Chapter 26- Diuretic Drugs

Question 1

Afferent arterioles

Answer 1

The small blood vessels branching from the renal artery approaching the glomerulus (proximal part of the nephron).

Question 2

Aldosterone

Answer 2

A mineralocorticoid steroid hormone produced by the adrenal cortex that mediates the actions of the renal tubule in the regulation of sodium and potassium balance in the blood.

Question 3

Ascites

Answer 3

An abnormal intraperitoneal accumulation of fluid (defined as a volume of 500mL or greater) containing large amounts of protein and electrolytes.

Question 4

Collecting duct

Answer 4

The most distal part of the nephron between the distal convoluted tubule and the ureters, which lead to the urinary bladder.

Question 5

Distal convoluted tubule

Answer 5

The part of the nephron immediately distal to the ascending loop of Henle and proximal to the collecting duct.

Question 6

Diuretics

Answer 6

Drugs or other substances that tend to promote the formation and excretion of urine.
Direct arteriolar dilation, decreasing peripheral vascular resistance. Reduce: extracellular fluid volume, plasma volume, and cardiac output.

Question 7

Efferent arterioles

Answer 7

The small blood vessels exiting the glomerulus. At this point, blood has completed its filtration in the glomerulus.

Question 8

Filtrate

Answer 8

The material that passes through a filter. In the kidney, the filter is the glomerulus, and the filtrate is the extracted material from the blood (normally liquid) that ultimately becomes urine.

Question 9

Glomerular capsule

Answer 9

The open, rounded, and most proximal part of the proximal convoluted tubule that surrounds the glomerulus and receives the filtrate from the blood.

Question 10

Glomerular filtration rate (GFR)

Answer 10

The volume of ultrafiltrate extracted per unit of time from the plasma following through the glomeruli of the kidney. .

Question 11

Glomerulus

Answer 11

The cluster of kidney capillaries that marks the beginning of the nephron and is immediately proximal to the proximal convoluted tubule.

Question 12

Loop of Henle

Answer 12

The part of the nephron that is immediately distal to the proximal convoluted tubule.

Question 13

Nephron

Answer 13

The microscopic functional filtration unit of the kidney, consisting of (in anatomical order from proximal to distal) the glomerulus, proximal convoluted tubule, loop of Henle. distal convoluted tubule, and the collecting duct, which empties urine into the ureters. There are approximately one million nephrons in each kidney.

Question 14

Open-angle glaucoma

Answer 14

Elevated pressure in an eye because of obstruction of the outflow of aqueous humour, but access to the trabecular meshwork remains open.

Question 15

Proximal convoluted tubule

Answer 15

The part of the nephron that is immediately distal to the glomerulus and proximal to the loop of Henile.

Question 16

Ultrafiltration

Answer 16

Filtration at a microscopic level; the term is often used to describe the filtration function of the kidneys, with the filtrate referred to more specifically as ultra filtrate.

Question 17

Sodium

Answer 17

In the nephron, where sodium goes, water follows.

If water is not absorbed, it is excreted as urine.

Question 18

Carbonic Anhydrase Inhibitors (CAIs) Mech of Action

Answer 18

ex) Acetazolamide (Acetazolam), Methazolamide.
Management of Ph. Reduces H+ ion concentratoin in renal tubules. Resorption of water is decreased and urine volume is increased.

Question 19

CAIs Indications

Answer 19

Open-Angle Glaucoma
Used with motics to lower intraocular pressure before ocular surgery in certain cases.
Also used in treatment of: Edema, Epilepsy, High-altitude sickness.
The metabolic acidosis they induce reduces their diuretic effect in 2-4 days.

Question 20

CAIs Contraindications

Answer 20

Drug allergy, Hypoatremia, Hypokalemia, severe Kidney for liver dysfunction, cirrhosis

Question 21

CAIs Adverse Effects

Answer 21

Metabolic acidosis, anorexoa, hypokalemia, drowsiness, paraesthesias, urticaria

Question 22

CAIs Interactions

Answer 22

Digitalis, Corticosteroids, oral hypoglycaemic drugs and quindine

Question 23

Loop diuretics Mech of Action

Answer 23

Common in Hospitals.
Ex) Furosemide (Lasix)- can be given IV
Act directly on the ascending limb of the loop of Henle to inhibit chloride and sodium resorption. Resulting in the dilation of blood vessels and reduced peripheral vascular resistance.

Question 24

Loop diuretics Drug effects

Answer 24

Potent diuresis.

Potassium and sodium depletion. (Especially Potassium)

Question 25

Loop Diuretics Indications

Answer 25

Edema, hypertension, hypercalcemia, certain cases of heart failure.

Question 26

Loop Diuretics Contraindications

Answer 26

Allergy to sulfonamide antibiotics, severe electrolyte loss

Question 27

Loop Diuretics Adverse Effects

Answer 27

Dizziness, N/V/D, Hypokalemia

Question 28

Osmotic Diuretics Mech of Action

Answer 28

Ex) Mannitol (Osmitrol).- IV only, use a filter

Work mostly in the proximal tubule.

Question 29

Osmotic Diuretics Indications

Answer 29

Reduction of intracranial pressure

Treatment of cerebral edema

Question 30

Osmotic Diuretic Contraindications

Answer 30

Severe Kidney Disease, Pulmonary edema

Question 31

Osmotic Diuretic Adverse Effects

Answer 31

Convulsions, Thrombophlebitis, Pulmonary congestion, Headaches

Question 32

Potassium-Sparing Diuretics Mech of Action

Answer 32

Ex) Spironolactone(Aldactone). Does not have same decrease in potassium.
Work in collecting ducts and distal convoluted tubules.
Block the resorption of sodium and water. Do not affect potassium. Prevent potassium from being pumped into the tubule, thus preventing its secretion.

Question 33

Potassium-Sparing Diuretics Indications

Answer 33

Spironolactone (Aldactone)-Hypertension.

Amiloride (Midamor)-Treatment of heart failure

Question 34

Potassium-Sparing Diuretics Contraindications

Answer 34

Hyperkalemia. Severe kidney failure or anuria

Question 35

Potassium-Sparing Diuretics Adverse Effects

Answer 35

Hyperkalemia, Gynecomastia, Amenorrhea, Irregular menses, postmenopausal bleeding.

Question 36

Potassium-Sparing Diuretics Interactions

Answer 36

Lithium, ACE inhibitors, Potassium supplments

Question 37

Thiazide and Thiazide like Diuretics Mech of Action

Answer 37

Ex) Hydrochlorothiazide.
Inhibit tubular resorption of sodium, chloride, and potassium ions. Dilate arterioles by direct relaxation.
Lowered peripheral vascular resistance.
Depletion of sodium and water (and potassium)

Question 38

Thiazide…..Indications

Answer 38

Hypertension, Edematous, Heart failure, and as an adjunct drugs in treatment of edema and hepatic cirrhosis.

Question 39

Thiazide….Contraindications

Answer 39

Anuria (failure of kidneys to produce urine), Severe Kidney Failure.

Question 40

Thiazide….adverse effects

Answer 40

Impotence, Hypokalemia, Glycosuria, Hyperglycemia, hyperuricemia

Question 41

Diuretic Drugs Nursing Implications

Answer 41

PT history and physical exam.
Assess baseline fluid volume status (Edema)
Bloodwork.
Instruct PT to take in the morning as much as possible to avoid interference with sleep patterns.
Maintain proper nutritional and fluid volume status.
Eat more potassium-rich foods when taking but with the potassium-sparing drugs.
Monitor blood glucose levels
Teach PTs to change positions slowly, keep log of their weight, encourage PTs to return to F/U visits and lab tests.
Puts who have been ill need to notify Doc.
S&S of hypokalemia: Muscle weakness, constipation, irregular pulse rate, overall feeling of lethargy.
Excessive consumption of liquorice can lead to additive hypokalemia in PTs taking Thiazides.
Montior for Adverse and Therapeutic effects.