Medications Affecting Urinary Output (Loop Diuretics)

Question 1

Medications that affect urinary output include…

Answer 1

-high-ceiling loop diuretics
-thiazide diuretics
-potassium-sparing diuretics
-osmotic diuretics

Question 2

What is the main high-ceiling loop diuretic?

Answer 2

Furosemide

Question 3

What are the other meds for high-ceiling loop diuretics?

Answer 3

-(E)thacrynic acid
-(B)umetanide
-(T)orsemide
-(E)thacrynic acid

Question 4

What is the purpose for high-ceiling loop diuretics?

Answer 4

-Block reabsorption of sodium and chloride and prevent reabsorption of water
-Cause extensive diuresis even with severe renal impairment

Question 5

When are high-ceiling loop diuretics used?

Answer 5

When there is an emergent need for rapid mobilization of fluid.

Question 6

What are other uses for high-ceiling diuretics?

Answer 6

-Pulmonary edema caused by heart failure
-Conditions not responsive to other diuretics (edema caused by liver, cardiac, or kidney disease/hypertension.

Question 7

Unlabeled used of high-ceiling diuretics

Answer 7

Hypercalcemia

Question 8

Route of Administration for high-ceiling diuretics

Answer 8

Oral, IV, IM

Question 9

1st complications of High-ceiling loop diuretics

Answer 9

Dehydration, hyponatremia, hypochloremia

Question 10

2nd complications of high-ceiling loop diuretics

Answer 10

-Hypotension
-Ototoxicity
-Hypokalemia

Question 11

Other adverse effects of high-ceiling loop diuretics

Answer 11

-Hyperglycemia
-Hyperuricemia
-Hypocalcemia
-HypoMagnesemia
-decrease in HDL cholesterol levels
-increase in LDL cholesterol levels

Question 12

High-ceiling loop diuretics Contraindications/Precautions 1

Answer 12

-Avoid meds in pregos unless absolutely required
-Furosemide can decrease milk production in breastfeeding clients
-Contraindicated in clients with anuria(no urine)

Question 13

High-ceiling loop diuretic precautions 2

Answer 13

-clients with cardiovascular disease, DM, dehydration, electrolyte depletion and gout

Question 14

High-ceiling loop diuretic precautions 3

Answer 14

-Clients taking digoxin, lithium, ototoxic meds, NSAIDS, or antihypertensives.

Question 15

When someone is taking high-ceiling loop diuretics and has hypokalemia, what toxicity can occur?

Answer 15

Digoxin(ventricular dysrhythmias)

Question 16

Nursing Actions of Digoxin Toxicity with hypokalemia

Answer 16

-Monitor cardiac status and potassium and digoxin levels
-Potassium-sparing diuretics in conjunction with loop diuretics to reduce risk of hypokalemia
-Administer potassium supplements as prescribed by provider

Question 17

Concurrent use of antihypertensive and loop diuretics can have what type of effect?

Answer 17

Additive hypotensive effect
-Monitor blood pressure

Question 18

What can happen if hyponatremia occurs due to the loop diuretic?

Answer 18

Lithium carbonate blood leaves can increase which leads to toxicity
-monitor lithium levels and adjust dosage if needed

Question 19

When interacting with loop diuretics…

Answer 19

NSAIDS can decrease blood flow to the kidneys which reduce the diuretic effect.
-watch for decrease in effectiveness of diuretic (decrease in urine output)

Question 20

Nursing Administration of Loop Diuretics 1

Answer 20

-Obtain baseline data, include orthostatic blood pressure, weight, electrolytes and location/extent of edema
-Weigh clients same day/time same amt of clothing upon wakening

Question 21

Nursing Administration of Loop Diuretics 2

Answer 21

-Monitor blood pressure and I&O
-Avoid giving meds late in day to prevent nocturia(dose time 0800 and 1400.

Question 22

Nursing Administration of Loop Diuretics 3

Answer 22

Administer furosemide orally, IM, IV bolus at 20 mg/min or slower to avoid abrupt hypotension/hypovolemia

Question 23

Nursing Administration of Loop Diuretic 4

Answer 23

If potassium level drops below 3.5 mEq/L, monitor the ECG and notify provider in case of potassium supplement.

Question 24

Loop Diuretic Client Education 1

Answer 24

-If med is used for hypertension, self-monitor blood pressure and weight by keeping log
-Get up slowly to minimize postural hypotension and monitor blood pressure and assess for hypovolemia.

Question 25

Loop Diuretic Client Education 2

Answer 25

-If faintness or dizziness occurs, instruct clients to sit or lie down.
-Report significant weight loss, lightheadedness, dizziness, GI distress, or general weakness. Can indicate hypokalemia or hypovolemia.

Question 25

Loop Diuretic Client Education 3

Answer 25

-Consume foods high in potassium
-If diabetic monitor for elevated blood glucose levels
-Observe for low magnesium levels(weakness, muscle twitching, tremors)

Question 26

Loop Diuretic Client Education 4

Answer 26

-Observe for manifestations of low calcium levels(muscle twitching, muscle cramps, tingling in hands and feet)
-Manifestations of ototoxicity(tinnitus or hearing loss)

Question 27

Nursing evaluation of medication effectiveness for loop diuretics

Answer 27

-Decrease in pulmonary/peripheral edema
-Weight loss
-Decrease in blood pressure
-Increase in urine output
-Decrease in calcium level