diuretics

Question 1

T of F

Diuretics are medications that inc urine formation and outut

Answer 1

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.

Question 2

diuretics are used in management of what conitions?

Answer 2

**Edematous: HF, renal disease, hepatic disease

Non-edematous: HTN, ophthalmic surgery

Question 3

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

Answer 3

regulate vol, composition and pH of body fluids

kidneys receive ~25% of CO

Question 4

what is the functional unit of the kidney?

Answer 4

nephron

Question 5

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

Answer 5

glomerular filtration, tubular reabsorption, and tubular secretion

Question 6

what is the day min urine output?

Answer 6

400 ml. remove normal amounts of metabolic end products

Question 7

diuretics act on kidneys to what?

Answer 7

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

Question 8

what are the major subclasses of diuretic drugs?

Answer 8

thiazides and related diuretics
ooo diuretics
potassium-sparing diuretics

Question 9

major clinical indications of diuretics? and how for each?

Answer 9

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

Question 10

which diuretic is preferred when rapid diuretic effect is needed?

Answer 10

loop diuretic ***

Question 11

what diuretic is used to manage hypokalemia?

Answer 11

potassium sparing diuretic

Question 12

examples of loop diuretics?

Answer 12

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

Question 13

MOA of loop diuretics?

Answer 13

**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

Question 14

what treatment are loop diuretics good for?

Answer 14

useful in treatment of edema

Question 15

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

Answer 15

rapid onset and last at least 2 hours

Question 16

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

Answer 16

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

Question 17

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

Answer 17

**K and Na
small calcium loss

tell them to take K supplements or eat bananas

Question 18

indications of loop diuretics?

Answer 18

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

Question 19

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

Answer 19

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

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

Question 20

where are loop diuretics toxic?

Answer 20

neurotoxic and nephrotoxic

Question 21

loop diuretics inc serum levels of what?

Answer 21

uric acid, glucose, alanine aminotransferase, and aspartate aminotransferase

Question 22

loop diuretics combined with thiazide (metolazone) cause what?

Answer 22

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

Question 23

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

Answer 23

NSAIDS ***

Question 24

what is the most commonly used loop diuretic?

Answer 24

furosemide (lasix)***

Question 25

what are the uses for furosemide ?

Answer 25

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

Question 26

how to administer furosemide? | why this way?

Answer 26

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

Question 27

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

Answer 27

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

Question 28

potassium-sparing diuretics are also known as what?

Answer 28

aldosterone-inhibiting diuretics

Question 29

examples of potassium spring diuretics?

Answer 29

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

Question 30

MOA of K-sparing diuretic?

Answer 30

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

Question 31

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

Answer 31

weak

Question 32

what are the indications of potassium-sparing diuretics?

Answer 32

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

Question 33

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

Answer 33

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

Question 34

adverse effects of spironolactone?

Answer 34

gynecomastia amenorrhea irregular mensus postmenopausal bleeding bc it affects prolactin levels

Question 35

interactions for K-sparing diuretics?

Answer 35

lithium ACE inhibitors K supplements NSAIDs

Question 36

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

Answer 36

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

Question 37

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

Answer 37

potassium- sparing diuretics and potassium supplements wit renal impairment avoid excessive amounts of potassium supplments avoid salt substitutes maintain urine output

Question 38

example of thiazide diuretics

Answer 38

hydrochlorothiazide

Question 39

examples of thiazide-like diuretics?

Answer 39

metolazone chlorthalidone indapamide

Question 40

MOA of thiazide and thiazide-like diuretics?

Answer 40

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

Question 41

when should thiazides not be used?

Answer 41

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

Question 42

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

Answer 42

metolazone

Question 43

indications for thiazide and thiazide-like diuretics?

Answer 43

``` htn edematous states idiopathic hypercalciuria diabets insipidus heart failure caused by diastolic dysfunction ```

Question 44

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

Answer 44

CNS: dizziness, headache, blurred vision GI: Anorexia, N+V, diarrhea GU: erectile dysfunction Hematological: jaundice, leukopenia, agranulocytosis

Question 45

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

Answer 45

**integumentary: urticaria, photosensitivity metabolic: hypokalemia, glycosuria, hyperglycaemia, hyperuricemia, hypochloremic, alkalosis

Question 46

when should patients take diuretics?

Answer 46

morning bc can't sleep at night

Question 47

what foods are high in potassium?

Answer 47

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

Question 48

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

Answer 48

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

Question 49

teaching strategies for diuretics?

Answer 49

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

Question 50

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

Answer 50

nausea, vomiting or diarrhea

Question 51

what are some signs and symptoms of hypokaemia? **

Answer 51

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

Question 52

how would hypotension or fluid loss present?

Answer 52

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

Question 53

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

Answer 53

hypokalemia

Question 54

what are some therapeutic effects?

Answer 54

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