ch 37 - second A

Question 1

what drug class helps in treating hypertension and mobilizes edematous fluid associated with heart failure, cirrhosis or kidney disease?

Answer 1

Diuretics

Question 2

3 basic renal processes

Answer 2

Filtration
reabsorption
secretion

Question 3

Out of reabsorption and secretion, which renal process is more important

Answer 3

reabsorption

Question 4

diuretics work primarily by interfering with what renal process

Answer 4

reabsorption

Question 5

what part of the loop of Henle is freely permeable to water

Answer 5

Descending limb

Question 6

what basic mechanism of action do most diuretics share

Answer 6

blockade of sodium and chloride reabsorption

Question 7

drugs that act early in the nephron have the opportunity to

Answer 7

block the greatest amount of solute reabsorption which produces the greatest diuresis

Question 8

what are the 3 most common adverse effects for diuretics

Answer 8

acid base imbalance
hypovolemia
altered electrolyte levels

Question 9

adverse effects of diuretics can be minimized by

Answer 9

using a short acting diuretic
timing drug administration such that the kidney is allowed to operate in a drug free manner in between periods of diuresis

Question 10

what type of diuretics is the most effective

Answer 10

loop diuretics

Question 11

site of action for loop diuretics

Answer 11

loop of henle (blocks reabsorption of sodium and chloride

Question 12

Furosemide (Lasix) is what type of diuretic

Answer 12

Loop diuretic

Question 13

Furosemide (Lasix) - diuresis begins in ___ min and persists for ___ hours

Answer 13

60 min

8 hours

Question 14

what conditions can you use lasix for

Answer 14

pulmonary edema associated with CHF

Edema of hepatic, cardiac ,or renal origin that has been unresponsive to less efficacious diuretics

HTN not controlled with other diuretics

Question 15

What diuretic can be used in patients with severe renal impairment and can be used when renal blood flow and GFR is low

Answer 15

Furosemide (Lasix)

Question 16

if treatment with furosemide alone is insufficient what can be added

Answer 16

thiazide diuretic

Question 17

what electrolytes problems associated with Furosemide

Answer 17

Hyponatremia
hypochloremia
dehydration

Question 18

How do you decrease the risk for dehydration with Lasix

Answer 18

initiate with low doses
adjust doses carefully
monitor weight loss every day

Question 19

signs of hypotension associated with Lasix

Answer 19

dizziness
lightheadedness
fainting

Question 20

why can lasix cause hypotension

Answer 20

loss of volume

relaxation of venous smooth muscle which reduces venous return to the heart

Question 21

what should you monitor with lasix r/t hypotension

Answer 21

Blood pressure

If BP falls precipitously (very steeply), d/c med

Question 22

how do you minimize postural hypotension

Answer 22

rising slowly

Question 23

loop diuretics and hearing

Answer 23

loop diuretics can cause hearing impairment

Question 24

what loop diuretic can cause irreversible hearing loss

Answer 24

ethacrynic acid (Edecrin)

Question 25

What diuretic can cause transient deafness

Answer 25

Lasix

Question 26

are diuretics safe in pediatric population

Answer 26

yes, in smaller doses

Question 27

Pregnant women and diuretics

Answer 27

can cause maternal death, abortion and fetal resorption, risks and benefits must be considered

Question 28

Breastfeeding and diuretics

Answer 28

may decrease milk production, not enough data to know if it transfers to milk

Question 29

older adults and diuretics

Answer 29

diuretics are the most common cause of adverse med reactions and interactions in older adults. monitor closely for dehydration and cardiac dysrhythmias

Question 30

what type of diuretic is safer with digoxin

Answer 30

potassium sparing diuretics. Low potassium with digoxin increases risk for serious digoxin induced tox (ventricular dysrhythmias)

Question 31

what antibiotic should be avoided with lasix due to increasing the risk for hearing loss

Answer 31

aminoglycoside diuretics (Gentamycin)

Question 32

what drug class are these drugs Ethacrynic acid (Edecrin) torsemide (Demadex) bumetanide

Answer 32

loop diuretics

Question 33

what 2 loop diuretics are approved for hypertension

Answer 33

Lasix | Torsemide (Demadex)

Question 34

Between Loop diuretics and Thiazides, which produces max diuresis

Answer 34

Loop diuretics

Question 35

what diuretic blocks the reabsorption of sodium and chloride in the early segment of the distal convoluted tubule

Answer 35

thiazide diuretics

Question 36

Thiazides are ineffective when the ___ is Low

Answer 36

GFR (less than 15-20 mL/min)

Question 37

can thiazides be used in patients with renal impairment

Answer 37

no

Question 38

when does diuresis begin for Thiazides

Answer 38

within 2 hrs peaks 4-6 hours persists up to 12 hours

Question 39

the primary indication for hydrochlorothiazide is

Answer 39

hypertension

Question 40

what type of diuretic is preferred for mobilizing edema associated with mild to moderate heart failure

Answer 40

Thiazides

Question 41

what is the difference in adverse effects for loop and thiazide diuretics

Answer 41

thiazide diuretics are not ototoxic, all others are the same

Question 42

how are potassium sparing diuretics used

Answer 42

typically in combination with loop and thiazide diuretics bc their diuretic effects are limited but helps to prevent loss of potassium

Question 43

What category are these meds? spironolactone triamterene amiloride

Answer 43

potassium sparing diuretics

Question 44

which diuretic blocks the actions of aldosterone in teh distal nephron.

Answer 44

Potassium sparing diuretics

Question 45

inhibition of aldosterone does what to potassium and sodium

Answer 45

retains potassium | increases excretion of sodium

Question 46

the effects of spironolactone takes up to ___ to develop

Answer 46

48 hours

Question 47

black box warning for spironolactone

Answer 47

tumorigenic in rats. avoid unnecessary use

Question 48

spironolactone is used primarily for

Answer 48

htn and edema

Question 49

electrolyte adverse effect for potassium sparing diuretic

Answer 49

hyperkalemia

Question 50

endocrine effects of spironolactone

Answer 50

``` it is a steroid derivative can cause gynecomastia menstrual irregularities impotence hirsutism deepening of the voice ```

Question 51

drug interactions for potassium sparing diuretics

Answer 51

risk for hyperkalemia with potassium supplements, salt substitutes (which contain potassium chloride) or other potassium sparing diuretics also ACE inhibitors, ARBS and Direct renin inhibitors

Question 52

How is Triamterene different from other potassium sparing diuretics such as spironolactone

Answer 52

acts on the sodium potassium pump itself without affecting aldosterone acts within hours as opposed to days still minimal diuresis

Question 53

adverse effects of Triamterene

Answer 53

``` nausea vomiting leg cramps dizziness Blood dyscrasias occur rarely ```

Question 54

Where does Amiloride act

Answer 54

similar to Triamterene

Question 55

what lab needs to be monitored with Spironolactone, Triamterene and amiloride

Answer 55

Potassium on a regular basis

Question 56

diet instructions for a potassium sparing diuretic

Answer 56

restrict intake of potassium rich foods

Question 57

examples of potassium rich foods to avoid in Potassium sparing diuretics

Answer 57

``` sports drinks papaya cantaloupe prune juice honeydew melons bananas raisins mangoes kiwis orange juice tomatoes oranges tomato juice white potatoes sweet potatoes asparagus pumpkin brussels sprouts salt substitutes that use potassium chloride instead of sodium chloride low sodium milk products ```

Question 58

what diuretics waste potassium, commonly need a potassium supplement when taking

Answer 58

loop diuretics

Question 59

do you need a potassium supplement in Thiazides

Answer 59

no

Question 60

spironolactone with sodium and potassium

Answer 60

increases NA and decreases K