Exam 2- Renal

Question 1

Where do Carbonic anhydrase inhibitors act

Answer 1

Proximal convoluted tubule

Question 2

Where do Osmotic diuretics act

Answer 2

Loop of henle

and anywhere that is water permeable

Question 3

Where do Loop diuretics act

Answer 3

Ascending loop of henle

Question 4

Where do Thiazide diuretics act

Answer 4

Distal convoluted tubule

Question 5

Where do Potassium sparing diuretics act

Answer 5

Collecting duct

Question 6

Nursing Implications: Diuretics (6)

Answer 6

1. Monitor intake and output
2. Monitor electrolytes
3. Complete health history
4. Monitor vitals frequently
5. Administer early in the day, allow access to bathroom
6. Safety precautions (esp. elderly)

Question 7

Nursing Implication specifically for Lasix

Answer 7

Will usually be administered with a K+ supplement (PO KCL normally)

Question 8

Furosemide (Lasix) class

Answer 8

Loop diuretic (most effective diuretic)

Question 9

Furosemide (Lasix) MOA/Onset

Answer 9

Acts on ascending loop of Henle to block reabsorption of sodium, chloride, and water. Excretion of potassium is increased
- Rapid onset (PO 60 min, IV 5 min)

Question 10

Furosemide (Lasix) Indications (3)

Answer 10

• Anytime you need rapid diuresis (e.g. Pulmonary edema)
• Edematous states
• Hypertension

Question 11

Furosemide (Lasix) Adverse effects (7)

Answer 11

• Hypokalemia
• Hyponatremia
• Hypochloremia
• Dehydration
• Hypotension
• Hyperuricemia
• Ototoxicity

Question 12

Lasix + Digoxin, corticosteroids, amphotericin B =

Answer 12

Danger of hypokalemia

Question 13

Lasix + lithium =

Answer 13

Increased excretion of lithium

Question 14

Lasix + sulonylureas and insulin =

Answer 14

Diminished hypoglycemic effect

Question 15

Lasix + NSAID’s =

Answer 15

diminished diuretic effect

Question 16

Lasix + antihypertensives

Answer 16

increased risk of hypotension

Question 17

Hydrochlorothiazide (Microzide) class

Answer 17

Thiazide

- Most commonly prescribed

Question 18

Hydrochlorothiazide (Microzide) MOA

Answer 18

Block sodium reabsorption at the distal tubule

Question 19

Hydrochlorothiazide (Microzide) Indications (3)

Answer 19

• Hypertension (first choice med!!)
• Diabetes Insipidus
• Edema

Question 20

Hydrochlorothiazide (Microzide) Side Effects (6)

Answer 20

(almost same as Lasix)

• Hypokalemia
• Hyponatremia
• Hypochloremia
• Dehydration
• Hypotension
• Hyperuricemia

Question 21

Hydrochlorothiazide (Microzide) Contraindications

Answer 21

Don’t use if creatinine clearance is less than 30-50 mL/min

Question 22

Mannitol (Osmitrol) class

Answer 22

Osmotic diuretic

Question 23

Mannitol (Osmitrol) MOA

Answer 23

Cause diuresis by increasing the osmolality (number of solutes) of the filtrate.
This causes water to shift compartments due to osmotic pressure.
In addition to increasing renal osmolality they also cause changes in osmolality throughout the body.
(pulling of fluid out of spaces is the main use of the drug)

Question 24

Mannitol (Osmitrol) Indications (3)

Answer 24

Traumatic head injury, glaucoma, high intraocular pressure

Question 25

Mannitol (Osmitrol) Adverse Effects

Answer 25

Electrolyte imbalance - Can cause either HYPO or HYPER kalemia and natremia. (HypER when pulling solute into intravascular space, HypO when increasing excretion of Na+ and K+ in urine) Fluid volume instability - Fluid overload when in vascular space - Dehydration when excreted - Dangerous in CHF due to fluid pulling

Question 26

Spironolactone (Aldactone) class

Answer 26

potassium sparing

Question 27

Spironolactone (Aldactone) MOA

Answer 27

Spironolactone acts by inhibiting the actions of aldosterone in the distal tubule and collecting ducts of the nephron. When the actions of aldosterone are blocked by spironolactone, sodium, chloride, and water excretion are increased and the body retains potassium.

Question 28

Spironolactone (Aldactone) Indications (4)

Answer 28

- Mild HTN - Useful in patients who need diuresis and are at high risk for hypokalemia - sodium retention associated with HF - edema or ascites in patients with hepatic cirrhosis, because it counteracts the large amount of aldosterone secreted by these patients.

Question 29

Spironolactone (Aldactone) Side Effects

Answer 29

- Hyperkalemia- can lead to life-threatening cardiac dysrhythmias. - Hormonal changes: In men, spironolactone can cause gynecomastia, impotence, and diminished libido. - Women may experience menstrual irregularities, hirsutism, and breast tenderness. Fertility may decrease during therapy.

Question 30

Spironolactone (Aldactone) Black box warning

Answer 30

Spironolactone produces tumors in laboratory animals; unnecessary use of the drug should be avoided.

Question 31

Spironolactone (Aldactone) CI/Cautions (5)

Answer 31

- Using potassium supplements or adding potassium-rich foods to the diet when taking these medications may lead to life- threatening hyperkalemia. - Anuria - severe renal impairment - Pregnancy - Caution in older patients and those with renal insufficiency or diabetes mellitus (high risk for hyperkalemia)

Question 32

Spironolactone (Aldactone) Drug Interactions (3)

Answer 32

- When combined with ammonium chloride, acidosis may occur. - Aspirin and other salicylates may decrease the diuretic effect of the medication. - Concurrent use with digoxin may decrease the effects of digoxin.

Question 33

Sodium Chloride (NaCl) indication

Answer 33

- treatment or prevention of sodium depletion when dietary measures are inadequate

Question 34

Sodium Chloride (NaCl) side effects

Answer 34

- HYPER natremia (too much sodium) | - Pulmonary edema in more concentrated solutions

Question 35

Signs of hypernatremia

Answer 35

lethargy, confusion, hypotension, restlessness, rigidity

Question 36

Potassium Chloride (KCl) indications

Answer 36

- treatment of potassium depletion when dietary means are not sufficient - Stop irregular heartbeats - Management of tachydysrhythmias that can occur after cardiac surgery

Question 37

KCl parenteral infusion implications

Answer 37

- IV potassium must not be given at a rate faster than 10 mEq/hr to patients who are not on cardiac monitors. - For critically ill patients on cardiac monitors, rates of 20 mEq/hr or more may be used - NEVER give as an IV bolus or undiluted

Question 38

Magnesium Sulfate (MgSO4) Indications (3)

Answer 38

- Severe hypomagnesemia - Catharsis of colon (milk of magnesia) - Anticonvulsant in patients with preeclampsia or eclampsia

Question 39

MgSO4 side effects (6)

Answer 39

- Flushing of the skin - Diarrhea - Sedation/Confusion - Muscle weakness --> Neuromuscular blockade - Respiratory paralysis - Heart block, Circulatory collapse

Question 40

MgSO4 nursing implications (6)

Answer 40

- Assess vital signs every 10 to 15 minutes when the drug is given IV - Monitor serum magnesium levels - Assess for early indicators of magnesium toxicity - Notify if respiratory rate falls below 12 breaths/minute - Test the patellar reflex before each repeated parenteral dose - Assess baseline and periodic urinary output; discontinue therapy if output less than 100 mL in preceding 4 hours

Question 41

MgSO4 Toxicity/Antidote

Answer 41

- BP decreased, Urine output decreased, Respiratory rate <12, patella reflex absent - Calcium gluconate

Question 42

Sodium Bicarbonate Indications (3)

Answer 42

- Correct metabolic acidosis - Alkalinize urine to speed the excretion of acidic medications - Neutralizes the metabolic acidosis that occurs in chronic renal failure

Question 43

Sodium Bicarbonate MOA

Answer 43

Bicarbonate ion buffers excess acid (H) to raise the pH of body fluids

Question 44

Sodium Bicarbonate side effects (5)

Answer 44

- Metabolic alkalosis - Confusion - Irritability - Slow respiration rate - Vomiting

Question 45

Sodium Bicarbonate CI/cautions

Answer 45

- Vomiting, Severe diarrhea or Continuous GI suctioning (all are losing acid and at risk for metabolic alkalosis) - Poor ventilation Precautions: - Cardiac disease - Renal impairment