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NURS 2266 > chapter 29 - week 2 > Flashcards

chapter 29 - week 2 Flashcards

1
Q

what are diuretic drugs

A
  • Drugs that accelerate the rate of urine formation
  • Result in the removal of sodium and water
  • Mainstay of therapy for the treatment of hypertension and heart failure and for prevention of kidney damage during acute kidney injury
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2
Q

sodium in relation to the nephron

A

In the nephron, where sodium goes, water follows.
60 to 70% of sodium and water is returned to the bloodstream by the proximal convoluted tubule.
20 to 25% of all sodium is reabsorbed 
into the bloodstream in the ascending loop of Henle.
5 to 10% is reabsorbed in the distal convoluted tubule.
Collecting duct is the final common pathway for the filtrate that started in the glomerulus.
If water is not absorbed, it is excreted as urine.

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3
Q

types of diuertic drugs

A
  • Carbonic anhydrase inhibitors
  • Loop diuretics
  • Osmotic diuretics
  • Potassium-sparing diuretics
  • Thiazide and thiazide-like diuretics
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4
Q

loop diuretics names

A

bumetanide
ethacrynic acid (rarely used clinically)
furosemide (Lasix®)

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5
Q

loop diuretics mechanism of action

A
  • Possess kidney, cardiovascular, and metabolic effects
  • Act directly on the ascending limb of the 
loop of Henle to block chloride and sodium resorption
  • Increase kidney prostaglandins, resulting in the dilation of blood vessels and reduced kidney, pulmonary, and systemic vascular resistance
  • Useful in treatment of edema
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6
Q

Loop diuretics:drug effect

A
  • Rapid onset; last at least 2 hours
  • Potent diuresis and subsequent loss of fluid
  • Decreased fluid volume causes a reduction in:
    * Blood pressure
    * Pulmonary vascular resistance
    * Systemic vascular resistance
    * Central venous pressure
    * Left ventricular end-diastolic pressure
  • Potassium and sodium depletion
  • Small calcium loss
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7
Q

loop diuretics indictations

A
  • Edema associated with heart failure and liver or kidney disease
  • Hypertension (to control)
  • Kidney excretion of calcium in patients with hypercalcemia (to increase excretion)
  • Heart failure resulting from diastolic dysfunction
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8
Q

loop diuretics adverse effects

A
  • Central nervous system: Dizziness, headache, tinnitus, blurred vision
  • Gastrointestinal: Nausea, vomiting, diarrhea
  • Hematological: Agranulocytosis, neutropenia, thrombocytopenia
  • Metabolic: Hypokalemia, hyperglycemia, hyperuricemia
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9
Q

loop diuretics interactions

A
  • Neurotoxic(alters the normal activity of the nervous system)
  • Nephrotoxic (Poisonous or damaging to the kidney)
  • Increase serum levels of uric acid, glucose, alanine aminotransferase, and aspartate aminotransferase.
  • thiazide (metolazone): sequential nephron blockade
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) may decrease the reduction of vascular resistance.
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10
Q

flurosemide

A
  • Most commonly used loop diuretic
  • Uses: pulmonary edema and the edema associated with heart failure, liver disease, nephrotic syndrome, ascites, hypertension
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11
Q

osmotic diuretics names

A
  • mannitol (Osmitrol®)
  • Most used osmotic diuretic
  • Urea
  • Organic acids
  • Glucose
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12
Q

osmotic diuretics mechanism of action

A
  • Works along entire nephron but mostly in the proximal tubule and descending loop of Henle
  • Nonabsorbable, producing an osmotic effect
  • Pull water into the renal tubules from the surrounding tissues
  • Inhibit tubular resorption of water and solutes, thus producing rapid diuresis
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13
Q

osmotic diuretic durg effects

A
  • Increase glomerular filtration rate and renal plasma flow; help to prevent kidney damage during acute kidney injury
  • Reduce intracranial pressure or cerebral edema associated with head trauma
  • Reduce excessive intraocular pressure (fludi pressure of the eye)
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14
Q

osmotic diureteics indications

A
  • Treatment of patients in the early, oliguric phase of acute kidney injury
  • To promote excretion of toxic substances
  • To reduce intracranial pressure
  • Treatment of cerebral edema
  • Used as a genitourinary irrigant in the preparation of patients for transurethral surgical procedures
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15
Q

osmotic diureteic adverse effects

A
  • Convulsions
  • Thrombophlebitis
  • Pulmonary congestion
  • Other: headaches, chest pains, tachycardia, blurred vision, chills, and fever
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16
Q

mannitol (osmitrol)

A

Intravenous (IV) infusion only
May crystallize when exposed to low temperatures. Therefore, vials are often stored in a warmer.
Use of a filter is required.

17
Q

potassim sparing diuretic names

A
  • Also known as aldosterone-inhibiting diuretics
  • amiloride (Midamor®)
  • spironolactone (Aldactone®)
  • triamterene
  • triamterene in combination with hydrochlorothiazide
18
Q

potassium-sparing diuretic mechanism of action

A
  • Work in collecting ducts and distal convoluted tubules
  • Interfere with sodium–potassium exchange
  • Competitively bind to aldosterone receptors
  • Block resorption of sodium and water usually induced by aldosterone secretion
19
Q

potassium sparing siuretic drug effects

A
  • Relatively weak compared with the thiazide and loop diuretics
  • Competitively block aldosterone receptors and inhibit their action
  • Promote the excretion of sodium and water
20
Q

potassoim sparing indications

A

spironolactone and triamterene
* Hyperaldosteronism
* Hypertension
* Reversing potassium loss caused by potassium-wasting diuretics
* Certain cases of heart failure: prevention of remodelling

amiloride
* Similar to spironolactone and triamterene but less effective in the long term

*

21
Q

potassoim sparing adverse effects

A
  • Central nervous system: Dizziness, headache
  • Gastrointestinal: Cramps, nausea, vomiting, diarrhea
  • Other: Urinary frequency,
weakness, hyperkalemia

spironolactone (Aldactone®)
* Gynecomastia
* Amenorrhea
* Irregular menses
* Postmenopausal bleeding

22
Q

potassoim sparing interactions

A
  • Lithium
  • Angiotensin-converting enzyme inhibitors
  • Potassium supplements
  • NSAIDs
23
Q

thiazide and thaizide-like diuretics names

A

Thiazide diuretics
* hydrochlorothiazide (Urozide®)

Thiazide-like diuretics
* metolazone (Zaroxolyn®)
* chlorthalidone
* indapamide

24
Q

thiazide and thaizide like consdierations

A

Thiazides should not be used if creatinine clearance is less than 30 to 50 mL/min (normal is 125 mL/min).
Metolazone remains effective to a creatinine clearance of 10 mL/min.

25
Q

thiazide and thiazide-like mechanism of action

A
  • Inhibit tubular resorption of sodium, chloride, and potassium ions
  • Action primarily in the distal convoluted tubule
  • Result in osmotic water loss
  • Dilate the arterioles by direct relaxation
  • Decrease preload and afterload
26
Q

thiazide and thiazide like indication

A
  • Hypertension (one of the most prescribed group of drugs for this)
  • Edematous states
  • Idiopathic hypercalciuria
  • Diabetes insipidus
  • Heart failure caused by diastolic dysfunction
27
Q

thiazide and thiazide likeadverse effects

A
  • Central nervous: Dizziness, headache, blurred vision
  • Gastrointestinal: Anorexia, nausea, vomiting, diarrhea
  • Genitourinary: Erectile dysfunction
  • Hematological: Jaundice, leukopenia, agranulocytosis
  • Integumentary: Urticaria, photosensitivity
  • Metabolic: Hypokalemia, glycosuria, hyperglycemia, hyperuricemia, hypochloremic alkalosis
28
Q

nursing implications - before diuretics

A
  • Perform a thorough patient history and physical examination.
  • Assess baseline fluid volume status, intake and output, serum electrolyte values, weight, and vital signs (especially postural blood pressure).
  • Assess for disorders that may contraindicate or necessitate cautious use of these drugs.
  • Instruct patients to take the medication in the morning if possible to avoid interference with sleep patterns.
  • Monitor serum potassium levels during therapy.
  • Teach patients to maintain proper nutritional and fluid volume status.
  • Teach patients to eat more potassium-rich foods when taking any diuretics but the potassium-sparing drugs.
  • Foods high in potassium include bananas, oranges, dates, apricots, raisins, broccoli, green beans, potatoes, tomatoes, meats, fish, wheat bread, and legumes.
  • Instruct patients to notify their primary care provider immediately if they experience rapid heart rates or syncope (reflects hypotension or fluid loss).
  • Teach patients to change positions slowly and to rise slowly after sitting or lying, to prevent dizziness and fainting related to orthostatic hypotension.
  • Encourage patients to keep a log of their 
daily weight.
  • Remind patients to return for follow-up visits and laboratory work.
29
Q

nurising implications montioring diuretics

A
  • Patients taking diuretics along with digoxin should be taught to watch for 
digoxin toxicity.
  • Patients with diabetes mellitus who are taking thiazide or loop diuretics should be told to monitor blood glucose and watch for elevated levels.
  • Patients who have been ill with nausea, vomiting, or diarrhea should notify their primary care provider because fluid and electrolyte imbalances can result.
  • Signs and symptoms of hypokalemia include anorexia, nausea, lethargy, muscle weakness, mental confusion, and hypotension
  • Excessive consumption of licorice can lead to additive hypokalemia in patients taking thiazides.
  • Monitor for adverse effects:
  • Metabolic alkalosis, drowsiness, lethargy, hypokalemia, tachycardia, hypotension, leg cramps, restlessness, decreased mental alertness
  • Monitor for hyperkalemia with potassium-sparing diuretics.
  • Monitor for therapeutic effects:
    Reduction of edema
    Reduction of fluid volume overload
    Improvement in manifestations of heart failure
    Reduction of hypertension
    Return to normal intraocular pressures

NURS 2266 (12 decks)

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