ATI chapter 18 Urinary Medications Flashcards
High- Ceiling Loop Diuretic prototype?
Furosemide (lasix)
others: Torosemide, Ethancrynic acid, Bumetanide
What is Furosemide mechanism of action?
-High-ceiling diuretics work in the loop of Henle
- Block reabsorption of sodium and chloride and prevent water reabsorption
- POTASSIUM WASTING
- Cause diuresis even with renal impairment
- Increases excretion of sodium, chloride, Potassium, magnesium, and calcium
What is Furosemide’s therapeutic use ?
- used for emergent need for rapid mobilization of fluid
- Pulmonary edema caused by heart failure
- Hypertension ( torsemide)
-Conditions not responsive to other diuretics
How fast do you give IV Furosemide?
-Push slowly at 40mg every 1-2 minutes
What are the adverse effects of Furosemide?
-Dehydration
- Hypotension
- Ototoxicity if pushed IV too fast
-Hypokalemia
- Hyperglycemia
- Electrolyte imbalances
What is the first sign of ototoxicity with Furosemide?
- Tinnitus
What are the Nursing education and actions for Furosemide?
- Monitor labs
- access for dehydration
- Report urine output less than 30ml/hr
- Daily weights
- Monitor BP
- Change positions slowly
- Notify provider if Tinnitus is present
- K+ less than 3.5 notify
- consume high K+ foods
- Monitor for s/sx of hypkomeia ( N/V, fatigue, cramps , muscle weakness)
When do you give diuretics and why?
In the morning to avoid Nocturia
What are the Contraindications for Furosemide?
- Contraindicated with individuals with no urine output ( Anuria)
- use caution in patients with hypoprotenemia as it can cause ototoxicity
What does Furosemide interact with
- Digoxin ( Digoxin toxicity can occur in the presence of hypokalemia)
What is the prototype for Thiazide Diuretics ?
Hydrochlorothiazide
-others: Chlorothiazide and Methyclothiazide
What is Thizaide diuretics mechanism of action?
- Work in the early distal convaluted tubule
- blocks the reabsorption of sodium and chloride and water
- Promotes diuresis when renal; function isn’t impaired
What are the Thiazide diuretics therapeutic uses?
- Often first choice medication for hypertension
- edema and mild to moderate heart failure
- often used in combination with antihypertensive medications
-promote reabsorption of calcium and reduce risk for postmenopausal osteoporosis
What are the adverse effects of thiazide diuretic (hydrochlorothiazide)?
-Dehydration
- Hyponatremia
- Hypokalemia
-Hyperglycemia
- electrolyte in balance
What are the Nursing education and actions for Thiazide diuretics?
- monitor for s/sx of dehydration
- Monitor electrolytes
-Monitor weight - Report urine output less than 30ml/her
- monitor cardiac status
- monitor K+ levels (fatigue, weakness, N/V)
- Consume foods high in K+
-monitor for increased BG - change positions slow
What are the contraindications for Thiazide diuretics?
- Pregnancy ( risk for jaundice or thrombocytopenia)
- Lactation ( contraindicated)
- renal impairment
What is the prototype for Potassium-Sparing diuretics?
-Spironolactone
others:
-Triamterene
- Amiloride
What is the mechanism of action for potassium sparing diuretics?
-Blocks the action of aldosterone which results in potassium retention and the excretion of sodium and water
- can be used in combo with other diuretics
- administered for heart failure
How much time to see a therapeutic effect for potassium sparing diuretics?
48-72 hr
What are the adverse effects of potassium sparing diuretics?
-Hyperkalemia
-Endocrine effects
-Gynecomastia
- Metabolic acidosis
What are the Nursing education and actions for potassium sparing diuretics?
-monitor potassium levels (above 5 initiate cardiac monitoring and notify)
-monitor for signs of hyperkalemia ( fatigue, weakness, N/V)
- educate on a low K+ diet
-notify provider for endocrine effects
-monitor for metabolic acidosis ( drowsiness, restlessness)
What are the contraindication for potassium sparing diuretics?
-do not admin to pt with hyperkalemia or who have kidney failure
What is the prototype for Osmotic Diuretics?
Mannitol
What is the mechanism of action for Mannitol
-Reduces intracranial and intraocular pressure by raising serum osmolality
- prevents kidney failure from hypovolemic shock
What are the adverse affects of Mannitol?
- Heart failure (pulmonary edmema)
- Rebound increased intracranial pressure
- metabolic acidosis
- fluid and electrolyte imbalance
What is the nursing action and education for Mannito?
-monitor for s/sx of heart failure ( dyspnea, weakness, fatigue, distended neck veins)
-Monitor for increased ICP (Neuros)
- Monitor electrolyte labs
What are the contraindications for Mannitol?
-Pt who have intracranial bleeds
- use caution with severe dehydration and renal failure
What interacts with Mannitol?
-Lithium excretion is increased (monitor levels
What increases the risk of digoxin toxicity?
Hypokalemia
