Cardiac Glycosides and Diuretics

Question 1

what does RAAS do?

Answer 1

regulates BP and vascular resistance

Question 2

what does angiotensin II do?

Answer 2

potent vasoconstrictor with a short half-life (1-2 minutes)

Question 3

what does aldosterone do?

Answer 3

balance Na+ and K+ in the blood (too much causes loss of K+ and retention of Na+ which causes H20 presentation)

Question 4

what is the goal of treating heart failure pts?

Answer 4

to not allow them to get to angiotensin II

Question 5

what are 1st treatments for pts with heart failure?

Answer 5

• ace inhibitors
• ARBS
• diuretics
• beta-blockers

Question 6

what is a 2nd line treatment for pts with heart failure?

Answer 6

digoxin

Question 7

what do ARBS do?

Answer 7

they block angiotensin II receptors which relaxes vessels and allows for more blood flow

Question 8

how does digoxin work?

Answer 8

• increases the force of muscle contraction but inhibiting sodium and potassium
• decreases SA and AV node stimulation which decreases HR

Question 9

what is the action of calcium?

Answer 9

contraction

Question 10

is digoxin inotropic?

Answer 10

yes - it modifies the force and speed of contraction of muscles

Question 11

when should digoxin be used?

Answer 11

• HF in adults and children

- chronic Afib (helps with rate control)

Question 12

what are some adverse effects of digoxin?

Answer 12

• bradycardia
• nausea and vomiting
• anorexia
• headache
• restlessness
• PVC
• hyperkalemia
• confusion
• visual disturbances - colorful halos and yellow tint
• dig toxicity

Question 13

what does the adverse effect of PVC mean when taking digoxin?

Answer 13

premature ventricular contraction - 1st warning sign, abnormal heartbeat

Question 14

what is the normal value for potassium?

Answer 14

3.5-5

Question 15

what is the normal therapeutic range for digoxin?

Answer 15

0.5-0.8 (very small range)

Question 16

what is digtoxicity?

Answer 16

a dig level greater than 2

Question 17

how does a decrease in potassium relate to digtoxicity?

Answer 17

a decrease in potassium increases the risk for digtoxicity because dig binds to potassium sites so less potassium creates more sites for dig to bind to
- best bet is to keep k+ in its normal range

Question 18

how do you treat digtoxicity?

Answer 18

typically on treat the symptoms

• atropine for bradycardia
• potassium to decrease MI function

Question 19

when should you call the physician related to digtoxicity and bradycardia?

Answer 19

• hr less than 60 in adults

- hr less than 70 in kids

Question 20

what is education needed with digoxin?

Answer 20

• take with food to avoid GI upset
• don’t eat black licorice or milk wheat because it will increase dig levels
• thyroid medication with increase dig levels

Question 21

what is the antidote for digoxin and when is it used?

Answer 21

digoxin immune fab - used only in life-threatening emergencies

Question 22

what is a loop diuretic?

Answer 22

1st line of action for fluid volume excess

Question 23

where does the action for a loop diuretic take place?

Answer 23

loop of Henle

Question 24

what is the action of loop diuretics?

Answer 24

increase urine output/diuresis, inhibit the reabsorption of Na+ and Cl which creates an osmotic pressure that blocks the passive reabsorption of water

Question 25

what is stronger: loop diuretic or thiazide diuretic?

Answer 25

loop diuretic is 10x stronger than a thiazide diuretic

Question 26

what would a loop diuretic be used for?

Answer 26

- HTN - pulmonary edema - HF - ARF - blood transfusions

Question 27

what are some adverse effects of loop diuretics?

Answer 27

- ototoxicity - fluid/electrolyte imbalance - increased blood glucose (watch with diabetes)

Question 28

true or false: loop diuretics are titrated

Answer 28

true - start low and increase

Question 29

what supplements might people on loop diuretics take?

Answer 29

K+ supplements to avoid hypokalemia

Question 30

what are some side effects of hypokalemia?

Answer 30

less than 3.5 - tired, cramps, SOB, numbness, brain fog

Question 31

what are thiazide diuretics?

Answer 31

combination of 2 diuretics to balance loss and sparing of K+

Question 32

what are some examples of loop diuretics?

Answer 32

furosemide (lasix), bumetanide (bumex), torsemide (demadex)

Question 33

what is the action of a thiazide diuretic?

Answer 33

decrease reabsorption of Na+, water, Cl, and bicarbonate

Question 34

what are some uses for a thiazide diuretic?

Answer 34

- edema | - HF

Question 35

what are some examples of thiazide diuretics?

Answer 35

hydrochlorothiazide (microzide), chlorothiazide (diuril), metolazone (zaroxolyn)

Question 36

what education is needed for thiazide diuretic?

Answer 36

- adequate intake of fluids (not enough fluids will cause a decreased blood volume which will decrease BP and cause dizziness) - don't take in the evening to avoid peeing at night - stand up slowly due to orthostatic hypotension - more susceptible to sunburn - meds with lithium can decrease potassium levels

Question 37

what are potassium-sparing diuretics?

Answer 37

diuretics that don't get rid of potassium

Question 38

what is the action of potassium-sparing diuretics?

Answer 38

blocks the effect of aldosterone (salt and water regulation)

Question 39

what are examples of potassium-sparing diuretics?

Answer 39

spironolactone (Aldactone), amiloride (midamor), and triamterene (dyrenium)

Question 40

what are some adverse effects of potassium-sparing diuretics?

Answer 40

- deepen voice - decreased BP - irregular menstruation - abdominal cramping - diarrhea - headache - electrolyte imbalance effects steroid receptors

Question 41

potassium-sparing diuretics increase the risk of ...

Answer 41

hyperkalemia

Question 42

what are the side effects of hyperkalemia?

Answer 42

- diarrhea - muscle spasms - bradycardia - nausea - chest pain - tingling - abnormal heart rhythm - decreased reflexes

Question 43

what is the black box warning with potassium-sparing diuretics?

Answer 43

tumorigenic - increased risk of tumors

Question 44

what pt education is needed with a potassium-sparing diuretic?

Answer 44

monitor BP and avoid operating heavy machinery

Question 45

what do osmotic diuretics do?

Answer 45

lower intracranial pressure and for short-term reduction of intraocular pressure

Question 46

what is the action of osmotic diuretics?

Answer 46

- increase osmotic pressure - increase blood volume - decrease water and electrolyte reabsorption

Question 47

what are the adverse effects of osmotic diuretics?

Answer 47

- angina - dizziness - HF

Question 48

what are the uses of osmotic diuretics?

Answer 48

- trauma - oliguria - decrease ICP - anuria - hypovolemic shock - dehydration - prevention of ARF - hypotension

Question 49

pt education needed for osmotic diuretics?

Answer 49

- monitor BP - assess for dehydration - maintain electrolyte balance