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Pharm 2 Exam > ch 37 - second A > Flashcards

ch 37 - second A Flashcards

1
Q

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

A

Diuretics

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2
Q

3 basic renal processes

A

Filtration
reabsorption
secretion

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3
Q

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

A

reabsorption

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4
Q

diuretics work primarily by interfering with what renal process

A

reabsorption

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5
Q

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

A

Descending limb

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6
Q

what basic mechanism of action do most diuretics share

A

blockade of sodium and chloride reabsorption

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7
Q

drugs that act early in the nephron have the opportunity to

A

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

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8
Q

what are the 3 most common adverse effects for diuretics

A

acid base imbalance
hypovolemia
altered electrolyte levels

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9
Q

adverse effects of diuretics can be minimized by

A

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

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10
Q

what type of diuretics is the most effective

A

loop diuretics

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11
Q

site of action for loop diuretics

A

loop of henle (blocks reabsorption of sodium and chloride

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12
Q

Furosemide (Lasix) is what type of diuretic

A

Loop diuretic

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13
Q

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

A

60 min

8 hours

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14
Q

what conditions can you use lasix for

A

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

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15
Q

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

A

Furosemide (Lasix)

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16
Q

if treatment with furosemide alone is insufficient what can be added

A

thiazide diuretic

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17
Q

what electrolytes problems associated with Furosemide

A

Hyponatremia
hypochloremia
dehydration

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18
Q

How do you decrease the risk for dehydration with Lasix

A

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

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19
Q

signs of hypotension associated with Lasix

A

dizziness
lightheadedness
fainting

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20
Q

why can lasix cause hypotension

A

loss of volume

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

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21
Q

what should you monitor with lasix r/t hypotension

A

Blood pressure

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

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22
Q

how do you minimize postural hypotension

A

rising slowly

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23
Q

loop diuretics and hearing

A

loop diuretics can cause hearing impairment

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24
Q

what loop diuretic can cause irreversible hearing loss

A

ethacrynic acid (Edecrin)

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25
Q

What diuretic can cause transient deafness

A

Lasix

26
Q

are diuretics safe in pediatric population

A

yes, in smaller doses

27
Q

Pregnant women and diuretics

A

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

28
Q

Breastfeeding and diuretics

A

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

29
Q

older adults and diuretics

A

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

30
Q

what type of diuretic is safer with digoxin

A

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

31
Q

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

A

aminoglycoside diuretics (Gentamycin)

32
Q

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

A

loop diuretics

33
Q

what 2 loop diuretics are approved for hypertension

A

Lasix

Torsemide (Demadex)

34
Q

Between Loop diuretics and Thiazides, which produces max diuresis

A

Loop diuretics

35
Q

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

A

thiazide diuretics

36
Q

Thiazides are ineffective when the ___ is Low

A

GFR (less than 15-20 mL/min)

37
Q

can thiazides be used in patients with renal impairment

A

no

38
Q

when does diuresis begin for Thiazides

A

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

39
Q

the primary indication for hydrochlorothiazide is

A

hypertension

40
Q

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

A

Thiazides

41
Q

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

A

thiazide diuretics are not ototoxic, all others are the same

42
Q

how are potassium sparing diuretics used

A

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

43
Q

What category are these meds?
spironolactone
triamterene
amiloride

A

potassium sparing diuretics

44
Q

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

A

Potassium sparing diuretics

45
Q

inhibition of aldosterone does what to potassium and sodium

A

retains potassium

increases excretion of sodium

46
Q

the effects of spironolactone takes up to ___ to develop

A

48 hours

47
Q

black box warning for spironolactone

A

tumorigenic in rats. avoid unnecessary use

48
Q

spironolactone is used primarily for

A

htn and edema

49
Q

electrolyte adverse effect for potassium sparing diuretic

A

hyperkalemia

50
Q

endocrine effects of spironolactone

A 
it is a steroid derivative 
can cause
gynecomastia
menstrual irregularities
impotence
hirsutism
deepening of the voice
51
Q

drug interactions for potassium sparing diuretics

A

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

52
Q

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

A

acts on the sodium potassium pump itself without affecting aldosterone

acts within hours as opposed to days

still minimal diuresis

53
Q

adverse effects of Triamterene

A 
nausea
vomiting
leg cramps
dizziness
Blood dyscrasias occur rarely
54
Q

Where does Amiloride act

A

similar to Triamterene

55
Q

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

A

Potassium on a regular basis

56
Q

diet instructions for a potassium sparing diuretic

A

restrict intake of potassium rich foods

57
Q

examples of potassium rich foods to avoid in Potassium sparing diuretics

A 
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
58
Q

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

A

loop diuretics

59
Q

do you need a potassium supplement in Thiazides

A

no

60
Q

spironolactone with sodium and potassium

A

increases NA and decreases K

Pharm 2 Exam (18 decks)

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