre-existing severe renal disease * Pulmonary congestion and edema * Intracranial bleeding (except during surgery) * Heart Failure
35
**Osmotic Diuretics** Adverse Effects
*r/t SUDDEN drop in fluid levels* * Fluid & Electrolyte imbalance * Nausea and Vomiting * Hypotension * Light-headedness * Confusion * Headache * Heart Failure * Pulmonary edema
36
**Diuretic Agents** Assessment
**History:** * Allergies, pregnancy, lactation * Fluid and electrolyte disturbances; hyperglycemia * Contraindications or cautions for each drug class **Physical:** * baseline: Skin, mucus membranes, heart and lung sounds * intake and output: voiding patterns * vitals, weight **Labs:** * Renal and hepatic function tests * electrolytes * glucose
37
**Diuretic Agents** Nursing conclusions
* Risk for alterations in fluid volume * Risk for electrolyte disturbances * Hypotension risk * Knowledge Deficit
38
**Diuretic Agents** Interventions/patient teaching
* Can take with food or milk * **EARLY** in the day * Administer IV diuretics SLOWLY and switch to Oral form ASAP * Assess weight daily: *Report >3lbs gain in one day or >5lbs gain in one week* * Assess for dehydration and electrolyte imbalance * Appropriate amount of potassium * Appropriate amount of fluid to prevent fluid rebound * Safety precautions: avoid excessive sweating, readily available bathroom * Patient teaching
39
# 6 Ls Signs of **HYPO**kalemia
**6 Ls** Lethargy Leg Cramps Limp Muscles Low, shallow respirations Lethal cardiac rhythms Lots of urine (polyuria)
40
# MURDER Signs of **HYPER**kalemia
**MURDER** Muscle aches Urine - oliguria or anuria Respiratory Distress Decreased Cardiac contractility ECG changes Reflexes - hyperreflexia or areflexia
41
# Banana Spin Pot Song Potassium Rich Foods
**Banana Spin Pot Song** Bananas Spinach Potatoes Salt Substitutes Orange (Citrus) Nuts Grapefruit (Citrus)

Pharmacology Exam #1 (10 decks)

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