Diuretics

Question 1

<p>Diuretics</p>

Answer 1

<p>Causing increased passing of urine</p>

Question 2

<p>Five Classes of Diuretics</p>

Answer 2

<p>Thiazide
Loop
Carbonic Anhydrase Inhibitors
Potassium-sparing
Osmotic</p>

Question 3

<p>Diuretics Indications</p>

Answer 3

<p>Edema (assoc. w/ CHF)
Acute PE (HF cx)
Liver Disease (+cirrhosis)
Renal disease
Hypertension
Conditions that cause hyperkalemia</p>

Question 4

<p>Two Functions of Diuretics</p>

Answer 4

<p>Increase the amount of urine produced by the kidneys

| Increase sodium excretion</p>

Question 5

Thiazide Function

Answer 5

Block Cl pump
Keep Na / Cl in the tubule to be excreted in urine, thus preventing reabsorption of both and decrease blood volume.
RAAS

Question 6

Thiazide Indications

Answer 6

Tx of edema (r/t CHF), liver disease, renal disease, HTN

Question 7

Thiazide Pharmacokinetics

Answer 7

Absorbed GI tract.
Metabolized in Liver
Excreted in Urine

Question 8

Thiazide Contraindications

Answer 8

Allergy.
Fluid + Electrolye Imbalance
Bipolar d/o (r/t lithium tox)
Pregnancy + Lactation (retain h2o when pregnant)

Question 9

Thiazide Cautions

Answer 9

Gout
Lupus
DM
Hyperparathyroidism

Question 10

Thiazide Adverse Effects

Answer 10

R/t interference w/ nephron function
Hypokalemia
Orthostatic hypotension
Nocturia / Polyuria
Lithium (bipolar d/o)
Decreased Ca2+ excretion
Altered Blood-Glucose levels
Urine will be alkanalized

Question 11

Thiazide Interactions

Answer 11

Cholestyramine (Before or after)
Digoxin (Decrease HR/BP)
Anti-DM

Question 12

Thiazide Prototype

Answer 12

Hydrochlorothiazide

Question 13

Furosemide

Answer 13

Lasix.
Loop diuretic.
Most common, not most powerful.

Question 14

More powerful than Lasix

Answer 14

Bumetandine (Bumex)

Torsemide (Demadex)

Question 15

Loop Diuretic Actions

Answer 15

Block the Cl pump, causing Na/Cl reabsorption, decreasing blood volume

Question 16

Loop Diuretics Indications

Answer 16

Acute CHF (+edema)
Acute PE
Liver + Renal disease
HTN

Question 17

Loop Diuretics Pharmokinetics

Answer 17

Metabolized + Excreted in Urine

Question 18

Loop Diuretics Contraindications

Answer 18

Allergy
Electrolyte depletion
Anuria
Severe renal failure
Hepatic coma
Pregnancy + lactation

Question 19

Loop Diuretics Caution

Answer 19

SLE, Gout, DM

Question 20

Loop Diuretics Adverse Effects

Answer 20

Fluid + electrolyte imbalance
Hypokalemia
Alkalosis
Hypocalcemia

Question 21

Loop Diuretics Drug Interactions

Answer 21

Aminoglycosides or cisplatine
Anti-Coag
Indomethacin, IBprof, Salicylates, NSAIDS (Decrese HTN effect)

Question 22

Carbonic Anhydrase Inhibitors When to Use:

Answer 22

Used when more intense diuresis is needed
Acetazolamide (Diamox)
Methazolamide (generic)

Question 23

Carbonic Anhydrase Inhibitors Action

Answer 23

Block the effects of carbonic anhydrase, slow down movt of H+
= More Na / Bicarb lost in the urine

Question 24

Carbonic Anhydrase Inhibitors Pharmokinetics

Answer 24

Rapidly absorbed and widely distributed

Excreted in urine

Question 25

Carbonic Anhydrase Inhibitors Caution

Answer 25

``` Lactation Fluid or Electrolye imbalance Renal or hepatic disease Adrenocortical insufficiency Respiratory acidosis COPD Related to disturbances in acid and base balance and electrolyte balances Metabolic acidosis Hypokalemia Paresthesias of extremities, confusion, drowsiness ```

Question 26

Carbonic Anhydrase Inhibitors Drug Interactions

Answer 26

Salicylates (increase conc to tox) | Lithium (increase conc to tox)

Question 27

Potassium-Sparing Diuretics Use When

Answer 27

Not as powerful as the loop diuretics, but they retain potassium instead of wasting it.

Question 28

Potassium-Sparing Diuretics Function

Answer 28

Cause a loss of sodium while retaining potassium | Block the actions of aldosterone in the distal tubule

Question 29

Potassium-Sparing Diuretics Indications

Answer 29

Adjuncts with thiazide or loop diuretics | Patients who are at risk for hypokalemia

Question 30

Potassium-Sparing Diuretics Pharmokinetics

Answer 30

Well absorbed, protein bound, and widely distributed | Metabolized in the liver and excreted in the urine

Question 31

Potassium-Sparing Diuretics Contraindications

Answer 31

Allergy Hyperkalemia, renal disease, or anuria Patients taking amiloride or triamterene

Question 32

Potassium-Sparing Diuretics Adverse Effects

Answer 32

Hyperkalemia

Question 33

Potassium-Sparing Diuretics Drug-to-Drug Interactions

Answer 33

Salicylates

Question 34

Osmotic Diuretics Function

Answer 34

Pull water into the renal tubule without sodium loss. | Mannitol (Osmitrol)

Question 35

Osmotic Diuretics Indications

Answer 35

Increased cranial pressure or acute renal failure due to shock, drug overdose, or trauma

Question 36

Osmotic Diuretics Pharmokinetics

Answer 36

Freely filtered at the renal glomerulus, poorly reabsorbed by the renal tubule Not secreted by the tubule Resistant to metabolism

Question 37

Osmotic Diuretics Contraindications

Answer 37

Renal disease and anuria Pulmonary congestion Intracranial bleeding, dehydration CHF

Question 38

Osmotic Diuretics Adverse Effects

Answer 38

Related to sudden drop in fluid levels | Nausea, vomiting, hypotension, light-headedness, confusion, and headache

Question 39

Nursing Consideration for Diuretics: Assessment

Answer 39

History and Physical Exam and known allergies Fluid or electrolyte disturbances, gout, glucose tolerance abnormalities, SLE Hyperparathyroidism and bipolar disorder Skin, edema, cardiopulmonary status, weight, I&O Liver status and appropriate lab values

Question 40

Effects of Hypertonic Solutions

Answer 40

Increases intravascular fluid by pulling from interstitial