ATI chapter 18 Urinary Medications

Question 1

High- Ceiling Loop Diuretic prototype?

Answer 1

Furosemide (lasix)

others: Torosemide, Ethancrynic acid, Bumetanide

Question 2

What is Furosemide mechanism of action?

Answer 2

-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

Question 3

What is Furosemide’s therapeutic use ?

Answer 3

• used for emergent need for rapid mobilization of fluid
• Pulmonary edema caused by heart failure
• Hypertension ( torsemide)
  -Conditions not responsive to other diuretics

Question 4

How fast do you give IV Furosemide?

Answer 4

-Push slowly at 40mg every 1-2 minutes

Question 5

What are the adverse effects of Furosemide?

Answer 5

-Dehydration
- Hypotension
- Ototoxicity if pushed IV too fast
-Hypokalemia
- Hyperglycemia
- Electrolyte imbalances

Question 6

What is the first sign of ototoxicity with Furosemide?

Answer 6

• Tinnitus

Question 7

What are the Nursing education and actions for Furosemide?

Answer 7

• 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)

Question 8

When do you give diuretics and why?

Answer 8

In the morning to avoid Nocturia

Question 9

What are the Contraindications for Furosemide?

Answer 9

• Contraindicated with individuals with no urine output ( Anuria)
• use caution in patients with hypoprotenemia as it can cause ototoxicity

Question 10

What does Furosemide interact with

Answer 10

• Digoxin ( Digoxin toxicity can occur in the presence of hypokalemia)

Question 11

What is the prototype for Thiazide Diuretics ?

Answer 11

Hydrochlorothiazide

-others: Chlorothiazide and Methyclothiazide

Question 12

What is Thizaide diuretics mechanism of action?

Answer 12

• Work in the early distal convaluted tubule
• blocks the reabsorption of sodium and chloride and water
• Promotes diuresis when renal; function isn’t impaired

Question 13

What are the Thiazide diuretics therapeutic uses?

Answer 13

• 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

Question 14

What are the adverse effects of thiazide diuretic (hydrochlorothiazide)?

Answer 14

-Dehydration
- Hyponatremia
- Hypokalemia
-Hyperglycemia
- electrolyte in balance

Question 15

What are the Nursing education and actions for Thiazide diuretics?

Answer 15

• 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

Question 16

What are the contraindications for Thiazide diuretics?

Answer 16

• Pregnancy ( risk for jaundice or thrombocytopenia)
• Lactation ( contraindicated)
• renal impairment

Question 17

What is the prototype for Potassium-Sparing diuretics?

Answer 17

-Spironolactone

others:
-Triamterene
- Amiloride

Question 18

What is the mechanism of action for potassium sparing diuretics?

Answer 18

-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

Question 19

How much time to see a therapeutic effect for potassium sparing diuretics?

Answer 19

48-72 hr

Question 20

What are the adverse effects of potassium sparing diuretics?

Answer 20

-Hyperkalemia
-Endocrine effects
-Gynecomastia
- Metabolic acidosis

Question 21

What are the Nursing education and actions for potassium sparing diuretics?

Answer 21

-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)

Question 22

What are the contraindication for potassium sparing diuretics?

Answer 22

-do not admin to pt with hyperkalemia or who have kidney failure

Question 23

What is the prototype for Osmotic Diuretics?

Answer 23

Mannitol

Question 24

What is the mechanism of action for Mannitol

Answer 24

-Reduces intracranial and intraocular pressure by raising serum osmolality
- prevents kidney failure from hypovolemic shock

Question 25

What are the adverse affects of Mannitol?

Answer 25

• Heart failure (pulmonary edmema)
• Rebound increased intracranial pressure
• metabolic acidosis
• fluid and electrolyte imbalance

Question 26

What is the nursing action and education for Mannito?

Answer 26

-monitor for s/sx of heart failure ( dyspnea, weakness, fatigue, distended neck veins)
-Monitor for increased ICP (Neuros)
- Monitor electrolyte labs

Question 27

What are the contraindications for Mannitol?

Answer 27

-Pt who have intracranial bleeds
- use caution with severe dehydration and renal failure

Question 28

What interacts with Mannitol?

Answer 28

-Lithium excretion is increased (monitor levels

Question 29

What increases the risk of digoxin toxicity?

Answer 29

Hypokalemia