CH 24: Diuretic drugs Flashcards
examines urine for the presence of blood cells, proteins, pH, specific gravity,
ketones, glucose, and microorganisms.
urinalysis
primary measures of structural kidney damage.
proteinuria and albuminuria
important laboratory tests for detecting
the buildup of nitrogen waste products in the blood.
Serum creatinine and blood urea nitrogen (BUN)
The best marker for estimating kidney function
glomerular filtration rate (GFR),
volume of filtrate passing through the glomerular capsules per minute. T
glomerular filtration rate (GFR),
GFR can be used to predict the:
onset and progression of kidney failure and provides an indication of the kidney’s
ability to excrete drugs from the body.
Kidneys are unable to synthesize
enough erythropoietin for red blood
cell production.
Anemia
treatment for anemia
Epoetin alfa (Epogen, Procrit) or
darbepoetin alfa (Aranesp)
Kidneys are unable to adequately
excrete potassium.
hyperkalemia
treatment for hyperkalemia
Dietary restriction of potassium;
patiromer (Veltassa) or polystyrene
sulfate (Kayexalate) with sorbitol
Kidneys are unable to adequately
excrete phosphate.
Hyperphosphatemia
Hyperphosphatemia treatment
Dietary restriction of phosphate
phosphate binders such as calcium
carbonate (Os-Cal 500, others),
calcium acetate (Calphron, PhosLo),
lanthanum carbonate (Fosrenol),
sucroferric oxyhydroxide (Velphoro)
or sevelamer (Renagel)
Kidneys are unable to excrete
sufficient sodium and water, leading
to water retention.
Hypervolemia
treatment for hypervolemia
Dietary restriction of sodium
loop diuretics in acute conditions
thiazide diuretics in mild conditions
Hyperphosphatemia leads to loss of
calcium.
Hypocalcemia
treatment for hypocalcemia
Usually corrected by reversing the
hyperphosphatemia, but additional
calcium supplements may be
necessary
Kidneys are unable to adequately
excrete metabolic acids.
Metabolic acidosis
treatment for metabolic acidosis
Sodium bicarbonate or sodium citrate
goal of diuretics
trigger the excretion of water and electrolytes from the kidneys, making these drugs a primary
choice in the treatment of renal disease, edema, hypertension, and heart failure.
uses of diuretics
HTN
Heart failure
AKI and CKD
Liver failure or cirrhosis
Pulmonary edema.
Inhibits sodium and chloride reabsorption, excretes potassium
Loop Diuretics
therapeutic uses of loop diuretics
Block reabsorption of Na and Cl
in the nephron loop
adverse effects of loop diuretics
hypokalemia
orthostatic hypotension
tinnitus
nausea
diarrhea
dizziness
fatigue
what to monitor for with loop diuretics
Monitor BP,
pulse rate,
I and 0
Check potassium
Contain sulfa!
Check for allergies
therapeutic effects of furosemide
Can cause large amounts of fluid to be excreted from the kidney quickly
Lower bp
adverse effects of furosemide
Significant hypokalemia
blood dyscrasias
dehydration
ototoxicity
electrolyte imbalances
circulatory collapse
what to monitor for with furosemide
Monitor potassium
Give IV dose over 1-2 minutes-+
diuresis in 5-10 min
After PO dose diuresis in about 30 min
Weigh the client daily
Don’t give at hs
Encourage potassium-containing foods
Ototoxicity with aminoglycocides
Increase chance of lithium toxicity
Monitor for arrythmias
digoxin toxicity
Hydrochlorothiazide: thiazide diuretic
therapeutic effects
Interferes with sodium transport
Decrease edema
Prevent renal calculi
Lower bp
hydrochlorothiazide adverse effects
Hypokalemia
Hyperglycemia
Blurred vision
Loss of Na+
·Dry mouth
Hypotension
Significant hypokalemia
electrolyte depletion
dehydration
hypotension
hyponatremia
hyperglycemia coma
blood dyscrasias
monitor for safety with hydrochlorothiazide
Monitor electrolytes,
especially potassium
I and 0
Monitor BUN and creatinine
Don’t give at hs
Weigh client daily
Encourage potassium-containing foods
Combined with other antihypertensives
have additive or synergistic effects
with hydrochlorothiazide on blood pressure.
Increased risk with NSAIDS nephrotoxicity
Lithium toxicity possible
Digitoxin additive effect
Absorbed in the GI tract
Spare potassium excretion
potassium-sparing diuretics
adverse effects of potassium sparing diuretics
Hyperkalemia
Hyponatremia
Hepatic and renal
damage
safety monitoring for potassium sparing diuretics
Used with other diuretics
Watch with potassium supplements
Spironolactone therapeutic uses
Reduce edema
Lower bp
adverse effects of spironolactone
Tinnitus
Rash
Significant Dysrhythmias (from hyperkalemia)
dehydration
hyponatremia
agranulocytosis
other blood dyscrasias
spironolactone safety monitoring
Give with meals
Avoid salt substitutes containing potassium
Monitor I and 0
ACE inhibitors increased risk of hyperkalemia
Digoxin toxicity risk
Lithium toxicity risk
ASA can increase levels
therapeutic effects of mannitol: osmotic diuretic
Inhibits reabsorption of sodium and water
and draws fluid from the intracellular to to vascular
Decrease ICP
Maintain urine flow pt with AKI
adverse effects of mannitol
thirst and dry mouth
safety monitoring of mannitol
I and O must be measured
Monitor vital signs
Monitor for electrolyte imbalance
I and O a must!
Very Potent!
Can worsen edema
important reminders of implementing diuretics
Teach the patient or caregiver how to monitor pulse and BP. Ensure the proper use and
functioning of any home equipment obtained
Daily Weights!
Daily weights should remain at or close to baseline weight. (An increase in weight over 1 kg (2
lb) per day may indicate excessive fluid gain. A decrease of over 1 kg (2 lb) per day may indicate
excessive diuresis and dehydration.)
Caution with older adult and hypotension!
Rise slowly
Do not take if BP below 90/60
Need regular labwork!
Report tinnitus
Encourage fluids unless contraindicated
educate diuretic pts on SS of:
o hypokalemia
o hyperkalemia
o digoxin toxicity
o hyperglycemia
o gout
take diuretics early in the day to avoid:
nocturia
most frequent cause of AKI
hypoperfusion
