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Pharm 2 (diuretics & aldosterone antagonists) > diuretics updated > Flashcards

diuretics updated Flashcards

1
Q

Diuretics GOAL

A

increase rate of urine formation
Increase urine volume
net loss of solute (electrolytes) and water

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2
Q

Osmotic Diuretics GOAL

A

Increase osmotic pressure of tubular filtrate
fluid moved from ICF to ECF, inhibits renin release
Increases renal blood flow
excretion of electrolytes–Na, K, Ca, Mg, Cl, HCO3, Phosphate

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3
Q

Osmotic Diuretics
Mannitol (Osmitrol)

Uses

A
  • reduce CSF pressure– with cerebral edema or pre or post neuro surgery
  • Reduce intraocular pressure–glaucoma and pre-op
  • Increase urine flow to prevent nephrotoxicity–dilute toxic substances
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4
Q

Osmotic Diuretics
Mannitol (Osmitrol)

Adverse effects

A
  • Headache, nausea, vomiting
  • with CHF–risk of fluid overload by increased ECF
  • Contraindicated with CHF, renal failure, hepatic failure
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5
Q

Osmotic Diuretics
Mannitol (Osmitrol)

Nursing Implementations

A
  • Give IV via filter
  • Monitor output, BP
  • Lungs sounds
  • Serum osmolality, electrolytes
  • Intracranial pressure
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6
Q

Carbonic Anhydrase Inhibitors GOAL

A
  • Lower intracellular pressure (IOP)
  • Not increase urine production
    • urine alkalizes, metabolic acidosis a risk
    • marked potassium excretion
    • Reduce aqueous humor production by (Ca inhibition in ciliary processses of the eye
    • Reduce intraocular pressure
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7
Q

Carbonic Anhydrase Inhibitors
Acetazolamide (Diamox)

Uses

A
  • Glaucoma, eye surgery
  • Allalinize urine for drug excretion
  • Altitude sickness
    (low to Mod. Efficacy to mobilize edema)
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8
Q

Carbonic Anhydrase Inhibitors
Acetazolamide (Diamox)

Adverse Effects

A
  • Sulfoamide derivatives (watch for sulfa drug allergies)
  • Hypokalemia (cause to loose potassium)
  • Metabolic acidosis (contraindicated with COPD (Resp Acidosis))
  • Paresthesias (pins and needles)
  • Risk of renal calculus R/T CaPO4 precipitation in alkaline urine (stay hydrated)
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9
Q

Thiazide Diuretics Goal

A
  • Sulfonamide derivatives
  • Increase excretion of Na+ and H2O
  • Increase excretion of K+
  • Loss of Mg+
  • Retention of Ca++
    Some antihypertensive effect
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10
Q

Thiazide Diuretics
Hydrochlorothiazide(HCTZ, Hydrodiuril)

Uses

A
  • Edema in mild-Mod CHF
  • Treat Hypertension –Mild-Mod HTN –often first line drug
  • Edema in hepatic disease
  • early, mild renal disease – less effective with more advanced disease
  • Combo’s with antihypertensive–synergistic effects
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11
Q

Thiazide Diuretics
*Hydrochlorothiazide(HCTZ, Hydrodiuril)

Adverse effects

A
  • Electrolyte loss –esp K+
  • Loss of other electrolytes –Na+, Cl-, H+
  • Retain Ca++, Uric acid
  • Renal insufficiency aggravated
  • Hyperglycemia in diabetics–reduces effectiveness of oral agents and Insulin
  • Hyperlipidemia
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12
Q

Thiazide Diuretics
*Hydrochlorothiazide(HCTZ, Hydrodiuril)

Nursing interventions

A 
Monitor BP, K+, edema
monitor BG's for diabetics
May need potassium supplements
K+ containing foods: citrus, bananas, salt substitutes etc 
Check for sulfa allergy
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13
Q

Loop Diuretics –High Ceiling– Goals

A

inhibit electrolyte re absorption in ascending loop of Henle, weak carbonic anhydrase effects
increase renal blood flow
some decrease in BP–? Prostaglandidn effect
Increase loss of K+, Mg, acid, ammonia (liver failure)
Rapid onset, short duration–except in renal, hepatic disease
Sulfa derivatives (allergies)

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14
Q

Loop Diuretics
Furosemide (Lasix)

Uses

A

edema of cardiac, renal, hepatic origin
acute pulmonary edema
early renal failure, nephrotic syndrome
hypertension

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15
Q

Loop Diuretics
Furosemide (Lasix)

Adverse Effects

A

Electrolyte loss – K+, Na++
Sulfa Allergy (except Ethacrynic acid)
Ototoxicity – high dose–reversible (Ethacrynic acid worse)
Hypotension – high dose – Esp. IV
Diabetics – hyperglycemia ( up BG)
long term –Ca++ or Mg+ loss
Increased LDL, Cholesterol, Triglycerides

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16
Q

Loop Diuretics
Furosemide (Lasix)

Nursing implications

A

monitor I&O, BP, electrolytes– K+, may need K+ supplements
edema, daily weight
toxicity
provide means to void or cath (30 min)
PO – 8 hour duration– give early in the day
diabetics–monitor glucose

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17
Q

Aldosterone antagonists GOAL

A

Potassium sparing diuretics
competitive antagonists of aldosterone
loss of sodium, water: CONSERVATION OF POTASSIUM
SLOW ONSET 24-48 HOURS

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18
Q

Aldosterone antagonists
Spironalactone (Aldactone)

Uses

A

hypertension, edema
drug of choice for edema and ascites with hepatic disease
some use with CHF
treat primary hyperaldosteronism (adrenal tumors)

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19
Q

antagonists
Spironalactone (Aldactone)

Adverse Effects

A

hyperkalemia (affinity for progesterone and androgen receptors)
gynecomastia, impotence, menstrual irregularity (not with eplerenone)

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20
Q

antagonists
Spironalactone (Aldactone)

Nursing implementations

A

CAUTION WHEN COMBINED WITH OTHER DIURETICS, ACE INHIBITORS OR IN RENAL DISEASE, NO POTASSIUM SUPPLEMENTS

ALSO NOT SALT SUBSTITUTES( they contain KCl

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21
Q

Why Combos??

A

Better diuresis with 2 sites of action
usually less problem with K+
Effects vary **STILL MONITOR K+**

22
Q

Other Combos

A

thiazides with antihypertensives ***MUST KNOW OTHER COMBOS

23
Q

Nitrates Goals

A

Source of nitric oxide–leads to relaxation of vascular smooth muscle by
dilate arterial and venous smooth muscle
reduce myocardial oxygen demands/ dilate coronary vessels/reduce preload and afterload
No change in heart rate or force of contraction

24
Q

Nitrates has other effects

A

Dilate smooth muscle – GI tract – especially esophagus
Nitrate dependence/tolerance–mechanism not clear but is not universal.(some develop only partial tolerance)
Ideally, interrupt therapy for 8-12 hours/day

25
Nitrate ***Nitroglycerin (NTG)*** Uses:
treat or prevent angina chest pain with MI may reduce the size of MI adjunct therapy for CHG
26
Nitrate ***Nitroglycerin (NTG)*** Adverse effects
Headache flushing, dizziness, arteriole vasodilation hypo tension -- especially postural, worse with ETOH treat with supine position if Bp too low to provide adequate cardiac output can worsen ischemia
27
Nitrate ***Nitroglycerin (NTG)*** Interactions:
with phosphodiesterase-5 inhibitors (Viagra) These also increase nitric oxide can cause extreme hypo tension (treat with fluids and alpha agonist ) ***MUST NOT USE NITRATES WITHIN 24 HOURS OF VIAGRA, ETC***
28
Nitrate ***Nitroglycerin (NTG)*** IV
titrate to reduce chest pain in ACS (MI, unstable angina) Reduce preload-->reduce pulmonary congestion in acute CHF Rapid onset/ short duration maintain BP >100 systolic // min to min BP observe for headache
29
Nitrate ***Nitroglycerin (NTG)*** Sub lingual
Onset 1-2 min, relief in ~3 min (spray is faster) DO NOT SWALLOW rinse mouth if dry before giving tablets or spray deteriorates in heat and light/ keep in dark, tightly closed container
30
Angina teach
rest with pain take NTG SL, repeat in 5 min if needed if NO RELIEF after 3 NTG call 911 rise slowly ETOH will increase any side effects
31
Nitrate ***Nitroglycerin (NTG)*** Trans dermal patch
slow onset, peak 1-2 hours, lasts 24 hours place where visible, non-hairy, not over bony prominences change every 24 hours or so
32
Nitrate ***Nitroglycerin (NTG)*** Paste
``` relieve ACUTE angina onset ~ 30-60 min, duration 4 hours measured in inches same placement as patch cover with occlusive material ```
33
Nitrate ***Nitroglycerin (NTG)*** Oral Pills/ capsules
for more than occasional angina some debate on effectiveness--requires high enough dose to develop tolerance and increase risk of adverse reaction
34
Nitrate | ***Nitroprusside (Nipride)*** goal
relax arteriole and venous smooth muscle reduce preload and afterload releases cyanide ion from smooth muscle worse over time (3-4 days) toxicity, worse in renal disease
35
Nitrate ***Nitroprusside (Nipride)*** use
Treat hypertensive crisis | treat severe CHF (with inotropics)
36
Nitrate ***Nitroprusside (Nipride)*** given
``` IV--via pump, titrate to effect rapid onset (1-2) min short duration(3min) ```
37
Nitrate ***Nitroprusside (Nipride)*** nursing interventions
monitor BP frequently (arterial cath) Monitor thiocyanate levels (IV pump usually only given in ICU setting)
38
Inotropic Medications ***Digoxin (Lanoxin)*** Uses
used for CHF to slow ventricular rate in atrial fibrillation and flutter IT INCREASES CONTRACTILITY IN CHF DUE TO POTENTIAL TOXICITIES, RESERVED FOR THOSE UNRESPONSIVE TO ACE INHIBITORS AND BETA BLOCKERS
39
Inotropic Medications ***Digoxin (Lanoxin)*** Adverse Effects
High risk for Toxicity narrow range of therapeutic index or range risk increases with renal disease , hypokalemia
40
Inotropic Medications ***Digoxin (Lanoxin)*** Toxicity
``` nausea, vomiting, diarrhea malaise, confusion Bradycardia, leads to heart block ventricular tachycardia, fibrillation ***Visual effects : blurred vision, halos around lights, seeing yellow/red spots ```
41
Inotropic Medications ***Digoxin (Lanoxin)*** treat toxicity
stop drug, treat dysrhythmias get serum drug level ***Digozin immune Fab (Digibing)*** binds digoxin, readily excreted, monitor K+
42
Inotropic Medications ***Digoxin (Lanoxin)*** Nursing implications
Can give PO or IV digitalization--can take a week to reach steady state use loading doses to reach steady state in 24 hours--not often used monitor therapeutic blood levels check apical pulse 1 min before giving hold if 120 monitor K+ especially with diuretics rapid digitalization requires cardiac monitoring
43
Inotropic Medications ***Dopamine (Intropin)*** Goal
it is positively chronotropic it is positively inotropic increases cardiac output with minimal increase in myocardial oxygen consumption
44
Inotropic Medications ***Dopamine (Intropin)*** Uses
treat hypotension in shock | Severe CHF or cardiogenic shock (short term)
45
Inotropic Medications ***Dopamine (Intropin)*** nursing
given via IV pump in ICU setting dose calculated by weight --mcg/kg/min--verify calculations Arterial BP, cardiac output IV site for extravasation--risk for tissue necrosis due to vasoconstriction EKG for tachycardia urine output for renal function
46
Inotropic Medications ***Dopamine (Intropin)*** Doses
``` low dose: affects Dopamine receptors dilate renal and mesenteric vessels improve response to diuretics Mod dose: affect Beta 1 receptors increase heart rate, contracitlity some increase in BP due to norepinephrine release High dose: affects Alpha receptors increase BP, vasoconstriction most useful in shock (sepsis, anaphylaxis) ```
47
***Nesiritide (Natrecor)*** what is it
human b-type natriuretic peptide (hBNP) Endogenous hBNP secreted by ventricles in response to fluid and pressure overload
48
***Nesiritide (Natrecor)*** Goal
reduce preload and afterload natriuresis, diuresis, suppress renin-angiotensin system lowers norepinephrine effects enhances endogenous hBNP function reduces pulmonary capillary wedge pressure and dyspnea can see hypotension can use for acute CHF treatment--given IV can be combined with diuretics, others CHF meds
49
Also remember
ACE inhibitors--reduce afterload, decrease ventricular remodeling (first line drugs for CHF
50
And remember this too
Beta-Blocker --Carvedilol --(mixed alpha 1 and Beta) reduce afterload antiproliferative properties

Pharm 2 (diuretics & aldosterone antagonists) (1 decks)

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