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Pharm > Ch. 43 - Diuretics > Flashcards

Ch. 43 - Diuretics Flashcards

1
Q

Diuretics:

A

Remove sodium & water from the body

For clients with:

- Edema
- HTN
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2
Q

Regulation of Sodium Balance by Kidney:

A

Determined by:
-Glomerular Filtration Rate (GFR)
+Aldosterone
+Baroreceptors

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3
Q

5 Categories of Diuretics:

A
  1. ) Thiazide & thiazide-like
  2. ) Loop
  3. ) Osmotic
  4. ) Carbonic anhydrase inhibitor
  5. ) Potassium - sparing
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4
Q

Thiazide & thiazide-like Diuretics:

A

Promotes sodium, chloride, & water excretion in distal convoluted renal tubule

For clients with normal renal function

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5
Q

Thiazide Diuretics — Adverse Effects (1):

A

Hypokalemia:
1.) Large concentration of sodium reaches the distal tubules —>

2.) Greater sodium-potassium exchange occurring = Potassium depletion
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6
Q

Thiazide Diuretics — Adverse Effects (2):

A

Large Amt of chloride excreted —>

 1. ) Chloride depletion 
 2. ) Metabolic alkalosis
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7
Q

Thiazide Diuretics — Adverse Effects (3):

A

Hypercalcemia —- d/t loss of:

 1. ) Sodium, Potassium, & Magnesium 
 2. ) Promotes calcium reabsorption
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8
Q

Prolonged tx of Thiazide Diuretics:

A

Potassium & chloride supplements

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9
Q

Thiazide Diuretics — Other Adverse Effect:

A

Hyperglycemia

Hyperuricemia sensitivity

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10
Q

Nursing Diagnoses — Thiazide Diuretics

A
  1. ) Excess fluid volume r/t body fluid retention

2. ) Risk for deficient fluid volume r/t use of thiazides

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11
Q

Nursing Interventions (1) – Thiazide Diuretics :

A

Monitor:

1. ) Vital signs 
2. ) Serum electrolytes:
      - Potassium = (3.5-5m Eq/l)
      - Glucose = (70-100 mg/dl)
      - Uric Acid = (3-7 mg/dl)
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12
Q

Nursing Interventions (2) – Thiazide Diuretics :

A
  1. ) Observe for s/s hypokalemia:
    • muscle weakness, leg cramps
    • cardiac dysrhythmias
  2. ) Weigh daily –> 2.2 lbs = 1L fluid
  3. ) Urine output
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13
Q

Thiazide Diuretics — Teaching:

A
  1. ) Take drug early in the morning
  2. ) Orthostatic hypotension = change positions slowly
  3. ) Potassium rich foods
  4. ) GI upset = take with food
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14
Q

Loop Diuretics (1):

A
  1. ) Inhibit reabsorption of sodium & chloride in ascending Loop of Henle
  2. ) Reduces kidney’s ability to concentrate urine
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15
Q

Loop Diuretics (2):

A
  1. ) More potent than thiazide diuretics
  2. ) Less effective as an antihypertensive
  3. ) Clients with impaired GFR
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16
Q

Loop Diuretics (3) – Adverse Effects:

A
  • Electrolyte imbalance
  • Orthostatic Hypotension
  • Ototoxicity w/ aminoglycosides
17
Q

Loop Diuretics – Examples::

A

Furosemide (Lasix)

18
Q

Loop Diuretics — Nursing Diagnoses:

A
  1. ) Risk for deficient fluid volume r/t fluid loss with excessive use of loop diuretics
  2. ) Risk for potassium deficit r/t excessive use of loop diuretics
19
Q

Loop Diuretics – Nursing Interventions (1):

A

Note onset of drug action:

  1. ) Increased urine output
  2. ) Oral = within 1 hour
  3. ) IV = 5-20 mins
    • If not –> notify health care provider
20
Q

Loop Diuretics – Nursing Interventions (2):

A
  1. ) Weight I & O
  2. ) Vital signs
  3. ) Adm IV furosemide slowly
21
Q

Loop Diuretics – Nursing Interventions (3):

A

S/S hypokalemia = (

22
Q

Loop Diuretics — Teach:

A
  1. ) Take Loop diuretic in am
  2. ) Take w/ food
  3. ) Change positions slowly
23
Q

Osmotic Diuretics:

A

Mainly used to tx:

  • Inc intracranial pressure
  • Inc Intraocular pressure

Prevent acute renal failure

24
Q

Osmotic Diuretics – Example:

A

mannitol (Osmitrol)

  1. ) IV
  2. ) powerful diuretic
  3. ) K+ depleting antidiuretic
25
Q

Potassium-Sparing Diuretics (1):

A
  1. ) NOT as strong as thiazide or loop diuretics

2. ) Combine with another diuretic or antihypertensive drug

26
Q

Potassium-Sparing Diuretics (2):

A
  1. ) Aldosterone mineralcorticoid hormone =

- Promotes Na+ retention & K+ excretion

27
Q

Potassium-Sparing Diuretics (3):

A

4.) Blocks action of aldosterone

  1. ) Inhibit K+ excretion –>
    • Combined with potassium-depleting diuretic to decrease occurrence of hypokalemia
28
Q

Potassium-Sparing Diuretics (4) – Adverse Effects:

A

Hyperkalemia = DO NOT use K+ supplement with K+ sparing diuretic

29
Q

Potassium-Sparing Diuretics – Example:

A

spironolactone (Aldactone):
-Inhibits action of aldosterone –> by causing the kidneys to excrete salt and fluid in the urine while retaining potassium

30
Q

Potassium-Sparing Diuretics Nursing Interventions (1):

A
  1. ) Monitor urinary output
  2. ) Report:
    - Less than 30ml/hour
    - Less than 600 ml/24 hrs
31
Q

Potassium-Sparing Diuretics Nursing Interventions (2):

A
  1. ) Observe for s/s hyperkalemia:
    • Nausea, diarrhea, abd cramps
    • Numbness, tingling
    • Tachycardia
32
Q

Potassium-Sparing Diuretics — Teach:

A
  1. ) Take with / after meals
  2. ) Do not d/c w/o consulting health care provider
  3. ) Avoid exposure to direct sunlight
33
Q

Potassium-Sparing Diuretics – Diet:

A

Avoid foods high in K+

Pharm (18 decks)

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